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My tianeptine experience for anxiety/depression

tianeptine

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#1 soulfly

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Posted 15 October 2017 - 06:47 PM


Background: 34yo male, couple of years ago was on SSRI escilatopram (Cipralex which is same as Lexapro) for social anxiety/depression and had good result with it. However then I cought a nasty bug that caused my intestines to get inflamed and was left with IBS ever since. When I tried to take the Cipralex again it made my IBS worse, so I had to stop after 3 weeks. This was 2 years ago and I did not take any medications since then.

 

My tianeptine experience: going through a difficult life situation, even though I excercise regularly and try to stay positive, I felt my anxiety/depression is getting worse and started researching the various antidepressants. I came across Tianeptine and it looked very good on paper. I live in Europe where Tianeptine is sold in pharmacy, so talked to my doctor about it and she agreed that this might be worth a try and prescribed it for me (12.5mg 3 times daily). I've been on it for one week now. It's truth that it does not affect my gut in a bad way (in fact I noticed some positive changes for my IBS), but oh boy does it make me feel weird. After the first pill in the morning I feel good (kind of high) for 3 hours and then just big crash, feel tired, irritable and lethargic. When I take another dose, it makes me feel just more sleepy and numb. Then in the evening I feel pretty depressed. The depression it gives me is quite bad and I have to force myself to take it in the morning again. Today took just one pill around noon, still noticed the crash after couple of hours, but without taking another pill I made it to the evening without feeling like a zombie. I will probably keep going on 1-2 pills a day for another week and then report back. I hope it's just my body getting used to new stuff, the side effects will get weaker and it will start having some antidepressant effect for a change.

 

Other side effects that I noticed so far: difficulty expressing myself (can't think of the right word - this is quite annoying too), made me more forgetful (forgot keys at home, forgot stuff at the gym, this never happened to me previously), decreased motivation, increased irritability


Edited by soulfly, 15 October 2017 - 06:50 PM.

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#2 CWF1986

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Posted 18 October 2017 - 07:30 AM

Are you getting treatment for the IBS?  It might be that once you get that under control, you can take the lexapro.  

 

I have nervous stomach syndrome and was prescribed a low doese of nortriptyline for it.  I eventually kept going up in dose for anxiety and depression to antidepressant levels and it helped a lot.  Later, I was prescribed lexapro.  If I take the lexapro at a different time than the nort. then I have stomach issues but taken at the same time I'm totally fine with it.  



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#3 soulfly

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Posted 18 October 2017 - 08:58 PM

Are you getting treatment for the IBS?  It might be that once you get that under control, you can take the lexapro.  

 

I have nervous stomach syndrome and was prescribed a low doese of nortriptyline for it.  I eventually kept going up in dose for anxiety and depression to antidepressant levels and it helped a lot.  Later, I was prescribed lexapro.  If I take the lexapro at a different time than the nort. then I have stomach issues but taken at the same time I'm totally fine with it.  

 

What I do for my IBS is that I take probiotics and avoid foods that I can't seem to tolerate anymore (lactose, fatty foods etc.). Not sure if there is really any treatment for IBS, the only thing that my GI gave me is Dicetel and told me to use that during flare ups.

 

From what I read about the tricyclical antidepressants those have some side-effects that don't sound like fun either (drowsiness, dry mouth, trouble urinating). Did you notice any of those?

Also you mention that you take lexapro at the same time as nortriptyline. Did your doctor prescribe you this combination? As both of these meds increase serotonine, isn't serotinine syndrome a concern with such a combo? What dosages are you taking?

Thanks



#4 Finn

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Posted 19 October 2017 - 06:51 AM

Is your IBS more constipation (IBS-C) or diarrhea (IBS-D) ?

 

5-HT3 antagonists can be used to treat IBS-D also they might potentiate SSRI antidepressant response. Negative effect of SSRI to IBS comes most likely from 5-HT3 activation, so antagonist could block it.

 

 

https://www.ncbi.nlm...pubmed/25697477

 

A 5-HT3 receptor antagonist potentiates the behavioral, neurochemical and electrophysiological actions of an SSRI antidepressant.

 

 

 


Edited by Finn, 19 October 2017 - 06:52 AM.

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#5 CWF1986

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Posted 19 October 2017 - 07:00 AM

The dose for tricyclics for IBS are very small and this alone will greatly reduce the likelihood of unbearable sides.

 

I take 150mg nortriptyline.  This  is 120 more mg than I need to treat nervous stomach syndrome.  I take that much to treat depression and anxiety in addition to NSS.  The SRI of nortriptyline is virtually negligible.  Think of it as an NRI with additional anxiolytic properties from it's antihistamine and anticholinergic effects.  In fact, it can be prescribed with parnate and taking it concurrently will reduce the severity of the 'cheese effect' of irreversible MAOIs.  The only side I experience from it is that I'm a little more likely to experience orthostatic hypotension than I would otherwise, but not to the point where I'm actually afraid I'll pass out.  

 

I take it at night.  It helps me fall asleep and stay asleep.  The sedative effect from the antihistamine properties wear off about the time I need to get up.  The NRI property actually help clear brain fog as I get ready for the day.  During the day it gives me a subtle mental stimulation which helps with focus, clarity, and mood.  

 

If you have the kind of IBS that involves discomfort/pain and having to go very often or at least feeling like you have to go a lot than a TCA may very well be your ticket.  

 

I take the lexapro at 10mg.  

 

My doctor did prescribe this.  

 

I even take adderall and if all you go by are pubmed or some other mainstream medical sites, then it doesn't surprise me at all that some people would think I should be dead from serotonin syndrome and heart problems.

 

Nortriptyline is actually a very 'clean' antidepressant even when compared to modern SSRIs.  It and desipramine are 2nd generation TCAs.  It has about the same toxicity as most SSRIs and less than luvoxetine or paroxetine.  Arguably, the sides from it aren't any worse but just different from most SSRIs.  

 

The bad rap TCAs get are mostly from the first generation ones granted there are times where they're preferred.  


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#6 soulfly

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Posted 21 October 2017 - 10:08 AM

The dose for tricyclics for IBS are very small and this alone will greatly reduce the likelihood of unbearable sides.

 

I take 150mg nortriptyline.  This  is 120 more mg than I need to treat nervous stomach syndrome.  I take that much to treat depression and anxiety in addition to NSS.  The SRI of nortriptyline is virtually negligible.  Think of it as an NRI with additional anxiolytic properties from it's antihistamine and anticholinergic effects.  In fact, it can be prescribed with parnate and taking it concurrently will reduce the severity of the 'cheese effect' of irreversible MAOIs.  The only side I experience from it is that I'm a little more likely to experience orthostatic hypotension than I would otherwise, but not to the point where I'm actually afraid I'll pass out.  

 

I take it at night.  It helps me fall asleep and stay asleep.  The sedative effect from the antihistamine properties wear off about the time I need to get up.  The NRI property actually help clear brain fog as I get ready for the day.  During the day it gives me a subtle mental stimulation which helps with focus, clarity, and mood.  

 

If you have the kind of IBS that involves discomfort/pain and having to go very often or at least feeling like you have to go a lot than a TCA may very well be your ticket.  

 

I take the lexapro at 10mg.  

 

My doctor did prescribe this.  

 

I even take adderall and if all you go by are pubmed or some other mainstream medical sites, then it doesn't surprise me at all that some people would think I should be dead from serotonin syndrome and heart problems.

 

Nortriptyline is actually a very 'clean' antidepressant even when compared to modern SSRIs.  It and desipramine are 2nd generation TCAs.  It has about the same toxicity as most SSRIs and less than luvoxetine or paroxetine.  Arguably, the sides from it aren't any worse but just different from most SSRIs.  

 

The bad rap TCAs get are mostly from the first generation ones granted there are times where they're preferred.  

 

Seems you are quite knowledgeable about this stuff so I will ask you some questions if you dont mind:

 

  • My IBS is on the IBS-D side, so the tryciclics do seem like it would be good fit, however it looks like over here we don't have Nortriptyline (Pamelor) just Maprotiline (Ludiomil), which according to wikipedia should be very closely related to Nortriptyline. Do you think it would be sufficient if I took this for my anxiety/depression or would I need to add also an SSRI?
     
  • Which of the SSRIs would be the mildest in terms of affecting my IBS? I read that citalopram (Celexa) should be the mildest, but also that Paroxetine (Paxil) compared to other SSRIs has a lower incidence of diarrhea, a higher incidence of anticholinergic effects (e.g., dry mouth, constipation).
     
  • How about the MAOIs? I know this is quite heavy stuff, but some people wiht social anxiety report that Phenelzine (Nardil) was life changing for them. Among its long list of sides it has both diarrhea and constipation listed, so not sure which of these two is more prevalent.


#7 Finn

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Posted 21 October 2017 - 11:24 AM

 

  • How about the MAOIs? I know this is quite heavy stuff, but some people wiht social anxiety report that Phenelzine (Nardil) was life changing for them. Among its long list of sides it has both diarrhea and constipation listed, so not sure which of these two is more prevalent.

 

 

Selective reversible MAO-A inhibitor moclobemide has very low diarrhea rates 4.2% compared to sertraline's 30% and paroxetine's 15%

 

Antidepressant Side Effects in Depression Patients Treated in A Naturalistic Setting: A Study of Bupropion, Moclobemide, Paroxetine, Sertraline, and Venlafaxine

 

Attached File  gastroSE.jpg   55.7KB   0 downloads

(Click to see larger version)


Edited by Finn, 21 October 2017 - 11:26 AM.

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#8 CWF1986

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Posted 31 October 2017 - 06:46 AM

 

The dose for tricyclics for IBS are very small and this alone will greatly reduce the likelihood of unbearable sides.

 

I take 150mg nortriptyline.  This  is 120 more mg than I need to treat nervous stomach syndrome.  I take that much to treat depression and anxiety in addition to NSS.  The SRI of nortriptyline is virtually negligible.  Think of it as an NRI with additional anxiolytic properties from it's antihistamine and anticholinergic effects.  In fact, it can be prescribed with parnate and taking it concurrently will reduce the severity of the 'cheese effect' of irreversible MAOIs.  The only side I experience from it is that I'm a little more likely to experience orthostatic hypotension than I would otherwise, but not to the point where I'm actually afraid I'll pass out.  

 

I take it at night.  It helps me fall asleep and stay asleep.  The sedative effect from the antihistamine properties wear off about the time I need to get up.  The NRI property actually help clear brain fog as I get ready for the day.  During the day it gives me a subtle mental stimulation which helps with focus, clarity, and mood.  

 

If you have the kind of IBS that involves discomfort/pain and having to go very often or at least feeling like you have to go a lot than a TCA may very well be your ticket.  

 

I take the lexapro at 10mg.  

 

My doctor did prescribe this.  

 

I even take adderall and if all you go by are pubmed or some other mainstream medical sites, then it doesn't surprise me at all that some people would think I should be dead from serotonin syndrome and heart problems.

 

Nortriptyline is actually a very 'clean' antidepressant even when compared to modern SSRIs.  It and desipramine are 2nd generation TCAs.  It has about the same toxicity as most SSRIs and less than luvoxetine or paroxetine.  Arguably, the sides from it aren't any worse but just different from most SSRIs.  

 

The bad rap TCAs get are mostly from the first generation ones granted there are times where they're preferred.  

 

Seems you are quite knowledgeable about this stuff so I will ask you some questions if you dont mind:

 

  • My IBS is on the IBS-D side, so the tryciclics do seem like it would be good fit, however it looks like over here we don't have Nortriptyline (Pamelor) just Maprotiline (Ludiomil), which according to wikipedia should be very closely related to Nortriptyline. Do you think it would be sufficient if I took this for my anxiety/depression or would I need to add also an SSRI?
     
  • Which of the SSRIs would be the mildest in terms of affecting my IBS? I read that citalopram (Celexa) should be the mildest, but also that Paroxetine (Paxil) compared to other SSRIs has a lower incidence of diarrhea, a higher incidence of anticholinergic effects (e.g., dry mouth, constipation).
     
  • How about the MAOIs? I know this is quite heavy stuff, but some people wiht social anxiety report that Phenelzine (Nardil) was life changing for them. Among its long list of sides it has both diarrhea and constipation listed, so not sure which of these two is more prevalent.

 

 

Maprotilline from what I read on it's wiki page says that it has strong antihistamine activity, but very low anticholinergic activity.  That anticholinergic activity may or may not be important for you individually. Both antihistamine effects and anticholinergic can help with IBS.  

 

I can't really help with your other two questions.  I don't wanna be like that gas station clerk you ask for directions, but doesn't know and just makes something up so he/she doesn't look bad haha.  



#9 soulfly

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Posted 08 November 2017 - 01:25 PM

Is your IBS more constipation (IBS-C) or diarrhea (IBS-D) ?

 

5-HT3 antagonists can be used to treat IBS-D also they might potentiate SSRI antidepressant response. Negative effect of SSRI to IBS comes most likely from 5-HT3 activation, so antagonist could block it.

 

 

https://www.ncbi.nlm...pubmed/25697477

 

A 5-HT3 receptor antagonist potentiates the behavioral, neurochemical and electrophysiological actions of an SSRI antidepressant.

Thank you for this information, I will bring this up with my doctor and see what he thinks.

 

 

 

 

  • How about the MAOIs? I know this is quite heavy stuff, but some people wiht social anxiety report that Phenelzine (Nardil) was life changing for them. Among its long list of sides it has both diarrhea and constipation listed, so not sure which of these two is more prevalent.

 

 

Selective reversible MAO-A inhibitor moclobemide has very low diarrhea rates 4.2% compared to sertraline's 30% and paroxetine's 15%

 

Antidepressant Side Effects in Depression Patients Treated in A Naturalistic Setting: A Study of Bupropion, Moclobemide, Paroxetine, Sertraline, and Venlafaxine

 

attachicon.gifgastroSE.jpg

(Click to see larger version)

 

Thanks for this, however I was more interested in the irreversible MAOIs such as Nardil and Parnate. I know that Moclobemide has very low side-effect profile, however there seem to be quite a few reports from people claiming that it looses any effects after a couple of weeks.



#10 soulfly

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Posted 08 November 2017 - 02:31 PM

Update after 4 weeks on Tianeptine: starting with the full dose (3x12.5mg) was too much for me. Had to start with just one pill around noon and gradually work my way up to 3 pills daily. After 4 weeks I can tell that most of the initial side-effects have disappeared (still feel increased anxiety at times though),  and I started noticing some antidepressant effects too. So far the antidepressant effect is noticable, but subjectively weaker compared to when I was on SSRIs (Escilatopram), I would say the antidepressant effect is probably like 30-40% of what I was feeling when on SSRI. The feeling is like it helps me to keep my head above the water, though I still need to put in the work not to drown. I'm hoping the AD effect will get still stronger, so I will probably stay on it for now and see how it goes. I also started doing CBT therapy, so hoping there will be some positive effects from that too (for 40 Euros an hour there better be:-). I will report back probably in a few weeks.



#11 BioHacker=Life

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Posted 21 November 2017 - 11:23 AM

I would highly recommend slowly going off and planning your next treatment. Tianeptine is an opioid, is addictive, can cause withdraw effects, and may end up worsening your anxiety down the road.



#12 soulfly

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Posted 21 November 2017 - 12:17 PM

I would highly recommend slowly going off and planning your next treatment. Tianeptine is an opioid, is addictive, can cause withdraw effects, and may end up worsening your anxiety down the road.

 

I'm sticking with the therapeutic dose (3x12.5mg) and do not feel any need/urge to increase it. From what I read withdrawal issues occur mainly for people who take it for euphoric effects (> 100mg). My plan was to stay on the therapeutic dose for couple of months as I read some studies claiming that positive effects of tianeptine continue even with prolonged use. Do you have bad experience with tianeptine withdrawal or why do you suggest to get off it after a couple of weeks?



#13 BioHacker=Life

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Posted 23 November 2017 - 05:49 AM

 

I would highly recommend slowly going off and planning your next treatment. Tianeptine is an opioid, is addictive, can cause withdraw effects, and may end up worsening your anxiety down the road.

 

I'm sticking with the therapeutic dose (3x12.5mg) and do not feel any need/urge to increase it. From what I read withdrawal issues occur mainly for people who take it for euphoric effects (> 100mg). My plan was to stay on the therapeutic dose for couple of months as I read some studies claiming that positive effects of tianeptine continue even with prolonged use. Do you have bad experience with tianeptine withdrawal or why do you suggest to get off it after a couple of weeks?

 

 

As long as you're not have any issues with it's opioid effects. I just don't view opioids in generally as the best approach for anxiety but if it works for you more power to you.



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#14 Cassandra

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Posted 11 January 2018 - 05:44 PM

Does anybody know if Tianeptine interacts with Provigil?







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