13 replies to this topic

[Migdonam]

Hello Comrades,

 

I've been taking Sertraline (50mg daily) for 9 months now.

Reason for taking Sertraline: Depression & SAD. Maybe some GAD.

 

So Sertraline treats my baseline anxiety quite well, also got rid of digestion problems, but I am struggling with side effects:

• Motor restlessness, agitation. I've always been quite "hyperactive", but Sertraline has worsened it by a good amount. I cannot sit still, I feel I have to walk, to pace. I move my fingers and toes to "release" some of the energy. Also lots of fidgeting, rocking back and forth. I have the urge to crawl out of my skin.​
  _
• Indifference, amotivation, apathy, lethargy. I get less things done on Sertraline than before Sertraline. Just want to sit around and do nothing. It is really disconcerting, because things would happen like a major car malfunction or someone f*ck*ng me over and I'd be thinking "this SHOULD piss me off, but, meh.. whatever.."! I've been doing some reading & research and there is the hypothesis that SSRI-induced-stimulation of 5HT2C & 5HT2A receptors dampens the dopaminergic transmission in the prefrontal cortex thus causing these specific SSRI side effects. Antagonism / Inverse Agonism of these receptors should theoretically resolve the problem. What medications do antagonize / inverse agonize these receptors? Are there any other reliable theories on what is causing this? And what could help?
  _
• Sleep disturbances, f*ck*d up sleep cycle, crappy sleep. Falling asleep is difficult, shallow sleep, waking up a lot in the night => daytime fatigue. (This week I've been sleeping a lot, maybe because the body wants to compensate for last month's bad sleep?)
  _

• Heat intolerance + hot flashes. My entire life I've been loving warmth and heat. I was the guy who could sit at the top row in the sauna for 20min @ 100°C (212 °F), but right now I cannot even stand a mild summer. And I have been getting hot flashes lasting between 10-15 mins several times a day (I am a 29 year old male, so pretty sure it is not menopause related)
  _

• I also lost quite a bit of weight, partially due to loss of appetite, but also due to increased metabolic rate. My appetite is back to normal, but I am still not gaining any weight. BMI 20 right now.
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• Palpitations (BUM BUM BUM BUM. BUM . . . BUM . . . BUM)
  _
• mild headaches and "pressure" in my neck. Nothing bad, but very annoying in the mid and long term.

Now I don't know what to do. I need some meds with "less" side effects. I haven't tried any combination of medications yet. To my dismay my doc prefers the SSRI merry go around aka SSRI carousel. I found a new psychiatrist and I will have a first appointment in about a month, but I don't know what to suggest to him. Has anybody some experience with a similar situation? Which antidepressant would be suitable for me? If there is someone who had the same problem and found some solution: please write me. Thank you. Greetings from Germany!

 

Edited by Migdonam, 05 February 2018 - 09:50 AM.

[Mind_Paralysis]

You can always switch to Tianeptine, which has a completely different mode of action.

 

Another possibility is to request Vortioxetine (trintellix, brintellix) which is a form of modified SSRI - specifically with antagonisation of several serotonin receptors - it was devised precisely to deal with side-effects from traditional SSRI's.

 

https://en.wikipedia...ne#Pharmacology

 

Since SSRI's have better effect on anxiety than Tianeptine, this is probably the way to go for you.

 

 

EDIT:

Btw, if you switch to another agent, and discontinue SSRI's, then I suggest you first switch to FLUOXETINE from Sertraline, since Fluoxetine has the longest half-life of any SSRI, and is hence the easiest to discontinue, making it easier and smoother to move on to other agents.

Edited by Stinkorninjor, 05 February 2018 - 11:12 AM.

[kvdv]

hi,

 

After years of (social and general) anxiety, OCD and a depression as a consequence,  I just had to turn to medication.

So I started Sertraline a couple of months ago startin with 25mg and slowly upping the dose until 125mg currently.

Overall, I feel it helps a lot with anxiety and depression,  not so much with OCD.

 

Anyway,  I have exactly the same concern regarding indifference, lack of motivation, etc. In other words : I feel better overall (less worried, less nervous and anxious), but...  I don't do that much anymore.  I can easily spend a day on the sofa, reading and watching Netflix .   This is not(!) good at all.

 

..."SSRI-induced-stimulation of 5HT2C & 5HT2A receptors dampens the dopaminergic transmission in the prefrontal cortex"..

I'm interested in antagonism of these receptors too. 

 

Is there anyone who knows how to 'fix' this?

 

Thanks,

Kris

 

 

----------------------------------------------------------

..."indifference, amotivation, apathy, lethargy. I get less things done on Sertraline than before Sertraline. Just want to sit around and do nothing. It is really disconcerting, because things would happen like a major car malfunction or someone f*ck*ng me over and I'd be thinking "this SHOULD piss me off, but, meh.. whatever.."! I've been doing some reading & research and there is the hypothesis that SSRI-induced-stimulation of 5HT2C & 5HT2A receptors dampens the dopaminergic transmission in the prefrontal cortex thus causing these specific SSRI side effects. Antagonism / Inverse Agonism of these receptors should theoretically resolve the problem. What medications do antagonize / inverse agonize these receptors? Are there any other reliable theories on what is causing this?"...

[Mind_Paralysis]

A way to fix motivational deficits, which is a bit more potent but also a bit more side-effects ladden, is to add ANOTHER agent as an addition to the SSRI - Reboxetine, combined with Sertraline, could be a good combo (especially if you have intense diarrhoea from Sertraline - Reboxetine causes a lot of constipation, which means they could balance out), which helps a lot of people with these issues. It will, however, cause a lot of issues with sleep, a fairly potent insomnia-cocktail, really.

 

There's of course also something like Duloxetine, which is honestly the better option for anxiety - proven in a 2013 meta-review.

 

Btw, it should be noted, that since there are NO dopamine-transporters in the PFC, hence, NRI's such as Duloxetine and Reboxetine has the potential to improve dopaminergic signalling there - since in the PFC, it's instead the Norepinephrine-transporter that handles dopamine, meaning that both activities will go up in the PFC, correcting dopaminergic errors in the PFC as well. (this is why Atomoxetine for instance, works for some people with ADHD)

[kvdv]

I'm not sure about Duloxetine and Reboxetine because (S)NRIs are difficult to quit and have a bad withdrawal profile I think?
Also, when I take something that elevates Norepinephrine like Wellbutrin or even Alcar,  I usually get nervous/anxious, which is not good for me.

 

 

 

 

A way to fix motivational deficits, which is a bit more potent but also a bit more side-effects ladden, is to add ANOTHER agent as an addition to the SSRI - Reboxetine, combined with Sertraline, could be a good combo (especially if you have intense diarrhoea from Sertraline - Reboxetine causes a lot of constipation, which means they could balance out), which helps a lot of people with these issues. It will, however, cause a lot of issues with sleep, a fairly potent insomnia-cocktail, really.

 

There's of course also something like Duloxetine, which is honestly the better option for anxiety - proven in a 2013 meta-review.

 

Btw, it should be noted, that since there are NO dopamine-transporters in the PFC, hence, NRI's such as Duloxetine and Reboxetine has the potential to improve dopaminergic signalling there - since in the PFC, it's instead the Norepinephrine-transporter that handles dopamine, meaning that both activities will go up in the PFC, correcting dopaminergic errors in the PFC as well. (this is why Atomoxetine for instance, works for some people with ADHD)

 

Edited by kvdv, 05 February 2018 - 03:41 PM.

[BlueCloud]

 

 

There's of course also something like Duloxetine, which is honestly the better option for anxiety - proven in a 2013 meta-review.

 

 

 

Duloxetine totally shot my anxiety through the roof, like few things did. I'm surprised it's consideedr an option for anxiety, especially considering its effect on Norepinephrine.

Edited by BlueCloud, 05 February 2018 - 06:54 PM.

[Migdonam]

You can always switch to Tianeptine, which has a completely different mode of action.

 

Another possibility is to request Vortioxetine (trintellix, brintellix) which is a form of modified SSRI - specifically with antagonisation of several serotonin receptors - it was devised precisely to deal with side-effects from traditional SSRI's.

 

https://en.wikipedia...ne#Pharmacology

 

Since SSRI's have better effect on anxiety than Tianeptine, this is probably the way to go for you.

 

 

EDIT:

Btw, if you switch to another agent, and discontinue SSRI's, then I suggest you first switch to FLUOXETINE from Sertraline, since Fluoxetine has the longest half-life of any SSRI, and is hence the easiest to discontinue, making it easier and smoother to move on to other agents.

 

Tianeptine. Never heard of this one before. How often does one have to take it during the day? Its half life is pretty short. Is there an Extended-Release-Version?

 

Vortioxetine is an interesting option, but unfortunately Lundbeck has withdrawn it from the German market:
http://www.lundbeck....vice/Brintellix

[Migdonam]

 

 

..."SSRI-induced-stimulation of 5HT2C & 5HT2A receptors dampens the dopaminergic transmission in the prefrontal cortex"..

I'm interested in antagonism of these receptors too. 

 

Is there anyone who knows how to 'fix' this?

 

 

+1

[Migdonam]

A way to fix motivational deficits, which is a bit more potent but also a bit more side-effects ladden, is to add ANOTHER agent as an addition to the SSRI - Reboxetine, combined with Sertraline, could be a good combo (especially if you have intense diarrhoea from Sertraline - Reboxetine causes a lot of constipation, which means they could balance out), which helps a lot of people with these issues. It will, however, cause a lot of issues with sleep, a fairly potent insomnia-cocktail, really.

 

There's of course also something like Duloxetine, which is honestly the better option for anxiety - proven in a 2013 meta-review.

 

Btw, it should be noted, that since there are NO dopamine-transporters in the PFC, hence, NRI's such as Duloxetine and Reboxetine has the potential to improve dopaminergic signalling there - since in the PFC, it's instead the Norepinephrine-transporter that handles dopamine, meaning that both activities will go up in the PFC, correcting dopaminergic errors in the PFC as well. (this is why Atomoxetine for instance, works for some people with ADHD)

 

But I am already quite skinny (BMI 20). Won't they (Reboxetine, Duloxetine) cause me to loose even more weight?

 

And what about the old stuff: tricyclics & tetracyclics?

[Mind_Paralysis]

 

You can always switch to Tianeptine, which has a completely different mode of action.

 

Another possibility is to request Vortioxetine (trintellix, brintellix) which is a form of modified SSRI - specifically with antagonisation of several serotonin receptors - it was devised precisely to deal with side-effects from traditional SSRI's.

 

https://en.wikipedia...ne#Pharmacology

 

Since SSRI's have better effect on anxiety than Tianeptine, this is probably the way to go for you.

 

 

EDIT:

Btw, if you switch to another agent, and discontinue SSRI's, then I suggest you first switch to FLUOXETINE from Sertraline, since Fluoxetine has the longest half-life of any SSRI, and is hence the easiest to discontinue, making it easier and smoother to move on to other agents.

 

Tianeptine. Never heard of this one before. How often does one have to take it during the day? Its half life is pretty short. Is there an Extended-Release-Version?

 

Vortioxetine is an interesting option, but unfortunately Lundbeck has withdrawn it from the German market:
http://www.lundbeck....vice/Brintellix

 

 

3 times a day is the dosage for Tianeptine Sodium, the form that's used in official medical treatment - which is admittedly a tricky dosing-schedule.

 

1-2 times a day for Tianeptine Sulphate - this form was researched in combination with a special cellulose capsule to create a time-release version - it has a much longer half-life than the sodium-form. I can't recall the specific numbers, but if I recall correctly it's at least twice as long. Sulphate is heavier than Sodium though, hence you need a slightly higher dosage, we're only talking a few milligrams higher though, like 45 mg compared to 37 mg, or something like that.

 

Sulphate is easily available for an affordable price from multiple nootropics-vendors. It's admittedly, NOT as proven as an antidepressant however.

 

Quite unfortunate that Lundbeck has withdrawn Vortioxetine from your market! Interesting how this is either because PURE GREED on their part, or possibly because of bone-headedness from your version of the FDA. Not sure which one is in the right there...

 

Anyways, if I recall correctly, because of EU-law, you can actually go to one of your neighbouring countries and then get the prescription, yes? And then your local health services have to continuously import the drug for you! At least, that's how I think it works - look into this... there's possibilities here.

Your neighbouring countries of Denmark, the Netherlands and France all have the drug readily available for prescription.

[Hannes2]

Migdonam,

 

unless your psychiatrist is a kind of experimenter, you will likely get next offered Venlafaxine (which might be worth a try). If you also emphasize GAD then perhaps Pregabalin (worth a try).

[Migdonam]

Migdonam,

 

unless your psychiatrist is a kind of experimenter, you will likely get next offered Venlafaxine (which might be worth a try). If you also emphasize GAD then perhaps Pregabalin (worth a try).

 

I think rather poorly of Venlafaxine. It's essentially just another SSRI, quite toxic and with a very short half life. A friend of mine was on it and going through a hellish withdrawal...

Edited by Migdonam, 08 February 2018 - 03:46 PM.

[Migdonam]

 

 

You can always switch to Tianeptine, which has a completely different mode of action.

 

Another possibility is to request Vortioxetine (trintellix, brintellix) which is a form of modified SSRI - specifically with antagonisation of several serotonin receptors - it was devised precisely to deal with side-effects from traditional SSRI's.

 

https://en.wikipedia...ne#Pharmacology

 

Since SSRI's have better effect on anxiety than Tianeptine, this is probably the way to go for you.

 

 

EDIT:

Btw, if you switch to another agent, and discontinue SSRI's, then I suggest you first switch to FLUOXETINE from Sertraline, since Fluoxetine has the longest half-life of any SSRI, and is hence the easiest to discontinue, making it easier and smoother to move on to other agents.

 

Tianeptine. Never heard of this one before. How often does one have to take it during the day? Its half life is pretty short. Is there an Extended-Release-Version?

 

Vortioxetine is an interesting option, but unfortunately Lundbeck has withdrawn it from the German market:
http://www.lundbeck....vice/Brintellix

 

 

3 times a day is the dosage for Tianeptine Sodium, the form that's used in official medical treatment - which is admittedly a tricky dosing-schedule.

 

1-2 times a day for Tianeptine Sulphate - this form was researched in combination with a special cellulose capsule to create a time-release version - it has a much longer half-life than the sodium-form. I can't recall the specific numbers, but if I recall correctly it's at least twice as long. Sulphate is heavier than Sodium though, hence you need a slightly higher dosage, we're only talking a few milligrams higher though, like 45 mg compared to 37 mg, or something like that.

 

Sulphate is easily available for an affordable price from multiple nootropics-vendors. It's admittedly, NOT as proven as an antidepressant however.

 

Quite unfortunate that Lundbeck has withdrawn Vortioxetine from your market! Interesting how this is either because PURE GREED on their part, or possibly because of bone-headedness from your version of the FDA. Not sure which one is in the right there...

 

Anyways, if I recall correctly, because of EU-law, you can actually go to one of your neighbouring countries and then get the prescription, yes? And then your local health services have to continuously import the drug for you! At least, that's how I think it works - look into this... there's possibilities here.

Your neighbouring countries of Denmark, the Netherlands and France all have the drug readily available for prescription.

 

 

Thanks for the info 

 

Lundbeck and the "Kassenärztliche Vereinigung" have a very strange working relation, but I am not sure who's to blame... 

 

You are right regarding the EU-law. It's a little tricky, but definitely possible. I know of people who have ordered it in France....

[CWF1986]

 

A way to fix motivational deficits, which is a bit more potent but also a bit more side-effects ladden, is to add ANOTHER agent as an addition to the SSRI - Reboxetine, combined with Sertraline, could be a good combo (especially if you have intense diarrhoea from Sertraline - Reboxetine causes a lot of constipation, which means they could balance out), which helps a lot of people with these issues. It will, however, cause a lot of issues with sleep, a fairly potent insomnia-cocktail, really.

 

There's of course also something like Duloxetine, which is honestly the better option for anxiety - proven in a 2013 meta-review.

 

Btw, it should be noted, that since there are NO dopamine-transporters in the PFC, hence, NRI's such as Duloxetine and Reboxetine has the potential to improve dopaminergic signalling there - since in the PFC, it's instead the Norepinephrine-transporter that handles dopamine, meaning that both activities will go up in the PFC, correcting dopaminergic errors in the PFC as well. (this is why Atomoxetine for instance, works for some people with ADHD)

 

But I am already quite skinny (BMI 20). Won't they (Reboxetine, Duloxetine) cause me to loose even more weight?

 

And what about the old stuff: tricyclics & tetracyclics?

 

 

I take nortriptyline for anxiety, depression, and adhd and I find it works for all three issues.  I know nortriptyline is very selective for NRI, but it really helps me from overreacting to little things and helps some with rumination and worry while improving motivation just a little bit and improving sustained focus a lot.  

 

It's often sedating and often causes people to gain weight.  For me, it helps me sleep at night and provides mental stimulation in the day.  I did gain a little weight when I started it, but didn't gain anymore.