Imipramine or Clomipramine

[SideFX]

Too much/little serotonin, probably not, at least not directly. It is more likely an indirect suppression of dopamine transmission by serotonin activity. The 5-HT1a receptor agonist buspirone (Buspar) is often prescribed for SSRI/SNRI induced bruxism. It is thought to work by enhancing dopamine transmission and increasing dopamine release in the frontal cortex. Buspirone may also alleviate other SSRI/SNRI side-effects such as sexual dysfunction and boost the effectiveness of these ADs. Unfortunately, you probably won't get it on the NHS. Seems they're not fans.



Mirtazapine also increases frontal dopamine release via the 5-HT2a receptor, so might work although its track record isn't as good as buspirone's.



Switching between SSRIs and TCAs isn't as easy as from one SSRI to another, and much of the data is from TCA to SSRI switches, but it usually goes relatively well. You also have the added benefit of mirtazapine, pregabalin and diazepam to dampen any anxiety swings. It will likely go much better than you fear. Getting into the right frame of mind is important as an anxious mind can create greater havoc than the meds if allowed free reign.

Thanks Ian

I have read that buspar can be a solution to SSRI induced bruxism...However that would mean me moving from Mirtazipine to buspar and that still doesn’t resolve my overall problem of not reaching remission...The Pdoc is talking of lowering the Mirtazipine, not increasing it and as you will know at higher doses it can become more activating.

I just feel this current combo of meds is causing me more problems, whilst helping me focus to work...However after over 2 years I would have expected to be fully recovered. Would you agree ???

And as I’m not fully recovered and still fell Anxiety, agitation and down then this poly pharmaceutical approach ain’t working. But I need to reach a stable point that I can start reducing Pregabalin and Diazipam for sure !!!!

I don’t want to be poly drugged and if you look at the *StarD study, level 4 was Venlafaxine plus Mirtazipine or an MAOI. Now as I’ve once recovered on the Ven/Mirt combo, but can no longer tolerate Ven or any SRI medication for some reason. It causes my skin to burn real bad and not in patches, but all over. And the docs wouldn’t believe me, which has been very frustrating I can tell you.

I even saw a dermatologist and he said it’s most probably a reaction to the SRI. I’m hoping so much that TCA’s don’t have the same reaction and when I tried amitriptyline very briefly this side effect wasn’t triggered. Plus TCA’s are used for nerve pain including burning and stabbing pain...This is why I’m gravitating to imipramine. Also mum did so well on it along with 3mg lorazepam.

I have also tried to research moving from an SSRI to a TCA and there is virtually nothing out there. However there’s lots of stuff on moving the other way...Seems strange as I would have thought after first line SSRI’s they would move to second line TCA’s and then to third line MAOI’s. Therefore studies around this progression would be readily available!!!!! Thanks again Ian

[panic_down_under]

I have read that buspar can be a solution to SSRI induced bruxism...However that would mean me moving from Mirtazipine to buspar and that still doesn’t resolve my overall problem of not reaching remission...

You can take buspirone with mirtazapine, assuming you can get it at all. It might even boost vortioxetine effectiveness, althought it is itself a weak serotonin 5-HT1a receptor partial agonist.

The Pdoc is talking of lowering the Mirtazipine, not increasing it and as you will know at higher doses it can become more activating.

It does become less sedating as the dose increases. I'm not sure you could call that more activating, although it can trigger strong paradoxical reactions in some.

I just feel this current combo of meds is causing me more problems, whilst helping me focus to work...However after over 2 years I would have expected to be fully recovered. Would you agree ???

If the combo was working well I would have expected better results within 4-6 months.

It causes my skin to burn real bad and not in patches, but all over. And the docs wouldn’t believe me, which has been very frustrating I can tell you.

Neuropathy and a host of other nerve and skin conditions are <> listed side-effects. Your doctors are clearly of the mushroom school of 'bedside manner', i.e. keep their patients in the dark and feed them male bovine manure...or ignorant!

If doctors were simply honest with their patients support groups would have much less traffic!

I have also tried to research moving from an SSRI to a TCA and there is virtually nothing out there. However there’s lots of stuff on moving the other way...

I take the view that if it works okay going one way it will likely work well in the reverse direction too.