View Full Version : antidepressants that do not cause sexual dysfunction and zombification
hello to you all :)
because of depression (Dystymia with reoccurring episodes of MDD) and a specific social anxiety (glossophobia | speech anxiety), I've been taking Sertraline 50mg for 3 weeks now...
I've started with 12,5mg for 3 days, then went up to 25mg for 7 days and finally upped to 50mg. Since I am on 50mg, I am dealing with some very "annoying" side effects:
# no appetite and no hunger (I've lost a few pounds and have become very skinny: 134 pounds @ 5'9, male)
# insomnia (falling asleep is difficult, shallow sleep, waking up a lot in the night... to my surprise I am not sleepy during daytime, but somewhat "stoned" and dazed.
# flat emotions, emotional dullness / blunting, apathy, anhedonia (it's like being a Vulcan or a Borg drone)
# loss of libido / no sex drive: I have no problem getting "him" hard, but there is no joy in it anymore. It's like being prepubescent. Even if Cara Delevingne jumped at me now, I wouldn't want to have sex with her.
I don't like this Sertraline-stuff. It took away everything human from me, everything that it's worth living for. Eating, sleeping, sex and emotions are the basic things of human existence, see Maslow's hierarchy of needs. I'd rather be depressive and anxious than how I am right now...
My next appointment with my psychiatrist is in 3 weeks. I will talk to him about discontinuing Sertraline and trying something else, maybe Mirtazapine? What can you recommend?
Greetings from Austria,
Duckbruck
Like most medical conditions, finding the right meds and their dosage is all trial and error. Don't get discouraged if it doesn't happen right away.
It took me three meds with varying dosages of each to find the right one.
Paxil took away the anxiety, but it made me pretty much apathetic to any anxiety, and I lost my sex drive. The house could be on fire with Paxil and I'd be like "meh." Then I tried Wellbutrin and I was bouncing off the walls. Lexapro is what I take now, 15 mg a day, and it's the right balance of healthy anxiety (like studying for a test) but it keeps the physical symptoms and dwelling thoughts at bay. No loss of sex drive either.
panic_down_under
07-05-17, 08:01
hello to you all
Guten Tag mein Herr, welcome to No More Panic, :welcome:
because of depression (Dystymia with reoccurring episodes of MDD) and a specific social anxiety (glossophobia | speech anxiety), I've been taking Sertraline 50mg for 3 weeks now...
...Since I am on 50mg, I am dealing with some very "annoying" side effects:
Unfortunately, all antidepressants have at least one annoying side-effect, especially at the beginning. :mad:
BTW-50mg is only just in the typical sertraline 50-200mg therapeutic range and antidepressants usually take 3-12 weeks to kick-in, so I wouldn't read too much into the side-effects at this stage. Things may appear completely different in a few more weeks.
# no appetite and no hunger (I've lost a few pounds and have become very skinny: 134 pounds @ 5'9, male)
This is usually only a temporary side-effect. In the longer term you're likely to not only regain the lost pounds, but pile on several more.
# insomnia (falling asleep is difficult, shallow sleep, waking up a lot in the night... to my surprise I am not sleepy during daytime, but somewhat "stoned" and dazed.
Insomnia is very common. It often eases after a while, but can be an ongoing issue for some. Small doses, 25-75mg, of immediate-release trazodone (Desyrel) will usually resolve it. Trazodone is an antidepressant which at doses below 150-225mg acts only as a very sedating antihistamine. It is actually a fairly good med in its own right with few side-effects other than severe sedation at low doses, but these days is mostly prescribed for SSRI induced insomnia. It becomes less sedating as the dose increases so taking more than 75-100mg is counterproductive. If this isn't available in Germany, then small doses of mirtazapine (Remeron) would be a good substitute. However, it has a longer half-life than trazodone so you may find it harder to get out of bed in the morning.
# flat emotions, emotional dullness / blunting, apathy, anhedonia (it's like being a Vulcan or a Borg drone)
This is often only a temporary initial side-effect. If it continues then switching to another SSRI will usually solve the problem. As AntsyVee has posted, sometimes it can require several med changes to find the antidepressant with the best efficacy to side-effects ratio. Unfortunately, trial and error is still the most reliable way of determining the best med for an individual.
# loss of libido / no sex drive: I have no problem getting "him" hard, but there is no joy in it anymore. It's like being prepubescent.
Pretty much all antidepressants will negatively impact the libido. The exceptions are bupropion (Wellbutrin), mirtazapine (Remeron) and trazodone (Desyrel, Oleptro).
Wellbutrin is a very stimulating antidepressant which can have many with anxiety disorders almost literally climbing the wall, but small adjuvant doses (<=75mg) may counter SSRI/TCA caused sexual dysfunction, usually without increasing anxiety.
Mirtazapine is a very effective med for pulling people out of very severe depression, but isn't a great long-term antidepressant, imho (whether it is a true antidepressant is debatable, it acts mostly just as an antihistamine). It is notorious for causing carbohydrate cravings which may trigger large weight gains and is by far the most poop-out prone med, often quitting within only a few months.
Trazodone is the pick of the bunch because at typical therapeutic doses, 225-300mg, it may enhance the libido. In the past it was never that successful as an antidepressant because of the severe sedation at lower doses, but there is now a slow-release version available (Oleptro) which is better at keeping plasma levels above the sedation threshold.
Supplementing SSRIs with 30mg buspirone (Buspar) may reduce SSRI induced sexual dysfunction. Buspar is a GAD specific med which doesn't actually work for most, but when taken with SSRIs can reduced some of their side-effects and boost their effectiveness.
Mianserin (Bolvidon, Depnon, Norval, Tolvon) at 15-20mg/day has been reported to ease dysfunction in about 60% of cases when taken daily. It may take 3-4 weeks to become active. Mirtazapine is chemically almost identical to mianserin (it was developed by the same company as the mianserin patent expired), but isn't quite as effective in countering sexual dysfunction apparently.
The 5-HT3 antagonist ondansetron (Zofran), a potentially very effective anti anxiety med BTW, supposedly temporarily reduces dysfunction if taken 2-3 hours beforehand, but cost might limit its use. And of course there are those little blue pills which no male admits to taking but which sell in their millions (there is some evidence (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003382.pub3/abstract;jsessionid=2D66700669D5F4F090E07A6AAF5F77 E7.f02t03) that tadalafil (Cialis) may be a little more effective than sildenafil (Viagra) for antidepressant induced erectile dysfunction).
Ginkgo biloba at 240mg/day taken in two divided dose of 120mg has been shown to reverse anorgasmia (http://www.issm.info/sexual-health-qa/what-is-anorgasmia-and-how-does-anorgasmia-affect-men/) and decreased libido in both men and women, plus erectile failure in men. Dosage should be increased from an initial 2 x 30mg/day by a similar amount every 5-7 days. Warning: it should not be used by those on anticoagulants or with a known allergy to Ginkgo. Some antidepressants, particularly the SSRIs and SNRIs, also some TCAs, also affect blood coagulation so caution is needed. Stop taking it if you become more prone to bruising, or if you experience nose, or gum bleeding! Don't take Ginkgo, or any other supplement, without first discussing its suitability and safety with your doctor or pharmacist.
Other things that may help are:
Slightly reducing the daily antidepressant dose by 10-20% after being on the med for a while. This can be enough to kick start the hormonal processes. Sometimes a break from taking an antidepressant for a day is enough to break the cycle for a few days. This seems to work best with the shorter half-life SSRIs, Zoloft (sertraline), Paxil (paroxetine) and Luvox (fluvoxamine), however, this can sometimes trigger withdrawal symptoms, so some trial and error may be needed. Taking the usual daily dose should stop the withdrawal symptoms within an hour or so.
For those (both genders) that are only affected by inability/difficulty in achieving orgasm while taking a SSRI, a change to either a TCA or MAOI class antidepressant will solve this problem in the majority of cases. However, both types may produce other sexual side-effects.
Problems with ejaculatory delay (anorgasmia) may be eased or even eliminated by changing to another SSRI. During research into meds that may reduce premature ejaculation the SSRI with the least effect on this condition, and therefore probably the least likely to cause delayed ejaculation, was fluvoxamine (Luvox) with an ejaculatory delay response of 1.9 times the non medicated response (those taking the placebo reported a 1.5 times delay). Sertraline( Zoloft) delayed things by 4.4 times, fluoxetine (Prozac) by 6.6 times normal and paroxetine (Paxil) had the worst results at 7.8 times normal. So if this is your problem then Luvox might be worth considering, but there is no guarantee that it will work as well as the antidepressant you're now on. It can also be problematic is there are other medical issues as it interacts with many other medications and supplements.
Problems with erectile disorder are mainly produced by the TCAs and paroxetine (Paxil). Switching to a SSRI (except Paxil) will often overcome this disorder, although other dysfunctions may occur.
hello to you all :)
because of depression (Dystymia with reoccurring episodes of MDD) and a specific social anxiety (glossophobia | speech anxiety), I've been taking Sertraline 50mg for 3 weeks now...
I've started with 12,5mg for 3 days, then went up to 25mg for 7 days and finally upped to 50mg. Since I am on 50mg, I am dealing with some very "annoying" side effects:
# no appetite and no hunger (I've lost a few pounds and have become very skinny: 134 pounds @ 5'9, male)
# insomnia (falling asleep is difficult, shallow sleep, waking up a lot in the night... to my surprise I am not sleepy during daytime, but somewhat "stoned" and dazed.
# flat emotions, emotional dullness / blunting, apathy, anhedonia (it's like being a Vulcan or a Borg drone)
# loss of libido / no sex drive: I have no problem getting "him" hard, but there is no joy in it anymore. It's like being prepubescent. Even if Cara Delevingne jumped at me now, I wouldn't want to have sex with her.
I don't like this Sertraline-stuff. It took away everything human from me, everything that it's worth living for. Eating, sleeping, sex and emotions are the basic things of human existence, see Maslow's hierarchy of needs. I'd rather be depressive and anxious than how I am right now...
My next appointment with my psychiatrist is in 3 weeks. I will talk to him about discontinuing Sertraline and trying something else, maybe Mirtazapine? What can you recommend?
Greetings from Germany,
Duckbruck
Since you're relatively new to the medication, you still may overcome these issues that you're having with the new medication. I've been on several medications where the start-up side effects were rather horrendous and similar to yours, but many times it just takes time for these side effects to go away. Your body needs to acclimate to the medications!
But for the time being, what I'd do (or did) in your shoes was help treat the symptoms as possible.
1.) No appetite or hunger? Well, you KNOW that you need to eat, right? Well, when you CAN eat, eat foods that are dense on a caloric level that are still healthy. For example, add in some good fats since your diet since per gram they have the highest caloric value of the major macronutrients. So, almond butter, salmon, etc. are great additions when possible.
You can also make smoothies since they're easier to take in at times, especially when not hungry. I remember when I was bulking I'd put the following into a blender: almond milk, almond butter, protein powder, banana and kale (for the extra nutrients). There are plenty of recipes online.
2.) Melatonin is one supplement that I personally use to help me fall asleep at times. I take a half of a 3mg tablet once in awhile when I foresee that I may have some issues falling asleep.
If you can get your doctor to prescribe you a benzo for a bit, these are also commonly used to help with sleep issues and/or an increase in anxiety while you're starting up.
Exercise is also good at draining your energy to help you fall asleep at night. Think about it - you're using your energy in a more dramatic and increased fashion to engage in the exercise! So it all makes sense. See my blog at the URL www.anxietypress.com for some more information as it pertains to anxiety/depression and fitness.
3.) I totally understand this one, and it is common among people on antidepressants. Many people never lose this feeling, or at least totally. I still have it, but I feel it's either this or the anxiety... It's seemingly difficult to find a medication/dosage to feel emotions without the anxiety, as sad as that sound. Your mileage may vary, friend. Consult with your doctor and let them know how you feel. They may say to wait it out and see if it remedies itself, as many side effects do.
4.) Sexual dysfunction is a HUGE issue many guys have on antidepressants. It was my first side effect when I started taking medication in my early 20's and it put me to tears because I thought it'd never work again lol. Usually the sexual side effects would remedy themselves over time as my body became acclimated, but your doctor may be able to prescribe you some Cialis or Viagra for the time being.
Some supplements that some people sweat by are Maca Root and L-Citrulline. Maca Root is an Adaptogen that supposedly increases libido. L-Citrulline is an amino acid that is a a precursor to L-Arginine and actually acts more efficiently than L-Arginine itself. They work as vasodilators by increasing Nitric Oxide in the bloodstream, which is a vital component for erections. You can find it for a decent price on Truenutrition.com or some bulk order websites. Mix the powder in some sort of juice like orange juice.
If it doesn't get better within the next month or so, some of the newer medications supposedly have less of a chance at causing some popular issues like weight gain and sexual dysfunction. The two I can think of is Viibryd and Trintellix (which is the medication I am on at the moment). They're expensive (at least here in the states) since they're still new. Even with insurance I pay $55 for a three month supply, whereas other medications are $20 for the general copay.
panic_down_under
09-05-17, 01:47
some of the newer medications supposedly have less of a chance at causing some popular issues like weight gain and sexual dysfunction. The two I can think of is Viibryd and Trintellix (which is the medication I am on at the moment). They're expensive (at least here in the states) since they're still new.
Supplementing a SSRI with the GAD specific med buspirone (Buspar) would accomplish the same thing. Vilazodone (Viibryd) and vortioxetine (Trintellix, aka Brintellix) are SSRIs which also have buspirone like properties.
Every Antidepressant I used lead to sexual disfunction. It's tricky but you can manage it.
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Every Antidepressant I used lead to sexual disfunction. It's tricky but you can manage it.
Even Mirtazapine & Bupropion?
EDIT: My libido / sex drive has become better for the last two days.
On the other hand I've been having headaches, upset stomach and hot flashes for the last 3 days.
I'll give the Sertraline 3 more weeks and see what happens.
I'll let you know in three weeks how it went...
---------- Post added at 23:04 ---------- Previous post was at 20:30 ----------
My dystymia is characterized mostly by mild/moderate anhedonia, difficulty making decisions and lack of motivation. It is some sort auf agitated dystymia with much restlessness. I have to say that the psychomotor agitation is the worst part about it... I would like to calm down and not be a psychotic hamster ^^
I had two acute depressions, but those were mostly reactive to difficult life circumstances.
I am not suicidal and I never was.
Don't get discouraged if it doesn't happen right away.
:hugs::bighug1:
Paxil took away the anxiety, but it made me pretty much apathetic to any anxiety, and I lost my sex drive. The house could be on fire with Paxil and I'd be like "meh."
*lol* I know that feeling. Sertraline makes me the same. I am totally indifferent since I am on 50mg.
Then I tried Wellbutrin and I was bouncing off the walls.
It is that much agitating?
I have the feeling that Sertraline is worsening my agitation & restlessness. I am sitting on my chair and whipping around O_o
Guten Tag mein Herr, welcome to No More Panic, :welcome:
Danke und Herzliche Grüße aus Deutschland :yesyes::)
Insomnia is very common. It often eases after a while, but can be an ongoing issue for some. Small doses, 25-75mg, of immediate-release trazodone (Desyrel) will usually resolve it. Trazodone is an antidepressant which at doses below 150-225mg acts only as a very sedating antihistamine. It is actually a fairly good med in its own right with few side-effects other than severe sedation at low doses, but these days is mostly prescribed for SSRI induced insomnia. It becomes less sedating as the dose increases so taking more than 75-100mg is counterproductive. If this isn't available in Germany, then small doses of mirtazapine (Remeron) would be a good substitute. However, it has a longer half-life than trazodone so you may find it harder to get out of bed in the morning.
Trazodone is available in Germany, although German doctors rather tend to prescribe Mirtazapine. Mirtazapine is the second most prescribed AD in Germany, often used as "sleep tranquilizer".
The exceptions are bupropion (Wellbutrin), mirtazapine (Remeron) and trazodone (Desyrel, Oleptro).
I've been reading up on the stuff and there are some quite interesting combos...
for example: Mirtapazine + Venlafaxine = California Rocket Fuel
or other heroic combos a la:
SSRI + Mirtazapine
Bupropion + Mirtazapine
I definitely need something that will stimulate my appetite & and help with my sleep & agitation... Mirtazapine / Trazodone seem to be promising candidates...
Wellbutrin is a very stimulating antidepressant which can have many with anxiety disorders almost literally climbing the wall, but small adjuvant doses (<=75mg) may counter SSRI/TCA caused sexual dysfunction, usually without increasing anxiety.
Maybe Bupropion combined with Mirtazapine / Trazodone would be worth a try.
Another potent drug is Nortriptyline. It has a very interesting and balanced activity spectrum. But I am not sure if German doctors will prescribe me a TCA.
Supplementing SSRIs with 30mg buspirone (Buspar) may reduce SSRI induced sexual dysfunction. Buspar is a GAD specific med which doesn't actually work for most, but when taken with SSRIs can reduced some of their side-effects and boost their effectiveness.
Mianserin (Bolvidon, Depnon, Norval, Tolvon) at 15-20mg/day has been reported to ease dysfunction in about 60% of cases when taken daily. It may take 3-4 weeks to become active. Mirtazapine is chemically almost identical to mianserin (it was developed by the same company as the mianserin patent expired), but isn't quite as effective in countering sexual dysfunction apparently.
The 5-HT3 antagonist ondansetron (Zofran), a potentially very effective anti anxiety med BTW, supposedly temporarily reduces dysfunction if taken 2-3 hours beforehand, but cost might limit its use. And of course there are those little blue pills which no male admits to taking but which sell in their millions (there is some evidence that tadalafil (Cialis) may be a little more effective than sildenafil (Viagra) for antidepressant induced erectile dysfunction).
Thank you for the detailed information :yesyes:
For those (both genders) that are only affected by inability/difficulty in achieving orgasm while taking a SSRI, a change to either a TCA or MAOI class antidepressant will solve this problem in the majority of cases. However, both types may produce other sexual side-effects.
To get a MAOI prescribed in Germany, I would have to lay down onto the track bed and wait for the train to cut my head off :roflmao: They'd rather prescribe me electro-convulsive therapy than MAOI. It's the last resort treatment in Germany. I've read that MAOIs are very effective in treating depression and anxiety.
panic_down_under
11-05-17, 03:44
On the other hand I've been having headaches, upset stomach and hot flashes for the last 3 days.
These are all common SSRI side-effects caused by the initial increase in serotonin activity. Serotonin is not just a brain neurotransmitter. In fact it makes and uses less than 2% of the total amount made.
It is also a signaling protein mediating blood vessel tone, constriction and dilation and SSRIs can throw this out of balance sometimes, triggering headaches. All the common painkillers should help, however, paracetamol, aka acetaminophen, is preferred as SSRIs are mild anticoagulants as are aspirin and the other NSAIDs so there is a bleeding risk when both are taken together for long periods. Taking NSAIDs for a day or two shouldn't be a problem.
The enteric nervous system (http://www.nytimes.com/2005/08/23/health/the-other-brain-also-deals-with-many-woes.html), the mini brain which controls the gastro intestinal tract uses about 50 times more serotonin than the brain so can be even more affected by serotonergic antidepressants at the beginning, hence the upset stomach.
The hot flashes may be partially anxiety, and partly the SSRI. The skin uses about as much serotonin as the brain, around 1.8% of the body total. The flashes should subside, but SSRIs can increase skin photo sensitivity so apply a high SPF sunscreen when outdoors for extended periods.
My dystymia is characterized mostly by mild/moderate anhedonia, difficulty making decisions and lack of motivation. It is some sort auf agitated dystymia with much restlessness. I have to say that the psychomotor agitation is the worst part about it... I would like to calm down and not be a psychotic hamster
In which case a TCA may be a better option as most are mild to moderately sedating.
Mirtazapine is the second most prescribed AD in Germany, often used as "sleep tranquilizer".
This is about all it's good for. While mirtazapine is classified as an antidepressant it is really only a very sedating antihistamine, binding to the histamine H1 receptor about a thousand times more strongly than it does to any serotonin, noradrenaline or dopamine receptor. It is in fact a more potent antihistamine that many of the prescription antihistamines. It can cause agitation at high doses.
Its success is a triumph of marketing. It was developed to replace mianserin which wasn't that successful. Mirtazapine was supposedly more potent, but on nearly every measure it is in fact a weaker med than mianserin.
To get a MAOI prescribed in Germany, I would have to lay down onto the track bed and wait for the train to cut my head off They'd rather prescribe me electro-convulsive therapy than MAOI.
The problem is most doctors and psychiatrists these days have no experience of them. They are also frightened by the food restriction problem. However, modern food processing techniques have pretty much solved this. With the exception of some aged cheeses and wines, most prepared foods now contain little tyramine. The risk of triggering a spike in blood pressure from ingesting too much is now very low, and can be almost completely negated by supplementing the MAOI with small doses of a noradrenaline, aka norepinephrine reuptake inhibitor such as nortriptyline (Pamelor) which block the tyramine pressor response.
I was on phenelzine (Nardil) for about 9 months some 30 years ago and it has been the most effective antidepressant I've tried. Unfortunately, back them the food restrictions were a real problem for me as I was mostly eating out so had little control over what was in the food.
If I have problems with my current med I intend going back to a MAOI, but tranylcypromine (Parnate) as it is a smoother med than phenelzine. Many of the old time psychiatrists/psycho pharmacologists I've asked nominated tranylcypromine as the antidepressant they would personally try first if they needed one even back when the diet restrictions were still an issue (a TCA, mostly clomipramine (Anafranil), was second, few picked a SSRI/SNRI).
I regained my libido /sex drive to some degree, so that's on the positive side.
That unpleasant "cocaine feeling" has also subsided.
What remains negative:
# insomnia
# no appetite | upset stomach | gastric malaise
# agitation
# anhedonia to some degree...
In which case a TCA may be a better option as most are mild to moderately sedating.
German inpatients (hospitals, psychiatric day clinics etc.) most often get prescribed TCAs.
Ambulant patients and GP-visitors most often are put on SSRIs and SNRIs.
That's the german psychiatric duality.
But I agree wit you. A TCA like Amitryptiline (Nortriptyline) or maybe even Clomipramine (?) would be worth a try. I will have to talk it over with my psychiatrist. This is always the difficult part, the fine line between being an patient and a "smartass". :D Many doctors are very allergic to suggestions from their patients ^^
This is about all it's good for. While mirtazapine is classified as an antidepressant it is really only a very sedating antihistamine, binding to the histamine H1 receptor about a thousand times more strongly than it does to any serotonin, noradrenaline or dopamine receptor. It is in fact a more potent antihistamine that many of the prescription antihistamines. It can cause agitation at high doses.
That may be true, but it would surely help overcoming insomnia and appetite-loss, wouldn't it?
Getting Mirtazapine prescribed should be relatively easy.
Does Trazodone also have antiemetic and appetite stimulating properties?
And what is your opinion on Maprotiline?
The problem is most doctors and psychiatrists these days have no experience of them. They are also frightened by the food restriction problem. However, modern food processing techniques have pretty much solved this. With the exception of some aged cheeses and wines, most prepared foods now contain little tyramine. The risk of triggering a spike in blood pressure from ingesting too much is now very low, and can be almost completely negated by supplementing the MAOI with small doses of a noradrenaline, aka norepinephrine reuptake inhibitor such as nortriptyline (Pamelor) which block the tyramine pressor response.
I was on phenelzine (Nardil) for about 9 months some 30 years ago and it has been the most effective antidepressant I've tried. Unfortunately, back them the food restrictions were a real problem for me as I was mostly eating out so had little control over what was in the food.
If I have problems with my current med I intend going back to a MAOI, but tranylcypromine (Parnate) as it is a smoother med than phenelzine. Many of the old time psychiatrists/psycho pharmacologists I've asked nominated tranylcypromine as the antidepressant they would personally try first if they needed one even back when the diet restrictions were still an issue (a TCA, mostly clomipramine (Anafranil), was second, few picked a SSRI/SNRI).
We do have Tranylcypromin (Parnate) in Germany, but it's quite expensive: 100 tablets @ 20mg cost 230€.
We don't have Phenelzin (Nardil) in Germany.
I found Sertraline + Nortriptyline to be an interesting combo. I've been doing some reading and all about it sounds very promising. They sell Nortriptyline (NORTRILEN) in Germany (50 dragees @ 10 mg cost around 12€)
---------- Post added at 18:03 ---------- Previous post was at 17:46 ----------
@panic_down_under
You are not by any chance "Gillman fan" from socialanxietysupport forum? ^^
---------- Post added at 19:40 ---------- Previous post was at 18:03 ----------
@poppadr3w
thank you for your post :yesyes::)
---------- Post added at 19:42 ---------- Previous post was at 19:40 ----------
I am on vacation as off tomorrow morning, so I wish you a nice weekend. I will post something new next week..
:emot-wave:
panic_down_under
13-05-17, 02:10
What remains negative:
# insomnia
# no appetite | upset stomach | gastric malaise
# agitation
# anhedonia to some degree...
These usually diminish after a few weeks.
German inpatients (hospitals, psychiatric day clinics etc.) most often get prescribed TCAs.
Ambulant patients and GP-visitors most often are put on SSRIs and SNRIs.
The less experienced GPs prefer SSRIs/SNRIs because most are safer in overdose, whereas psychiatrists appreciate the greater efficacy of TCAs and are less spooked by the black box warnings.
But I agree wit you. A TCA like Amitryptiline (Nortriptyline) or maybe even Clomipramine (?) would be worth a try.
Amitriptyline is a little weaker than clomipramine, which is arguably the most potent non MAOI antidepressant, but is more sedating which may be beneficial in your case.
Many doctors are very allergic to suggestions from their patients
True, though in the end they are merely the hired help, not the slightly lesser god many see themselves as and, imho, they should take suggestions on their merits and have a very good reason for rejecting them.
That may be true, but it would surely help overcoming insomnia and appetite-loss, wouldn't it?
Sure. The main reason I suggested the trazodone as a sleep aid is its shorter half-life, about 3-4 hours compared to 20-40 for mirtazapine, so you're much less likely to be sedated during the day.
And what is your opinion on Maprotiline?
It's not a med I come across often. It is a noradrenaline/norepinephrine reuptake inhibitor with receptor affinities pretty close to that of nortriptyline, but is a more potent histamine H1 antagonist.
We do have Tranylcypromin (Parnate) in Germany, but it's quite expensive: 100 tablets @ 20mg cost 230€.
Yikes!! I guess they have to charge more because of short production runs these days, but even so, that seems excessive.
We don't have Phenelzin (Nardil) in Germany.
They finally used up all the ex WW2 rocket fuel stocks, huh? :winks: No loss, tranylcypromine is the better med.
I found Sertraline + Nortriptyline to be an interesting combo. I've been doing some reading and all about it sounds very promising.
It is definitely worth try if either med alone isn't completely effective. The only thing to watch out for is that when both are being taken at high doses sertraline may begin slowing the rate at which nortriptyline is metabolized so occasional blood tests to ensure nortrityline blood levels remains in the 50-150ng/mL therapeutic range is advised.
You are not by any chance "Gillman fan" from socialanxietysupport forum?
Nope. This is the only support group which has to endure my presence. :ohmy:
I am on vacation as off tomorrow morning, so I wish you a nice weekend.
And me to you. I've been retired for nearly 18 years so am on a permanent vacation. :)
All my wisdom teeth are finally out :yesyes:
I've had an appointment with my psychiatrist and we agreed on that I will take 50mg of Sertraline for another month or so and if the side effects (mainy insomnia and appetite loss) haven't subsided by then, we will try augmenting it with either Mirtazapine or Trazodone or alternatively try another standalone med...
These usually diminish after a few weeks.
Well, the waiting game continues... :D
The less experienced GPs prefer SSRIs/SNRIs because most are safer in overdose, whereas psychiatrists appreciate the greater efficacy of TCAs and are less spooked by the black box warnings.
Amitriptyline is a little weaker than clomipramine, which is arguably the most potent non MAOI antidepressant, but is more sedating which may be beneficial in your case.
Indeed.
Clomipramine is top-notch when it comes to efficiency, but Amitriptyline and Nortriptyline are also quite interesting. Nortriptyline has an overall better side effect profile.
Sure. The main reason I suggested the trazodone as a sleep aid is its shorter half-life, about 3-4 hours compared to 20-40 for mirtazapine, so you're much less likely to be sedated during the day.
Trazodone is definitely an interesing AD & sleep-aid and it doesn't poop-out as often as Mirtazapine. Nice one.
They finally used up all the ex WW2 rocket fuel stocks, huh? :winks:
That what has been left by Werner von Braun :D
panic_down_under
23-05-17, 22:24
ve had an appointment with my psychiatrist and we agreed on that I will take 50mg of Sertraline for another month or so and if the side effects (mainy insomnia and appetite loss) haven't subsided by then
You may find that these would lessen if the dose was increased. It sounds counter-intuitive, but often works, possibly because sometimes 50mg isn't quite enough to trigger the reduction in serotonin synthesis and expression which reverses the initial SSRI increase in serotonin activity.
You may find that these would lessen if the dose was increased. It sounds counter-intuitive, but often works, possibly because sometimes 50mg isn't quite enough to trigger the reduction in serotonin synthesis and expression which reverses the initial SSRI increase in serotonin activity.
Thanks for the advice.
I will have it raised to 75mg.
I am beginning to like that Setraline stuff :)
self-confidence is at an all time high, even been impulsive the last few days and positively aggressive.
nonetheless, lack of appetite and moderate insomnia is still a problem. (61kg @ 5'9'')
EDIT: And I am a little bit agitated, whipping up and down on my chair ^^
panic_down_under
29-05-17, 03:14
even been impulsive the last few days and positively aggressive.
You will need to watch this if it continues as it can sometimes lead to dangerous activity. Dr Google will have us believe SSRIs increase brain serotonin levels. They don't they actually reduce them (http://www.nomorepanic.co.uk/showthread.php?t=193671%22]Serotonin%20-%20The%20'chemical%20imbalance'%20myth) after a couple of weeks. Unfortunately, this may trigger an increase in impulsiveness, and especially aggressiveness. For example, genetically modified mice lacking an enzyme to make serotonin are not only much less anxious, but much more aggressive (http://www.nature.com/doifinder/10.1038/tp.2012.44) than the controls.
You will need to watch this if it continues as it can sometimes lead to dangerous activity.
I will. I was worried myself, because I've read of people running AMOK on SSRIs :unsure:
So hoping right now that I do not go nuts ^^
Is the "feverish" feeling a normal side effect under Sertraline? It coincides with my hot flashes... it makes me feel somewhat sick.
panic_down_under
29-05-17, 23:11
I was worried myself, because I've read of people running AMOK on SSRIs :unsure:
So hoping right now that I do not go nuts ^^
99.9% of what you've read is probably male bovine manure. Most of it originates from one country where some are desperate to divert attention away from the real causes of "people running AMOK."
Is the "feverish" feeling a normal side effect under Sertraline? It coincides with my hot flashes... it makes me feel somewhat sick.
It can be a SSRI side-effect. Are you on any other medication, or supplements?
It can be a SSRI side-effect. Are you on any other medication, or supplements?
No, just the Sertraline.
But a week ago I've been taking Amoxicillin, Omeprazole and Ibuprofen because of my wisdom teeth extraction.
panic_down_under
30-05-17, 02:20
No, just the Sertraline.
Cool. Then you don't have any potential drug-drug interactions. The other meds would be effectively out of your system by now.
Cool. Then you don't have any potential drug-drug interactions. The other meds would be effectively out of your system by now.
:yesyes:
time for an update:
it's been 8 weeks on 50mg of Sertraline.
on the pro side:
# helps with social anxiety and somewhat with depression
# some subtle psychosomatic symptoms have diminished
# diarrhea no longer an issue! Mr. Hankey is hard and cohesive.
cons:
# insomnia | ****ed up sleep cycle
# weight loss. My appetite is nearly back to normal, but I am still loosing weight or at least not gaining any. BMI 19 right now. That is bothering me. I don't want to become underweight.
# heat intolerance (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 the mild summer.
# exhaustion (walking 2km around the block makes me feel exhausted & breathless. I feel somewhat weak, without power)
# agitation /motoric restlessness seems to be worse than before taking Sertraline
# and the many times mentioned "zombification"
# mild heachache and "pressure" in my neck. Nothing bad, but very annoying in the mid and long term.
I am unsure about the further course of action: Staying on Sertraline as a standalone treatment is not an option, as the side effects are not bearable in the mid to long term. I've been thinking about the popular Sertraline + Nortriptyline combo, but Lundbeck has withdrawn Nortrilen from the German market, so this is no longer a viable option. I've been also thinking about Sertraline + Mirtazapine (heroic combo | Stephen Stahl), but I am not sure if Mirtazapine will counteract & attenuate the side effects of Sertraline!? Although it might be worth a try before discontinuing Sertraline forever...
What other options are there? Well, there are of course TCAs, which might be worth a try as standalone treatment, for example Amitriptyline, Clomipramine, Trimipramine etc.! Considering Gillmans TCA article & "When to consider avoiding SRIs as first choice" (http://www.psychotropical.com/anti-depressants/tcas) I seem to be a prototype for someone who shouldn't be treated with SSRIs but rather try a TCA as first line treatment *lol*
What are your thoughts?
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