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Thread: Why are SSRIís too stimulating !!!!!!

  1. #11
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    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by SideFX View Post
    Thanks I’ve been battling for nearly 4 years now, which is too long and I never thought I’d still be trying to sort meds out for this long Ta John
    It took me 20 years to get mine sorted...but it's worth it.
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  2. #12
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    Re: Why are SSRI’s too stimulating !!!!!!

    Quote Originally Posted by SideFX View Post
    I have a full awareness of Dr Ken Gillman and his YouTube channel, plus website and it all sounds accurate good information to me.
    I didn't know Ken had a YT channel. Thanks for the heads-up, John.

    However why did I completely recover after only 6 weeks on Peroxatine??? It was an amazing AD and is the strongest SSRI. I have never had a drug turn me round so fast and make me feel so good...Why is that ???? I donít know !!!!
    Six weeks is when ADs are most likely to kick-in, at least for the first exposure. It tends to take progressively longer through each subsequent discontinuation/restart cycle. The side-effects also often gradually become more severe each time too, and they can be different at each time too. I don't think anyone knows why. Paroxetine isn't the most potent SSRI. Vortioxetine has a stronger affinity to serotonin transporters, as do escitalopram, sertralineand vilazodone and the SNRI duloxetine and the TCA clomipramine.

    If I could only find another Peroxatine I would be a happy man again, for now I live a life, albeit not to the quality I used to have.
    Parotetine has no intrinsic advantage. There is a good chance another AD will be just as effective, if not more so. But it can take a while to find it.

    But to be honest I donít think itís the serotonin thatís the problem, I think itís the mechanism of action thatís causing it.
    It is being mediated through serotonin pathways. Serotonin has many roles in the body besides brain neurotransmission and the skin and its blood vessels utilize about as much serotonin as the brain does, a little less than 2% of the body's output.

    I took Amatriptyline a couple of times at the beginning of this protracted episode and first time just wanted to fall asleep, no other side effect, but the second time I took it I also took duloxetine and Mirtazipine and had a huge panic attack - I had to take a lot of Diazipam to stop it and that spooked me with it...Donít know why this didnít happen the first time.
    It can take a few days, sometimes weeks for the effects of an AD to cross the side-effects threshold. Amitriptyline is also a fairly potent antihistamine hence the sedation. Why someone would prescribe both it and duloxetine is puzzling unless it was part of a switch attempt.

    Also pregabalin isnít a walk away from med and will blow up in doctors faces as Benzos did !!!! Their being dished out for everything!!!!
    Not a fan. Apart from the dependency and tolerance issues, almost everyone taking it ends up on at least one other med, often mirtazapine.

    But I do feel TCA is the way to go, but not with vortioxatine, so swapping that out, without falling into the pit of debilitating depression and anxiety. I like the idea of Amatrip but that PA spooked me, I also like the idea of imip or even Clomipramine the strongest serotonin biased TCA.
    If you wean off vortioxetine first then I think imipramine would be the better option of the three TCAs.

    I donít have the burning reaction to TCAís but itís getting through the drop in one med and the start up of another and as you know people with high anxiety disorders donít do well on switching meds !!!!
    It helps if there is a competent doctor supervising it and that is my reservation in your case, John. It was the second reason I suggested switching to nortriptyline rather than imipramine. Much harder to stuff it up.
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  3. #13

    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by AntsyVee View Post
    It took me 20 years to get mine sorted...but it's worth it.
    Wow how did you cope and what saved you after 20 years...Iíve had a lot of good years on ADís, but canít get there now !!! Thanks John

  4. #14

    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by panic_down_under View Post
    I didn't know Ken had a YT channel. Thanks for the heads-up, John.



    Six weeks is when ADs are most likely to kick-in, at least for the first exposure. It tends to take progressively longer through each subsequent discontinuation/restart cycle. The side-effects also often gradually become more severe each time too, and they can be different at each time too. I don't think anyone knows why. Paroxetine isn't the most potent SSRI. Vortioxetine has a stronger affinity to serotonin transporters, as do escitalopram, sertralineand vilazodone and the SNRI duloxetine and the TCA clomipramine.



    Parotetine has no intrinsic advantage. There is a good chance another AD will be just as effective, if not more so. But it can take a while to find it.



    It is being mediated through serotonin pathways. Serotonin has many roles in the body besides brain neurotransmission and the skin and its blood vessels utilize about as much serotonin as the brain does, a little less than 2% of the body's output.



    It can take a few days, sometimes weeks for the effects of an AD to cross the side-effects threshold. Amitriptyline is also a fairly potent antihistamine hence the sedation. Why someone would prescribe both it and duloxetine is puzzling unless it was part of a switch attempt.



    Not a fan. Apart from the dependency and tolerance issues, almost everyone taking it ends up on at least one other med, often mirtazapine.



    If you wean off vortioxetine first then I think imipramine would be the better option of the three TCAs.



    It helps if there is a competent doctor supervising it and that is my reservation in your case, John. It was the second reason I suggested switching to nortriptyline rather than imipramine. Much harder to stuff it up.
    Thanks again PDU, thing is I feel Iíve hit the tolerance wall with Pregabalin, as I wake feeling very down until it gets back into my body. This can take up to 2 and a half hours to peak. Then Iím more stable....Itís got a silly 6.5Hrs half life so gone in 12 hours !!!!

    I have deliberated coming off Pregabalin, but am I just tearing off the fire blanket and screwed cause vortioxatine and itís side effects could come back with avengamce !!!!

    I need to either try dropping the pregab or swapping out the vortioxatine for a TCA. Therefore giving a different mechanism of action.

    Itís a decision Iím finding very hard to make and could Pregabalin be causing my daily yo yo effect ?????

    If you were in my position what would you go for and what would justify that decision....Please bear in mind that I have to work and maintain functionality. I canít risk losing my home and job again - it would be the end of me.

    Your thoughts please based on the above ??? Again a huge mega thanks John

  5. #15
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    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by SideFX View Post
    Wow how did you cope and what saved you after 20 years...I’ve had a lot of good years on AD’s, but can’t get there now !!! Thanks John
    I did the best I could, but I had a lot of ups and downs. i've had GAD and depression since I was a little kid. I remember symptoms of anxiety as early as age 5, but when I was a kid, my parents didn't really know and/or understand what I was dealing with, and my bio mom had her own mental illness she never dealt with (I believe mine are genetic). The meds I was on as a kid never really did much for me except make the problems worse. When I became an adult, I tried a different few, but nothing did the trick. Therapy helped me immensely. I had gone off meds for several years between 2008 and 2014. But then in the fall of 2014, I lost my best friend, and my anxiety skyrocketed to the worst I've ever had it (I found his body). I got myself back into therapy, specifically grief counseling. I learned that I had C-PTSD as I didn't properly deal with other things that had happened to me before then, and my doctor said, "Hey, there is this new SSRI that they didn't have back in 2008 when you were last on meds, why don't you give it a try?" And I did. Lexapro. I take 20 mg daily and I love it. It's improved my quality of life so much. I'm so glad I've been on it for this pandemic because I'm not sure I'd be able to deal with the stress of everything that's happened without it.
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  6. #16
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    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by SideFX View Post
    I wake feeling very down until it gets back into my body. This can take up to 2 and a half hours to peak. Then Iím more stable....Itís got a silly 6.5Hrs half life so gone in 12 hours !!!!
    Are you taking pregabalin in an immediate-release or controlled/extended/slow-release formulation, John? Peak plasma levels are usually reached within 30-90 minutes of taking the immediate-release, 8-10 hours for the controlled-release.

    Itís a decision Iím finding very hard to make and could Pregabalin be causing my daily yo yo effect ?????
    Yes, it could. But it could just be your mood is usually lower in the mornings. We split about 50:50 in being most affected by these disorders either in the mornings, or late in the day.

    If you were in my position what would you go for and what would justify that decision....Please bear in mind that I have to work and maintain functionality. I canít risk losing my home and job again - it would be the end of me.
    Given your circumstances, I'd go for a slow cross taper from vortioxetine to a TCA, either amitriptyline, or its main metabolite nortriptyline as you'd still be treated throughout the switch and it would usually be easier/quicker to recover if things go amiss. Quitting vortioxetine and then starting the TCA will leave you exposed for some weeks. But the final arbiter on this will be your doctor/s. I suspect they'll opt for stopping the vortioxetine before prescribing a TCA. You might even get resistance to TCAs. Many doctors have little experience of them and believe, wrongly, that they are inferior to SSRIs/SNRIs when the opposite is the case.
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    The opinions expressed above are based on my observations and, where applicable, interpretation of cited data and are general in nature. Consult your physician before acting on anything stated.

  7. #17

    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by AntsyVee View Post
    I did the best I could, but I had a lot of ups and downs. i've had GAD and depression since I was a little kid. I remember symptoms of anxiety as early as age 5, but when I was a kid, my parents didn't really know and/or understand what I was dealing with, and my bio mom had her own mental illness she never dealt with (I believe mine are genetic). The meds I was on as a kid never really did much for me except make the problems worse. When I became an adult, I tried a different few, but nothing did the trick. Therapy helped me immensely. I had gone off meds for several years between 2008 and 2014. But then in the fall of 2014, I lost my best friend, and my anxiety skyrocketed to the worst I've ever had it (I found his body). I got myself back into therapy, specifically grief counseling. I learned that I had C-PTSD as I didn't properly deal with other things that had happened to me before then, and my doctor said, "Hey, there is this new SSRI that they didn't have back in 2008 when you were last on meds, why don't you give it a try?" And I did. Lexapro. I take 20 mg daily and I love it. It's improved my quality of life so much. I'm so glad I've been on it for this pandemic because I'm not sure I'd be able to deal with the stress of everything that's happened without it.
    Iím sorry to hear your decades of enduring depression and anxiety and your genetic history...I unfortunately saw my mum try to take her life when I was about 13, she took nearly 200 paracetamol and how she survived is a miracle. My dad took his life in 93 and I was the unfortunate to find him !!!! That was a tough time, but it was just a case of get on with it in those days

    I had my first nervous breakdown in 2001 in my 30ís and it happened so quickly within weeks I was ready to end it all. Then I was prescribed Peroxatine and Yipeeee I felt on top of the world...Many stops and starts on meds left me in the deepest black hole ever and it was Effexor & Mirtazipine that eventually pulled me out of it, but as usual I stop taking meds and I get burnt again. This time I am struggling to get there and canít see why I want to at times thanks for sharing your history itís not easy Ta John
    Last edited by SideFX; 05-03-21 at 16:54.

  8. #18

    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by panic_down_under View Post
    Are you taking pregabalin in an immediate-release or controlled/extended/slow-release formulation, John? Peak plasma levels are usually reached within 30-90 minutes of taking the immediate-release, 8-10 hours for the controlled-release.



    Yes, it could. But it could just be your mood is usually lower in the mornings. We split about 50:50 in being most affected by these disorders either in the mornings, or late in the day.



    Given your circumstances, I'd go for a slow cross taper from vortioxetine to a TCA, either amitriptyline, or its main metabolite nortriptyline as you'd still be treated throughout the switch and it would usually be easier/quicker to recover if things go amiss. Quitting vortioxetine and then starting the TCA will leave you exposed for some weeks. But the final arbiter on this will be your doctor/s. I suspect they'll opt for stopping the vortioxetine before prescribing a TCA. You might even get resistance to TCAs. Many doctors have little experience of them and believe, wrongly, that they are inferior to SSRIs/SNRIs when the opposite is the case.
    Hi PDU thanks again and your valued input...Your correct I am treated by a Pdoc not a GP and heís happy to move to a TCA and Iíve even dropped the MAOI bomb if TCAís donít work and he didnít say no !!!!

    I take instant release Pregabalin and itís gone in 12 hours and working on the 5 half lives theory thatís 30 hours after a single dose (Not good) So you wouldnít touch Pregabalin for now then ???? Why is that ????

    Also why is nortriptyline a less risky option than imipramine??? Surely any switch is fraught with its own risks and I canít afford to mess this up. Iíve pushed myself and worked so so so hard to rebuild my life, I could lose all that ground and couldnít live with that.

    If you look at my response to AntsyVee my past has not been a smooth one with suicide and mental health being a huge part of my life !!!!

    As ever your input and continued support, through this decision making is very much appreciated Ta John

    Oh and the duloxetine with amitriptyline was my doing not a doctors (Mistake I know) !!!!!
    Last edited by SideFX; 05-03-21 at 17:05.

  9. #19
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    Re: Why are SSRIís too stimulating !!!!!!

    You've been through so much trauma, SideFX and I can understand your need to medicate yourself through the ongoing pain of daily life.

    I have a diagnosis of "agitated depression" from way back and like you found SSRIs just added to the problem. My son is on a whole cocktail of meds including vortioxetine and quetiapine after being sectioned last year. They don't really touch him, depression-wise, but have limited the self-harming.

    One psychiatrist we consulted said that in her experience TCAs worked better in males than SSRIs/SNRIs. Trouble is, every psychiatrist has a different "favourite" med and you're at the mercy of their area of expertise. I find with my son it's a question of throwing the book at the problem and hoping something works..I've preferred the less is more approach for myself.

    When you're under pressure to be functioning in your life it makes med choice all the more critical. Are you actually happy with your psychiatrist?

  10. #20
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    Re: Why are SSRIís too stimulating !!!!!!

    Quote Originally Posted by SideFX View Post
    I am treated by a Pdoc not a GP and heís happy to move to a TCA and Iíve even dropped the MAOI bomb if TCAís donít work and he didnít say no !!!!
    The most effective AD I've tried was the MAOI phenelzine (Nardil). Unfortunately, dietary issues were a problem back in the 1980s which became a real pain in the posterior, but these days much less so because modern food processing techniques create significantly less tyramine, plus we now know that adjunct doses of a NRI like desipramine and nortriptyline will pretty much block the response if a high tryramine dose food is eaten. However, should I need to go back onto a MAOI then it would be tranylcypromine (Parnate) as seems to provide a smoother 'ride' than the rocket fuel derive phenelzine.

    So you wouldnít touch Pregabalin for now then ????
    Because I think it is less important than switching the AD, might still be having a positive effect on anxiety and it could speed up neurogenesis a little by accelerating the maturation of the new cells.

    Also why is nortriptyline a less risky option than imipramine??? Surely any switch is fraught with its own risks and I canít afford to mess this up. Iíve pushed myself and worked so so so hard to rebuild my life, I could lose all that ground and couldnít live with that.
    Imipramine is a fairly potent serotonin reuptake inhibitor, in fact slightly more so than vortioxetine, so there may be a small risk of triggering serotonin syndrome/toxicity when taking both. Nortriptyline is a much weaker SRI, so much so that before SNRIs were readily available it was quite common to prescribe it and a SSRI, usually sertraline, at highish doses to create a bespoke SNRI. Some old time psychiatrists still prefer the combo to a SNRI.

    If you look at my response to AntsyVee my past has not been a smooth one with suicide and mental health being a huge part of my life !!!!
    Understood, which is why I think it preferable to not leave you untreated while switching if possible as you would be when stopping the vortioxetine before starting a TCA, John.

    Oh and the duloxetine with amitriptyline was my doing not a doctors (Mistake I know) !!!!!
    Tsk, tsk. Never a good idea, mate, not even if someone like me suggests it. Your GP, or psychiatrist should always be the gatekeeper as they have both the expertise, and even more importantly, a better grasp of your mental and physical state and the meds you are and have taken.
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