What does tolerance means? Does it have a limit?

[panic_down_under]

Is it possible that it can work now for me, (Paroxetine) while it didn't in 2016 which I had bad reaction to it in that time... have you seen similar cases like this? people who tries the same antidepressant that it didnt work for them after trying them a long time ago,

Depends on why it didn't work. How long did you take paroxetine and at what dose?

I have set this list of meds that I still have faith in them, especially Abilify.

Antidepressant I didn't try:
TRIMIPRAMINE
MIANSERINE
SERTRALINE
FLUVOXAMINE
ESCITALOPRAM (I did not give it much time to see if it works or not)
DULOXETINE / CYMBALTA
CITALOPRAM
MAPROTILINE
MIRTAZAPINE

Imo, the pick of these are citalopram/escitalopram and sertraline. Trimipramine, mianserin and mirtazapine are not really antidepressants, but antihistamines which mostly ease anxiety by sedation and aren't really effective for depression. Mianserin and mirtazapine are nearly the same med. Mianserin was the makers first attempt and it soon proved useless so they came out with mirtazapine which is actually a weaker AD than mianserin. The fact it is still popular demonstrates the power of marketing and the placebo effect. That isn't only my opinion, see: Mirtazapine: dubious and misleading evidence supporting its dual action status and Mirtazapine: dubious and misleading evidence supporting its dual action status by Ken Gillman who knows more about antidepressants and neurotransmitters than most.

Fluvoxamine is generally the pick of the SSRIs for OCD spectrum disorders, but the TCA clomipramine is the better med, imo. the SNRI duloxetine is often very effective, but can produce severe side-effects at the beginning so I'd try the TCAs amitriptyline, imipramine, or clomipramine first.

Neuroleptics: (I hate zombie feeling drugs, I want something to give me mental energy and emotions like Clomipramine did to me before it pooped out)
ABILIFY
CLOZAPINE
SULPIRIDE
OLANZAPINE

...
(What do you think?)

All the neuroleptics and anti psychotics are sedating to some degree.

Sorry that I didn't tell you that I had some psychotic ideas in past, once I gave my money on the street to people thinking that god was telling me things to do...
Also lost a job because one time I had paranoia and thinking god was telling me that my father did an accident on road after taking me to my job location and I had to quit the job to check the road where my brain was telling and lying to me.
But for now I learned to manage this problem, I don't respond to these psychotic obsessions anymore,

Where you taking anything at those times which may have triggered, or worsened the psychotic episodes?

the only struggle I have now is the extreme low mood and the zero motivation to do things I once enjoyed, like walking 6kms everyday and spotting old and interesting cars around me, collecting music, use my pc... I lost all interest because of the low mood...

Your best chance of recovering is by taking an antidepressant daily exactly as prescribed for at least 12 weeks and none of the other crap you've experimented with. There is no quick fix. It will take months before you begin seeing positive results.

[SufferingSilent]

Hello again!
No I wasn't taking anything illegal when I was delusional.

I'm now on week 3 Paroxetine after switching from Clomipramine, every next week feels worse than the previous one, should I switch to another antidepressant or just keep giving it time and feel more worse and worse?
I feel unstable and my ocd is back now with the intrusive thoughts and the distress. (it was 20% controllable on Clomipramine now it's less than 5%)

[panic_down_under]

No I wasn't taking anything illegal when I was delusional.

What about legal medications and substances, alcohol, for example?

I'm now on week 3 Paroxetine after switching from Clomipramine, every next week feels worse than the previous one, should I switch to another antidepressant or just keep giving it time and feel more worse and worse?
I feel unstable and my ocd is back now with the intrusive thoughts and the distress. (it was 20% controllable on Clomipramine now it's less than 5%)

Unfortunately, antidepressants will often make things worse at the beginning and typically take 5-12 weeks to begin working well. Given you've been on paroxetine before it will probably take closer to 12 weeks than 5. Frequently changing ADs will just prolong the agony. Take a small, repeat small dose of diazepam, say 2mg to 5mg maximum, if you have it, but only if you need it, or maybe ask your doctor to prescribe a small dose, 7.5mg, of mirtazapine as a sedative.

[SufferingSilent]

12 Weeks which is 3 months.
When I started Clomipramine I didn't feel worse at first, but I was given Lorazepam with it, it was my first time Benzo, it was giving me much relief. Now I have built such a high tolerance on Benzo so that none of them will work on me in little doses.
Even most doctors in my country won't give you the medicine you suggest.
I've never tried Mirtazapine before, but I think I asked my doctor and she said it is not available in Algeria, I think she lied to me... because I found it avaliable on the online Encyclopedia of meds in Algeria:
http://www.pharmnet-dz.com/m-2552-re...-comp-enro-b30

[SufferingSilent]

Does everything that affects GABA builds tolerance and lose efficacity by time?
I wanted to ask my doctor about Zolpidem for sleep but I already have Lorazepam tolerance (doesn't work until I reach 10mg+).
I think it will be useless, right?

[panic_down_under]

Does everything that affects GABA builds tolerance and lose efficacity by time?
I wanted to ask my doctor about Zolpidem for sleep but I already have Lorazepam tolerance (doesn't work until I reach 10mg+).
I think it will be useless, right?

I'm afraid so. Tolerance to BZD sedation typically develops quickly, often within a few weeks and this is true of both benzodiazepines and meds such as zolpidem which target the same BZD binding sites. The anti anxiety effect is produced by different binding sites and tolerance is much slower to develop, especially with the long half-life BZDs such as diazepam and chlordiazepoxide.

[SufferingSilent]

I've stopped taking Paroxetine 40mg after few days, almost a week (I was 20mg for the 2 previous weeks). The extreme bad mood started being unbearable, and my suicidal ideas went so bad, this medication is clearly not for me.
I wanted to ask about the best combinations of antidepressants? Do you know some about this? And can you mix an SSRI with TCA? I've checked on drugs.com that it causes the serious hell of Serotonin Syndrome (I remember one time a doctor add me Venlafaxine to Clomipramine, was it trying to kill me with this evil way of Serotonin Syndrome, I'm not afraid of death but I'd rather git hit by a semi truck than diying by a SS)
Althought I think they can be mixed but in low doses right? (TCA with SSRI)
Please if you can list me the best effective AD's combinations.
Thank you so much.

[panic_down_under]

I've stopped taking Paroxetine 40mg after few days, almost a week (I was 20mg for the 2 previous weeks). The extreme bad mood started being unbearable, and my suicidal ideas went so bad, this medication is clearly not for me.

Have you considered only taking 20mg to see whether it works?

I wanted to ask about the best combinations of antidepressants?

I'm not a fan of taking multiple ADs unless other options have failed and you are a long way from that.

Should it ever become necessary the best initial option would be taking the SSRI sertraline and if it didn't work adding the TCA nortriptyline to make a tailored SNRI. This was the preferred combination of old time psychopharmacologists before SNRIs became available and many still rate it as better than any of the SNRIs.

And can you mix an SSRI with TCA?

Some yes. The only two that are a definite no are clomipramine and imipramine. Amitriptyline is generally okay as long as not taken in excess. The others don't have enough serotonin action to trigger serotonin syndrome.

I remember one time a doctor add me Venlafaxine to Clomipramine, was it trying to kill me with this evil way of Serotonin Syndrome

Sigh! Do doctors in your country use computers to print prescriptions? If so, they usually flag such errors. If not the pharmacist should pick it up. This is the reason people should only see one doctor and get all medications from the same pharmacy.

[SufferingSilent]

Yes, I've seen my psychiatrist today she decreased the Paroxetine to 20mg.
About the computer use of prescriptions, it varies but most doesn't I think.
My doc now is putting me on:
20mg Paroxetine
10mg Clorazepate (Tranxene) x2 times per day, I'm sure it will be useless since Lorazepam is more powerful than Clorazepate and I have already a high Lorazepam tolerance.
25mg Hydroxyzine
200mg Amisulpiride (Solian)
Thank you panic_under_down

[panic_down_under]

My doc now is putting me on:
20mg Paroxetine
10mg Clorazepate (Tranxene) x2 times per day, I'm sure it will be useless since Lorazepam is more powerful than Clorazepate and I have already a high Lorazepam tolerance.
25mg Hydroxyzine
200mg Amisulpiride (Solian)
Thank you panic_under_down

Yes, the clorazepate is unlikely to do much on its own, however, hydroxyzine may help as it has strong anti anxiety properties. Not quite as potent as the BZDs, but often potent enough to make a difference. Unfortunately, the dose is low, but that might be because of a potential interaction with the amisulpride and clorazepate. Amisulpride should also ease anxiety levels.