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SSRI Stimulation Scale

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Posted (edited)

I'm being way too lazy ATM. This is not from forum as far as I know (or at least easily collated in one post, but I didn't search either).

1) Activation to Sedation level of the SSRIs. Prozac at the top of activating, Paxil at the lowest. Lexapro & Celexa at the middle. I'm addled off of too much sleep, so I'll edit this thing or you edit my useless comments. I think it goes.

Activating <-- Neutral --> Sedating

This varies for everyone, based on body chemistry and how the drug works for you (or does not work), but from a pharmacology view, this is true. I will not label what may or may not be activating, but only put them in an ordered potential list based on clinical knowledge, again, your own experience is the best guideline. Keep in mind depression keeps most people sedated in physical and mental activity, so an activating medication may feel more neutral than activating in practice.

Prozac (Fluoxetine), Zoloft (Sertraline), Lexapro (Escitalopram), Celexa (Citalopram), Fluvoxamine (Luvox), and Paxil (Paroxetine).

How does this scale compare to non-SSRI medications? It's off-label for the forum, but a quick summary might be worth mentioning.

1) Wellbutrin (Bupropion) will be more activating than any SSRI.

2) Deseryl (Trazodone) will be the most sedating of any AD.

3) Remeron (Mirtazapine) at low doses is near the sedation of trazodone. This effect lesses as one reaches higher doses (i.e. 60mg) and for some people becomes extremely activating.

4) Effexor XR (Venlafaxine) a SNRI would be placed below Wellbutrin, but above Prozac. The activating properties will increase as the dose increases.

5) Cymbalta (Duloxetine) another SNRI. I would place this at the neutral range of ADs, and as the dose increases so dose the sedation.

6) MAOIs: Two old-school drugs are mostly used now. Parnate (Tranylcypromine) is extremely activating for some people, not at all a sedating medication. Nardil (Phenelzine) would be a polar opposite of Parnate in some ways, and it can be neutral to extremely sedating.

7) TCAs: These range all over the scale from extremely activating, to neutral, to sedating. Ask in the non-SSRI forum.

Edited by Velvet Elvis

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Posted (edited)

Prozac (Fluoxetine), Zoloft (Sertraline), Lexapro (Escitalopram), Celexa (Citalopram), Fluvoxamine (Luvox), and Paxil (Paroxetine).

Also of important note is that stimulation does not equal potency or efficacy.

In fact, ssri stimulation, whilst very useful in some case of solemnent depression, is actually a side effect of ssris.

The Potency scale of SSRIs is different to the stimulation scale.

Essentially the potency scale, from strongest to weakest is:

paxil-->zoloft-->luvox-->lexparo/celexa-->prozac.  Arguably you could switch luvox with lexparo/celexa. 

With dosage adjustments similar efficacy and potency can be achieved across the different ssris.  eg, 60mg paxil is approximately the same as 200mg zoloft, which is approximately the same as 300mg luvox.  80mg celexa, 80mg prozac and 40mg lexapro would also be pretty much the same at the top end.

Despite

http://www.crazymeds.us/dosequal.html

the increase in dose of these drugs at higher levels is not always linear - that is, 60mg paxil is much more than 50% more that 40mg paxil, if that makes sense at all. 

At the lower end of the spectrum though, the dosage equivalents at the above link apply.

The stimulating vs activating effects do tend to lean towards appropriateness for treatment of different disorders.  Hence paxil is often prescribed in anxiety disorders and zoloft in straight depression, with little or no anxiety.

The bottom line though, is that independent clinical tests show that all 5 major ssris demonstrate similiar efficacy across a range of anxiety and depressive disorders if prescribed at the right dose, but we all react differently to different drugs and some of us just find one better than the other, whether it be side effects or whatever.

Edited by chimpmaster

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Posted

If I had to guess I'd say hypomania.

There shouldn't be any stimulating effect that kicks in after 6 months.  If anything SSRIs sometimes become less effective and require a dose increase somewhere around then.

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Posted (edited)

There is another option.

ADD hyperfocus.  Sometimes folks with ADD have trouble controling where their focus goes and get stuck on a particular task and do that one thing for hours without realizing how long they have been doing it.

Due to the change in mood after after 5 months as you previously mentioned, I still think you should see a psychiatrist.

Edited by Velvet Elvis

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Posted

Right. Sudden, dramatic changes like that are really beyond the scope of GPs' experiences. Get thee to a pdoc.

Hyperfocused ADD is the kind where you're always going "WTF? What time is it? HOW long was I doing that for? Goddammit, I had other things to do! I hate it, I keep getting sucked into things!" Unless it's something you like or really need to work on, of course. At which point it can be an advantage.

I get that. I also get mood swings. They're not mutually exclusive.

Mimi

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Posted

How does this scale compare to non-SSRI medications? It's off-label for the forum, but a quick summary might be worth mentioning.

Effexor XR (Venlafaxine) a SNRI would be placed below Wellbutrin, but above Prozac. The activating properties will increase as the dose increases.

<{POST_SNAPBACK}>

To emphasize the individual reactions to these meds, I currently take 450 mg EFXR XR in the AM and it knocks me out. Sometimes I have to go back to bed for a few hours to sleep it off. Thats also with 150 mg of WB! I'm changing my dosing schedule as we speak!

Jafco

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