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My psych and I decided to give Fetzima a try this morning, so she gave me a self-titrating sample pack to try out. I started with 20mg this morning. Surprisingly, I'm already experiencing quite a bit of nausea despite having taken 4mg ondansetron (Zofran) with the Fetzima this morning. I did take everything on an empty stomach (which obviously isn't ideal), but eating later didn't help much, and normally the Zofran combined with my PPI is enough to mitigate most of the effects of taking stuff on an empty stomach...

The reason we decided to try Fetzima is because I've responded relatively well to NRIs in the past (partially implying that I should be able to better tolerate it), and because I've tried a very large number of antidepressants without much success. Since we've now wholly embraced using a brand-name drug for the antidepressant (previously an issue, but after Trintellix and Pristiq, I've given up on that), Fetzima seemed like the logical choice (superior to Viibryd at least)...

I currently can't take more than two doses of Zofran per day, so I'm saving my second dose for at least a few more hours or until the nausea gets too bad to tolerate (although I'm very tempted to just take it now). It's odd that the Zofran would do such a good job with med-induced nausea from Trintellix and other meds (like it basically wiped it out!), but then do so poorly when it comes to Fetzima... If this nausea doesn't recede it'll be a dealbreaker.

I'm not sure what to try next if Fetzima turns out to be a failure. Nefazodone, the MAOIs, ECT, and rTMS are off the table. TCAs are likely off the table judging by how horribly I reacted to the one TCA that I've tried. That leaves me with Viibryd and paroxetine, or retrying a past med. I won't touch bupropion or sertraline ever again, so those are disqualified. Might as well add mirtazapine to that list as well - really didn't like that med. The remaining SSRIs, SNRIs, and atypicals are all relatively "meh". Out of all of them, I've had the most robust response to vortioxetine (Trintellix), but it wasn't sustained. Still, it's the most likely fallback option right now. Augmentation-wise, Depakote seems to be the best augmentative agent I've tried so far, so there's no sense in changing that.

...well, I guess there's always psychotherapy...

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This is day #3 on Fetzima. Started 40mg today and will continue on that dosage until I see my psych in 11 days. Nausea seems to have improved, but I'm wary. Some unpleasant side effects. BP/HR are noticeably elevated. Not sure if I'll be able to tolerate this drug. I finally looked up the binding profile (Ki/IC50) and discovered that Fetzima is an even more ridiculously strong NRI than I had thought it was. To put it in context, I used methylphenidate as my reference (a fairly strong NRI that I have extensive knowledge of), and Fetzima beat it by a concerning margin. It seems a bit unwise to me to mix this with so much Adderall... If these side effects persist maybe I'll try lowering the dose of Adderall.

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18 hours ago, JustNuts said:

I finally looked up the binding profile (Ki/IC50) and discovered that Fetzima is an even more ridiculously strong NRI than I had thought it was. To put it in context, I used methylphenidate as my reference (a fairly strong NRI that I have extensive knowledge of), and Fetzima beat it by a concerning margin.

 

I've been curious about this data about Fetzima, because I've always read that the ratio of NRI to SRI of Fetzima is 2:1, yet the data I've found on it suggests that it's a stronger SRI than NRI (or maybe I'm misinterpreting the data?). What were the numbers that you found for Fetzima? Can you share the link where you found the data?

I sincerely hope Fetzima works for you! Unfortunately, I can't say that I responded too well to it myself, though. It seemed to "wear off" half way through the day and I would get withdrawal symptoms like brain zaps, plus I would start feeling very weepy and dysphoric.

On 12/15/2016 at 3:09 PM, JustNuts said:

The reason we decided to try Fetzima is because I've responded relatively well to NRIs in the past (partially implying that I should be able to better tolerate it), and because I've tried a very large number of antidepressants without much success. 

I'm not sure what to try next if Fetzima turns out to be a failure. Nefazodone, the MAOIs, ECT, and rTMS are off the table. TCAs are likely off the table judging by how horribly I reacted to the one TCA that I've tried. That leaves me with Viibryd and paroxetine, or retrying a past med. 

Augmentation-wise, Depakote seems to be the best augmentative agent I've tried so far, so there's no sense in changing that.

1

Why are nefazodone, MAOIs, ECT, and rTMS off the table?

I tried nefazodone for a brief while... 100 mg bid (200 mg/day). It was an adjuvant agent to my Cymbalta at the time (60 mg). It didn't really seem to do much, so I discontinued it by my next appointment instead of pursuing increasing the dose.

Which TCA did you try? The secondary amine TCAs (desipramine (Norpramin), protriptyline (Vivactil), and nortriptyline (Pamelor)) tend to have a more tolerable side effect profile (less orthostatic hypotension, weight gain, and sedation) than the tertiary amines (amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), doxepin (Sinequan), and trimipramine (Surmontil)). Of the secondary amines, nortriptyline (Pamelor) tends to be the most innocuous for most people. Also, you mentioned that you respond relatively well to NRIs—the secondary amine TCAs are stronger NRIs than SRIs, desipramine being the strongest NRI, followed by protriptyline, then nortriptyline.

Speaking of NRIs, I've read case studies of people who were partial responders to SSRIs like escitalopram, sertraline (which you said you'd never touch again), and fluoxetine, and had Strattera (a selective NRI which is more selective for the NET than the secondary amine TCAs) added to their regimen, which caused them to achieve remission. It seems in these case studies, the final dose in all cases was 25 mg bid (50 mg/day). Personally, I've taken Zoloft 150 mg + Strattera 40 mg, but it was my second time taking Zoloft and it didn't help. The Strattera helped, though.

Interesting about the Depakote, what benefits do you get from it? Antidepressant? Anxiolytic? Have you been on it long enough to know whether it's prone to induce any weight gain or any other side effects?

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1 hour ago, mikrw33 said:

I've been curious about this data about Fetzima, because I've always read that the ratio of NRI to SRI of Fetzima is 2:1, yet the data I've found on it suggests that it's a stronger SRI than NRI (or maybe I'm misinterpreting the data?). What were the numbers that you found for Fetzima? Can you share the link where you found the data?

I sincerely hope Fetzima works for you! Unfortunately, I can't say that I responded too well to it myself, though. It seemed to "wear off" half way through the day and I would get withdrawal symptoms like brain zaps, plus I would start feeling very weepy and dysphoric.

Why are nefazodone, MAOIs, ECT, and rTMS off the table?

I tried nefazodone for a brief while... 100 mg bid (200 mg/day). It was an adjuvant agent to my Cymbalta at the time (60 mg). It didn't really seem to do much, so I discontinued it by my next appointment instead of pursuing increasing the dose.

Which TCA did you try? The secondary amine TCAs (desipramine (Norpramin), protriptyline (Vivactil), and nortriptyline (Pamelor)) tend to have a more tolerable side effect profile (less orthostatic hypotension, weight gain, and sedation) than the tertiary amines (amitriptyline (Elavil), clomipramine (Anafranil), imipramine (Tofranil), doxepin (Sinequan), and trimipramine (Surmontil)). Of the secondary amines, nortriptyline (Pamelor) tends to be the most innocuous for most people. Also, you mentioned that you respond relatively well to NRIs—the secondary amine TCAs are stronger NRIs than SRIs, desipramine being the strongest NRI, followed by protriptyline, then nortriptyline.

Speaking of NRIs, I've read case studies of people who were partial responders to SSRIs like escitalopram, sertraline (which you said you'd never touch again), and fluoxetine, and had Strattera (a selective NRI which is more selective for the NET than the secondary amine TCAs) added to their regimen, which caused them to achieve remission. It seems in these case studies, the final dose in all cases was 25 mg bid (50 mg/day). Personally, I've taken Zoloft 150 mg + Strattera 40 mg, but it was my second time taking Zoloft and it didn't help. The Strattera helped, though.

Interesting about the Depakote, what benefits do you get from it? Antidepressant? Anxiolytic? Have you been on it long enough to know whether it's prone to induce any weight gain or any other side effects?

You can easily obtain reasonably accurate Ki values for MPH on its Wikipedia page, although my use of preexisting personal knowledge obtained from extensive prior research into MPH's binding affinity (which is surprisingly difficult to define decisively!) was a major factor in my analysis, and that is too much work to write up right now. I was extremely lazy about the IC50 values for MPH and just pulled up a random study that had that info for both MPH and atomoxetine instead. For Fetzima, I pulled the data from its drugbank.ca listing and from a PDF related to its regulatory review located on fda.gov. You'll want to keep in mind that drug half-life, rate of receptor occupancy, and various other factors impact your reaction to a NRI significantly, but the data is discrepant to an alarming degree even with that factored in.

I can't say if it's working or not yet, I'll have to give it more time.

Nefazodone and MAOIs are off of the table due to my provider being uncomfortable with their risks (and they had bad experiences with prescribing them in the past, so it's not surprising that they'd be gun-shy about them now). I do have to admit that neither drug is particularly compelling when it comes to the risk-benefit profile.

rTMS is not viable for coverage/price/distance reasons.

I'm interested in ECT, but the physician my provider is associated with is the only person in the area that will do it, and he has already rejected me as a candidate because I'm too young and apparently he'll only do ECT on people my age in exceptionally bad cases of schizophrenia or something along those lines.

I tried nortriptyline and had an absolutely awful experience (severe side effects, could NOT tolerate the drug). In hindsight, I think it's possible that I was switched from fluvoxamine to nortriptyline a bit too fast and an interaction occurred, but even then I'm not sure. What really worries me about Fetzima is that one of the side effects I've been seeing since starting Fetzima is a less-pronounced version of one of the most problematic/intolerable side effects that I had on nortriptyline.

Sertraline is on the "never again" list because the combination of sertraline and a high dose of methylphenidate resulted in serotonin syndrome, something that I definitely never want to experience ever again.

Atomoxetine is definitely interesting, but it's more of a last resort option IMO as it doesn't have many unique characteristics.

The Depakote was prescribed primarily for depression with the intention of it also being a mild mood stabilizer and reducing BPD-derived impulsivity (which the prescribing psychiatrist viewed as distinct from the impulsivity shared by ADHD and BPD). It appeared to have some slightly limited but immediately visible positive effects on my depression when I first started it (despite being rather skeptical about it after having lamotrigine and lithium do nothing, and knowing that Depakote is a mood stabilizer that Stahl claims only really helps significantly with mania and not with depressive symptoms). Side effects are noticeable but tolerable.

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Oh fuck me, I just found out that the Depakote is likely behind the mysterious failure of my estradiol/spironolactone to work properly recently. Apparently it really screws with T and E levels, as well as a few other hormonal things. Of course you can't just fucking discontinue Depakote because of the seizure risk, so it's not as if I can just stop it abruptly for a short while to see if there's a noticeable change - now I have to decide if I want to titrate down and off of the Depakote or remain on it, and if things go pear-shaped I have to resume it the normal way... Fuck.

This begs the question of if Depakote improved my symptoms by suppressing the HRT (HRT worsening my depression is a recurring concern among my providers), but given that its hormonal changes seem to take time to take place, and that its benefits have not been fully sustained, I think I can partially dismiss that concern...

Well, I guess the best course of action is to titrate down and off of the Depakote independently of what I do about my antidepressant, then to see what changes over the course of a few weeks after stopping completely... And it seems like Depakote is by no means an easy med to get off of either. Fuckkkkk. This could take quite a long time.

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12 hours ago, JustNuts said:

You can easily obtain reasonably accurate Ki values for MPH on its Wikipedia page, although my use of preexisting personal knowledge obtained from extensive prior research into MPH's binding affinity (which is surprisingly difficult to define decisively!) was a major factor in my analysis, and that is too much work to write up right now. I was extremely lazy about the IC50 values for MPH and just pulled up a random study that had that info for both MPH and atomoxetine instead. For Fetzima, I pulled the data from its drugbank.ca listing and from a PDF related to its regulatory review located on fda.gov. You'll want to keep in mind that drug half-life, rate of receptor occupancy, and various other factors impact your reaction to a NRI significantly, but the data is discrepant to an alarming degree even with that factored in.

I can't say if it's working or not yet, I'll have to give it more time.

Nefazodone and MAOIs are off of the table due to my provider being uncomfortable with their risks (and they had bad experiences with prescribing them in the past, so it's not surprising that they'd be gun-shy about them now). I do have to admit that neither drug is particularly compelling when it comes to the risk-benefit profile.

rTMS is not viable for coverage/price/distance reasons.

I'm interested in ECT, but the physician my provider is associated with is the only person in the area that will do it, and he has already rejected me as a candidate because I'm too young and apparently he'll only do ECT on people my age in exceptionally bad cases of schizophrenia or something along those lines.

I tried nortriptyline and had an absolutely awful experience (severe side effects, could NOT tolerate the drug). In hindsight, I think it's possible that I was switched from fluvoxamine to nortriptyline a bit too fast and an interaction occurred, but even then I'm not sure. What really worries me about Fetzima is that one of the side effects I've been seeing since starting Fetzima is a less-pronounced version of one of the most problematic/intolerable side effects that I had on nortriptyline.

Sertraline is on the "never again" list because the combination of sertraline and a high dose of methylphenidate resulted in serotonin syndrome, something that I definitely never want to experience ever again.

Atomoxetine is definitely interesting, but it's more of a last resort option IMO as it doesn't have many unique characteristics.

The Depakote was prescribed primarily for depression with the intention of it also being a mild mood stabilizer and reducing BPD-derived impulsivity (which the prescribing psychiatrist viewed as distinct from the impulsivity shared by ADHD and BPD). It appeared to have some slightly limited but immediately visible positive effects on my depression when I first started it (despite being rather skeptical about it after having lamotrigine and lithium do nothing, and knowing that Depakote is a mood stabilizer that Stahl claims only really helps significantly with mania and not with depressive symptoms). Side effects are noticeable but tolerable.

3

Thanks for your response!

I'll have to see if I can find that information related to Fetzima's Ki/IC50. That type of information fascinates me. I obsessively make Excel spreadsheets with that sort of data to pass the time and quell my OCD... lol. Fetzima is one that I currently have missing from my spreadsheet. 

I certainly wish you all the best luck with the Fetzima. When I was on it, I was on 40 mg for a while and got sick of the wearing-off effect, so started taking 40 mg bid for 80 mg/day on my own, which seemed to help a little with the withdrawal symptoms, but I was still feeling very dysphoric and weepy. I don't know why I didn't respond to it, because all the other SNRIs I've tried I've responded to pretty well (with the exception of Pristiq, which in my opinion is a joke of a medicine, but then again it works wonders for some people, so who am I to say?).

Sorry the nortriptyline didn't work for you... :( I've taken it alone and with Emsam together and quite frankly I didn't respond to it at all. Protriptyline I responded to a little better, but desipramine... Wow! Desipramine was amazing! I'd still be on it if it didn't make my resting heart rate around 100 BPM (I think that's because of my stimulant—desipramine and stimulants must not mix well or something...) What problematic/intolerable side effects did you have on nortriptyline that you seem to be starting to have one of on Fetzima, if you don't mind me asking?

Interesting that you developed serotonin syndrome with sertraline and methylphenidate since methylphenidate doesn't really affect serotonin (at least from everything I've read). I don't blame you for not wanting to experience that again!

Atomoxetine is said to be a selective norepinephrine reuptake inhibitor, but really, at therapeutic doses, it actually inhibits both the NET and the SERT, occupying > 90% of NET and > 85% of SERT (in a PET imaging study of rhesus monkeys), so if these findings translate to humans, atomoxetine, would in fact, be an SNRI rather than a selective NRI. Its metabolite, 4-hydroxyatomoxetine exhibits weak affinity for μ-opioid and κ-opioid receptors, for whatever that may be worth in a therapeutic context, as an antagonist for the former and a partial agonist for the latter. It also acts as an NMDA receptor antagonist at clinically relevant doses.

I'm glad that Depakote seems to be helping with your depression. I, too, had always assumed that Depakote was more for mania than depression, having read what Stahl had to say about it.

12 hours ago, JustNuts said:

Oh fuck me, I just found out that the Depakote is likely behind the mysterious failure of my estradiol/spironolactone to work properly recently. Apparently it really screws with T and E levels, as well as a few other hormonal things. Of course you can't just fucking discontinue Depakote because of the seizure risk, so it's not as if I can just stop it abruptly for a short while to see if there's a noticeable change - now I have to decide if I want to titrate down and off of the Depakote or remain on it, and if things go pear-shaped I have to resume it the normal way... Fuck.

This begs the question of if Depakote improved my symptoms by suppressing the HRT (HRT worsening my depression is a recurring concern among my providers), but given that its hormonal changes seem to take time to take place, and that its benefits have not been fully sustained, I think I can partially dismiss that concern...

Well, I guess the best course of action is to titrate down and off of the Depakote independently of what I do about my antidepressant, then to see what changes over the course of a few weeks after stopping completely... And it seems like Depakote is by no means an easy med to get off of either. Fuckkkkk. This could take quite a long time.

1

Sorry to hear that... :( Any ideas of an alternative you could bring up to your pdoc at your next appointment?

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12 hours ago, mikrw33 said:

Thanks for your response!

I'll have to see if I can find that information related to Fetzima's Ki/IC50. That type of information fascinates me. I obsessively make Excel spreadsheets with that sort of data to pass the time and quell my OCD... lol. Fetzima is one that I currently have missing from my spreadsheet. 

I certainly wish you all the best luck with the Fetzima. When I was on it, I was on 40 mg for a while and got sick of the wearing-off effect, so started taking 40 mg bid for 80 mg/day on my own, which seemed to help a little with the withdrawal symptoms, but I was still feeling very dysphoric and weepy. I don't know why I didn't respond to it, because all the other SNRIs I've tried I've responded to pretty well (with the exception of Pristiq, which in my opinion is a joke of a medicine, but then again it works wonders for some people, so who am I to say?).

Sorry the nortriptyline didn't work for you... :( I've taken it alone and with Emsam together and quite frankly I didn't respond to it at all. Protriptyline I responded to a little better, but desipramine... Wow! Desipramine was amazing! I'd still be on it if it didn't make my resting heart rate around 100 BPM (I think that's because of my stimulant—desipramine and stimulants must not mix well or something...) What problematic/intolerable side effects did you have on nortriptyline that you seem to be starting to have one of on Fetzima, if you don't mind me asking?

Interesting that you developed serotonin syndrome with sertraline and methylphenidate since methylphenidate doesn't really affect serotonin (at least from everything I've read). I don't blame you for not wanting to experience that again!

Atomoxetine is said to be a selective norepinephrine reuptake inhibitor, but really, at therapeutic doses, it actually inhibits both the NET and the SERT, occupying > 90% of NET and > 85% of SERT (in a PET imaging study of rhesus monkeys), so if these findings translate to humans, atomoxetine, would in fact, be an SNRI rather than a selective NRI. Its metabolite, 4-hydroxyatomoxetine exhibits weak affinity for μ-opioid and κ-opioid receptors, for whatever that may be worth in a therapeutic context, as an antagonist for the former and a partial agonist for the latter. It also acts as an NMDA receptor antagonist at clinically relevant doses.

I'm glad that Depakote seems to be helping with your depression. I, too, had always assumed that Depakote was more for mania than depression, having read what Stahl had to say about it.

Sorry to hear that... :( Any ideas of an alternative you could bring up to your pdoc at your next appointment?

Np. If you like gathering that type of data, please consider contributing some of it to Wikipedia when appropriate (and contributing to Wikipedia in general) - we're always short on pharmacology contributors. There are a ton of really frustratingly complicated rules and guidelines to follow, but that's less of an issue for obsessive people like us than it would be for other people.

I'm not sure if or if not I can see a wearing-off effect attributable to the Fetzima specifically, I've long suspected such an effect is present, but as it's something I've seen on other ADs, it's probably related to another med I'm on, or an environmental/physical factor... Chasing down candidates for blame hasn't been easy, and every time I think I've finally eliminated one of the candidates for good it eventually comes back up as a possibility later on...

Desipramine sounds like another option to keep in mind, thanks.

The primary side effect is one that's very hard to conclusively define and explain. It manifests as unexpected brief attacks. It feels like a strange presentation of lightheadedness, dizziness, and weakness, but not quite, and it's variable in its extent of presentation of those symptoms. There is a feeling almost like impending doom, which would imply anxiety, but it does not respond to benzodiazepines. I've wondered if it could be some form of heart palpitations, as it vaguely feels like those, but there's no clearly detectable palpitations (but they cannot be ruled out). It seems to be associated with somewhat low BP and somewhat high HR on nortriptyline, but with somewhat high BP and somewhat high HR on Fetzima (post-episode association). It could be a variant of orthostatic hypotension, but it was not clearly attributable to that on nortriptyline, and even less so on Fetzima. However there is still some vague connection between generalized orthostatic dysautonomia and this. It appears to occur more frequently when my HR is naturally elevated for some reason. I have failed to find any firm links between this and anything other than being on nortriptyline/Fetzima (the only two variables that were inviolably associated with this side effect). It is maddeningly inconsistent. I vaguely suspect some sort of interaction/association with Depakote due to a few suspicious temporal correlations, but cannot prove anything. At this point I think you understand why I didn't want to even attempt to define this side effect (and this is an abbreviated definition at that!). The reason this side effect is a dealbreaker is because of its severity, frequency, unpredictability, and tendency to mess with my thinking/functioning.

I looked into the association between methylphenidate and serotonin syndrome back then and discovered that there were a few documented case reports at various dosages, so I'm by no means the first person to have experienced this particular drug interaction despite its rarity. This was quite a while ago so I don't remember all the details, but I think that several (at minimum it must have been one, but I keep recalling more than one) were explicitly describing a methylphenidate-sertraline drug interaction, while others described more generalized drug interactions between methylphenidate and various serotonergic drugs. I remember that the dosages of methylphenidate in the case reports ranged from relatively small to moderate, so while being on such a large dose of methylphenidate definitely didn't do me any favors, the interaction could have still happened at any dose.

No ideas of alternatives to Depakote, I'm either going to stay on it or titrate down and off (with no planned replacement - lamotrigine was useless and fucked with my other meds, I'm not touching useless lithium again, aripiprazole was never really effective enough to warrant another trial, and there are no other mood stabilizers that I'd deem acceptable options). If I titrate down and off, I'll decide if I'll stay off of it or resume it based on the change in my depression and in the effectiveness of my HRT over a sufficiently sized time sample (ideally this would be a minimum of 2-4 weeks completely off of Depakote, meaning it'd only start after I finished titrating to 0mg, not during the titration downwards).

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On 12/17/2016 at 10:17 PM, JustNuts said:

This is day #3 on Fetzima. Started 40mg today and will continue on that dosage until I see my psych in 11 days. Nausea seems to have improved, but I'm wary. Some unpleasant side effects. BP/HR are noticeably elevated. Not sure if I'll be able to tolerate this drug. I finally looked up the binding profile (Ki/IC50) and discovered that Fetzima is an even more ridiculously strong NRI than I had thought it was. To put it in context, I used methylphenidate as my reference (a fairly strong NRI that I have extensive knowledge of), and Fetzima beat it by a concerning margin. It seems a bit unwise to me to mix this with so much Adderall... If these side effects persist maybe I'll try lowering the dose of Adderall.

I just started taking Fetzima this week and I have been worried about taking my adderrall with it. I am on adderall for focus and to keep me awake because I've always been super tired as long as I can remember. I am worried that it'll make my anxiety way worse though. How is it going for it?

Also I am not noticing much side effects with the Fetzima but I also asked for zofran to take with it because I work two jobs and I know better. 

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3 hours ago, lovebrittany said:

I just started taking Fetzima this week and I have been worried about taking my adderrall with it. I am on adderall for focus and to keep me awake because I've always been super tired as long as I can remember. I am worried that it'll make my anxiety way worse though. How is it going for it?

Also I am not noticing much side effects with the Fetzima but I also asked for zofran to take with it because I work two jobs and I know better. 

I think I'm tolerating it a bit better, not sure yet. It has increased my anxiety to some extent, but not hugely. I'm on a lot of Adderall, which was part of my concern, but I'm also on benzos, so it balances out... Haven't felt the need to try a reduced dose yet, keeping my fingers crossed that it'll stay that way.

It's always wise to have some Zofran handy IMO (especially when taking psych meds that usually have nausea/vomiting as side effects).

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On 12/18/2016 at 11:13 PM, JustNuts said:

Oh fuck me, I just found out that the Depakote is likely behind the mysterious failure of my estradiol/spironolactone to work properly recently. Apparently it really screws with T and E levels, as well as a few other hormonal things. Of course you can't just fucking discontinue Depakote because of the seizure risk, so it's not as if I can just stop it abruptly for a short while to see if there's a noticeable change - now I have to decide if I want to titrate down and off of the Depakote or remain on it, and if things go pear-shaped I have to resume it the normal way... Fuck.

This begs the question of if Depakote improved my symptoms by suppressing the HRT (HRT worsening my depression is a recurring concern among my providers), but given that its hormonal changes seem to take time to take place, and that its benefits have not been fully sustained, I think I can partially dismiss that concern...

Well, I guess the best course of action is to titrate down and off of the Depakote independently of what I do about my antidepressant, then to see what changes over the course of a few weeks after stopping completely... And it seems like Depakote is by no means an easy med to get off of either. Fuckkkkk. This could take quite a long time.

To expand further... I was prescribed Depakote 250mg morning, 250mg late afternoon, 250mg x2 (500mg) bedtime. Around the 18th I stopped taking the second evening dose, effectively turning it into 250mg TID. Due to circumstances beyond my control I was unable to take it yesterday, and I decided not to take it at all today because I had skipped a day and while there are some other reasons behind this decision, I won't disclose them. Anyways, I haven't had any seizures so far and am feeling okay. However, I'm having an inexplicably massive breakout of acne on my chest and shoulders (not something I'd normally see even before I started HRT), but I'm not sure if that's due to the Depakote/HRT interaction, the HRT dose change recently, dropping Depakote so abruptly, or some combination of those...

The Fetzima is performing pretty well, and has had tolerable side effects (they have definitely diminished vs when I started).

Edited by JustNuts

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On 12/22/2016 at 6:50 PM, JustNuts said:

To expand further... I was prescribed Depakote 250mg morning, 250mg late afternoon, 250mg x2 (500mg) bedtime. Around the 18th I stopped taking the second evening dose, effectively turning it into 250mg TID. Due to circumstances beyond my control I was unable to take it yesterday, and I decided not to take it at all today because I had skipped a day and while there are some other reasons behind this decision, I won't disclose them. Anyways, I haven't had any seizures so far and am feeling okay. However, I'm having an inexplicably massive breakout of acne on my chest and shoulders (not something I'd normally see even before I started HRT), but I'm not sure if that's due to the Depakote/HRT interaction, the HRT dose change recently, dropping Depakote so abruptly, or some combination of those...

The Fetzima is performing pretty well, and has had tolerable side effects (they have definitely diminished vs when I started).

Bizarre acne breakout from hell continues... It isn't really expanding further (I think?), but it's not shrinking either. Wondering WTF caused it. Still not taking Depakote, still no seizures, yay.

Fetzima feels weaker to the point that I think I want to try upping it to 80mg when I see my psych. It does still seem to be a decent antidepressant so far though, not perfect, but helpful. We'll see if that continues with time...

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I've taken Pristiq since May 2011. I was given Fetzima about a year ago with Pristiq. I know the combination may seem like it's "too much" of the same drug, BUT it actually seems to help... The highest dose I've been on is 80 MG of Fetzima and 200 MG of Pristiq (at the same time).

Looking back my depression has been so bad, that prior to Pristiq, I've been housebound and in bed for over 2 months!!! The reason I realized this is because I covered all the mirrors in my house and my hair became really long over my eyes (my normal hairstyle is short). I took an orange handled scissors (that I bought in HS when I worked at AC Moore) and cut my hair. When my mother came home and saw me she said I'll need to buzz it all off, because it was uneven. I didn't care because I was already housebound for weeks and nobody was going to see me anyway... My mother buzzed it all off and I waited until my hair grew back. Once it was long enough I went to finally get my haircut--I believe this was the first time I left the house...

During this terrible time period the only way I can describe my pain is that it literally hurt to take space up in a room. I tried to get my hand on barbiturates over the internet to end my life. I'm not sure if I would've 100% went through with the suicide, but I NEEDED the option... Because the pain I was living in, was NOT LIVING. It was cruel to make a human live in so much torment, agony, and suffering. The barbiturates ended up not being real. I only took one to see how it effected me, nothing happened, so I took a few to see if anything happened and nothing occurred. I knew they were sugar pills or not what they said they were. 

If I didn't have my mother I would've probably starved to death. I still don't know why my mother let my hair get so long--I was a complete wreck and like I said I didn't leave the house for at least 2 months. I know during this time period she hated having to get my groceries. I went from holding down a job in HS; being on high honors and involved in extra curricular activities; while buying my OWN groceries! To being a hollow shell who couldn't even take a shower, let alone leave the house to buy groceries.

Currently, I am back on my Fetzima in the AM and Pristiq at night. Sometimes I take Trazodone to help me sleep. I also use Vyvanse as needed to help me stay awake or feel capable. My depression makes everything seem futile and pointless. Using Vyvanse, judicially, has been like a magic wand. It does help with energy, but unlike caffeine it also makes me feel capable--as if I have the ability to take a shower, drive, and make doctor appointments. 

With that being said: I would 100% be careful or start at a lower than normal dosage when trying to take a stimulant (Vyvanse, Adderall, or Ritalin) with Fetzima or Pristiq. I've noticed on days that I take Vyvanse I usually need to decrease my Pristiq to 50 MG or not take it at all--otherwise my heart races. On these days I typically take Trazodone, instead of Unisom to help me sleep... On the days I take Vyvanse in the MORNING, the Unisom at nighttime will have the opposite effect on days I take Vyvanse (make me more awake and my heart race)--so I need to take Trazodone instead. Trazodone has the weird effect of making my nose stuffy and the next day I feel drowsy for awhile (I've heard people refer to it as a Trazodone "hangover").

Getting back to the topic of this thread; Fetzima does seem to cause my stomach to become upset in the AM lately... Recently a new psychiatrist tried weaning me off of everything to do a washout in order to put me on an MAOI.

I was almost off of my Pristiq, BUT I was literally becoming unstable and suicidal. I forced myself out of the house to try and do the elliptical at the gym. I had to leave after about 20 mins on the machine, because I was so miserable... On my way home I was crying for NO REASON; I also kept thinking I could swerve the car into the guard rail to end the pain... Usually cardio makes me happy and even when I'm in dysthymia/clumsy the elliptical machine is easy to use--it doesn't require too much coordination.

After leaving the gym and crying for no reason, I knew something was wrong. So the minute I came home (around 7:00 or 8:00 PM)--I started taking my normal dose of Fetzima and Pristiq that night. I needed Trazdone to sleep that night, because Fetzima is stimulating. It's been several days and I'm starting to feel like myself again... It's far from perfect, but if it keeps me from entering that dark of a hole again--I'll take it...

At times, I feel like my life's wasting away (it's hard to make plans when I don't know if it will be a bed-bound day or not). Recently 3 friends offered to take me to 6 Flags with them tomorrow (Dec. 28) and with the state I was just in I'm not sure if I'd even be able to enjoy it... Being back on Fetzima and Pristiq is so much better than actively planning way to end my life or being in completely agony and dread 24/7.

All of this made me realize that maybe I took dysthymia for granted and should've been thankful I was not in complete agony and pain.

This depression wasn't the one where I just become clumsy and want to sleep all the time; it was pure hell. I kept calling Columbia to try and get into their inpatient hospital. I kept getting disconnected... After several failed attempts I was told the only way to see if: 

A) I was eligible to be admitted 

B) If there was a bed available I had to come into the hospital.

I desperately had my plan set to go in on Christmas Eve (3 days ago). I was too lethargic in the AM... Christmas Day came around and I was housebound again with a lot of naps. I really regret missing Christmas Eve and Christmas Day with family (homemade ravioli), but I was in NO state to drive. Therapists and psychiatrists don't realize when they say push yourself--if I was to push myself in that state I'd end up being a risk to everyone on the road... My coordination and thinking is nowhere near normal, nor do I really care about my life; I become indifferent to everything. I've been housebound since today. I will probably spend today in the house again; it's the first day I woke up not feeling completely dreadful and miserable. 

I was also in an emergency room on December 19, 2016. My psychiatrist recommended I go. While I was there I witnessed really violent people waiting to be admitted. One was a Veteran with PTSD and I really felt uncomfortable having to live with people who had to be held down and given a needle, just while waiting. 

I didn't realize how much Fetzima seems to help with the pain or fibromyalgia that comes with depression. This past month I've been in so much pain that I've been taking 6 Tylenol a day--I know this isn't healthy, but the pain makes me non-functional. I'll just constantly say out loud that, I'm in pain and I wish I was dead. I think my landlord heard me once and asked his daughter to ask me if everything was okay. They're used to it now...

I guess I should also note, I've been on 20+ drugs and the rTMS always seems to be extremely helpful around the 15th treatment... Once I stop a course of 30 rTMS treatments--the depression comes back around 2-4 weeks (maybe sooner). I went through around 70+ rTMS treatments (2 rounds plus boosters)--while being on Fetzima 80 MG during the day and Pristiq 200 MG at night. I was also taking Vyvanse or Ritalin as needed. At some point they switched me to Ritalin and it doesn't last as long as Vyvanse and isn't as smooth. For what it's worth, I've performed beautifully on rTMS, but the results just don't seem to last that long for me. 

I also wanted to note that I do horrible on augmentation/combination drugs like Abilify, Tegretol, Trileptal etc. They tend to cause me to be spacey and I'll have an increase in rashes or hives. Gabapentin seems to help with the pain--especially the comedown from Vyvanse or Ritalin, but it also seems to make me have an increase in rashes--not as bad as the prior ones. Gabapentin also seems to cause cysts/acne (in abnormal places) and weird bumps--including my ears at times. 

One of the reasons I like Unisom (doxylamine) is because it's an antihistamine that helps me sleep. The antihistamine effect usually takes care of the rashes or hives that I've always been prone to as a child. Yet, when I add a mood stabilizer I'll tend to get rashes regardless; where even a prescription steroid cream (Triamcinolone Acetonide cream 0.1%) from the allergist takes a really long time to work. I STILL have a black "bruise-like" mark on my inner thigh from one of these medications. 

I showed a regular doctor this weird black bump/rash I had, and she had no idea what it was. She advised me to use a warm compress on it and to contact her if it became worst. She also helped ease my mind that it wasn't an STD, because I knew for a fact I didn't have intercourse but I was just so paranoid. I have had rashes and hives from medication, but never a swollen bumps that were black before. 

I've heard of Lamictal, but with all the weird skin reactions I've had I'm afraid of the rash (Steven Johnson syndrome). Apparently if you're of Asian decent there's an increase risk of the Steven Johnson syndrome due to the genotype marker called HLA-B*1502. 

Here's a picture of the severity of Steven Johnson syndrome (worst case scenario--it's just not worth the risk in my opinion:

image.jpeg

The atypical antidepressant Latuda caused weird sensations on the left side of my face with left eye twitches. It also caused sexual side effects--which in all honesty are the least of my worries. I just want to be content in life--without pain and dread for no rhyme or reason.

This was my phone call trying to become a psychiatric inpatient at Columbia's hospital (Dec. 22): image.jpeg

I know pain can be a symptom of depression, but the physical agony I just went through only further makes me want to get the tests for Multiple Sclerosis and Lupus done... Also because of how much I sleep and how "dumb" and hungry I become during some bade periods; my psychiatrist wants me to be tested for Kleine Levin syndrome. 

#GraspingAtStraws

Current Medications:

AMNoon With Dinner ~1 Hour before  

Fetzima 80 MG (split/opened in half approx. 40 then 40)

Generic Claratin 

Generic Zantac

Genric Pepto-Bismol

SAM-E maybe helps with some pain and promotes energy. 

DLPA no noticeable effects 

Ginger helps my stomach 

*Prior to gastritis I handled Fetzima and Vyvanse perfectly fine, but now they seek to upset my stomach. 

Noon

Rest of the Fetzima

3 Tylenol

More Generic Pepto-Bismol

Usually in between I'll take another 3 Tyenol and more Pepto-Bismol and Generic Zantac. 

With Dinner

200 MG Pristiq 

Vitamin A

Probiotics it does help my stomach. On the rare occasion I have dairy; it does help "digest or process" small amounts of dairy. If I have too much dairy I have  gas and diarrhea.

I had to stop my fish/Vitamin D oil, due to sensitive stomach

~1 Hour Before Bed

Trazodone or Unisom, depending on if I took Vyvanse or not.

I should note I think a lot of my stomach issues happened, because I took too much Alieve or Advil. After my shoulder surgery in October 2015 I was in a lot of pain, especially after physical therapy. I relied too heavily on Alieve and Advil. The endoscopy states I have gastritis. It awhile for my shoulder to have an MRI.

First, I didn't know I injured it that badly, because the pain from my depression made it difficult to tell what the pain I was.

Second, telling a doctor you suffer from any mental disorder can 100% lead to Diagnostic Overshadowing; I was initially told it was all in my head. Yet, several anchors in my shoulder, a torn labrum, and bicep tendon stated something very different. 

Mental health patients 100% NEED a biological test for mental illness. The DSM can be helpful for what it is, BUT it also gives way too much power to error and a diagnosis can largely be effected by a physicians opinion rather than cold hard facts. 

Edited by BAE
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On 12/24/2016 at 2:17 PM, JustNuts said:

Bizarre acne breakout from hell continues... It isn't really expanding further (I think?), but it's not shrinking either. Wondering WTF caused it. Still not taking Depakote, still no seizures, yay.

Fetzima feels weaker to the point that I think I want to try upping it to 80mg when I see my psych. It does still seem to be a decent antidepressant so far though, not perfect, but helpful. We'll see if that continues with time...

Bizarre acne breakout from hell has receded significantly. It looks like I can blame this one on the Depakote - Fetzima is innocent.

Saw my psych today. She was fine with me dumping Depakote. We decided to raise the Fetzima to 80mg, which I will start taking tomorrow. 60mg was initially and briefly discussed but I preferred 80mg for a few reasons and she had no problem with that. I talked to her a bit about Fetzima in general - she said that her patients tend to have trouble tolerating it (nausea and poor interactions with hypertension/anxiety were the primary reasons), and that she doesn't prescribe it that often as a result. However she did say that her patients on Fetzima (the ones that can tolerate it) tend to do well with it, which is encouraging.

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1 hour ago, JustNuts said:

Bizarre acne breakout from hell has receded significantly. It looks like I can blame this one on the Depakote - Fetzima is innocent.

Saw my psych today. She was fine with me dumping Depakote. We decided to raise the Fetzima to 80mg, which I will start taking tomorrow. 60mg was initially and briefly discussed but I preferred 80mg for a few reasons and she had no problem with that. I talked to her a bit about Fetzima in general - she said that her patients tend to have trouble tolerating it (nausea and poor interactions with hypertension/anxiety were the primary reasons), and that she doesn't prescribe it that often as a result. However she did say that her patients on Fetzima (the ones that can tolerate it) tend to do well with it, which is encouraging.

Yeah any of the mood stabilizers or anti-seizure medications can have a side effect of causing acne. Also Gabapentin causes me to get  cysts which I never have otherwise. 

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16 hours ago, BAE said:

Yeah any of the mood stabilizers or anti-seizure medications can have a side effect of causing acne. Also Gabapentin causes me to get  cysts which I never have otherwise. 

Depakote seems to be the worst at interfering with hormones though, at least for someone on HRT...

Never had any issues with gabapentin. No hormonal issues with lamotrigine or lithium for me either...

One thing that I've definitely noticed with both the Fetzima and the increased dose of spiro is that it makes the Adderall-induced dry mouth much worse (not surprising, but it's rather annoying and makes me very concerned about its effects on my teeth and gums). I just realized that increasing the Fetzima dose to 80mg is probably going to make that even more terrible. Shit.

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So, status update time. I've been on levomilnacipran for a month and a half now. I think this has been the most successful antidepressant I've tried so far (vortioxetine was better during the initial period on it, but it did not last while this one has). The most noticeable persistent side effects have been intermittent nausea, stimulation, some anxiety (duh), and increased dry mouth (duh). I have continued to experience enough problematic symptoms of depression despite the overall sustained improvements that my psych suggested seeing if 120mg would work better for me, given that my response to Fetzima has improved with the dosage and that she has noticed that her patients on Fetzima who saw partial response at 80mg responded significantly better to 120mg. I was hesitant to increase the dosage purely to keep the option of a future dosage increase open in case it was badly needed in the future, but I realized that I was being foolish, there's no guarantee that delaying a dose increase is actually a better idea, and that this kind of hesitancy had already made enough problems for me in the past. So we decided to go forwards with an increase to 120mg, and I should start that dosage on Sunday if all goes well with the pharmacy. We'll see if it's helpful, does nothing, or even makes things worse.

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Hello, does anyone know if Fetzima is available in Australia? If not, apart from flying over to the USA does anyone know how I can get access to it.  I have tried every antidepressant that has ever been available in Australia and I end up suffering intolerable side effects and have to stop the medication. The most common side effect I usually get is a headache.  I usually get them as soon as I take the new medication and I try and wait at least 2-3 weeks for the headache to disappear but it just doesn't and I can't take it anymore the pain actually makes me want to take my life.  So then I stop the medication and feel physically well again but chronically depressed. The medications that do not give me a headache just never seem to work I am still depressed after trying high doses of them. I am on a waiting list to try Ketamine but other than that I cannot think of anything I have not tried.  Hopefully sometime can help me access Fetzima in Australia!

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3 hours ago, Abbey said:

Hello, does anyone know if Fetzima is available in Australia? If not, apart from flying over to the USA does anyone know how I can get access to it.  I have tried every antidepressant that has ever been available in Australia and I end up suffering intolerable side effects and have to stop the medication. The most common side effect I usually get is a headache.  I usually get them as soon as I take the new medication and I try and wait at least 2-3 weeks for the headache to disappear but it just doesn't and I can't take it anymore the pain actually makes me want to take my life.  So then I stop the medication and feel physically well again but chronically depressed. The medications that do not give me a headache just never seem to work I am still depressed after trying high doses of them. I am on a waiting list to try Ketamine but other than that I cannot think of anything I have not tried.  Hopefully sometime can help me access Fetzima in Australia!

I just read the TGA/AusPAR assessment of levomilnacipran. The application for approval was submitted in mid 2014, and it was rejected in early 2017. Based on the assessment, I would not expect an approval of levomilnacipran to occur before 2020 due to the two in-progress studies that would satisfy the majority of TGA/AusPAR's concerns which are not expected to be completed until 2017 and 2019 respectively, with the second (2019 completion) study being much more critical to obtaining approval than the first (2017 completion) study. A lag time of one year from study conclusion to drug approval is highly optimistic, so 2020 is an optimistic date at best. I think it is highly unlikely that the sponsor would be able to force an earlier approval, as the assessment was extremely clear about what the Australian guidelines were and how they failed to be met by the current submission/data, making the 2017+2019 trials a necessary requirement for any attempt at resubmitting the application for approval. This is of course assuming that the 2017+2019 trials do not encounter any issues significant enough for TGA/AusPAR to potentially consider major flaws - in that case, I do not expect the sponsor to attempt any further registration efforts in Australia.

You do have a relatively accessible alternative - milnacipran. It isn't quite as "ideal" as levomilnacipran in a few ways and appears to require twice-daily dosing, but if you can get an off-label prescription for it (I don't know how viable that is in the Australian healthcare system), it's good enough.

I looked into other methods to directly access levomilnacipran in Australia. Importation appears to be impossible unless by some freak chance levomilnacipran was either directly or indirectly approved for importation - I doubt it's been approved directly, and I am not sure about indirect approval as I could not easily locate this listing, but the probability of it being allowed is low. If it is allowed, it appears that you would at a minimum require a prescription from an Australian medical practitioner to be written for levomilnacipran, and you would need to locate a trustworthy and legal pharmacy based in the United States or Canada that is willing and able to fill a prescription from an Australian medical practitioner and ship the drug to you. The cost would be extraordinarily high as levomilnacipran is not a cheap drug and there would be substantial markup added on top of that, as well as shipping costs. I would expect your cost to be in excess of $400 USD per month (possibly well in excess), or $350 at the absolute possible minimum. All this assumes importation is even permitted - something that I have not been able to verify.

I hope this helps!

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Thank you so much JustNuts that is so kind of you to look up that information for me. I will look into the Milnacipran when I see my Psychiatrist next week. Fingers crossed I find something suitable soon :(

 

 

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Previously, I was on Effexor Xr  and xanax for 6 years up to either 300 or 450 mg. We kept trying to add in a stabilizer, but I didn't like Abilify and with Lamicital I would end up talking long and vivid conversations in my sleep. I tried Pristiq when it came out, and it turned me into a rage bitch. Cymbalta worked well for the pain, but not the depression. Eventually, when we quit the Effexor, we moved to Saphris and Wellbutrin. I also switched to Ativan and added Vyvanse, then adderall instead. As you would have it, I was on Wellbutrin for 4 years, having to take my doses up higher and higher as time went on, just to get relief. I already knew my sex life was exiled over the Saphris, but I was having panic attacks in my kitchen and couldn't make meals for my family for almost 3 weeks. I decided to look back at SNRIs that may have become available since I was on Effexor and I found Fetzima. I spoke to my doctor and told him I understand I've got at least a 50/50 shot "what do you think"? He started me out on 20s and I quit the wellbutrin. Then he went on vacation before we'd worked out a titrate schedule and his sub doc wrote me 20s x 40, So I moved up to 40 mg and then told him I was ready for 80 when he got back to the office on my next fill. I did get a bunch of hot flashes. The nausea was fun, but no huge issue as I rarely felt like vomiting. The worst thing I can say is that if I'm stretching out my hands, face, neck, back, legs, feet - the muscles will usually go right into a cramp instead of a stretch and release. I have had some psychosis with severe delusions 2-3 times in the past seven months. Otherwise I'm just good old bipolar depression with anxiety and add. I just haven't seen anyone around here with this combination and few that have stuck with Fetzima this long. I take 10 mg Saphris at night and it helps me sleep and helps with the frequency of the manias and duration. I take 20 mg xr adderall in the morning with my allergy meds, bc, prilosec, and 80 mg fetzima. I'm allowed up to 4 mg Ativan per day. I usually take a second, regular 10 mg adderall between 2-3pm.

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Hi All,

I wanted to bump this thread as I am currently taking Fetzima.  Has anyone had success with this medication?

I have been taking it for 2 weeks now and it has been making a difference with my mood, but I am really tired during the day.  The instructions say it takes 6-8 weeks to really have an effect, so I guess I have to wait.  But has anyone else had a similar experience?

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I'm still taking it to this day. It's been 1.44 years since I first started it (1 year 5 months 11 days // 17 months 11 days // 75 weeks 2 days). I think that may be a personal record, as I can't think of any other antidepressant that I've stayed on for anywhere near this long of a period of time.

It's still working pretty well for me, although I have noticed that the issues mikl_pls had experienced and warned me about do appear to be present to some extent (they're quite inconsistent & variable though, and I don't seem to experience them as strongly as he did).

I don't typically get tired during the day on this med unless I haven't had enough sleep/water/food (although I used to be constantly tired back when I was taking cariprazine (Vraylar) to augment the Fetzima -- are you possibly on any other meds that could be causing the tiredness?). I'm probably not the best judge of this though given that I'm on a high dose of Adderall as well.

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On 5/26/2018 at 8:50 AM, JustNuts said:

I'm still taking it to this day. It's been 1.44 years since I first started it (1 year 5 months 11 days // 17 months 11 days // 75 weeks 2 days). I think that may be a personal record, as I can't think of any other antidepressant that I've stayed on for anywhere near this long of a period of time.

It's still working pretty well for me, although I have noticed that the issues mikl_pls had experienced and warned me about do appear to be present to some extent (they're quite inconsistent & variable though, and I don't seem to experience them as strongly as he did).

I don't typically get tired during the day on this med unless I haven't had enough sleep/water/food (although I used to be constantly tired back when I was taking cariprazine (Vraylar) to augment the Fetzima -- are you possibly on any other meds that could be causing the tiredness?). I'm probably not the best judge of this though given that I'm on a high dose of Adderall as well.

Thanks for the response.  Do you remember how long it took to take effect?  My doctor says to give it 1 month.  That will be next week for me.  I'm patiently waiting for that to happen because I feel terrible.

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I just stumbled on these boards by accident and wanted to share my experience. 

33 year old white male, 185ish pounds. 

I started Fetzima 7 weeks ago. I was very hesitant to start it. I’ve tried several SSRIs in the past and just didn’t like them. I haven’t been on any depression medication for years because of it. I finally got fed up and decided I had to do something. So I went to my primary care doc and told him all about it. I had made up my mind that I wasn’t doing another pill, but I wanted to see what kind of alternatives he had in mind.  My depression manifests in a way that I’m very low energy. As such, he asked me to try an SSNRI (which I had never heard of) called Fetzima. I was weary but decided to give it a try. I was told to take 20mg for two days then start on 40. An “acclimation period”. The pharmacy wanted $30 copay for both prescriptions even though the 20mg was only two pills. I wasn’t having it so I recklessly chose to decline the two day 20mg script and start at 40. 

Within 10 days I noticed an improvement. My relationship with my wife had been rocky, but we’ve been much better since I started. After like 6 weeks, I think I got the full effect. I have more energy and motivation to do little stuff around the house. I don’t feel as “meh” all the time and I just feel better equipped to deal with daily life. I still want to sleep waaaay I’m in the morning, but that’s been all my life. I was particularly concerned about the sexual side effects. My wife has always wanted more frequent sex and I just didn’t usually feel like it.  However, I’ve had no ED issues and my libido has actually increased. I think because the depression has lessened, I’ve been more inclined to do the deed. Overall it has been an extremely positive change for me. 

I have had some negative side effects, but not many. I have always sweat a lot but now I sweat A LOT. It hasn’t been enough to even kind of make me want to consider coming off Fetzima. My heart rate has markedly increased. It used to be that at the gym I’d try to sustain a heat rate of 140-150 for 30 minutes on the treadmill and if I really really pushed I’d get to 180BPM. Now, I achieve that 150 waaay too easily. I’ve had to kind of tone it down because I’m afraid of too much strain on my heart. I haven’t been to the gym enough to get a great read on it. I’m also getting that orthostatic hypotension pretty bad; if I stand up too quick I’ll get very dizzy. A few times I’ve thought I was going to pass out. This hasn’t been a huge problem, I just need to remember to watch it. I’ve also steadily lost weight. About 10 pounds since going on the med with no change in habits or diet. 

At the end of the day, Fetzima has been wonderful for me. Everyone is different and I know many people on here have had the opposite experience. 

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