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Everything posted by Skeletor

  1. Depends highly on how you metabolize it. You could rapidly metabolize Clomipramine into Desmethylclomipramine, and then desmethylclomipramine gets metabolized slowly ^^
  2. It has a tricyclic structure (btw: Sertraline also has a tricyclic structure) https://psychotropical.com/tca-intro/
  3. That's because Venlafaxine works predominantly on Serotonin. Its SNRI-label is more marketing than pharmacologically justified. Relative to other SNRIs, levomilnacipran, as well as milnacipran, differ in that they are much more balanced reuptake inhibitors of serotonin and norepinephrine.[8][9][10] To demonstrate, the serotonin:norepinephrine ratios of SNRIs are as follows: venlafaxine = 30:1, duloxetine = 10:1, desvenlafaxine = 14:1, milnacipran = 1.6:1, and levomilnacipran = 1:2.[8] The clinical implications of more balanced elevations of serotonin and norepinephrine are unclear,[8] but may include improved effectiveness, though also increased side effects.[9][10][11] - source: https://en.wikipedia.org/wiki/Levomilnacipran#Pharmacodynamics The strongest and most balanced SNRI is Clomipramine: https://en.wikipedia.org/wiki/Clomipramine It probably is the most effective non-MAOI antidepressant.
  4. Thanks for clarifying it. I myself have been suspecting some form of "mixed states" affecting me. I have deeply dysphoric states, but they change from dysphoric to "okay" within the span of one day... sometimes many times in a day: In the morning I am dysphoric, depressive and ful of despair, in the afternoon I feel okay, but have my head full of thoughts and can't concentrate on a task, then in the evening it is somewhat worse... dysphoria, bad mood, and in late evening and night I feel good... not perfect, but good... clear mind, somewhat relaxed. (I have lots of psychomotor agitation: even as a child I was psychomotorically agitated.) I've never looked into Bipolar Disorder. I suspected maybe some form of ADHD, but am not sure. I am always tardy and have difficulties organizing myself and my day. Too much stuff in my head, too agitated. btw: How were your experiences with Remeron and Zoloft? How did they affect you and your BP?
  5. This is interesting. Never heard of this before... so some kind of "masked mania"...? Interesting! How did you get diagnosed? It seems difficult do diagnose something like this, because many conditions share these kind of symptoms...
  6. Why do strong SRIs (serotonin reuptake inhibitors) often cause / induce apathy, indifference and laziness? Maybe not in everyone, but it's one of the most common complaints. I regularly read about it on the internet. I myself was affected by it. My questions would be: 1.) What causes it? 2.) Were you affected? 3.) Did you successfully get rid of these specific side effects? If so, how so? 4.) Further comments regarding that "phenomenon"?
  7. Here some articles I've been reading: https://psychotropical.com/dopamine-and-depression-part-1/ https://psychotropical.com/anti-psychotics/ https://psychotropical.com/quetiapine-the-miracle-of-seroquel/ https://psychotropical.com/risperdal-chicanery/
  8. Yes, but in that case wouldn't it be wiser to choose Mirtazapine, Buspirone or some trricyclic AD? They also (ant)agonize 5HT-receptors, but without the strong anti-dopamine effects... It's just that I am unsure about the anti-dopamine effects. It seems to me that one does not want that when having run-of-the-mill-depression.
  9. There is a growing trend for antidepressant + antipsychotic combos. One does regularly read that patients get prescribed an SSRI and in addition they get some atypical antipsychotic. What is the goal of prescribing an antipsychotic to a person with Depression, Panic, Anxiety or OCD? Shouldn't it be last resort? https://psychotropical.com/psychotic-depression-and-tranylcypromine/
  10. I hope so 😁 I am visiting the mental institution of a local hospital. Maybe they are more open to prescribing TCAs... at least I hope so.
  11. Sertraline standalone makes many people somewhat apathetic, indifferent and unmotivated, and that's why doctor Gillman suggests augmenting it with Nortriptyline OR alternatively taking Clomipramine standalone for the full SNRI effect... Did anyone here try both combos? I am getting back on antidepressants and not sure how to proceed... but if I had to choose, I would preferably go for one of the two possibilities.
  12. see tables... https://en.wikipedia.org/wiki/Clomipramine#Pharmacodynamics
  13. As far as I am informed you need stimulants for treatment of ADHD. Most commonly used are Methylphenidate and Atomoxetine. Sometimes stuff like Bupropion is applied. But what about classic antidepressants with stimulant (NRI) properties? Let's say Desipramine or Nortriptyline, Reboxetine!? Can they help to some degree?
  14. Paroxetine: a selective serotonin reuptake inhibitor showing better tolerance, but weaker antidepressant effect than clomipramine in a controlled multicenter study. Danish University Antidepressant Group. [April 1990] Citalopram: Clinical effect profile in comparison with clomipramine. A controlled multicenter study [August 1986, Danish University Antidepressant Group | Psychopharmacology, Springer-Verlag] It may be an old set, but the quality of the study is high, it's overall well designed, and the study's creators are "independent". It is ridiculous that they are afraid of prescribing efficient drugs which had been the well-established Gold-Standard for millions of psychiatric patients during the 60s, 70s and 80s... and even to this day those old drugs have bigger effect sizes than "modern" antidepressants. I don't mind that they prescribe SSRIs as first line treatment, but that never-ending focus on SSRIs and ongoing SSRI-roulette is a pain in the butt. This is cause for despair.
  15. There's an old study regarding the combination of high dosed Clomipramine, Tryptophan and Lithium. Quite a powerful combo. "Clomipramine, Tryptophan and Lithium in Combination for Resistant Endogenous Depression: Seven Case Studies" - August 1987 | A. S. Hale (a1), A. W. Procter (a2) and P. K. Bridges (a3)
  16. From the classical trio? Least sedating: Clomipramine and Imipramine... Amitriptyline is more sedating. Least side effects? Probably Imipramine. TCA's have mostly been discarded because you can overdose on them. They are still more effective than SSRIs. There are some side effects involved, but it all depends on the constitution of the patient. https://psychotropical.com/tca-before-ssri/ Least sedating and least side effects overall: Nortriptyline, Desipramine...
  17. That Sertraline Nortriptyline Combo sure has its fans Probably Nortriptyline: strong 5HT2 antagonism and no Dopamine antagonism. Otherwise, if you don't want NRI properties: probably Mirtazapine / Mianserin...
  18. Doxepin is a sedative, does not have substantial antidepressive properties. Nortriptyline is good, especially when combined with an SSRI. Amitriptyline, Clomipramine and Imipramine are the most effective ones, with Clomipramine probably being the most effective one (statistically speaking), because it is the strongest SNRI.
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