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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.

I've been reading the following articles: https://psychotropical.info/clomipramine-potent-snri-anti-depressant/ https://psychotropical.info/tca-intro/ https://psychotropical.info/snri-intro/ Seems to be a pretty potent drug: SNRI, antagonist of the alpha1-adrenergic receptor, the histamine H1 receptor, the serotonin 5-HT2A, 5-HT2C receptors, the dopamine D1, D2, and D3 receptors, and the muscarinic acetylcholine receptors. It is on the World Health Organization's List of Essential Medicines, the most effective and safe medicines needed in a health system; so that speaks for itself. The reviews on drugs.com and other sites also are quite positive. The following ranking is interesting: http://slatestarcodex.com/2015/04/30/prescriptions-paradoxes-and-perversities/ These numbers are based on aggregated patient ratings. Top 4 drugs: # Nardil 1.25 # Parnate 1.23 # Chlomipramine 1.22 # Emsam/selegeline 1.07 => Clomipramine roughly on pair with MAOI, followed by Nefazodone (R.I.P) and Imipramine. Imipramine is also a potent SNRI, but lacks the strong 5HT-antagonism compared to Clomipramine. I suppose that's the pharmacological difference which makes Clomipramine superior... ? Clomipramine exhibits some antagonism of dopamine D1, D2 and D3 receptors... can one expect some clinical & therapeutic benefits from this? Clomipramine acts as a functional (potent!) inhibitor of acid sphingomyelinase (FIASMA): http://en.wikipedia.org/wiki/FIASMA Some interesting graphs regarding antidepressant FIASMAs: http://d-nb.info/1011278227/34 Who here has been on Clomipramine and what were your experiences with it?

Hi There, I'm not much of a poster. But, I've noticed when you are trying to look up people's personal experience with meds, usually the reports are from people who have had really bad experiences, and so you don't normally get the full range of experiences. I'm assuming, the people who are fine, on certain meds, don't really post anything, because they've had no problems with it. Also, I wanted to post about Fetzima, because there is basically not a lot of information on it, so I felt like I wanted to share with the community to help others out who are deciding what to do. And, these forums were always helpful for me on my med research, so I wanted to contribute. I was on Fetzima for probably 3 years. My main medicine was Lamotrigine/Lamictal 150mg, which controlled my depression crashes. And, I needed a depression booster because of my dysthymia. I was on 40mg the whole time of Fetzima. I learned over the years, the SSRI's did nothing for me. I tried everything in the book. Finally, this, actually, good psych doctor recommended an SNRI, Fetzima. I remember in the beginning, my only side effect was cold sweats. Like wake up in the middle of the night, drenched in sweat. It was not that fun. But, my depression improved and I was finally stable and felt good for the first time in my entire life. And, I told myself, I'll take the cold sweats, if it means I feel like a normal functioning adult human being. But, after a while, maybe 2-3 weeks, the cold sweats subsided. After that, Fetzima worked! It was great, the first depression med that I ever felt good on, didn't feel weird, was happy, held a job, friends, etc. Amazing! Then, I worked really, really hard with my therapist. I did everything I could possibly do to get better. I never wanted to be on meds. I wanted to treat myself and get better, and the end. I have severe trauma as a kid, and in result, suffered from severe depression, suicidal ideation, couldn't move or function, anxiety, social anxiety, and pretty much everything that goes along with that. Although, on the outside, you would never suspect it; I have a master's degree, I'm outgoing, friendly, etc. (Just trying to give you guys a picture of the situation). So, yes, I, personally, would recommend it. And, had no problems with it. Although, because it's a newer med, and no one has ever heard of it, there is no a lot of research on the long term effects. Obviously, medicine is different for everyone, but Fetzima worked for me. I finally felt good enough and stable enough to try to get off my meds, 3 years later. I recently tapered off of Fetzima, 20mg for 1 month, and then off. It was not that fun, but, it wasn't horrible, and it is not the horror stories that I've read from others online. I had one day of a pretty bad depression crash (maybe two), although, I knew it, and I knew what was happening, and I just reached out to everyone to help me through it. And, I know that a side effect of withdrawal is depression! Because your body is used to the meds, and then it doesn't have it anymore, so it takes a while for your brain to even out. The other very seriously difficult part for me- was the brain fog- brain cognition defects. I've never had anything like this before in my life, always good in school, always able to concentrate. I never even pay attention to that one on the list of issues that could arise. But, I was in a class that week, and it was rough! I couldn't concentrate, couldn't focus, fidgety, I felt like my brain was at 80%. It was a big struggle. I was scared my brain was going to be like this forever, and kept having to remind myself that it's the withdrawal. I, also, decided I'd rather deal with the withdrawal, then be on this forever, so I put up with it. And, probably after a week or two it went away. And, that's it! My emotions are okay! No depression! I'm very proud of myself, and I feel like the trauma therapy really worked! (So, I'd recommend that too). A lot of people "poo poo" talk therapists, and honestly, going through a lot of them since I was a teenager, a lot of them are pretty bad. But, once you find a good one, which can take a bunch of tries. It pretty much changed everything for me. Took a solid 4 years, I'd say of serious talk therapy from 2014-2018. But, I am a happy/content human being now! And, it was worth everything! And, I have someone I can check in with now, but don't need to go regularly, which feels amazing too! The meds teach you (or, taught me) what it was like to be stable and content. Which, I had never felt before in my life. And, then once you get off of them, your brain has been trained to know what being stable and content is, (and you've added the skills and tools you need to, through talk therapy to help yourself through), so, it'll go back to where it needs to go. Obviously, some people will need to be on meds forever, and that's okay too. I'm just sharing my personal experience. I'm now feeling strong enough to taper off my Lamotrigine 150mg. Which will be 125mg for 3 weeks, then 100mg for 3 weeks, then 75mg, 50mg, 25mg each for 3 weeks, and then 0! We're just doing it very, very slow. And, I hope it goes well! So, I'll share that experience too, in a couple months. Anyways, that's my review of Fetzima! And, it worked for me, while it needed to.

Hello there, I'am taking Duloxetine 120mg for Depression and Pure O (OCD) since Feb. 2017. Unfortunately, I still have intrusive thoughts and some symptoms of depression (low mood, no energy etc.), although I can handle my everyday life somehow. However, the whole situation is not satisfying for me and my family. I'm constantly tired, lethargic, grumpy, hungry and unhappy. So what's next? I've already tried to augment with Seroquel (300mg; horrible, horrible experience) and Abilify (2,5mg-5mg, quit working after two months). What's about switching the baseline med? Can I go back to SSRIs like Citalopram, Fluvoxamine or Paroxetine?* Or is it pointless, since the doctors kept telling me that Duloxetine and Venlafaxine were far more potent than the SSRIs... *Lexapro did considerably well in the past, but it unfortunately pooped out after two years. Sertraline did nothing for me (I'm an ultra rapid metabolizer).

The med tinkering is driving me nuts. Anyone with me here? Sigh. I have had depression and major depressive episodes for the past 20 years, but I have only been doing the med thing for the past three years. I feel like I get so close to finding a combo that works, albeit with some intolerable side effect... and then I try to get the combo better and wind up making it worse. My latest foray brought back my PMDD crying/depression/irritability for the past week and I'm just at a loss of what to do next. My psychiatric nurse is pretty much up for whatever I want to try, but I don't know what to do anymore. Maybe you all have some ideas? Here's what I'm on right now: Lamictal 200mg (for MDD; *supposed* to be my main antidepressant), Wellbutrin XL 150mg (for giving me more energy and helping with my sex drive), and Lexapro 2.5mg (I had been up to 15mg, but completely lost my ability to orgasm and decided to go off it; hence going on Lamictal). Dx: MDD, PMDD, Primary Insomnia (which may or may not be related to my depression) Antidepressants I've been on: 1) Prozac: numbed me to the point of apathy, caused periodic limb movement disorder at night, sedated me 2) Zoloft 75mg: improvement over Prozac! actually helped me sleep through the night! Yay! Killed my ability to orgasm. Boooo! ... until I added Wellbutrin, then WOW! Sedated me so badly that I only survived on caffeine pills that I had to carefully time through the day, at 100mg every four hours. I hated the sedation (as in I would fall asleep wherever I was multiple times a day if I ran low or out of caffeine), so decided to try something else... 3) Wellbutrin 150mg: Added to help give me my sex drive back. Worked wonderfully! Love this one! Wish it still worked with Lexapro... 4) Lexapro 15mg: Swapped out the side effects. Caused periodic limb movement disorder like Prozac, but NO SEDATION! :-). Sadly, killed my ability to orgasm so completely that not even 300mg Wellbutrin could touch it. I could say that I could live with this, but the endless frustration in my relationship has made me want to pursue another option. 5) Lamictal 200mg: I started this in January of this year, for the purpose of getting off Lexapro, and have been titrating up ever since! Holy crap; it's been forever. Within that seven months, I tried to go off the Lexapro three times. The first two times, my Lamictal was at 100mg and I got down to 7.5mg of Lexapro before having a return of depressive symptoms. This past attempt at going off Lexapro, Lamictal was brought up to 200mg for two weeks before attempting to titrate down on the Lexapro. I titrated by 2.5mg every 5 days and I got down to 2.5mg before having discontinuation symptoms, including depressive symptoms along with headache, irritability, and nausea. So now I'm at 2.5mg of Lexapro and have been holding there, afraid to go off it completely and afraid to go back up. Clearly the 200mg of Lamictal, plus 150mg Wellbutrin are not enough to deal with my depression, particularly the menstrual/hormonal version of it. I was at 200mg of Lamictal for 7 weeks before this last period hit, so I know that there was plenty of time for it to work. If I increase the Lexapro, it defeats the purpose of why I went on the Lamictal. I've never had good anti-depressant results from Wellbutrin, only increased energy, so no reason to go up on that. I am disappointed at the possibility that I've given Lamictal this entire year to work and I don't know if it is marginally working, or not really at all. I'd like to think that the reason I was able to get down to 2.5mg of Lexapro without return of symptoms this time means that the Lamictal is doing *something.* Do I ask to increase the Lamictal? Go up to 300mg? Do I add a different SSRI and go off Lexapro completely? Pdoc thinks I should try Zoloft again. Aaack! Must I live in a sedated state for the rest of my life?! I don't know if there is even the possibility that another SSRI would be better than Lexapro with the side effect profile. But maybe try Celexa and hope for the best? Do I add an antidepressant that is not an SSRI, like Strattera, Abilify, etc.... Since I know y'all are going to ask, I have tried Mirena and Nuva Ring to control the hormone influenced depression and it has been a crap shoot. Mirena turned me into a raging bitch for months and I bled and bled for weeks at a time. So I had that taken out, needless to say. Nuva Ring caused weight gain, pimples, break through bleeding, and did not seem to make any difference with the hormonal depression. So I went off that too. Talk to me, people. Lend me your ideas.

I have ADD (on Adderall), and have suffered from depression for years. I have tried every med, but the one that worked best was Effexor. Problem was that I would get the withdrawal symptoms if I was an hour or two late with my dose. SNRI seems to be the way to go, but I don't want to be on Effexor, and both Cymbalta and Pristiq are too expensive (no insurance), and not available in generic. I am currently on Prozac, and was wondering if adding Wellbutrin would be a way to go. In other words, is an SSRI combined with Wellbutrin equal to an SNRI? Can I get the benefits of Effexor through the use of two meds? If so, what form of Wellbutrin is best... Extended release? Generic? Thanks so much for any help anyone cangive me.

Hi guys, I recently switched doctors. I gave him a list of every med I've ever tried and my results. He said based on how I reacted to those that he thinks Fetizma will work better for me. My Celexa is starting to become less effective, so I want to make a switch. I'm just really scared. I tried to switch to Luvox from Celexa (stopped being effective) last year and it was a nightmare - Luvox didn't work for me and I essentially had no help for a month while my old doctor forced me to wait and see how it made me feel. I cried every day. Had panic attacks. Could barely leave the house. Then my doctor finally relented and let me try something else. I was put on Lexapro. It helped and brought me out of it. But i felt sedated all the time. So I asked to be put back on Celexa. Now 4 months later it's starting to poop out again. I can't function without antidepressants. I've been taking them since I was 12. I have OCD, GAD and panic. Anyway, curious to know if anyone takes it and how they felt on it? I just figured it might make me feel better to read other people's reviews. Wish me luck. Thanks, Steph Just for a little background... I've taken: Effexor - results were ok Wellbutrin - made me feel crazy Celexa - worked well for a long time but pooped out Lexapro - worked but felt sedated. Luvox - no effect. Anafranil - made me feel weird. Vybriid - terrible side effects; couldn't get past it. abilify - made my anxiety worse. risperdal - made my anxiety worse. seroquel - made my anxiety worse.

Something I've always been curious about. Shouldn't the norepinephrine reuptake feature be stimulating? It seems like drugs such as Effexor get more complaints of severe fatigue than SSRI'S

I am a concerned mom. My 16 year old has suffered from OCD, Anxiety, and ADHD for the last 7 years. We were on zoloft for 5 of them and it worked well until she suffered a major depressive episode from struggling in school socially and academically. The academics surprised us for she has always been a top student in the hardest classes and suddenly she can't focus, remember things, or stay on task. They tried her on Strattera with Zoloft and it made her seriously tired and have a racing heart when she was awake. They took her off that and put her on Ritilin with did nothing. They then put her on Wellbutrin which worked great for the depression but nothing for the anxiety and ADHD. They tried to then layer in Concerta with the Wellbutrin and it caused her fatigue and fevers. Then they switched her to Lexapro which made her numb to everything and not care about anything but did not address the focus issues. They layered in Concerta again to address the focus and again the fevers and fatigue came back. So now they have her on 50 mg of Pristiq (for one month) but she says her focus is still horrible (I know for she is failing school) and her OCD/intrusive thoughts are horrible. I am saddened and desperate to seek advice for she is so tired of the side effects of all the medicine and feeling horrible. Her therapist and Psychiatrist don't know what to do. Any advice? What is the best medicine combo for ADHD and OCD/anxiety? This wonderful young girl has a IQ that is through the roof and might not even graduate from HS because she cannot stay on track. She is so tired of feeling bad…please advise.

Does anyone have any bad experiences with this med? It's an snri or whatever and my psychiatrist told me it'll give me more adrenaline? or just energy? I don't know. Any success with this drug?

Hi, this is my first post so please be gentle. I'm wanting some feedback on medications really, have you guys had any success with the SSRI/SNRI medications for OCD racing thoughts, anxiety, agitation, etc? If so which meds? I've tried a whole bunch (Paroxetine/Paxil, Sertraline/Zoloft, Venlafaxine/Effexor, Citalopram/Celexa) with absolutely no benefits whatsoever. I've had bad side effects from some but without a doubt ALL of them made me more agitated, restless, anxious and so on. As much as I believe I have a good doctor I am running out of patience, all he wants to do is switch from one SSRI to another. I feel my main issue is anxiety not depression and I'm starting to feel the idea that anti-depressants can cure anxiety is a myth, UNLESS the anxiety is actually secondary to depression itself. Anyone care to argue differently?

Hi all! As of lately, I've been experiencing some fairly concerning side effects, and would appreciate any feedback/insight that anyone may have. I'll try to be as concise as possible, as to avoid confusion (as though mental health isn't a freaking never ending puzzle with a piece missing). I currently take Effexor XR 75mg, usually around lunch time. In addition, the only medications I take are birth control (Tri-Sprintec), and the occasional GummyVite. I never miss my medication, nor screw them up. I've been on the birth control forevr, and on Effexor for about two months, since switching to it from Celexa. For the first month and a half, I was living the good life, completely symptom free. Then, out of nowhere, I started getting these head rushes roughly every 2 minutes, for periods of hours at a time. The best way I can describe them is comparable to that slightly scary feeling you get when sitting upright too hastily after sleeping. It feels like a sudden rush of blood to my head, which almost propels me forward, and makes me hyper aware of my head for that second. This happens every few minutes..for a few hours..yeah, its quite the disturbance. With this, I also feel extremely dizzy. In addition, I sometimes feel an intense jolt of anger for absolutely no reason. I tend to have fairly decent self-awareness, and try not to supress anything. I have never experienced anything like this prior to now. I will literally be having a wonderful day, and one second, I will become spontaneously raging, usually directed toward someone, like a co-worker, or boyfriend. Needless to say, this isn't exactly good for the whole "being a normal person" bit. Now, these little fits of rage last for roughly an hour, and dissipate with my efforts to think of positive things, or otherwise occupy myself. Has anyone else ever experienced these types of symptoms? Perhaps on other medications? Help! I'm going crazy here (hehe, see what I did there?)

Hiya, First of all, I suffer from major depression, anxiety and sleep disorders, and ADHD and severe lethargy. Cymbalta worked great for a while, but then its effectiveness got weaker and weaker. I've since found out that I have developed restless leg syndrome and severe sleep apnea. I was off Cymbalta for a while, but have now been back on it for three weeks, and I'm hoping I'll have energy again soon. The thing is though, I wasn't 100% the first time I tried Cymbalta, but close to. My sleep specialist has prescribed me Strattera. There's only a moderate interaction between the two, so my doc has no problem with me taking both, but is there any point? You see, one is an SNRI (Cymbalta) and the other is an NRI (Strattera), and if I'm already taking an SNRI don't I have norepinephrine covered already? ...and why are the withdrawal effects from an SNRI much worse than those of an SSRI or an NRI? Thanks, ~ Danny