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thoughtcrime

GeneSight results, possible switch from Prozac to Lexapro/Zoloft

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So, I was extremely depressed in January after tapering off all my meds on my own (stupid). My doctor put me back on Wellbutrin, and we decided to try Prozac as an SSRI. The Prozac wasn't kicking in and I learned about the GeneSight genetic test for antidepressants. I asked for and had the task done. They never sent me a copy of the results.

After a month on the Prozac and no help, I also asked to go up from 300mg Wellbutrin XL to 450mg, and that seemed to help. I had an appointment mid-April and was mostly feeling better. He decided to keep me where I was at. I forgot to ask about the GeneSight results.

I generally feel good during the week but am miserable on the weekends. I generally lay in bed all day feeling depressed, binge eat, try and sleep as much as possible. I don't know if this is something that can be fixed with medication or if it is purely behavioral. My therapist suggests making plans for the weekend ahead of time and trying to make my weekends structured.

I finally got around to sending the doc a message on the patient portal asking about the GeneSight results. He responded that the report showed all my meds were good for me except Prozac. The test recommends Lexapro or Zoloft instead. He did not say anything about changing the Prozac.

For three days I have been trying to make an appointment to see the doctor. If I call I'm on hold for 10 minutes before leaving a message. I've also tried requesting an appointment with the patient portal. Nothing. So, I'm thinking about just messaging the doc (since I know he responds) and mention the problems I'm having on the weekends as well as concerns I have about staying on Prozac. I want to know if I should switch, or if I should just stay where I'm at since I'm basically doing good except no motivation and very depressed on the weekends.

What do you all think I should do? Ask the doctor online about switching, keep trying to make an appointment, or just try and add structure to the weekends and see if I can get by without a med change?

Current meds (all generic):

Wellburtrin XL: 450mg
Prozac: 20mg
Seroquel: 200mg
trazodone: 400mg
hydroxyzine: 25mg 3x daily P.R.N.

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I think you should keep trying to contact your doctor. At this point you’re most likely to get in touch electronically before you see each other in person, so you can discuss the idea over the phone, and at the same time decide whether you want to make any changes without seeing each other in person.

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Thank you. I ended up sending the dr. a message online. I found out that they have been short-staffed at the desk and their phone system was done for a while. I figured it had to be something like that as I've never had problems getting through before.

Well, I told him everything that was in the post and he did decide to switch me to Zoloft 50mg. I picked it up yesterday and get to start it today (I've decided to wait until evening). I was a little surprised he didn't have me do a wash-out period, but probably because it's such a low dose of Prozac it isn't necessary. I am excited and hopeful, we'll see if this helps. I think Zoloft is supposed to kick in fairly fast for an SSRI.

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Prozac also has an extremely long half-life, so traces of it are going to be rattling around in your system for some time to come. Particularly at a low dose, that would protect you from withdrawals. 

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On 5/15/2020 at 2:32 PM, thoughtcrime said:

Well, I told him everything that was in the post and he did decide to switch me to Zoloft 50mg. I picked it up yesterday and get to start it today (I've decided to wait until evening). I was a little surprised he didn't have me do a wash-out period, but probably because it's such a low dose of Prozac it isn't necessary. I am excited and hopeful, we'll see if this helps. I think Zoloft is supposed to kick in fairly fast for an SSRI.

You're definitely going to want to take Zoloft in the morning unless for some reason it sedates you (not likely).

Generally, switching between SSRIs and SNRIs don't require you to do a wash out period between them. Not even really between SSRI/SNRI to a TCA or between two TCAs. The only time when it's absolutely necessary to do a wash-out between antidepressants is when you're switching between any serotonergic antidepressant (SSRI, SNRI, mirtazapine, imipramine, clomipramine) and for some reason, bupropion and buspirone, to an MAOI, including going from one MAOI to another. That requires a wash-out of, bare minimum, at least 5 half-lives of the drug to be washed out from, but to be absolutely sure it's done properly, 2-3 weeks are done (5 weeks if you're washing out Prozac because of its extra long half-life) before starting the MAOI. The noradrenergic secondary-amine TCAs can either be started concurrently with the MAOI or can be used as a bridging agent between the washout and the start of the MAOI (both are not commonly done anymore due to lack of knowledge and training in this manner of prescribing). The "atypical" TCA trimipramine, the moderately serotonergic TCA amitriptyline, and the primarily noradrenergic tetracyclics amoxapine and maprotiline can be used in this same fashion too.

For some reason, both my best friend and I experienced marked benefits after just a day or two after switching from our previous antidepressants to Zoloft (it was more pronounced of a difference for him). But that is very uncommon for most any antidepressant, really. There's not really anything super special about Zoloft that would make it work any quicker, except maybe its supposed mild dopamine reuptake inhibition. If you wanted the benefits to take effect quicker, perhaps your doctor could add a low dose of buspirone or pindolol to your cocktail for the time being until the Zoloft takes effect.

On 5/14/2020 at 12:12 PM, thoughtcrime said:

Current meds (all generic):

Wellburtrin XL: 450mg
Prozac: 20mg
Seroquel: 200mg
trazodone: 400mg
hydroxyzine: 25mg 3x daily P.R.N.

May I ask what you're taking the Seroquel, traozodone, and hydroxyzine for? Also, is your doctor a general practitioner or a psychiatrist?

I assume the hydroxyzine is likely for anxiety, but want to make sure. The Seroquel, at that dose, I'm thinking might be for insomnia. But the trazodone I absolutely can't be sure about.

That's literally a metric ton of trazodone, especially for someone who is on an SSRI of any dose. Trazodone isn't a very potent SRI on its own, but at doses approaching 300-400 mg, it does become considerably potent. The max dose for insomnia is usually 200 mg, because at doses above that, the blood levels of its active metabolite, mCPP, become high enough for most people to where it becomes considerably more stimulating than it is sedating. Also, the pro-depressant, anxiogenic effects of mCPP are liable to "bleed through" at high doses of trazodone, since mCPP is a very potent 5-HT2C partial agonist. If you are indeed taking trazodone for insomnia, I would absolutely, definitely consider backing way, way off the trazodone by at least half what you're taking now—down to 200 mg max, maybe even 150 mg. If you're taking it for anxiety, I would still back down to 200 mg, maybe 300 mg at the very most. While 400 mg is technically the very max dose for outpatients allowed (600 mg max for inpatients), that is intended as a monotherapy dose for sure. If you're going to be on Zoloft, even 200 mg trazodone provides quite a lot of supplemental serotonin reuptake inhibition.

If 200 mg trazodone + 200 mg Seroquel (that's also as high as I would personally go on Seroquel for insomnia) aren't enough to help you with insomnia, I would suggest maybe discussing adding a third agent that works to sedate via yet another, seperate mechanism of action, like a benzo (Restoril, Ativan, Dalmane, Doral, etc.; try to stay away from Halcion, for some reason it's supposedly a bad one... ???)/Z-drug (Ambien, Sonata, Lunesta, etc.) which would work through enhancing the activity of GABA at GABA-A receptors, a melaton receptor agonist like Rozerem (or just plain old melatonin, usually lower doses are better than higher doses which can cause vivid dreams and nightmares), and/or an orexin receptor antagonist like Belsomra or Dayvigo (be vigilant for sleep paralysis and the frightening hallucinations that may happen during those events!). Sometimes the anticonvulsant gabapentin helps some people with sleep quality but not necessarily with sleep latency, induction, or even maintenance. It can possibly help with anxiety to boot. Adding a third drug for insomnia may allow you to also further reduce the other two agents to get a better balance of effects. You only have so many H1 histamine receptors (Seroquel) and 5-HT2A receptors (trazodone) to inhibit in your brain, and can only inhibit a certain percentage of them with those drug before you start recruiting other additional mechanisms of action, such as the activating norepinephrine reuptake inhibition of norquetiapine, the active metabolite of Seroquel, or the activating SRI of trazodone in higher doses as well as all the undesirable effects that result from mCPP's serotonin 5-HT2C receptor stimulation and the stimulating properties that its induction of serotonin release can have. Speaking of balance, the hydroxyzine is also an antihistamine (H1 antagonist) like Seroquel primarily is (yes it's technically an "antipsychotic," but only at doses of 800 mg/day), roughly about as potent as Seroquel, so I kinda feel like there's a bit of redundancy there too. If the hydroxyzine is for anxiety, I would suggest maybe something like a benzo (Xanax, Ativan, or Valium/Klonopin) if you can take them, or something like BuSpar to take regularly if you're not able/not allowed to take benzos.

Probably the most potent antihistamines are doxepin (either as the old Sinequan, or the newer micro-dosed Silenor), mirtazapine (Remeron—this one will make you gain a ton of weight), and trimipramine (Surmontil), roughly in descending order of potency. Lower doses of all of them are generally better as they are more selective for the H1 receptor. For doxepin, Silenor comes in 3 mg and 6 mg tablets, lower than the minimum 10 mg capsules of generic Sinequan which of course can't be split. With Remeron, 7.5-15 mg is best for insomnia, and Surmontil 25-50 mg probably is best.

As for 5-HT2A antagonism, trazodone is probably your best bet, but many people do develop a sort of "tolerance" to its effects after a while, and get to a point where there are significantly reduced potential for beneficial returns from further increasing the dose as mentioned above. If you want to try to get away from the potential for trazodone's metabolite mCPP to have negative effects on you, there are other agents that are antagonists of 5-HT2A. Remeron is actually also a 5-HT2A antagonist (but also a 5-HT2C antagonist, which can be activating, but it's unlikely it will be at all activating at the lowest doses used for insomnia). Seroquel is a 5-HT2A antagonist, but not quite as potent as trazodone. Surmontil is somewhere between trazodone and Seroquel in potency at inhibiting 5-HT2A. One possibility might be to replace both the trazodone and the Seroquel with the typical antipsychotic, Thorazine, perhaps at a low, low dose of 10-25 mg at first. It is more potent of a 5-HT2A antagonist as trazodone and roughly as potent as a H1 antagonist as Seroquel, while being a significantly more potent D2 dopamine antagonist than Seroquel, which will contribute more to the sedating effects (but not likely significantly to mood at low, low doses). Thorazine got me sleeping when almost nothing else could at the time (I did have quite a lot of side effects from it though... It's not messing around!)

Didn't mean to generate literally a whole wall of text here. Also, I absolutely hope that I didn't come across as hounding you for your medication doses or as trying to tell you what you need to do with your meds/how to take them or anything.

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Posted (edited)

Wow, thank you for your very detailed reply! I do take the hydroxyzine for anxiety, but not very often. The trazodone and Seroquel are both for sleep. I know the trazodone dose is high, but that's the only dose that helps (sometimes 300 helps, but usually I have to take the full 400). I find the combination of the two works really well for me and I don't feel too tired in the morning. I've taken z drugs, Ambien works great and Lunesta doesn't work at all. One stretch of time I took them well and didn't abuse them, but this last time I did abuse them and that was a nightmare, so we decided no more of that. As far as benzos go, I was on Ativan 0.5 mg up to 3x daily, never abused them, but then I finally went to rehab for my real drug problem (meth) and they wouldn't let me have it there. After rehab, I moved into a sober-living home and they wouldn't allow me to have the benzos either, so the doc switched me to hydroxyzine. That was over 2 years ago. My anxiety is really good right now, actually. (I've had a lot of therapy). So I don't think I need a benzo and would rather not. I'd also like to stay away from zolpidem, although I do take it when I have sleep studies, which is infrequent.

I'm pretty sure I could take less of both trazodone and Seroquel and still sleep ok. My prescription is actually for 300-400mg trazodone, and 100-200mg Seroquel. So sometimes I only take 300 and 100, respectively. I am open to taking melatonin, it has helped before. I don't know if the doc (a psychiatrist) keeps me on that high trazodone just for sleep or if it is also as an antidepressant.

I didn't understand what you were saying about the interactions and the receptors and all that. Are you saying that trazodone and/or Seroquel could be making my depression worse? Or that it could lead to serotonin syndrome? I've never had anything like serotonin syndrome (before the 20mg Prozac I was on 300mg Luvox, along with the trazodone and Seroquel). I like to think the high dose of trazodone is helping me, but if it's making things worse then I should look at that.

You mentioned a lot about anti-histamines, and I should mention that I am on some of those aside from the psych meds. I take 10mg Zyrtec every night and 4mg chlorpheniramine as needed. These are pretty much only for allergy season. I also occasionally use Alaway eye drops (ketotifen, same as Zaditor). Am I inhibiting too much histamine overall? I don't really understand how histamine and antidepressants go together.

I should clarify that I do not get high or drunk on anything anymore.

Edited by thoughtcrime
clarified that I do not do drugs anymore

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15 hours ago, thoughtcrime said:

Wow, thank you for your very detailed reply! I do take the hydroxyzine for anxiety, but not very often. The trazodone and Seroquel are both for sleep. I know the trazodone dose is high, but that's the only dose that helps (sometimes 300 helps, but usually I have to take the full 400). I find the combination of the two works really well for me and I don't feel too tired in the morning. I've taken z drugs, Ambien works great and Lunesta doesn't work at all. One stretch of time I took them well and didn't abuse them, but this last time I did abuse them and that was a nightmare, so we decided no more of that. As far as benzos go, I was on Ativan 0.5 mg up to 3x daily, never abused them, but then I finally went to rehab for my real drug problem (meth) and they wouldn't let me have it there. After rehab, I moved into a sober-living home and they wouldn't allow me to have the benzos either, so the doc switched me to hydroxyzine. That was over 2 years ago. My anxiety is really good right now, actually. (I've had a lot of therapy). So I don't think I need a benzo and would rather not. I'd also like to stay away from zolpidem, although I do take it when I have sleep studies, which is infrequent.

You're very welcome! I'm glad I could have been of help to you!

Wowzers, I'm very surprised you're still being sedated by that much trazodone! When I was taking trazodone, I had pushed it to the 200 mg limit, and wasn't even being sedated by that. I tried 300 mg once and I felt like I was about to have a heart attack with my heart pounding extremely hard in my chest—never doing that again! lol

Good on you for getting clean and sober! :) That all makes perfect sense and I totally respect that.

As for the other meds... Rozerem is not a scheduled substance and is basically a glorified prescription melatonin supplement (it is a MT1 and MT2 melatonin receptor agonist). Belsomra and Dayvigo are scheduled though, I believe both are Schedule IV, so same as benzos/Z-drugs. I'm not really sure why they're scheduled though because literally nothing about them is potentially "pleasurable" to take as their side effects include potential depression exacerbation and suicidality... Also the REM sleep paralysis and associated frightening hallucinations that can occur if you wake up during an episode of that... no thanks! (Never happened to me with Belsomra, but I did get the increased depression side effect). Anywho, what I'm getting at is if you were open to trying any of those in an attempt to lower your other meds, I'm not sure that your pdoc would allow the Belsomra or Dayvigo.

Really, though, if it ain't broke, don't fix it! lol But I do think that you will have to really watch what dose you get taken up to on Zoloft. 50 mg really may be the highest dose that would be safe to go up to with that much trazodone on board, maybe 100 mg. I'm really not an expert though, I would discuss that with your pdoc for sure.

15 hours ago, thoughtcrime said:

I'm pretty sure I could take less of both trazodone and Seroquel and still sleep ok. My prescription is actually for 300-400mg trazodone, and 100-200mg Seroquel. So sometimes I only take 300 and 100, respectively. I am open to taking melatonin, it has helped before. I don't know if the doc (a psychiatrist) keeps me on that high trazodone just for sleep or if it is also as an antidepressant.

You do you, whatever works most importantly. It's possible that your pdoc is keeping your trazodone that high for a little of both reasons.

15 hours ago, thoughtcrime said:

I didn't understand what you were saying about the interactions and the receptors and all that. Are you saying that trazodone and/or Seroquel could be making my depression worse? Or that it could lead to serotonin syndrome? I've never had anything like serotonin syndrome (before the 20mg Prozac I was on 300mg Luvox, along with the trazodone and Seroquel). I like to think the high dose of trazodone is helping me, but if it's making things worse then I should look at that.

My bad! I tend to get into the super technical stuff about medicines like that.

Basically what I was saying is that the active metabolite of trazodone, mCPP, which is basically another psychoactive chemical byproduct that is produced by your liver breaking the trazodone down, has properties that can cause or worsen anxiety and depression. It also is stimulating, which if levels of mCPP are high enough (with a high enough trazodone dose), can "override" trazodone's primarily sedating effects. Also, when the trazodone dose gets high enough to recruit sufficient serotonin reuptake inhibition (starting around 200 mg, picks up at 300 mg, pretty high at 400 mg and above), it too will become stimulating as serotonin reuptake inhibition itself is stimulating.

As for serotonin syndrome, the combination of trazodone at that dose with a sufficiently high dose of a rather potent SSRI like Zoloft could possibly lead to serotonin syndrome. Prozac at 20 mg is a pretty mild dose (it's the typical starting dose for adults for most indications). If the dose were approaching 60-80 mg Prozac, then it would be time to evaluate possibly lowering the trazodone or holding back on the Prozac at maybe 40 mg I think. That's really quite a lot of Luvox! (Typical max dose actually.) Luvox isn't nearly as potent of an SSRI as Prozac and definitely not as potent as Zoloft, so that's one thing to consider in the equation.

Seroquel, if anything, will improve your depression, especially if you increase the dose to 300 mg, which is the typical "antidepressant" dose, especially if you take the XR form. I think that the hydroxyzine doesn't have much room to do anything though with the Seroquel on board, since both act primarily through blocking H1 histamine receptors (acting as an antihistamine) as well as blocking serotonin 5-HT2A receptors, both responsible for sedation (and weight gain) and anti-anxiety effects. But it's good to know that your anxiety is well managed now!

The trazodone may well be doing just fine for you, really! I think I got tunnel vision when I saw that last night and started overanalyzing everything. I think that your pdoc may be underestimating trazodone's effect on serotonin reuptake inhibition at that dose and its potential to interact with other serotonergic medications. 300 mg Luvox + 400 mg trazodone, while obviously didn't cause you to have serotonin syndrome, is still a pretty risky combo. With Zoloft, which as I said is a way more potent SSRI, you're going to get a lot more serotonin reuptake inhibition per mg out of it than say Luvox. I don't believe that it's as potent mg-per-mg as Prozac, but the way they are dosed, their max doses (Prozac 80 mg and Zoloft 200 mg) work out to be roughly equipotent.

Definitely don't change anything on your own. If you are concerned about your medication, bring your concerns up with your pdoc who should be able to answer any questions you may have. I will say that Zoloft is pretty stimulating, much like Prozac for most people, so you may find yourself needing something a bit extra for sleep anyway. I'm not an expert, but I feel strongly that if you go past 100 mg Zoloft that it would probably be a really good idea to back off on the trazodone a good bit. If you need something for sleep, maybe ask about the Rozerem, Belsomra, or Dayvigo, since they sedate through a totally different mechanism of action that shouldn't be abusable in any way.

16 hours ago, thoughtcrime said:

You mentioned a lot about anti-histamines, and I should mention that I am on some of those aside from the psych meds. I take 10mg Zyrtec every night and 4mg chlorpheniramine as needed. These are pretty much only for allergy season. I also occasionally use Alaway eye drops (ketotifen, same as Zaditor). Am I inhibiting too much histamine overall? I don't really understand how histamine and antidepressants go together.

Oh wow. Well, what's actually kinda interesting here is that Zyrtec (cetirizine) is actually the active metabolite of hydroxyzine (Vistaril, Atarax) (in other words, in the process of metabolizing hydroxyzine, your body produces cetirizine and is released into your system as a result). Zyrtec is less able to cross the blood-brain barrier and into the central nervous system, so you generally have less sedation and other central nervous system side effects associated with H1 receptor blocking.

Chlorpheniramine is another first generation antihistamine like hydroxyzine and diphenhydramine, but it is a bit of an oddball antihistamine for its generation in that it is actually a pretty potent serotonin reuptake inhibitor (surprisingly) and that it completely lacks any affinity for the muscarinic acetylcholine receptors (most of them, like diphenhydramine, block these receptors, and are thus also anticholinergics, which is responsible for their ability to "dry" up a sniffly, runny nose and watery eyes, as well as being useful for overactive bladder and hyperhidrosis, but at the same time, it can go too far and dry out your sinuses and your eyes, cause you to have a very dry mouth and throat, blurry vision on account of causing you do lose your ability to focus and accommodate with your eye's lens muscles, become constipated, and have urinary retention/hesitancy. If it crosses the blood-brain barrier and into the central nervous system, it can cause cognitive side effects like memory loss and focusing/learning problems, and in some people, especially elderly people as well as anyone with dementia, delirium, specifically known as anticholinergic delirium if caused by an anticholinergic). I don't know about clorpheniramine's ability to pass through the blood-brain barrier, but I know that from my experience and from what I've read about it, it tends to be the least sedating first generation antihistamine despite being one of the most potent in its generation, probably since it is a serotonin reuptake inhibitor. Many people use it off-label as a sort of anti-anxiety medicine alternative. 

As for the ketotifen eyedrops, I don't think there's any issue there as I don't believe that crosses into your central nervous system at all.

Do you find that you're having any additional relief with these additional antihistamines? I'm pretty astonished at how much antihistamine you've got going on here! lol

As far as how histamine and antidepressants go together, really, is that it just so happens to be that most of the tricyclics (mainly amitriptyline (Elavil), doxepin (Sinequan, Silenor), and trimipramine (Surmontil), somewhat with nortriptyline (Pamelor), imipramine (Tofranil), clomipramine (Anafranil), and protriptyline (Vivactil)) and the tetracyclics (mostly maprotiline (Ludiomil) and mirtazapine (Remeron), and somewhat with amoxapine (Asendin)) just so happen to be potent antihistamines as well as being serotonin/norepinephrine/dual reuptake inhibitors (in other words, they happen to be both antihistamines and antidepressants). For some people, this is a good thing, like those with agitated depression, anxious depression, and for those who experience psychomotor agitation, insomnia, and anorexia (loss of appetite) as part of their symptoms in depression. But for those who have the opposite problems with their depression—hypersomnia, hyperphagia (excessive eating/binge eating), and/or psychomotor retardation and anergia/lack of energy/motivation—this would be a problem, since it would worsen their depression symptoms more. If someone with this type of depression were going to take an older generation antidepressant, then one of the secondary amine TCAs would be best, like nortriptyline (Pamelor), desipramine (Norpramin), or protriptyline (Vivactil), since they tend to be the most activating and generally have the least affinity/binding to the H1 receptor (least antihistamine effects). On a side note which is somewhat related, many of the atypical antipsychotics, which are being used more and more as an adjunct treatment for major depressive disorder with an antidepressant, as well as being approved specifically for the depressed phase of bipolar disorder instead of just the manic and mixed phases and for schizophrenia, happen to also be very potent antihistamines as well. Combine this with the serotonin 5-HT2C blockade that many of them also have, and you have a recipe for weight gain and appetite stimulation/disinhibition (the 5-HT2C receptor is kind of like one of the "off switches" for the appetite in the brain, and with it now blocked, serotonin can't stimulate it to tell your brain "I'm full!"). The most commonly associated atypical antipsychotics for this problem tend to be clozapine (Clozaril, used only as a drug of last resort due to potentially serious side effects), olanzapine (Zyprexa) (also a potent M3 muscarinic antagonist, which has effects on insulin-secreting β-cells in the pancreas and eventually leads to type-2 diabetes), and quetiapine (Seroquel, Seroquel XR). While Saphirs (asenapine) is both a potent 5-HT2C antagonist and a potent antihistamine, it tends to be more weight friendly than the aforementioned. Ziprasidone (Geodon) has potent 5-HT2C antagonism, but is often weight neutral and may even allow for weight loss if switching from an agent that has caused weight gain (probably due to lack of significant affinity for H1). Risperidone (Risperdal) and paliperidone (Invega) both tend to cause moderate weight gain relative to the first three mentioned, but this is probably more due to the imbalance of hormones, mainly excess prolactin, that they so infamously cause. Others, which tend not to be weight gain offenders can still cause weight gain even though there doesn't seem to be any reason for it, like aripiprazole (Abilify) and Rexulti (brexpiprazole), which are both actually 5-HT2C partial agonists (partially stimulate the receptor instead of antagonize it, but not as much as the endogenous ligand, serotonin, does), don't have significant H1 affinity, and are both dopamine D2 partial agonists as well (D2 antagonism tends to be another mechanism of weight gain but not consistently). Vraylar (cariprazine) tends to be weight friendly, and has no really significant affinity for either H1 or 5-HT2C, but can still cause weight gain and appetite stimulation in some people somehow... I'm sorry if I sort of convoluted that more than I clarified that... I kinda went on a tangent there. lol

Have you tried a leukotrine receptor antagonist like montelukast (Singulair) before? I took that for many years for both asthma and allergies year around until just recently and it worked absolute miracles when nothing else would touch my allergies.

16 hours ago, thoughtcrime said:

I should clarify that I do not get high or drunk on anything anymore.

Duly noted and clearly understood. I didn't think you did.

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Quick update: I got my GeneSight test results in the mail yesterday, and it shows that I have genetic variants which mean I require a higher dose of both trazodone & Luvox (among others) to be effective. So I guess that explains everything. Oh yah, Seroquel too. Although, those prescriptions were all before I did the genetic test.

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      Basically, I don't want to take more than 3 meds (keeping with Lamictal & Ritalin). I want to avoid A/Ps...I like the calming feeling of Prozac & Effexor, but it's as if I am in this fuzzy cloud and I can't move or do anything, comfortably numb. Totally apathetic, in addition to sexual dysfunction, maybe my dosage is wrong. I'm also considering Viibryd, but don't know if it works on Serotonin...?
    • By Britton777
      Hey everyone. I’ve been in a bad way for 4 1/2 years when remeron stopped working for sleep and sudden onset OCD (ruminating thinking, intrusive thoughts, looping songs), treatment resistant insomnia, anxiety- stick in fight flight, panic, 24/7 derealization, brain fog and dizziness set in. Over time with symptoms not going away, depression set in. 
      Obviously my meds were not working. I am on day 11 off Zoloft/remeron after a long taper. I and am wondering when these meds will completely be out of my system. Am I out of the woods yet? Or could withdrawal still jet hard?  I’m hoping these meds are part of my problem and some of this hell I’ve been going through will get better. 
      I have felt bad since discontinuation, but I always feel awful, so not sure what’s what. How long does withdrawal typically last? 
      I’m still on 5 mg lorazepam a day (I know that’s a lot and plan to start weaning when I’m ready) 20 mg geodon X2 and 2 mg prazosin. 
      Wondering if my meds could be doing this to me? 
      Ive been on Zoloft for over 14 years, remeron for 8 1/2 years, lorazepam for 8 1/2 years and geodon for 11 1/2 years. 
      As mentioned, I have been wanting to get off Zoloft/remeron (really all my meds) and have been weaning for months off these two, but have been scared to pull the plug. After reading about MAOI’s, which I have never taken and talking to the doctor, I decided to stop to give me the opportunity to try Nardil, but I’m wondering if less is more may be the ticket for me and maybe I should hold off on trying Nardil. I just don’t know. 
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