There is a certain irony here:
"Ugh, tricyclics! Low selectivity for the serotonin transporter over the noradrenaline transporter, and what's with all the antagonism at histamine, alpha and 5HT2A receptors? Dirty stuff! Thankfully this is the 90's, and we have Selective Serotonin Reuptake Inhibitors!"
"...eh, maybe you do need a bit of a noradrenaline boost on top. Thankfully this is 2000, and we have SNRI's!"
"...and maybe it would be nice to have some histamine/5HT2-antagonism-mediated anti-anxiety action, too. It's 2010, try some Seroquel or Mirtazapine on top of your antidepressant!"
"...and we do want some alpha1-adrenergic receptor antagonism to normalize the HPA axis! And some FIASMA / BDNF would be nice. R&D, get started! It's 2018!"
"...or just have a tricyclic."
I would not be surprised if they try to market anticholinergics as new groundbreaking anxiolytics in a few years from now...
I've been taking Sertraline (50mg daily) for 9 months now.
Reason for taking Sertraline: Depression & SAD. Maybe some GAD.
So Sertraline treats my baseline anxiety quite well, also got rid of digestion problems, but I am struggling with side effects:
Motor restlessness, agitation. I've always been quite "hyperactive", but Sertraline has worsened it by a good amount. I cannot sit still, I feel I have to walk, to pace. I move my fingers and toes to "release" some of the energy. Also lots of fidgeting, rocking back and forth. I have the urge to crawl out of my skin.
_ Indifference, amotivation, apathy, lethargy. I get less things done on Sertraline than before Sertraline. Just want to sit around and do nothing. It is really disconcerting, because things would happen like a major car malfunction or someone f*ck*ng me over and I'd be thinking "this SHOULD piss me off, but, meh.. whatever.."! I've been doing some reading & research and there is the hypothesis that SSRI-induced-stimulation of 5HT2C & 5HT2A receptors dampens the dopaminergic transmission in the prefrontal cortex thus causing these specific SSRI side effects. Antagonism / Inverse Agonism of these receptors should theoretically resolve the problem. What medications do antagonize / inverse agonize these receptors? Are there any other reliable theories on what is causing this? And what could help?
_ Sleep disturbances, f*ck*d up sleep cycle, crappy sleep. Falling asleep is difficult, shallow sleep, waking up a lot in the night => daytime fatigue. (This week I've been sleeping a lot, maybe because the body wants to compensate for last months's bad sleep?)
_ Heat intolerance + hot flashes. My entire life I've been loving warmth and heat. I was the guy who could sit at the top row in the sauna for 20min @ 100°C (212 °F), but right now I cannot even stand a mild summer. And I have been getting hot flashes lasting between 10-15 mins several times a day (I am a 29 year old male, so pretty sure it is not menopause related)
_ I also lost quite a bit of weight, partially due to loss of appetite, but also due to increased metabolic rate. My appetite is back to normal, but I am still not gaining any weight. BMI 20 right now.
_ Palpitations (BUM BUM BUM BUM. BUM . . . BUM . . . BUM)
_ mild headaches and "pressure" in my neck. Nothing bad, but very annoying in the mid and long term. Now I don't know what to do. I need some meds with "less" side effects. I haven't tried any combination of medications yet. To my dismay my doc prefers the SSRI merry go around aka SSRI carousel. I found a new psychiatrist and I will have a first appointment in about a month, but I don't know what to suggest to him. Has anybody some experience with a similar situation? Which antidepressant would be suitable for me? If there is someone who had the same problem and found some solution: please write me. Thank you. Greetings from Germany!
Just a poll to see what your take is on MAOI's or TCAs (for Depression)...which do you prefer, and WHY? Both are not the 1st line of treatment (says my pdoc) she is hesitant to suggest either, but i have not tried either class.
Is one or the other more helpful and are they worth the side effects? (I've heard both have pain-in-the-butt side effects but why not try)
Anyone have experiences on the reversible-MAOI Meclobemide (aka Manerix)? Apparently it’s not in the US (but in Europe, Australia & everywhere else). I cannot seem to get much info on this drug but from Wikipedia - seems like a promising choice for someone that has gone through most all the SSRIs, SNRIs, A/Ps etc.
Of 2300 people in multiple clinical trials who were treated with moclobemide in doses up to 600 mg with no dietary restrictions, none experienced a tyramine-mediated hypertensive reaction.
Moclobemide is tolerated to a similar degree to the SSRI antidepressants, although unlike SSRIs, moclobemide does not cause sexual dysfunction and gastrointestinal disturbance is less common. Moclobemide has been found to be superior to tricyclic and irreversible MAOI antidepressants in terms of side effects, as it does not cause anticholinergic, sedative or cardiovascular adverse effects as well as not causing weight gain.
Unlike the irreversible MAOIs there is no evidence of liver toxicity with moclobemide. Moclobemide has a similar efficacy profile compared to other antidepressants but is significantly superior to the tricyclic antidepressants and the classic (unselective or irreversible) MAOIs, in terms of tolerance and safety profile.
Below, Per “Dr. Bob” (though I can’t vouch for this source) : http://www.dr-bob.org/tips/split/Experience-with-moclobemid.html
“Moclobemide is the most frequently prescribed antidepressant in psychiatric practice in Finland. According to a Finnish double-blind multicenter trial, it was as good as or better than fluoxetine in all aspects when treating major depression (DSM-III-R criteria). Moclobemide was better in patients with atypical features.”
“Further useful for the group of patients who might benefit from MAOIs but are too frightened of a possible hypertensive crisis to proceed with a trial of standard MAOIs.”
“I now use this drug as a first choice in Depression (usually mild to moderate depression in my practice). It is usually remarkable in the absence of any exciting side effects (not much to talk about sometimes!)”