Irene Iesu Posted September 29, 2016 Share Posted September 29, 2016 (edited) My primary problems are a lack of energy/motivation, procrastination, and having a hard time focusing on a task and completing it (I may have ADD) ... I'm currently on Bupropion 200mg + Fluoxetine 20mg. I'm considering if I should switch to Sertraline from Fluoxetine (as I continue Bupropion). Has anyone tried both Fluoxetine and Sertraline? Which worked better for you? I read the article that seems to claim Sertraline has a positive effect on the dopamine level as well. If so, then, does Sertraline give you a lot of energy? The relationship between sertraline and dopamine lies in the unique action that the selective serotonin reuptake inhibitor (SSRI) has on the dopamine pathway. Sertraline possesses the ability to partially block dopamine reuptake pumps. When dopamine pumps become blocked, more dopamine is left to circulate in the synaptic cleft, leading to increased neurotransmission and action. These two substances are often thought of together in psychiatry because sertraline is the only known SSRI that has a significant impact on the dopamine pathway. This additional ability to interact with dopamine is thought to account for the drug’s efficacy and unique effect on depression and other mental illnesses.http://www.wisegeek.com/what-is-the-relationship-between-sertraline-and-dopamine.htm Edited September 29, 2016 by Irene Iesu Link to comment Share on other sites More sharing options...
Wooster Posted September 29, 2016 Share Posted September 29, 2016 So in rats at least, fluoxetine impacts serotonin, norepinephrine, and dopamine all.https://www.ncbi.nlm.nih.gov/pubmed/11919662 I haven't been on fluoxetine. Sertraline has been by go to for quite a while. Eventually it got switched out and then after a few more switches, swellbutrin (bupropion) was great for me. Then we supplemented it with sertraline. That combo does alright by me and my brain soup. Link to comment Share on other sites More sharing options...
albertolobat Posted September 30, 2016 Share Posted September 30, 2016 For me Setraline was extremely activating, up to the point that I wasn't able to sleep and thus I could not tolerate it for more than 4 days. Maybe I should have give it more time but my pdoc chose to suspend it instead. Link to comment Share on other sites More sharing options...
mikl_pls Posted September 30, 2016 Share Posted September 30, 2016 On 9/29/2016 at 1:11 AM, Irene Iesu said: My primary problems are a lack of energy/motivation, procrastination, and having a hard time focusing on a task and completing it (I may have ADD) ... I'm currently on Bupropion 200mg + Fluoxetine 20mg. I'm considering if I should switch to Sertraline from Fluoxetine (as I continue Bupropion). Has anyone tried both Fluoxetine and Sertraline? Which worked better for you? I read the article that seems to claim Sertraline has a positive effect on the dopamine level as well. If so, then, does Sertraline give you a lot of energy? You're right, sertraline does tend to be stimulating and does have an effect on dopamine (slight dopamine reuptake inhibition). However, fluoxetine has an effect on dopamine and norepinephrine too via 5-HT2C antagonism (it essentially cuts the brake line for dopamine and norepinephrine release). So Prozac, too, is stimulating in its on right. Perhaps you aren't dosed high enough to feel the stimulating effects yet? It wasn't until 40-80 mg when I felt fluoxetine's "true colors." 20 mg was nothing for me. So how long have you been on these meds? The reason I ask is that you're below the target dose of bupropion, and you're pretty much at a starting dose of fluoxetine. I can't advise you to do anything with your meds on this site, but I can tell you what I'd do if I were you. If it hasn't been that long, if it were me in your shoes, I wouldn't be looking at switching just yet. You've got some room to go with both your meds. If I were you (which is impossible lol), I would try asking my doc/pdoc if we could at least increase the bupropion to 300 mg and maybe the fluoxetine to 40 mg—it could stay at 20 mg for now, though—and reassess how I felt over the next few weeks. The increase in bupropion might give you that stimulating effect you're looking for. If after that I still didn't feel better, maybe raising the fluoxetine to 40 mg would bring out its stimulating "hues" more. Try that for a few weeks. If I still felt your aforementioned ADHD-like symptoms, I would bring them up to my doc/pdoc (unless you've already done that, in which case I would do it again and remind them that I still have these symptoms), and if they didn't suggest it, then I would ask if a trial of a stimulant would be worthwhile (which shouldn't alarm the doctor or anything, there's nothing wrong with asking for meds). Hopefully, then, they would add either methylphenidate (Ritalin) or dextroamphetamine/amphetamine (Adderall) or a similar stimulant (there are plenty to try!). Tweak the dose of the stimulant. If that still doesn't help, then maybe see about pushing the bupropion to 450 mg and the fluoxetine to 80 mg. If after that, and you're on or close to the max dose of stimulant, maybe give thought to switching meds. The reason I say this is because it's better to stick with the meds you've got, especially if you have room to go up and if you're tolerating them than to switch meds because you don't know what kind of side effects you might get from the new med(s). You can always augment your current regimen to try and boost its efficacy. You don't want to hop on the medi-go-round unless you have to... lol. I will say, though, if you're looking for a "stimulant"-stimulation from sertraline, though, I personally don't think you're going to find it from an SSRI no matter what. You might be able to get a similar stimulation from an SNRI like venlafaxine (Effexor), Pristiq (desvenlafaxine), Fetzima (levomilnacipran), or duloxetine (Cymbalta), and would be even more likely to get something close to it from the selective norepinephrine reuptake inhibitor (SeNRI) Strattera (atomoxetine) or any of the secondary amine tricyclic antidepressants like nortriptyline (Pamelor), desipramine (Norpramin), or protriptyline (Vivactil)—especially protriptyline and desipramine (for me). Fluoxetine and desipramine apparently make a good couple. I don't know about how well they play with stimulants though... might not be safe on your heart. You may need to keep the desipramine dose as low as possible if you were going to combine it with stimulants. Peronally, Zoloft gave me "mental energy," the energy to engage socially, to do things I was interested in, to actually be interested in things. It didn't give me physical energy or anything. I would get that from Wellbutrin or my stimulant. 1 Link to comment Share on other sites More sharing options...
Irene Iesu Posted September 30, 2016 Author Share Posted September 30, 2016 Thank you all for your replies Yes, that was my understanding too, that fluoxetine has an effect on dopamine to some extent, in fact, I thought fluoxetine was the most activating among SSRIs, that's the reason I chose it. I actually thought sertraline was one of the most sedating ones ... but I guess I was wrong. (Though I know the effect of meds totally depends on an individual. Each person reacts in their own way, often experiencing a completely opposite effect from that of others.) The only way for me to know how sertraline works on me (activating or sedating) is to try it for myself. A little bit of my background ... I started taking anti-depressants about a year and a half ago. I went thru escitalopram, fluoxetine, venlafaxine, citalopram ... Escitalopram made me drowsy most of the day, made me calm, but apathetic too, didn't feel any energy which I desperately wanted. I did okay on fluoxetine when I increased the daily dosage to 60mg but I had to discontinue it because I experienced severe dry mouth/throat to the point I'd wake up in the middle of the night and cough for a half hour (even drinking a full glass of water at bedtime didn't help) and that affected my sleep quality ... And then switched to venlafaxine 75mg. I could tell my mood was improved, and wanted to increase to 150mg, but it raised my blood pressure to 150/110, so my doc told me to discontinue ... and put me on citalopram ... which just made me lethargic all the time ... and led me to the bupropion + fluoxetine combo ... I've been on bupropion for over four months now. I've tried both 300mg-XL and 150mg-SR x2/day. Both times, I experienced extra anxiety, irritability, or a hard time falling asleep at night until I reduced the dosage to 150mg-SR 1x/day and added fluoxetine 20mg. I've switched to bupropion 100mg-IR twice a day and I actually like it. I was worried that IR tabs would give me too much energy all at once upon taking (thus make me jittery and excitable) and later I'd have a sudden mood drop ... But no, I don't feel any noticeable ups and downs ... just steady wakefulness and I'm content with the result. I'm definitely considering increasing bupropion to 300mg, and fluoxetine to 40mg, actually, that's exactly what I asked my pdoc at the last session, but she wants me to stay on 200mg+20mg for at least a month ... I'll have to beg her to increase the dosage at the next session! lol ... And then, if that still doesn't give me enough energy and focus, I'll consider switching to sertraline and/or adding different meds. Thanks again to you all. You guys' knowledge of phych meds is amazing, and hearing about firsthand experiences really helps!! Link to comment Share on other sites More sharing options...
Southern Discomfort Posted September 30, 2016 Share Posted September 30, 2016 Yeah I have sertraline to be incredibly activating. I had trouble sleeping (part because my fucking GP didn't tell me when I should be taking it!) and I had elevated mood quite a bit. Link to comment Share on other sites More sharing options...
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