New A/D experiences? Vibryd, Brint & Trintellix, etc?

[cloudmonger]

I'd love some feedback from anyone here that has given fair trials to new antidepressants (like Vibryd, Brintellex, Trintellex, or any others you know?)

Considering moving on from the SSRI's/SNRI's due to sexual side effects, weight gain and apathy. I had good results with Celexa (not too activating, no restlessness or weight gain - but still felt super anhedonic with sexual dysfunction.) This class of drugs is such a mixed bag....

Also, not super excited about trying an older MAO or Tricyclic-type drug that could have even more side effects (more drowsiness, weight gain, metabolic issues + dietary restrictions) A/P's are out for me.

I'd love to find something that works with Dopamine but does not cause weight gain, anxiety, or Akasthia (like Abilify - though I may get desperate to try it again) Unfortunately Wellbutrin has had no effect on me. Ritalin (with it's single/simple action on Dopamine) works really well, but I'd like to gather ideas on something else for everyday/longterm solution (if any).

Any suggestions for an add-on??

[CantEven]

I gave Brintellix/Trintellix a fair shot. Unrelenting nausea for most of the day for like six weeks. I was constantly taking dramamine and eating crystallized ginger with no relief. 

I have heard Viibryd is like an SSRI+Buspar. Mostly good b/c of lack of sexual side effects. 

I was taking Latuda, which seemed to help and had no effect on my appetite. Actually I've lost weight. But I'm not going to pay $900 for something that only helps a little. If I'm going to pay $30 per pill it better cure me.  I called my pdoc and I think she's going to call in Abilify or something. I am willing to try anything at this point.

I keep telling myself that just because something CAN cause weight gain/increased appetite, that does not mean it WILL. So don't write off things that are known to potentially cause that, because they might not for you. 

Edited January 26, 2017 by CantEven

[JustNuts]

On 1/20/2017 at 9:57 AM, cloudmonger said:

I'd love some feedback from anyone here that has given fair trials to new antidepressants (like Vibryd, Brintellex, Trintellex, or any others you know?)

Considering moving on from the SSRI's/SNRI's due to sexual side effects, weight gain and apathy. I had good results with Celexa (not too activating, no restlessness or weight gain - but still felt super anhedonic with sexual dysfunction.) This class of drugs is such a mixed bag....

Also, not super excited about trying an older MAO or Tricyclic-type drug that could have even more side effects (more drowsiness, weight gain, metabolic issues + dietary restrictions) A/P's are out for me.

I'd love to find something that works with Dopamine but does not cause weight gain, anxiety, or Akasthia (like Abilify - though I may get desperate to try it again) Unfortunately Wellbutrin has had no effect on me. Ritalin (with it's single/simple action on Dopamine) works really well, but I'd like to gather ideas on something else for everyday/longterm solution (if any).

Any suggestions for an add-on??

Brintellix was rebranded to Trintellix, not sure if you knew that. Also, methylphenidate is more than just dopamine (norepinephrine is a significant component and there are some other minor receptor actions too), which I wanted to point out specifically because of the norepinephrine component (which is present in some drugs - vortioxetine has a minor NE component, while SNRIs are all norepinephrine reuptake inhibitors to varying extents, and this component tends to be quite usefully activating).

So... Vortioxetine was pretty nifty at first, really strong effects that helped a LOT, but it didn't last long-term for me and the nausea was pretty horrible until I started taking ondansetron. I'd still strongly recommend trying it despite that, it's really quite a unique antidepressant and is definitely worth a try. No experience with vilazodone, but from what I've heard it's not the best choice if you are adverse to typical SSRI side effects. Desvenlafaxine was pretty useless, not much different from venlafaxine (which you've already tried), definitely not worth the price premium - don't bother with it. Levomilnacipran has been decent, it's definitely activating, but if anxiety is an issue for you I would avoid it, starting/titrating it can be a bit rough for a few days following dose increases, and it tends to cause some nausea (much less than vortioxetine though).

Those are all the fancy modern brand-name ones currently on the market unless I missed something. So let's look back at our other options... As far as augmentation goes, it looks like you've given that a decent try. If antipsychotics have helped even a bit in the past, maybe consider trying lurasidone? It has a very nice receptor binding profile that minimizes metabolic/hunger/weight effects. Other than that I'm out of ideas for augmentation assuming everything you listed failed. I can certainly understand your hesitancy to try the old ADs, my one experience with a TCA was a disaster and my pdoc flat-out refuses to prescribe MAOIs or nefazodone.

So you want dopamine but bupropion doesn't work... How about modafinil? Or failing that, maybe you could just stick with the methylphenidate if it helps? I mean, it's a great augmentative agent for depression in certain cases, it just suffers from some nasty tolerance/addictiveness issues that severely limits its use. Amphetamines are also an option, although methylphenidate seems to be generally preferred over them for treating depression. Outside of that you're pretty low on options as far as dopamine goes unless you want to try nefazodone or a MAOI (which you probably don't).

Past that... Well, there's always ECT! And I guess rTMS, although its efficacy is not quite as well proven. I wouldn't consider ketamine viable in its current state though. If you're desperate for options I suppose atomoxetine could be worth a try, but it's not exactly intended for use as an antidepressant and kinda sucks as an ADHD med, so I wouldn't consider it very high on the list of things to try.

And if all that doesn't do the trick, well, therapy is always useful!

12 hours ago, CantEven said:

I gave Brintellix/Trintellix a fair shot. Unrelenting nausea for most of the day for like six weeks. I was constantly taking dramamine and eating crystallized ginger with no relief. 

I have heard Viibryd is like an SSRI+Buspar. Mostly good b/c of lack of sexual side effects. 

I was taking Latuda, which seemed to help and had no effect on my appetite. Actually I've lost weight. But I'm not going to pay $900 for something that only helps a little. If I'm going to pay $30 per pill it better cure me.  I called my pdoc and I think she's going to call in Abilify or something. I am willing to try anything at this point.

I keep telling myself that just because something CAN cause weight gain/increased appetite, that does not mean it WILL. So don't write off things that are known to potentially cause that, because they might not for you. 

Ondansetron (Zofran) works wonders with vortioxetine.

Vilazodone is a SSRI, hence it will be expected to have sexual side effects to some degree.

[Catwoman]

I'm interested in these new antidepressants as well. Like you Cloudmonger I'm not really looking forward to going on a TCA. The pdoc I've spoken to said I could try sertraline (as my third SSRI) but if this one doesn't do anything for my intrusive thoughts he advised me to go on clomipramine (Anafranil). I know it does good things for people with OCD, but for me Luvox and Lexapro did enough, so why would I try a less selective SSRI? I'm very anxious about Zoloft/sertraline not working (I'm on day 25 today with 100 mg), but I'm not familiar with TCA's and I would rather stay in a 'safer' area and try another SSRI. At least I know what I will be dealing with!

Viibryd/vilazodone isn't available where I live, so now I'm just reading up on vortioxetine. My general doctor will probably let me go on Prozac if I'll ask for it. It will take a few failed trials before they switch me to something new like Brintellix/Trintellix. It's like: "Oh she read something on a forum -again-, but most things on forums aren't true, so she just needs to take something we are familiar with".

I'm sorry I can't help you with my own experience on new AD's...I know that is what you're looking for. 

Edited January 27, 2017 by Catwoman

[dtac]

On 1/20/2017 at 9:57 AM, cloudmonger said:

I'd love some feedback from anyone here that has given fair trials to new antidepressants (like Vibryd, Brintellex, Trintellex, or any others you know?)

Considering moving on from the SSRI's/SNRI's due to sexual side effects, weight gain and apathy. I had good results with Celexa (not too activating, no restlessness or weight gain - but still felt super anhedonic with sexual dysfunction.) This class of drugs is such a mixed bag....

Also, not super excited about trying an older MAO or Tricyclic-type drug that could have even more side effects (more drowsiness, weight gain, metabolic issues + dietary restrictions) A/P's are out for me.

I'd love to find something that works with Dopamine but does not cause weight gain, anxiety, or Akasthia (like Abilify - though I may get desperate to try it again) Unfortunately Wellbutrin has had no effect on me. Ritalin (with it's single/simple action on Dopamine) works really well, but I'd like to gather ideas on something else for everyday/longterm solution (if any).

Any suggestions for an add-on??

Depending on what your coverage looks like, Rexulti may be worth a shot. Has a better profile than Abilify, less problems with akathisia, weight-neutral, and it doesn't cause my anxiety to go sky-high like Abilify did.