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Are there ADs which do NOT target serotonin (i.e. SSRIs, SNRIs), are modern, and also not Wellbutrin?


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I cannot take medications that affect serotonin for any extended period of time. I can handle an Imitrex, but I still get unpleasant side effects. It's just that they go away sooner and also don't result in me being locked in the loony bin for four or five days. Long (but probably familiar) story.... Thanks, Effexor.....  >:\

So anyway, like the title says, are there any modern antidepressants which are not of the SNRI or SSRI class? I know Wellbutrin's an NDRI but I'm not aware of any others like that. 

I've been taking Wellbutrin for a VERY long time. I've taken as much as 450mg/day. I think it makes my baseline slightly less depressed, but as soon as any crappy and stressful life circumstances that would bum out a normal person come swinging my way, I'm pummeled. I've never been *not* depressed for longer than a few days. I don't like my life. I've tried so many medications. My Effexor experience not only damaged my eye, got me fired, and got me locked in a mental ward, it also made me terrified to ever try a new antidepressant again. All those years I suffered.....and it was because doctors were giving me SSRIs and SNRIs. They didn't monitor me. I was losing my mind for years and they didn't even notice. And then the mood stabilizers... they put me on them, then never ever once do my goddamned bloodwork. I was on Lithium and got an intensely horrible full-body burning itching. No one checked my lithium blood levels. I threw them away. One doctor tried to repeatedly get me to take a medication that gave me a rash that indicates this person should NEVER EVER EVER TAKE THIS PILL AGAIN according to all of the medical literature. But her? She tried to give me 3 things that could have killed me. The warning was written on the front of my fucking case file. And she tried to prescribe them anyway. More than once.

Sorry. Went off on a bit of a tangent there. I'm pissed off. My antidepressants don't exactly work.

Are there any promising new antidepressants out there? (ECT is not an option for me) 

 

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Older TCAs, but the efficacy isn't great and the side-effects aren't either. Anti-psychotics would be your dopamine-affecting class of psych meds. Some have a mild/moderate affinity for serotonin, but nothing like SNRI/SSRIs. Some could prove useful for your depression.

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Seconding dtac with regard to the atypical antipsychotics. You could try Abilify or Rexulti or even Vraylar. They do affect serotonin to varying degrees but in a different way than the SSRIs and SNRIs. I never had much of a response to SSRIs or SNRIs, but when Abilify was added, the difference was night and day.

Edited by jt07
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Pdocs seem to like using atypical antipsychotics for BP depression. Seroquel and Latuda are both FDA approved for the purpose. Lamictal is another that is prescribed a lot for BP depression.

You could call these meds antidepressants, as that has become one of their most common uses.

Some doctors avoid conventional antidepressants in BP due to fears of ineffectiveness, manic switching and acceleration of cycling.

Anecdotally, some people seem to benefit whereas others can't handle them. You might be in the latter catagory.

Edited by mcjimjam
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Very rarely will you find an antidepressant that doesn't work on serotonin. I think your options are agomelatine which works on melatonin, bupropion which works on norepinephrine and dopamine, and lamotrigine an anticonvulsant which is used off-label to treat MDD.

I think the question you're looking to ask are what antidepressants are there that don't have any affinity for the serotonin transporter. So this of course would exclude all of the SSRI class as well as most of the tricyclics. Some tricyclics have a higher affinity for the norepinephrine transporter but almost all of them still have SOME affinity for the serotonin transporter. If you want something that is considered an antidepressant but doesn't touch the serotonin transporter like every other antidepressant on the market then your only choice is pretty much just mirtazapine (Remeron). Other than that your only other options are antipsychotics and even some of those have affinities for the serotonin transporter like ziprasidone (Geodon).

Anyone else have any ideas of what would fall under this criteria

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On 6/1/2017 at 5:49 PM, jt07 said:

There is an ADHD medication called Strattera that is an NRI. Other than that, I know of no other that doesn't target serotonin in some way. Why is ECT not an option for you?

Strattera affects SERT quite a bit more than you'd expect.

Outside of the options people have already listed above, the only other thing I can think of that doesn't touch 5-HT much is stimulants, but those are not commonly used to treat depression and when they are used it's generally preferred to use them as adjunctive treatments (alongside antidepressants) instead of direct treatments (except in certain special patient populations). 

Edited by JustNuts
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I would second Strattera, even though it does affect serotonin a bit. I would also recommend a secondary amine tricyclic, like nortriptyline (Pamelor), protriptyline (Vivactil), and especially desipramine (Norpramin) (most selective for the NET over the SERT).

Other than that, like @JustNuts said, you could augment with stimulants.

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