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Trintellix - Been on 20 mg for a little over a month WHAT TO EXPECT IF ANYTHING?


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Okay, so I've been taking Trintillex (as t involves GABA, Serotonin, Dopamine, Norepinephrine, Acetyl-choline, some others).....this seems to be the most versitile antidepressant on the market. I also take 30 mg Mirtazapine, 20 mg a day of diazepam (pretty worthless....switching from Clonazepam 2 mg per day), 15 mg Olanzapine, beta-blockers for my heart, amphetamine salts (adderall 40 mg XR). So in terms of the efficacy of Trintellix, should I be concerned and am I wasting my money and time since I've yet to really see any true benefit after being on it for 32 or so days at 20 mg? Perhaps a slight shift in mood for the better but NO Anxiolytic effects at all - quite the opposite. I've been on just about every other anti-depressant out there and am extremely TREATMENT RESISTANT and even did a whole therapy of "TMS" treatments costing over 10k or so about two years ago. What are my chances given the scenario? I suffer from MDD, Anxiety beyond belief, insomnia occasionally, Restless Leg Syndrome, OCD to the point of insanity, HPPD, and a slew of other nasty things. Anyway, first time here - just wanted to know if I should hold out hope for this "mega-anti-depressant" or give it up and try another strategy? BTW - interestingly enough, the amphetamine salt combo is MUCH Weaker or so it seems than before I started Trantillex. I should note that I was taking Fluvoxomine or Luvox a really weak pathetic medication 30 years old or so.....but I stayed on it for many years. I'm still tapering off and was at 200 mg..... now - at about 25 mg Fluvoxomine with the rest of my meds. And no serotonin syndrome is not a concern....don't worry about that. Heck, I know what thats like. Its like tripping on LSD. More or less. As far as being on Olanzapine and Mirtazapine I already am underweight and I'm worried if I got off those medicines, I would waste away and no Adderall XR does not effect my weight hardly at all. I've always been very thin. Anyway, thanks now that I've told everyone my life story.....

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Hi @Medicaided Same issue here. I also seem to be treatment-resistant. I've been on Trintillex 20mg for over a month and I swear it's like a placebo. Nada. I mean, my Lamictal is taking care of the major depression, but the everyday low mood, no motivation, anhedonia, lack of pleasure is still there. I might go off of it myself pretty soon as it seems to be pretty useless. I had high hopes for this one as supposedly, the newer AD's have less side effects compared to older ones.

BTW did the TMS treatments do anything at all? My old pdoc suggested that but it's not affordable or covered by my insurance.

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oh damn....yeah you sound the same as me right now .....crap do we have any other really good antidepressants that target a plethora of neurotransmitters? a regular old SSRI ain't gonna do jack and TCA's are worthless. MAOI's well MAOI's are actually VERY effective but you eat a cheeseburger on those you'll pretty much kill over or so I'd presume. So what say ye? anyone anyone? Shall I keep going on this trip or go back to the original cocktail and look for another anti-depressant such as VILAZADONE - ANY THOUGHTS?

 

The TMS treatments sort of gosh how to I put it.....they seemed to help at the time but maybe it was the amphetamine/dextro-amphetamine that made me feel not so much euphoric cannot say... i don't know. But as far as long term solution for depression TMS is not WORTH IT. IT WILL NOT BE COVERED BY INSURANCE TRUST ME. 

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I wouldn't dismiss MAOI's if you really have tried everything.  The diet, once you learn it, is annoying but no big deal.  If it helps you significantly, isn't that a small price to pay?  I tried Nardil and it didn't help me out much.  I'm TRD too.

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Vortioxetine (Trintillex) is not an effective anxiolytic medication, it is only approved for the treatment of MDD, and the scientific literature does not support its use for GAD or any other form of anxiety.

Esketamine is supposed to potentially hit the market in 2018, so that's a major new antidepressant with a novel MOA and strong efficacy that'll be available soon.

You've tried TMS, have you tried ECT? ECT is generally extremely effective for depression. It may be a bit difficult finding someone willing and able to administer ECT though.

Have you tried all of the SNRIs/SSRIs (including levomilnacipran (Fetzima))? Which atypicals (broadly classified as such) other than mirtazapine have you tried? Have you tried MAOIs yet? How about atypical antipsychotics - have you gone through all of the major candidates, or just a few of them? Have you tried mood stabilizers such as lithium, lamotrigine, divalproex sodium (Depakote), etc?

Edited by JustNuts
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IT actually exhibits anxiolytic properties especially when functioning with the GABA neurotransmitters. Interestingly enough, I dropped all the Luvox and for the past week, (plus switching to valium 5mg x 4 a day) I feel quite a bit better but I am sleeping a lot. 

 

ECT scares the living daylights out of me....You know I read and saw the movie "One Flew Over the Cookoo's Nest" (Ken Kesey famous LSD proponent) and I am just frightened to be put under and then have an electrical storm surge through my body and brain. Fetzima I have, to my disadvantage, never even heard of. Esketamine - sounds like it might be molecularly similar to "ketamine" a cat tranquilizer that effects humans much akin to an "out of body" experience. I've heard that Pscilosybin and Ketamine may be used for antidepressants. Of course perhaps add an acetyl group who knows.

I have NEVER tried MAOI's but I hear they are absolutely great. I simply cannot give up my cheeseburgers :)  I already weigh hardly anything at all, I don't want to kill over from eating something that does not agree with an MAOI.

 

Atypicals - mirtazapine, gosh you know perhaps I exaggerated when saying I've tried them all....that is all anti-depressants.....

 

I've tried olanzapine for augmenting the anti-depressant - i'm at 15 mg. however I usually break it into half so around 7.5 mg seems to be okay. Lamectal would perhaps be a good choice what say ye? Lithium, cambarmazepine, anti-convulsants, stuff like that I cannot stand. Depakote was on my list of cocktail meds but after I got off of it, I felt so much better. Honestly, I tend to think Psychopharmacology is in the dark ages and what we have available is total junk. At least for treatment resistant depression such that I have. (and that includes severe anxiety, OCD, i mean every darn neuroses that you could imagine. Plus I have constant LSD flashbacks.  I truly know what INSANITY really is. I've been there. Once you cross that boundary, its no going back....your kind of screwed from then on. Let me just say please people stay away from illicit drugs. they are nothing but horror and suffering.

 

Eskatamine - what else can you tell me about this med? And when you say MOA Do you mean Mono Amine Oxidase? I'm not sure I follow. 

 

And yes my doctor said she would be willing to use ECT. Would ECT actually rewire my neural networks so that I would not have the anxiety, OCD, depression, etc., that I suffer from?

Thanks so much for taking the time to write about this....I would pay millions to get rid of my mental illness. I simply feel like I cannot deal with myself so I am a recluse, no friends, no social life, live with parents, totally NON-Functional or rather dysfunctional to the core. No self-pity just the reality of the situation. My only real therapy is recording music and playing drums, guitar, bass, piano, organ, mandolin, etc., writing my own songs, making albums etc. I'm for sure talented in that arena.

 

Just wanted to say, the same neurotransmitters involved in alleviating anxiety I presumed were also the same as relieving depression? 

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30 minutes ago, Medicaided said:

IT actually exhibits anxiolytic properties especially when functioning with the GABA neurotransmitters. Interestingly enough, I dropped all the Luvox and for the past week, (plus switching to valium 5mg x 4 a day) I feel quite a bit better but I am sleeping a lot. 

The science says otherwise: https://www.ncbi.nlm.nih.gov/pubmed/27143896

There may be some minor anxiolytic properties, but it's agreed that vortioxetine has not been demonstrated as a viable primary treatment for anxiety.

33 minutes ago, Medicaided said:

ECT scares the living daylights out of me....You know I read and saw the movie "One Flew Over the Cookoo's Nest" (Ken Kesey famous LSD proponent) and I am just frightened to be put under and then have an electrical storm surge through my body and brain.

ECT scares me too—anyone in their rightful mind should be scared about a procedure that involves electrically induced seizures—but it's extremely effective for depression, the risks and side effects are quite a bit lower than most people realize, and for treatment-resistant cases, it can be a godsend.

36 minutes ago, Medicaided said:

Fetzima I have, to my disadvantage, never even heard of.

It's a SNRI with a highly unusual 1:2 SERT:NET ratio (the three other major SNRIs used for depression have ratios of 30:1 and 10:1), so it's quite stimulating, although often too much so (many people can't tolerate it due to initially-nasty side effects and the increased anxiety, especially people with significant uncontrolled existing anxiety).

40 minutes ago, Medicaided said:

Esketamine - sounds like it might be molecularly similar to "ketamine" a cat tranquilizer that effects humans much akin to an "out of body" experience. I've heard that Pscilosybin and Ketamine may be used for antidepressants. Of course perhaps add an acetyl group who knows.

Esketamine is the S(+) enantiomer of ketamine. It's formulated as an intranasal spray and indication is being sought for adjunctive use in treatment resistant depression, although it has been designated as a breakthrough drug from the FDA for treatment resistant depression and MDD with associated suicidal ideation, so those indications may be developed as well.

Ketamine itself is known for being a very useful and widely used human/animal anesthetic, a significant drug of abuse (with some nasty side effects in chronic abuse, major risks in abusing it, and several notable deaths of famous people having been associated with its abuse), and being one of the very few rapid-acting antidepressants (exhibiting a completely novel mode of action in the process - a big deal in this field).

55 minutes ago, Medicaided said:

I have NEVER tried MAOI's but I hear they are absolutely great. I simply cannot give up my cheeseburgers :)  I already weigh hardly anything at all, I don't want to kill over from eating something that does not agree with an MAOI.

The dietary restrictions for MAOIs are actually not as bad as you'd expect, and you can eat most processed cheeses while taking MAOIs, it's the aged cheeses that have enough tyramine in them to cause trouble. But if you're already having trouble eating enough, it's certainly reasonable to avoid MAOIs (although low-dose Emsam is exempt from dietary restrictions and is still an option you could potentially consider).

1 hour ago, Medicaided said:

Atypicals - mirtazapine, gosh you know perhaps I exaggerated when saying I've tried them all....that is all anti-depressants.....

Then let me list off the antidepressants often classified as atypicals:

  • bupropion (Wellbutrin)
  • mirtazapine (Remeron)
  • vilazodone (Viibryd)
  • vortioxetine (fluvoxamine
  • trazodone
  • nefazodone (rarely prescribed)

There are some niche drugs occasionally prescribed off-label as antidepressants that could possibly be thrown in the atypical pool, but I've omitted them.

There are also a lot of TCAs out there (and MAOIs, but we'll ignore those). And a ton of SSRIs. And a bunch of SNRIs. I'll list off the SSRIs and SNRIs.

SSRIs:

  • citalopram (Celexa)
  • escitalopram (Lexapro)
  • fluoxetine (Prozac) - can be useful for OCD in high doses.
  • sertraline (Zoloft)
  • paroxetine (Paxil)
  • fluvoxamine (Luvox) - this SSRI is indicated for OCD only in the US but is an effective antidepressant as well.

SNRIs:

  • venlafaxine (Effexor)
  • desvenlafaxine (Pristiq)
  • duloxetine (Cymbalta)
  • levomilnacipran (Fetzima)
1 hour ago, Medicaided said:

I've tried olanzapine for augmenting the anti-depressant - i'm at 15 mg. however I usually break it into half so around 7.5 mg seems to be okay.

Have you tried any other atypical antipsychotics? Other atypical antipsychotics used for augmentation other than olanzapine include:

  • quetiapine (Seroquel)
  • ziprasidone (Geodon)
  • lurasidone (Latuda)
  • aripiprazole (Abilify)
  • brexpiprazole (Rexulti)
  • cariprazine (Vraylar)
1 hour ago, Medicaided said:

Lamectal would perhaps be a good choice what say ye?

Lamotrigine is definitely a good option for augmentation, although an atypical antipsychotic may be a better choice.

1 hour ago, Medicaided said:

Lithium, cambarmazepine, anti-convulsants, stuff like that I cannot stand. Depakote was on my list of cocktail meds but after I got off of it, I felt so much better.

Understandable.

1 hour ago, Medicaided said:

Honestly, I tend to think Psychopharmacology is in the dark ages and what we have available is total junk. At least for treatment resistant depression such that I have. (and that includes severe anxiety, OCD, i mean every darn neuroses that you could imagine.

In some ways it is, but in others it's not. Things were far worse even just a few decades ago. But it's true that they'll only keep getting better as we move forwards, and that treatment options for some things aren't currently all that ideal.

1 hour ago, Medicaided said:

Eskatamine - what else can you tell me about this med?

Gave you most of what I know earlier in this reply. With luck you'll be seeing it released in 2018. If you're interested, there's at least one long-term open-label clinical trial of the drug that's currently recruiting: https://clinicaltrials.gov/ct2/show/NCT02497287

1 hour ago, Medicaided said:

And when you say MOA Do you mean Mono Amine Oxidase? I'm not sure I follow.

Oh, sorry, I meant method/mechanism/mode of action (essentially the way it works), not monoamine oxidase. Acronyms like that can get quite confusing if you're unaware of them or don't catch the context, I should have just written it out since it was a bit overly ambiguous in that context.

1 hour ago, Medicaided said:

And yes my doctor said she would be willing to use ECT. Would ECT actually rewire my neural networks so that I would not have the anxiety, OCD, depression, etc., that I suffer from?

Depression, very likely to see benefit over the short/medium term, but may not be sustained over the long term (however more treatments can be done in that case). Anxiety or OCD - evidence for ECT in those disorders is limited, I'd say the evidence for OCD is a bit stronger than that for anxiety (yet still weak and limited), but I only briefly surveyed the literature.

1 hour ago, Medicaided said:

Thanks so much for taking the time to write about this....I would pay millions to get rid of my mental illness. I simply feel like I cannot deal with myself so I am a recluse, no friends, no social life, live with parents, totally NON-Functional or rather dysfunctional to the core. No self-pity just the reality of the situation. My only real therapy is recording music and playing drums, guitar, bass, piano, organ, mandolin, etc., writing my own songs, making albums etc. I'm for sure talented in that arena.

No problem! I'm always glad to help. We're actually in somewhat similar situations, and one of the numerous things I do to try to distract myself from my problems is research topics like these ones and answer questions on crazyboards.

1 hour ago, Medicaided said:

Just wanted to say, the same neurotransmitters involved in alleviating anxiety I presumed were also the same as relieving depression?

Yes and no. Serotonin is important in depression and anxiety, but GABA is much more specific for anxiety (hence the efficacy of benzodiazepines), and depression-related neurotransmitters such as norepinephrine and dopamine usually increase anxiety (although there are some exceptions - SNRIs for example). Other neurotransmitters involved in anxiety and depression generally have less overlap. This is a major oversimplification and focuses only on the most commonly targeted neurotransmitters.

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