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I will make this as to the point as possible. First time ever posting on blogs, Hoping this place can aid decisions along with psychiatrist. 

I was diagnosed with Depression, Anxiety, and Adhd at age 14. (22yo now) My depression has gone from moderate to bad, to severe over the years. This is not the suicidal, crying every night type of depression. This is a (Complete Lack of motivation, energy, drive, initiation,) type of depression. I oversleep and when i wake up, my life is just grey, and uninteresting. Doing anything takes sooooo much fuckin effort. I litterally cannot hold a job, or do any simple tasks. Life is Overwhelming.

Past medications include, Zoloft, Wellbutrin, cymbalta, remeron, strattera, are the main ones, with little to no benefit, however strattera had the biggest impact on my energy, depression, and motivation. The issue with strattera is that the burst of motivation did not last long. An increase of Strattera equalled 3 weeks of Motivation Boost, followed by nothing (as if i never took the medication.) 

Had a genetic test done that shows i might react better to SNRI's rather than SSRI's. Because of my report of Strattera, my doc now Prescribed Fetzima (Works more on norepinephrine neurotransmitter). I might have Treatment Resistant Depression so he augmented Fetzima with Abilify (2mg), in hopes of them enhancing Each other. 3 months on fetzima, (now max dose of 120mg) i noticed very Minor changes. Which could indicate my TRD. 

Well i Indicated my depression has not improved much so he increased abilify to 4mg. Second day on 4mg and i feel as though its making my Energy and Depression Worse. I really want to stop taking abilify, however i might take it a couple more days to test it out.

 

Here is my Main Question. 

Are there any atypical antipsychotics that do not cause any sedation, or one that causes the least amount of sedation compared to others?

That is basically my only question actually. Feel free to chime in on how Fetzima has worked out for you, and if you have TRD, and have found the right combo that helps you.

Thank You Guys!

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Welcome to the forum.

My story is very similar to yours, except that I was not diagnosed at the age of 14 but carried on my grey life till I was 25 and at a point where I was not suicidal but couldn't care less if I were to suddenly get hit by a car.

Same thing about depression and anxiety, everything is an effort...

To the point:
I have no experience on Fetzima but have been on Milnacipran (Fetzima's parent drug).
It was the exact opposite of sedating - the most activating/energizing med I have ever been on, including Wellbutrin+stimulants combined. Frankly, it was too much for me but it definitely helped with depression.

Generally I found SNRI+low dose AAP to be effective. Higher doses of AAP can cause a flat affect (i.e. "greying out").

If you are looking for a different AAP:
Amisulpride (Solian), if available, can be an effective one with minor side effect profile
Risperidone is sedating above 1mg, but 0.5 was very effective for me when I've been on it.

Stimulants like Ritalin can be useful for the lack of energy.

I would also not rule out Prozac. It is an SSRI with 5HT2C antagonist property, which means it indirectly increases norepinephrine/dopamine.
... and yes, this effect is noticable.

Please update.

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I second Ritalin, best quick acting anti depressant I've found for prn.  I've been on Viibryd for a little over a week, now completely off Lexapro and feeling pretty good. 

Had the genetic test as well.  Added Deplin for the folic acid mutation.  Works very well so far. 

Sorry you feel like this, I only get like that in the winter.. 

Edited by gb84
Brain fart
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Not an ap or aap but some of us with mdd on this board have had luck with an anticonvulsant like tegretol, gabapentin or lamictal 

By all accounts both my own and others, the effects kicked in pretty quick. My symptoms sound almost exactly like yours. Gabapentin takes 3 to 4 days to pull me out of an episode. Still gauging prophylactic use but so far so good. Holding steady 

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seconding low-dose risperidone. 0.75 mg helped me tremendously with motivation, concentration, and ability to see through the grey.

from what i've heard on the boards, fetzima should be quite stimulating (though ymmv, of course. i know at least one member who said they found it sedating). have you noticed much of a boost from it? i've seen a lot of mixed reviews.

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I have TRD, and my magic cocktail is antidepressant + anticonvulsant + atypical antipsychotic. So the backbone of my cocktail listed in my signature is citalopram + Tegretol + Abilify. I do not find Ritalin particularly helpful for motivation because it will give you energy but not the desire to do anything with it. Also, Ritalin is short-acting and can be pretty nasty as it wears off. But it is good for waking up the brain, concentration, and cutting through brain fog.

About Abilify ... Abilify never worked for me until I hit 10 mg and then, wow, did it work. When it works, it is not subtle and you will definitely know it. Abilify is approved for MDD up to 15 mg. Four milligrams is not enough to judge the med by. I urge you to talk to your doctor about it and perhaps consider increasing it up to 10 mg. It's that good. It is the only med that substantially touched my lack of motivation and gave me back an interest in life again.

I also had some luck with low-dose risperidone. It wasn't as good as Abilify, but it did help me at a particularly low period in my life. At low doses, I had no side effects from it at all. It was like taking a sugar pill. But it did help a little.

My anticonvulsant, Tegretol, helps to keep me from falling too far deep into depression and keeps me from becoming suicidal. The fact that it took away all serious suicidal ideation makes it somewhat of a miracle drug for me. However, some have claimed that Tegretol makes them tired and more depressed. That is not the case for me. I find it energy neutral and, as I said, keeps me from falling too far down the rabbit hole. On this med particularly, YMMV.

Good luck.

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Thank you guys so much for the feedback! it really means alot to hear people who understand what I am going through. i am actually tearing up a bit now (rare). I will continue to read over all responses and next time I see my Doc i will print out this article. I instantly feel welcomed here. Iv almost lost all hope and @ HydroCat, i am the same way, i wouldnt mind being hit by a car but am not suicidal in any way.

@gb84  I too am on deplin 15mg. with 5000mcg of vitamin b12. I have not noticed too much of a difference but will continue to take it. 

I will be dropping abilify to 2mg because i did feel flat and more depressed on 4mg. 

@ all other responders - I will defiantly mention the possibility of adding an anticonvulsant and see what my docs, and or swithcin from abilify to another AAP.  

Again thank you guys for the responses i will be checking back in this forum for future responses. 

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I'm currently on an antidepressant+low dose antipsychotic+low dose anticonvulsant and it's working well for me right now. I'm the most stable I've been in quite a while. I feel genuinely glad to be alive.

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18 hours ago, aspillane said:

This is not the suicidal, crying every night type of depression. This is a (Complete Lack of motivation, energy, drive, initiation,) type of depression. I oversleep and when i wake up, my life is just grey, and uninteresting. Doing anything takes sooooo much fuckin effort. I litterally cannot hold a job, or do any simple tasks. Life is Overwhelming.

I totally empathize, this sounds a lot like my depressive phases. I'm bipolar type 2, and have very treatment resistant depressive phases. I am not a professional, so I cannot diagnose, but from my reading and research, this sounds to me like atypical depression, which responds better to stimulating antidepressants. This would be the SSRIs like Zoloft and Prozac, and the SNRIs, which, as you mention later in your post that your genetic test reported that you respond better to, as well as the MAOIs (probably want to save those for a last resort though, although Emsam is pretty friendly to take as far as diet restrictions unless you go past the 6 mg dose). Strattera, being a NRI (technically an SNRI), also do the job, as you mention later in your post. This also could tie in with your ADHD.

18 hours ago, aspillane said:

Had a genetic test done that shows i might react better to SNRI's rather than SSRI's. Because of my report of Strattera, my doc now Prescribed Fetzima (Works more on norepinephrine neurotransmitter). I might have Treatment Resistant Depression so he augmented Fetzima with Abilify (2mg), in hopes of them enhancing Each other. 3 months on fetzima, (now max dose of 120mg) i noticed very Minor changes. Which could indicate my TRD. 

Well i Indicated my depression has not improved much so he increased abilify to 4mg. Second day on 4mg and i feel as though its making my Energy and Depression Worse. I really want to stop taking abilify, however i might take it a couple more days to test it out.

Fetzima was a bad medicine for me, so I can't weigh in as far as that medicine goes.

But Abilify has been a miracle medicine for me. It tends to be more stimulating at lower doses for most people than in higher doses. You could just be very sensitive to it, or maybe it just isn't the right medicine for you. I've heard of one person I know who was zombified by just 2 mg! When I first started it, 2 mg almost induced hypomania for me, but it settled down, and then suddenly pooped out. Then my pdoc increased it to 5 mg, which helped modestly, but pooped out. Went on 10 mg briefly, and pushed to go up to 15 mg, and was hit over the head with the akathisia hammer. But that was the first time I was on it. The second time around I went up much slower and it was a lot better of an experience. 15 mg is my happy spot and while I do have akathisia flare-ups from time to time, they're very benign, and my mood is more stable than I ever remember it being, maybe a little too stable... lol. But I know that's not what you're asking about...

18 hours ago, aspillane said:

Are there any atypical antipsychotics that do not cause any sedation, or one that causes the least amount of sedation compared to others?

IME, AAPs that were not sedating were low doses of Latuda (20-40 mg) and Geodon (20-40 mg 2x/day) and high doses of Rexulti (> 2 mg). Anything higher than Latuda 40 mg or Geodon 40 mg 2x/day was sedating to me, especially Latuda 120 mg or Geodon 80 mg 2x/day. Low doses of Rexulti were not only sedating, but they were flattening and made me more depressed. I'm not the only one who has had that experience, my mom had that happen to her and a friend of mine had that happen to her, @Amethyst674. But others swear by Rexulti, however. So it really varies from person to person. Vraylar was a tiny bit stimulating, I think, but it didn't really help me with depression all that well. That's just my experience though. Others seem to like it on here. Everything else I took was sedating. Haven't had any experience with low dose Risperdal, so I can't weigh in on that, though from what I know of its pharmacology, I don't think it should be sedating. You would probably have to worry about orthostatic hypotension though, theoretically speaking.

I would also second a stimulant, such as Ritalin (or Metadate CD, Concerta, or Focalin/Focalin XR) or an amphetamine-based stimulant such as Adderall, Dexedrine, or Vyvanse. They would help you with both your TRD and your ADHD, which I know at least for me both interact with each other, so perhaps the same could be true for you? You'd have to have your doctor really monitor your pulse and blood pressure, though, because the combination of a stimulant and Fetzima would be very stimulating cardiovascularly.

Another thing to consider would be to add a mood stabilizer, particularly a stimulating one, like Lamictal (lamotrigine). It requires a very slow and steady titration schedule, though, and there is a risk for a deadly skin rash, but people like to hype that up quite a bit. The schedule is 25 mg for 2 weeks, 50 mg in divided doses for 2 weeks, 100 mg in divided doses for 2 weeks, and the target dose is typically 200 mg after that in divided doses, but if you have a response before that, like at 100 mg, you may just take 100 mg. Just something to consider.

Best of luck to you! Let us know how you are doing! :)

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@mikl_pls I am also into pharmacology, more so when I am unbalanced and more ocd-ish.

Risperidone is an inverse agonist of Histamine H1 but with lower affinity than to dopamine/serotonin. I guess that with higher doses this becomes sedating in a more pronounced way.

I really liked this one, changed to Abilify because of high blood cholesterol levels, which turned out to be unrelated. Trying to change back did not work as expected.

FWIW, Lamictal is a miracle drug for me.

Edited by HydroCat
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I have TRD and Lamictal is the backbone of my cocktail (low dose 100mg). It has caused the least amount of side effects, no sedation or weight gain. Its a container that "holds" me. Keeps me from feeling distressed and prevents suicidal ideations.

As far as A/Ds, SNRIs are less sedating for me. I'm currently on Effexor, which has literally demolished the deeper depression and negative ruminations. I feel soooooooo calm and collected. But After 7 months though, I am feeling too apathetic on it.

Ritalin has been great for me. Moreso in the beginning. Unfortunately, you become tolerant very quickly. When I started, I was soooo focused and driven, productive, motivated and literally would "pop" out of bed within an hour of taking it (the instant release). Over time, it works less and less (or you get used to the effect). It mainly helps "clear brain fog" and helps you focus on 1 thing (feel less scattered and disorganized). I take the extended release, because sometimes you feel a noticeable crash/drop when the IR wears off (in only 2-3 hours).

 

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9 hours ago, Blahblah said:

I have TRD and Lamictal is the backbone of my cocktail (low dose 100mg). It has caused the least amount of side effects, no sedation or weight gain. Its a container that "holds" me. Keeps me from feeling distressed and prevents suicidal ideations.

As far as A/Ds, SNRIs are less sedating for me. I'm currently on Effexor, which has literally demolished the deeper depression and negative ruminations. I feel soooooooo calm and collected. But After 7 months though, I am feeling too apathetic on it.

Ritalin has been great for me. Moreso in the beginning. Unfortunately, you become tolerant very quickly. When I started, I was soooo focused and driven, productive, motivated and literally would "pop" out of bed within an hour of taking it (the instant release). Over time, it works less and less (or you get used to the effect). It mainly helps "clear brain fog" and helps you focus on 1 thing (feel less scattered and disorganized). I take the extended release, because sometimes you feel a noticeable crash/drop when the IR wears off (in only 2-3 hours).

 

Interesting, I've never tried ER Ritalin before.  Generally my AM dose of 40mg Ritalin lasts about 8 hours then I take another 20mg.  I haven't really noticed a crash but I can definitely tell when it's worn off.  Do you like the ER version better, or have you become tolerant to that as well?  Does the ER version take longer to kick in.?

Edited by gb84
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Outside of Abilify, Risperdal, and maybe Latuda, you're going to have a hard time finding an AP that's not at least somewhat sedating, at least within the family of SGA's (second generation antipsychotics). 

FGA's like Thorazine, Haldol, etc. are known for less sedation than SGA's, but also come with their own unique side effects you might not find pleasant either. Plus, they're straight D2 blockers and known even less for anti-depressant properties than newer SGA's.

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On 5/22/2018 at 12:10 PM, gb84 said:

I second Ritalin, best quick acting anti depressant I've found for prn.  I've been on Viibryd for a little over a week, now completely off Lexapro and feeling pretty good. 

Had the genetic test as well.  Added Deplin for the folic acid mutation.  Works very well so far. 

Sorry you feel like this, I only get like that in the winter.. 

Hi, did the genetic test tell you what meds should work best?

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14 minutes ago, GettingUpThere said:

Hi, did the genetic test tell you what meds should work best?

Well, as I now understand it, the test isn't about which meds should work best, but how the body metabolizes the drug.  That said, Viibryd is working really well for me and the addition of L-Methylfolate has helped as well.  I wouldn't have known about either's potential without the test. 

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3 minutes ago, gb84 said:

Well, as I now understand it, the test isn't about which meds should work best, but how the body metabolizes the drug.  That said, Viibryd is working really well for me and the addition of L-Methylfolate has helped as well.  I wouldn't have known about either's potential without the test. 

Actually what I meant to ask is, my pdoc did the test and told me the results only tell you how your current meds work but nothing about how other meds may  work. Does that sound right? Or should I doctor shop?

4 minutes ago, gb84 said:

Well, as I now understand it, the test isn't about which meds should work best, but how the body metabolizes the drug.  That said, Viibryd is working really well for me and the addition of L-Methylfolate has helped as well.  I wouldn't have known about either's potential without the test. 

And then all she would say is that all the meds I’m on are in the green or something. That they’re all “ok” for me? Can it be any more vague?

Edited by GettingUpThere
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19 minutes ago, GettingUpThere said:

Actually what I meant to ask is, my pdoc did the test and told me the results only tell you how your current meds work but nothing about how other meds may  work. Does that sound right? Or should I doctor shop?

And then all she would say is that all the meds I’m on are in the green or something. That they’re all “ok” for me? Can it be any more vague?

I don't know what your Dr. ordered for the test to show.  But on mine it had current meds listed as well as ones I had tried, and others that I hadn't.  

Viibryd for example, was in the green, while Lexapro was in the red.  I had been on Lexapro for almost 6 years with no real results..  

I don't want to give you any advice about whether or not you should stay with your current Dr.  Did you get a copy of your report? 

Edited by gb84
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Just now, gb84 said:

I don't know what you're Dr. ordered for the test to show.  But on mine it had current meds listed as well as ones I had tried, and others that I hadn't.  

Viibryd for example, was in the green, while Lexapro was in the red.  I had been on Lexapro for almost 6 years with no real results..  

I don't want to give you any advice about whether or not you should stay with your current Dr. 

Okay, fair enough. Thanks for the replies. Have a good weekend. 

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Sorry for the delay guys finally saw the pdoc. Genetic test shows I react better to snri rather than ssri. With a variety of other jargon. Shows deplin might be effective to take. 

So here's what I'm doing now. Dosing off fetzima to get on viibryd, also starting Lamictal, and staying on abilify 2mg. I am currently in the process of dosing off fetzima and starting Monday I will take viibryd. It was approved for PA. BTW. For some reason viibryd was in the green. My pdoc described the drug as a sort of an ssri +, as it works a bit differently than most ssri's. 

My main goal is for the combo of viibryd, Lamictal, abilify, and deplin to help with my energy.

I could care less about my anxiety, side effects, sexual libido, sleep, everything else. If my energy and and motivation improve I call it a win for me. 

My fingers are crossed, getting tired of trying all these meds with little improvement. After 2 weeks of being of viibryd I will update this thread with hows its working. 

Again thank you all for taking time to respond it means the world to me. 

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