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Only Day 2 back on Effexor (I took previously for 7 months at 150mg, but don't remember much). I've literally been laying in bed, blank-minded, just staring at the wall for 3 hours. This is really not normal for me, I slept well last night (9 hours) and was up, OK & out walking earlier. I'm only on 37.5mg!...It's only Day 2! I'm shocked that I would feel effect immediately.

Haven't felt this tired, heavy and zoned out for a loooong time. In fact, I don't recall feeling this numb since Citalopram or when I was on Cymbalta a decade ago. I've been consistently taking Ritalin , I had 3 coffees today....and the Effexor (obviously) has completely wiped out any stimulant effect.

I mean, it's nice to not be over-emotional, stressed with crying jags, but on other hand, I don't want to be flatlined, lifeless, unable to get out of bed, no cares about anything. Please tell me this is temporary and will go away in 1-2 weeks or with a dose increase??  Does anyone know the dosage breakdown of Effexor? (for example: 37mg-75mg works on Serotonin....75mg-150mg works on Norepinephrine, etc?) I feel Serotonin overload, I thought that Effexor worked on 3 transmitters at once...

I can't seem to find the right combo balance with anything (all SSRIs made me feel like this too) and many other meds are too sedating or they do nothing for me. Any thoughts? @browri  @mikl_pls ?

Edited by Blahblah

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20 hours ago, Blahblah said:

Only Day 2 back on Effexor (I took previously for 7 months at 150mg, but don't remember much). I've literally been laying in bed, blank-minded, just staring at the wall for 3 hours. This is really not normal for me, I slept well last night (9 hours) and was up, OK & out walking earlier. I'm only on 37.5mg!...It's only Day 2! I'm shocked that I would feel effect immediately.

Haven't felt this tired, heavy and zoned out for a loooong time. In fact, I don't recall feeling this numb since Citalopram or when I was on Cymbalta a decade ago. I've been consistently taking Ritalin , I had 3 coffees today....and the Effexor (obviously) has completely wiped out any stimulant effect.

I mean, it's nice to not be over-emotional, stressed with crying jags, but on other hand, I don't want to be flatlined, lifeless, unable to get out of bed, no cares about anything. Please tell me this is temporary and will go away in 1-2 weeks or with a dose increase??  Does anyone know the dosage breakdown of Effexor? (for example: 37mg-75mg works on Serotonin....75mg-150mg works on Norepinephrine, etc?) I feel Serotonin overload, I thought that Effexor worked on 3 transmitters at once...

I can't seem to find the right combo balance with anything (all SSRIs made me feel like this too) and many other meds are too sedating or they do nothing for me. Any thoughts? @browri  @mikl_pls ?

Effexor is generally serotonin-only until you start reaching 150mg. Then it starts hitting norepinephrine, which is dose-dependent above 150mg to about 225-300mg where it starts to also hit dopamine.

So basically at 37.5mg, it's just another SSRI. You have to really get to 150mg before it's meaningfully different than SSRIs.

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1 hour ago, browri said:

Effexor is generally serotonin-only until you start reaching 150mg. Then it starts hitting norepinephrine, which is dose-dependent above 150mg to about 225-300mg where it starts to also hit dopamine.

So basically at 37.5mg, it's just another SSRI. You have to really get to 150mg before it's meaningfully different than SSRIs.

That's what I figured. Ugh. Is Cymbalta basically the same in this regard? Do you know if increasing my stimulant would help with the lethargy? Maybe I could do this until I hit 150mg.

I'm worried whether the norepinephrine will be a good thing for me or not....norepinephrine is to mobilize the brain and body for action, so essentially it's like the adrenalin  fight or flight response, right? Putting pressure on the adrenals. Wouldn't this cause one to feel MORE stressed? heart racing, restlessness, increased blood pressure, etc. I'm bummed that Id have to take over 200mg to hit dopamine. Would take many months if I ever needed to wean off it. 😞

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2 hours ago, Blahblah said:

Is Cymbalta basically the same in this regard?

No actually not. Cymbalta is quite balanced between serotonin and norepinephrine and you can achieve noradrenergic response across most of the dose range. However, unlike Effexor as well, it does not appreciably touch dopamine even at the highest doses. That's not to say there won't be enhancement of dopaminergic activity. There's cross-conversion between norepinephrine and dopamine and an increase in one can induce a downstream increase of the other, but Cymbalta doesn't DIRECTLY affect dopamine reuptake.

2 hours ago, Blahblah said:

Do you know if increasing my stimulant would help with the lethargy? Maybe I could do this until I hit 150mg.

I would think so. 20mg is a smallish dose of Ritalin. Have you ever tried Focalin? If amphetamine-based stimulants aren't an option for you but you need more oomph out of your Ritalin then generic Focalin (dexmethylphenidate) is more potent by weight. 20mg of D-methylphenidate is fairly equivalent to 40mg of methylphenidate by potency. And it would only need to be taken once a day.

2 hours ago, Blahblah said:

I'm worried whether the norepinephrine will be a good thing for me or not....norepinephrine is to mobilize the brain and body for action, so essentially it's like the adrenalin  fight or flight response, right? Putting pressure on the adrenals. Wouldn't this cause one to feel MORE stressed? heart racing, restlessness, increased blood pressure, etc. I'm bummed that Id have to take over 200mg to hit dopamine. Would take many months if I ever needed to wean off it. 😞

This does indeed seem counter-intuitive. Why would you ever want to ramp up adrenergic response in people who need an anxiolytic effect? Well there's two ways to deal with anxiety. You either throw benzos or Buspar at it, hope they stick, and you don't develop an addiction to the former, OR you ramp up the adrenergic system to desensitize the body to the normal adrenergic response. Basically, when you have a panic/anxiety episode, your adrenergic system starts activating, because your body isn't used to this, you experience acute somatic anxiety (physical symptoms) that stresses the body. When you take a norepinephrine reuptake inhibitor, you increase the baseline adrenergic signaling to basically deflate the response you would normally have during an anxiety episode. You may consistently feel an increased heart rate or slightly higher blood pressure, but because of that, the body's normal chemical response to stressful situations is lost on the individual because adrenaline no longer really fazes them.

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2 hours ago, browri said:

I would think so. 20mg is a smallish dose of Ritalin. Have you ever tried Focalin? If amphetamine-based stimulants aren't an option for you but you need more oomph out of your Ritalin then generic Focalin (dexmethylphenidate) is more potent by weight. 20mg of D-methylphenidate is fairly equivalent to 40mg of methylphenidate by potency. And it would only need to be taken once a day.

This does indeed seem counter-intuitive. Why would you ever want to ramp up adrenergic response in people who need an anxiolytic effect? Well there's two ways to deal with anxiety. You either throw benzos or Buspar at it, hope they stick, and you don't develop an addiction to the former, OR you ramp up the adrenergic system to desensitize the body to the normal adrenergic response. Basically, when you have a panic/anxiety episode, your adrenergic system starts activating, because your body isn't used to this, you experience acute somatic anxiety (physical symptoms) that stresses the body. When you take a norepinephrine reuptake inhibitor, you increase the baseline adrenergic signaling to basically deflate the response you would normally have during an anxiety episode. You may consistently feel an increased heart rate or slightly higher blood pressure, but because of that, the body's normal chemical response to stressful situations is lost on the individual because adrenaline no longer really fazes them.

@browri  You're such a wealth of knowledge! Thank you!  I've only ever tried Ritalin (ridiculously difficult for me to get with no ADD history) I think getting Adderall would be tough. So Focalin sounds possible, a more potent version of Ritalin, but same class (and extended)? I take 20mg (extended) and sometimes 10(IR) in afternoon, but the IR makes me feel crashy and quickly wears off, so I usually just stick to extended.

That is really interesting about the adrenergic desensitization response. Anxiety is not really an issue for me at moment, I get these intense mixed/dysphoric bouts easily. I guess I was just thinking that the norepinephrine could potentially cause anxiety or stress by flooding the adrenal system. I usually don't experience much anxiety, yet physically, I can see that Effexor already makes me sweat a hell of a lot more... And it's only been 3 days.

I'll try upping my Ritalin to see if it balances the lethargy a bit. I always thought Effexor was a stimulating antidepressant, and surprised I feel so dulled and lethargic on it. I see my motivation completely drained already. I guess a higher dose will be different. Thanks again!

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17 hours ago, Blahblah said:

@browri  You're such a wealth of knowledge!

Why thank you! Glad to be of service ^_^

17 hours ago, Blahblah said:

Thank you!  I've only ever tried Ritalin (ridiculously difficult for me to get with no ADD history) I think getting Adderall would be tough. So Focalin sounds possible, a more potent version of Ritalin, but same class (and extended)? I take 20mg (extended) and sometimes 10(IR) in afternoon, but the IR makes me feel crashy and quickly wears off, so I usually just stick to extended.

Yeah it can be difficult to get stimulants if you can't get an ADHD diagnosis, which is why I went and got one. My pdoc had been treating me for bipolar disorder, and over the months and years he had been treating me, I would have an ongoing conversation with him about focus/concentration issues (NOT energy and motivation). By the time we stabilized my mood, I hadn't had a depressive or a hypomanic blip in a while yet I was still having issues staying focused. Very well may be med fog caused by the mood stabilizers, but the fact remains that when my mood is stable, I'm still left with ADHD-related symptoms, which you really shouldn't attempt to address until the mood is stable.

So I got to a point where i brought it up again and he gave me an ADHD assessment questionnaire for adults. I simply filled it out, he looked at it, and then he wrote for Adderall IR. We used the IR form to determine my best daily dose that was enough to stimulate me and improve my executive function but not make me jittery or trigger hypomania, then we converted to the Adderall XR at about 20mg. But then after a while I was complaining of afternoon poop-out, which is quite common for Adderall, so I asked to be switched to Vyvanse. Depending on the time of year and my dose of Trintellix, my Vyvanse dose floats somewhere between 30mg and 40mg. I've been on it ever since.

And yes, your assessment is correct. Ritalin is methylphenidate. Focalin is just the dextro (right) half off the methylphenidate molecule (dexmethylphenidate), which has most of the pharmacological effect. I found that Focalin lasted a good portion of the day more like Vyvanse than like Adderall which pooped out around 1PM or 2PM.

17 hours ago, Blahblah said:

That is really interesting about the adrenergic desensitization response. Anxiety is not really an issue for me at moment, I get these intense mixed/dysphoric bouts easily. I guess I was just thinking that the norepinephrine could potentially cause anxiety or stress by flooding the adrenal system. I usually don't experience much anxiety, yet physically, I can see that Effexor already makes me sweat a hell of a lot more... And it's only been 3 days.

Well keep in mind that even in bouts of dysphoria, there can be an adrenergic response that creates somatic symptoms of anxiety like a tight stomach or an ache in your chest. A norepinephrine reuptake inhibitor can desensitize these kinds of reactions.

17 hours ago, Blahblah said:

I'll try upping my Ritalin to see if it balances the lethargy a bit. I always thought Effexor was a stimulating antidepressant, and surprised I feel so dulled and lethargic on it. I see my motivation completely drained already. I guess a higher dose will be different. Thanks again!

Effexor generally is stimulating, but more so at >150mg. 37.5mg and even 75mg are too low to get an appreciable amount of stimulation.

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10 minutes ago, browri said:

So I got to a point where i brought it up again and he gave me an ADHD assessment questionnaire for adults. I simply filled it out, he looked at it, and then he wrote for Adderall IR. We used the IR form to determine my best daily dose that was enough to stimulate me and improve my executive function but not make me jittery or trigger hypomania, then we converted to the Adderall XR at about 20mg. But then after a while I was complaining of afternoon poop-out, which is quite common for Adderall, so I asked to be switched to Vyvanse. Depending on the time of year and my dose of Trintellix, my Vyvanse dose floats somewhere between 30mg and 40mg. I've been on it ever since.

And yes, your assessment is correct. Ritalin is methylphenidate. Focalin is just the dextro (right) half off the methylphenidate molecule (dexmethylphenidate), which has most of the pharmacological effect. I found that Focalin lasted a good portion of the day more like Vyvanse than like Adderall which pooped out around 1PM or 2PM.

Thanks for your help @browri I upped my ritalin today to 30mg and was doing fine for 4-5 hours. Now super tired and hungry. It used to last longer but then again, I've been on it now consistently for a year. I guess I either add a post-lunch dose, or switch to something above with better coverage. Especially because the Effexor is going to be adding to my mental fogginess and lethargy. The cognitive boost really helps me a lot to function.

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for the record, effexor isn't stimulating at all for me, and actually sedates me pretty significantly. i actually like that, though, because it totally knocks out my anxiety and day-to-day jitters, and has me sleeping like a rock. it does mean that i'm reliant on coffee to get going in the morning, though, and my body appreciates a mid-day nap when i can swing it.

the sleepiness was more acute when i started effexor (cue flashbacks to falling asleep in lectures...) but obviously it never totally wore off for me. i believe it got better for me after i reached my target dose (225 mg), but i also adapted better and found ways to minimize the sleepiness.

it's a really good med for me. i hope it works out for you, too. 

also, @browri, thank you for sharing your knowledge! very interesting stuff.

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On 5/9/2019 at 12:34 PM, browri said:

And it would only need to be taken once a day.

Just figured I'd mention that dexmethylphenidate (Focalin) instant-release is usually taken twice daily, but the Focalin XR is the once daily formulation.

4 hours ago, browri said:

Effexor generally is stimulating, but more so at >150mg. 37.5mg and even 75mg are too low to get an appreciable amount of stimulation.

This. But personally, I didn't get any stimulation out of it until 375-450 mg. But it takes a lot of anything to do anything for me... lol.

4 hours ago, Blahblah said:

Thanks for your help @browri I upped my ritalin today to 30mg and was doing fine for 4-5 hours. Now super tired and hungry. It used to last longer but then again, I've been on it now consistently for a year. I guess I either add a post-lunch dose, or switch to something above with better coverage. Especially because the Effexor is going to be adding to my mental fogginess and lethargy. The cognitive boost really helps me a lot to function.

If your Ritalin is 10 mg tablets, you could try dividing your dose into 3x/day (one in AM, one at noon-ish, one around suppertime) for 30 mg.

If you have them available where you live, you could try a higher dose of an extended release methylphenidate (other than Ritalin SR or Ritalin LA because they're kinda crappy) and possibly add on a low-dose Ritalin IR dose as needed up to 2-3x/day. Like Metadate CD 40 mg + Ritalin 5 mg 2-3x/day as needed or 10 mg 2x/day as needed.

Also, switching to an amphetamine product may produce a better response. It works entirely differently with different mechanisms of action, and they are more potent than methylphenidate. (10 mg dextroamphetamine = ~20 mg methylphenidate).

Also, I second possibly giving dexmethylphenidate (Focalin) or the ER version a try.

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53 minutes ago, mikl_pls said:

Just figured I'd mention that dexmethylphenidate (Focalin) instant-release is usually taken twice daily, but the Focalin XR is the once daily formulation.

Oh that's right I totally forgot they bothered making an IR of Focalin. Guess it was an opportunity to make more money. Come out with IR first even though you know it should have been XR from the get-go lol.

53 minutes ago, mikl_pls said:

 switching to an amphetamine product may produce a better response. It works entirely differently with different mechanisms of action, and they are more potent than methylphenidate. (10 mg dextroamphetamine = ~20 mg methylphenidate).

OP said that because they don't technically have an ADHD diagnosis and that the Ritalin is technically being used as an augment for fatigue it would be hard for them to get anything amphetamine based.

53 minutes ago, mikl_pls said:

Also, I second possibly giving dexmethylphenidate (Focalin) or the ER version a try.

Definitely. Might give you the kick you once had with Ritalin. And like I said, the XR actually does last pretty long unlike Adderall XR.

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7 hours ago, browri said:

Oh that's right I totally forgot they bothered making an IR of Focalin. Guess it was an opportunity to make more money. Come out with IR first even though you know it should have been XR from the get-go lol.

OP said that because they don't technically have an ADHD diagnosis and that the Ritalin is technically being used as an augment for fatigue it would be hard for them to get anything amphetamine based.

Definitely. Might give you the kick you once had with Ritalin. And like I said, the XR actually does last pretty long unlike Adderall XR.

Then perhaps the long-acting methylphenidate + instant-release methylphenidate as needed plan might be more feasible; if not that, then at least just a long-acting methylphenidate at a higher dose.  

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Hi @browri @mikl_pls Up to 112mg Effexor now. Ugh. What a long annoying titration. I feel lethargic, blah, sweaty and more hungry. Basically same feeling on SSRIs. Pdoc is out of town, so I can't increase my stimulant (and I don't feel it working much at all now)

I know I need to get up to around 200mg+ to get out of the Serotonin range, but question:

How long do I need to take around 225mg to know if it's really going to help me?? Do I need to stay at that dose for like 6 weeks?? I'm small and usually sensitive to meds, so I doubt I'll need to increase a lot higher than that.

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7 hours ago, Blahblah said:

Hi @browri @mikl_pls Up to 112mg Effexor now. Ugh. What a long annoying titration. I feel lethargic, blah, sweaty and more hungry. Basically same feeling on SSRIs. Pdoc is out of town, so I can't increase my stimulant (and I don't feel it working much at all now)

I know I need to get up to around 200mg+ to get out of the Serotonin range, but question:

How long do I need to take around 225mg to know if it's really going to help me?? Do I need to stay at that dose for like 6 weeks?? I'm small and usually sensitive to meds, so I doubt I'll need to increase a lot higher than that.

You'll know if it's going to help you if by the time you get to 150 mg you don't start feeling better, or actually start feeling worse. That's when the NRI activity kicks in usually for most folks.

The Ritalin needs to come up, IMO. 20 mg is a starting dose, not maintenance dose. Going up to 30-40 mg might make you feel better.

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40 minutes ago, mikl_pls said:

You'll know if it's going to help you if by the time you get to 150 mg you don't start feeling better, or actually start feeling worse. That's when the NRI activity kicks in usually for most folks.

The Ritalin needs to come up, IMO. 20 mg is a starting dose, not maintenance dose. Going up to 30-40 mg might make you feel better.

+1

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Well...been at 150mg for over a week and just seem to feel more constipated and blah. I'll give it a bit longer (and maybe try going higher) but I feel so discouraged. I don't feel like it's doing much of anything to "brighten" my mood.

I still feel very tired, unmotivated and well, terribly constipated 😞 It also seems to be taking away the effect of my stimulant.

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12 hours ago, Blahblah said:

Well...been at 150mg for over a week and just seem to feel more constipated and blah. I'll give it a bit longer (and maybe try going higher) but I feel so discouraged. I don't feel like it's doing much of anything to "brighten" my mood.

I still feel very tired, unmotivated and well, terribly constipated 😞 It also seems to be taking away the effect of my stimulant.

It looks like you've previously tried Cymbalta (duloxetine). How was your experience with that compared to Effexor (venlafaxine)?

I say this because duloxetine is orders of magnitude more stimulating at norepinephrine than venlafaxine in my experience. And a combo of 60mg duloxetine + 100-200mg of bupropion (Wellbutrin) could give you a solid boost and you theoretically would no longer need the methylphenidate. The bupropion would essentially take over that function. Duloxetine would handle serotonin and norepinephrine, while bupropion would also handle norepinephrine in addition to dopamine. It should be a far more energizing cocktail.

I seem to notice based on the symptoms you report that your depression is enervating, feeling lots of fatigue, lack of motivation, and just general low energy / "down-ness". Typically, SNRIs and bupropion are used for these kinds of depression. Duloxetine+bupropion or venlafaxine+bupropion would make a solid combo.

I would say to continue pushing ahead to 225mg of venlafaxine, but if you get there and still have issues surrounding the energy/fatigue domain, then talk to your pdoc about adding 100mg bupropion SR in the AM or bid (twice daily) with your venlafaxine and potentially dropping the methylphenidate.

It does look like you've tried both duloxetine and bupropion but not sure if you've tried bupropion TOGETHER with either venlafaxine or duloxetine. That could be a real game-changer for you. The other option would be combining bupropion with an energizing SSRI, specifically sertraline (Zoloft) or fluoxetine (Prozac). If you augment venlafaxine, duloxetine, or fluoxetine with bupropion, a lower dose of bupropion should be sufficient as all three of those antidepressants do increase norepinephrine on their own to a certain extent, which is what causes them to be energizing. Additionally, with fluoxetine, you have to tread carefully with the dose because bupropion modestly inhibits CYP2D6 like fluoxetine does and this can result in much higher fluoxetine blood levels than fluoxetine monotherapy. This means that with 150-300mg of bupropion on-board, 20mg of fluoxetine could very well be sufficient Sertraline on the other hand has modest dopamine stimulating activity at MUCH higher doses (i.e. 150mg+) but no noradrenergic activity at any doses and therefore more moderate doses of bupropion would be required due to sertraline's lack of noadrenergic activity, which is intrinsic to the treatment of depression with prominent fatigue, low energy/motivation, and somnolence.

Using either sertraline, fluoxetine, venlafaxine or duloxetine in combination with bupropion also gives you flexibility to address specific symptom domains. You could increase the SSRI/SNRI to address mood symptoms like feeling sad or crying or just general depressed mood, while bupropion, the NDRI, can be used to address the specific symptoms of sexual dysfunction, anhedonia, apathy, fatigue, motivation/energy; some of which are actually caused by SSRIs/SNRIs. I would expect your experience with methylphenidate and bupropion to be somewhat similar.

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22 hours ago, Blahblah said:

Well...been at 150mg for over a week and just seem to feel more constipated and blah. I'll give it a bit longer (and maybe try going higher) but I feel so discouraged. I don't feel like it's doing much of anything to "brighten" my mood.

I still feel very tired, unmotivated and well, terribly constipated 😞 It also seems to be taking away the effect of my stimulant.

California rocket fuel? Slang for an effexor and remeron combination.

https://mentalhealthdaily.com/2015/01/26/california-rocket-fuel-remeron-mirtazapine-and-effexor-venlafaxine-combination/

 

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On 6/14/2019 at 3:30 PM, browri said:

It looks like you've previously tried Cymbalta (duloxetine). How was your experience with that compared to Effexor (venlafaxine)?

Using either sertraline, fluoxetine, venlafaxine or duloxetine in combination with bupropion also gives you flexibility to address specific symptom domains. You could increase the SSRI/SNRI to address mood symptoms like feeling sad or crying or just general depressed mood, while bupropion, the NDRI, can be used to address the specific symptoms of sexual dysfunction, anhedonia, apathy, fatigue, motivation/energy; some of which are actually caused by SSRIs/SNRIs. I would expect your experience with methylphenidate and bupropion to be somewhat similar.

@browri  Thanks for the input. I was on Cymbalta 10 years ago...I don't really remember it helping a lot more than Effexor for the anhedonia/motivation type symptoms. It might of made me a bit more physically energetic though...My physical energy is fairly normal but my mental energy is drained, like it's a chore to force myself to do everything.

Wellbutrin did nothing for me but give me Tinnitus, restless legs. I've only taken it by itself. I trialed it 2 times up to 350mg. Shame because on paper, sounds like it'd be great for me.

Prozac I did not find to be stimulating (but it really helps with the crying/sadness/labile depression symptoms which SSRIs and SNRIs usually help with). Zoloft made me psychotic years ago, may have been a fluke but it really didn't agree with me.

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On 6/16/2019 at 3:34 PM, Blahblah said:

@browri  Thanks for the input. I was on Cymbalta 10 years ago...I don't really remember it helping a lot more than Effexor for the anhedonia/motivation type symptoms. It might of made me a bit more physically energetic though...My physical energy is fairly normal but my mental energy is drained, like it's a chore to force myself to do everything.

I wouldn't expect either Effexor or Cymbalta to be all that helpful specifically with anhedonia, but they should help with energy levels at moderate dosing (150mg+ for Effexor and 60mg+ for Cymbalta)

Thinking more about @argh's suggestion, I do really wonder if that may be a good option for you, combining Effexor with Remeron (mirtazapine). With Effexor at least 150mg but closer to 225mg and Remeron at 15-30mg. Remeron is more sedating on the lower end of the dose range and gets more stimulating towards the max dose of 45mg, but with Effexor on-board, you should experience extra stimulation sooner. Additionally, Remeron should help with anhedonia/apathy, sexual dysfunction, any reduced appetite from the Ritalin. One downside of Remeron is possible weight gain. That is something to keep in mind, but combined with an SNRI, the noradrenergic stimulation should help to counteract some of that weight gain.

On 6/16/2019 at 3:34 PM, Blahblah said:

Wellbutrin did nothing for me but give me Tinnitus, restless legs. I've only taken it by itself. I trialed it 2 times up to 350mg. Shame because on paper, sounds like it'd be great for me.

Yeah Wellbutrin gave me tinnitus as well, but I'm thinking that using it as your primary AD may have been part of the issue as you went all the way to 350mg when 100-200mg would be sufficient as an augment to another stimulating AD.

On 6/16/2019 at 3:34 PM, Blahblah said:

Prozac I did not find to be stimulating (but it really helps with the crying/sadness/labile depression symptoms which SSRIs and SNRIs usually help with). Zoloft made me psychotic years ago, may have been a fluke but it really didn't agree with me.

Depends on the Prozac dose. I found Prozac to only be slightly stimulating until I got to 40mg, then it started to become very stimulating.

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      As far as I am informed you need stimulants for treatment of ADHD. Most commonly used are Methylphenidate and Atomoxetine. Sometimes stuff like Bupropion is applied. But what about classic antidepressants with stimulant (NRI) properties? Let's say Desipramine or Nortriptyline, Reboxetine!? Can they help to some degree?
    • By Blahblah
      Have a strong itch to drop Effexor...(I won't go cold turkey). It stopped my dysphoric crying spells, but now, 10 months later, I'm feeling increasingly flat, apathetic, numb, no motivation (even after dropping to 75mg). I hate how all A/Ds have this lobotomy effect on me longterm. It's initially fine in acute episodes, I'm not sad now, but I can't function properly, and I continue to score Moderate-Severe on the depression scale.
      I think it's counteracting my Ritalin (which I increased to 30-40mg)? I don't want to increase Effexor above 150mg, I'd never be able to go off.
      I'm trying dosing at night instead, will this make any difference @mikl_pls ? I skipped yesterday's morning dose (then came the intense nausea, over stimulation & brain slosh awfulness @10 hours later) and I took my dose with dinner.
      I'm seriously considering going on low-dose mild SSRI instead (Prozac?) I'm sensitive to meds & side effects, and I'm also VERY worried about withdrawals. Especially from Effexor, they are the WORST, and I just read study that Effexor withdrawal syndrome is not dose-dependent:
      https://www.researchgate.net/publication/7402189_Venlafaxine_and_Serious_Withdrawal_Symptoms_Warning_to_Drivers
      https://metro.co.uk/2018/01/24/woman-shares-coming-off-antidepressant-ruined-life-7255570/
       
       
    • By Blahblah
      Starting this thread because boredom, idleness, lack of stimulation is often a key trigger of depression and bad habits. When I get bored, I feel an emptiness, uselessness and physical/mental lethargy, cue ruminations, then I sleep excessively. This isn't always fatigue: It's an automatic (and very negative) avoidance behavior.
      This link lists 150 ideas (from high effort to minimal effort - from "fun" to mundane) in order to build healthier habits. I need to stop waiting to "feel good" before taking any action. Any thoughts?
      https://www.developgoodhabits.com/what-to-do-bored/
      Today, I:
      Journaled, Cleaned my desktop, Backed up computer, unsubscribed to some junk email, Did some stretching, called a relative, dealt with an admin issue, read some blogs about depression, provided some words of support/appreciation for someone.
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