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Why do strong SRIs induce apathy, indifference and laziness?


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16 hours ago, browri said:

Make sure anything you do is done with your doctor's approval. The concern with lamotrigine is decreasing too fast and precipitating seizures, although it looks like you did take it slowly which is good at least. The likelihood any mind blanks were coming from lamotrigine is pretty high. On 200mg myself, I had plenty of issues with word recall specifically.

It's possible that SSRIs and SNRIs can cause true restlessness for some people. I mentioned in a previous post that imipramine has anticholinergic effects and this may be helping you to tolerate the SRI and NRI effects.

And yes, with quetiapine, starting around 150mg to 200mg, there is a norepinephrine stimulating effect that picks up and becomes stronger as you get to 300mg. From there, it generally doesn't increase considerably and is drowned out by blockade of adrenergic receptors.As I said previously, between that and the alpha-2 antagonism, it's liable to possibly make you feel "nervous" even though your general anxiety level may be lower. Said another way, perhaps you have less anxiety "spiking" during the day and a more steady low level nervousness that never goes away. Nervousness is a known side effect of quetiapine, albeit less common unless your sensitive to those kinds of things.

Hey if you're taking time off work, even better. Now is definitely the time to figure this stuff out before you have to get back to it. I hate doing med changes and having to work at the same time. Sometimes it's fine, but sometimes it's just miserable.

Nope :) I just read more than I probably should. But my pdoc has told me before that he thinks I may have missed my calling soooooooo....... ;) 

I’m a really bad patent I’m always changing stuff around to find the best result. I am sensible I will reduce the lamotragine 25mg a week. My doctor would do it far faster, I’m not in a rush. My plan is 50mg of lamotragine in morning the rest in the evening.

I have taken myself off tons of meds. My doctor said to me once you haven’t asked for any repeats for Lyrica in 4 months. She had it off my prescription in seconds as it was expensive. There was no comment either way!

I managed to sleep ok on 1.87mg of Zopiclone night. I did wake up a few time’s. I have the mother of all headaches, that could be from any of the changes or all of them. I will stick with the reduced Zopiclone for the next 2 weeks and try and stop from there. Depending if there are any withdrawals..

The imipramine has killed about 80% of the neuropathic  pain in my leg, I might be able to get rid of the gabapentin. I don’t think it did anything anyway and it’s a low dose of 900mg a day.

I think I will park any changes to the quetiapine for a few months my brain has been messed around enough for a little while 🤯🤯🤯 I have been on it so long I’m not sure how my brain will react without it.

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Hey guys-

A reminder that we encourage people to share individual experiences, and information about the mechanisms of action of various drugs, but we draw the line at telling people what will work for them, or what they should try. That is for doctors to do.

Gearhead- Admin

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Gearhead is delightfully tactful. Me, not so much.

Nobody here is qualified to diagnose anybody over the internet, let alone prescribe for them. And yes, telemedicine, blahblahblah, but even if another member here is a mental health care professional IRL, they can't diagnose you blind over the internet via a forum, and it would be unethical to try. So anyone who purports to tell you what is wrong with you, what med you need to take, or how much of it, is talking out of his or her ass.

We share experiences and research here, because our similarities are greater than our differences, and more information and different perspectives help us become more involved in our own healing and care. We're a support group, not a clinic. Always remember that.

Cerberus

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10 hours ago, Cerberus said:

Gearhead is delightfully tactful. Me, not so much.

Nobody here is qualified to diagnose anybody over the internet, let alone prescribe for them. And yes, telemedicine, blahblahblah, but even if another member here is a mental health care professional IRL, they can't diagnose you blind over the internet via a forum, and it would be unethical to try. So anyone who purports to tell you what is wrong with you, what med you need to take, or how much of it, is talking out of his or her ass.

We share experiences and research here, because our similarities are greater than our differences, and more information and different perspectives help us become more involved in our own healing and care. We're a support group, not a clinic. Always remember that.

Cerberus

Sorry I was asking very specific questions. Apologies.

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13 hours ago, crazyguy82 said:

Sorry I was asking very specific questions. Apologies.

No, no - the questions aren't the problem, it's the answers. We do a lot of educated guessing around here, but we try to back it up with citations.  No worries. ;) 

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On 5/29/2020 at 11:49 PM, MisterMelancholy said:

Has anyone else felt the apathy/laziness symptoms on an SSRI, but have them eventually go way on their own? 

In my experience? No....

On 5/31/2020 at 12:33 AM, echolocation said:

i had increased anhedonia when i started on clomipramine, and not too long after a dose increase i found it eased up quite a lot. clomipramine is a TCA, not an SSRI, but i figured i'd drop my two cents in.

Clomipramine is probably the strongest SNRI on the market. Its NRI effect might ease the anhedonia to some degree...

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15 hours ago, Cerberus said:

No, no - the questions aren't the problem, it's the answers. We do a lot of educated guessing around here, but we try to back it up with citations.  No worries. ;) 

yes @crazyguy82 in this case I was in the wrong. My apologies @Cerberus. While I'd like to think I've read a lot and I know what I'm talking about, I'm not a doctor. And the best I should be providing is my own experience with these different medications. I've never personally taken a combination of bupropion/quetiapine, but I have taken bupropion and I know it isn't for me. It does work immensely for some people though. In fact it looks @Gearhead may be on that combo in tandem with lamotrigine/topiramate.

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I seem to be doing better. I feel awful stupid. I’m finding speaking difficult sometimes it almost feels I have to force my words out. I’m hoping this will go away. It is concerning as I have to speak all day for my job!

I don’t normally feel medicated but I think I do now. I really don’t want to drop the imipramine.

Edited by crazyguy82
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1 hour ago, crazyguy82 said:

I seem to be doing better. I feel awful stupid. I’m finding speaking difficult sometimes it almost feels I have to force my words out. I’m hoping this will go away. It is concerning as I have to speak all day for my job!

I don’t normally feel medicated but I think I do now. I really don’t want to drop the imipramine.

Something like Olanzapine (or Aripiprazole) might be better suited than "Seroquel"... Olanzapine has some potent 5T2 antagonism that should ease the side effects of Imipramine... Seroquel is primarily a strong antihistamine with some moderate NRI action, but you've already get enough NRI action with Imipramine.

Alternatively Cyproheptadine if you can get it. Mirtazapine would also be a good choice.

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20 hours ago, Skeletor said:

Something like Olanzapine (or Aripiprazole) might be better suited than "Seroquel"... Olanzapine has some potent 5T2 antagonism that should ease the side effects of Imipramine... Seroquel is primarily a strong antihistamine with some moderate NRI action, but you've already get enough NRI action with Imipramine.

Alternatively Cyproheptadine if you can get it. Mirtazapine would also be a good choice.

I’ve had olanzapine didn’t do anything. Mirtazapine is great but I want to eat everything in sight! I’m really on the end of the line with meds.

I hope it will improve over time. I have to say imipramine has significantly less side effects of any SSRI/SNRIS I’ve tired. Fingers crossed it will get better in time!

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19 hours ago, crazyguy82 said:

I’ve had olanzapine didn’t do anything. Mirtazapine is great but I want to eat everything in sight! I’m really on the end of the line with meds.

I hope it will improve over time. I have to say imipramine has significantly less side effects of any SSRI/SNRIS I’ve tired. Fingers crossed it will get better in time!

Okay, then "Abilify" might be interesting.... partial agonist at D-Receptor(s), partial 5HT2C agonist, weak sedation @H1... Partial agonist at 5HT1A...

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4 hours ago, Skeletor said:

Okay, than "Abilify" might be interesting.... partial agonist at D-Receptor(s), partial 5HT2C agonist, weak sedation @H1... Partial agonist at 5HT1A...

It's an antidepressant up to 15 mg, above that it starts showing itself as an antipsychotic. I find it to be a strong antidepressant which compliments Wellbutrin and does not interfere with amphetamine treatment.

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10 hours ago, notloki said:

It's an antidepressant up to 15 mg, above that it starts showing itself as an antipsychotic. I find it to be a strong antidepressant which compliments Wellbutrin and does not interfere with amphetamine treatment.

It is one of the very few atypical antipsychotics that I would be willing to try... as adjunct for depression / for mood stabilization. Quite interesting drug.

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Abilify never agreed with me. Was way too stimulating. I started at 2mg and worked my way up to 7.5mg over the course of about 10-15 days but I was getting battier and battier by the second. Rexulti, by contrast has behaved nothing like Abilify even though they are chemically very similar.

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6 hours ago, Skeletor said:

It is one of the very few atypical antipsychotics that I would be willing to try... as adjunct for depression / for mood stabilization. Quite interesting drug.

Due to it's long half life it does not stabilize until 2 weeks have past. It is not worth, in my opinion, trying it if you cannot devote that much time. Any stimulation I felt was gone by 2 weeks.

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28 minutes ago, notloki said:

Due to it's long half life it does not stabilize until 2 weeks have past. It is not worth, in my opinion, trying it if you cannot devote that much time. Any stimulation I felt was gone by 2 weeks.

Yes this is the unfortunate part of Abilify along with Rexulti and Vraylar. Their long half-lives largely inhibit their use. However, I have been keeping an eye on patents. They are working on a Rexulti orally-disintegrating tablet. The patent request has already been submitted. It is feasible considering Rexulti's time-to-peak is only 4 hours with oral administration. I imagine with sublingual administration, it may be a useful emergent therapy in larger doses. We'll see how that evolves. And with Vraylar, I think the fact that they generally go right to 3mg after just a few days with normal dosing is overpowering the half life limitation to try and reach treatment efficacy. 

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1 hour ago, notloki said:

Due to it's long half life it does not stabilize until 2 weeks have past. It is not worth, in my opinion, trying it if you cannot devote that much time. Any stimulation I felt was gone by 2 weeks.

Time goes by and I have nothing to lose... ;)

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On 6/8/2020 at 10:17 PM, browri said:

Yes this is the unfortunate part of Abilify along with Rexulti and Vraylar. Their long half-lives largely inhibit their use. However, I have been keeping an eye on patents. They are working on a Rexulti orally-disintegrating tablet. The patent request has already been submitted. It is feasible considering Rexulti's time-to-peak is only 4 hours with oral administration. I imagine with sublingual administration, it may be a useful emergent therapy in larger doses. We'll see how that evolves. And with Vraylar, I think the fact that they generally go right to 3mg after just a few days with normal dosing is overpowering the half life limitation to try and reach treatment efficacy. 

Aren't long half lives good when it comes to psychotropics? Better than those SNRIs (Venlafaxine, Duloxetine) with their ridiculously short half lives and interdose-withdrawal... !?

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1 hour ago, Skeletor said:

Aren't long half lives good when it comes to psychotropics? Better than those SNRIs (Venlafaxine, Duloxetine) with their ridiculously short half lives and interdose-withdrawal... !?

Generally. Sometimes a pain when trying to get off a med. Sometime a pain when titrating. Sometime helpful when getting off a med as it can sometimes give a gentle landing. Prozac takes a month so you can just stop it. If you hit an nasty side effect and want to quit  you are stuck with it for a while if it has a long half life.

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