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Why do strong SRIs induce apathy, indifference and laziness?


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21 hours ago, notloki said:

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.

 

23 hours 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... !?

Well yes a shorter half life means it's more likely to start working more quickly (like number of days until it kicks in fully), also means more chance of withdrawal if you miss a dose. Advantage though that if there are side effects or if you need something to work immediately, you can adjust the dose, and that change takes effect very quickly (half life times 5.5). With long half-lives, it makes for more stable levels. Less variation should theoretically lend to better stability, but it also means that a dose change takes several days to weeks to fully take effect. For Vraylar, in 12-week studies, patients hadn't even reached steady state of one of the major metabolites by the end of the study. 12 WEEKS. And in that time, treatment effect could be improving and side effects could be getting worse. So yeah, long half-lives are advantageous for depot-level control and especially if compliance is an issue and you have a patient who might skip a pill one day or two but then gets back on the bandwagon. With long half-lives, you can worry less about destabilization due to adherence issues.

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On 6/13/2020 at 2:18 PM, crazyguy82 said:

Does anybody know if lamictal increases serotonin, norepinephrine or dopamine?

Directly, no. However, Lamictal is a glutamate reducing agent, which can have disinhibiting effects on dopamine at least (could cause slight increases in dopamine signaling). It also is a very weak antagonist of the 5HT3 receptor like Trintellix (vortioxetine) and Zofran (ondansetron). Those are ion channel receptors which regulate glutamate and GABA. Could theoretically cause an increase in the release of glutamate and dopamine. Lamictal is a very confusing medication. 

Most importantly though are its effects on electrical activity and glutamate. Lamictal's DIRECT impact on any of the monoaminergic systems like serotonin is negligible.

On 6/13/2020 at 2:18 PM, crazyguy82 said:

If Seroquel is NRI and imipramine is also, are they not battling for the same receptions? Surly one would be blocking the other? 

They won't necessarily battle or displace each other. They're both NRIs so doses of both will ADDITIVELY inhibit the norepinephrine transporter in aggregate. 

Example

Drug A and Drug B are NRIs. You can take two pills of Drug A, two pills of Drug B, or one of each to get the "same" effect. (Disclaimer: not actually the "same" because, you know, dose equivalency an affinity differences for the receptor, etc.)

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I’m going to have to give up on the imipramine. It’s making some things worse. I’m quite angry a tiny bit manic. I partner said they are not doing any good.

Waiting for doctor to call me on the next medication. I think it maybe back to citalopram I know that works somewhat. Mirtazapine would be great but the weight gain is an issue. Needs must at the moment I might have to just deal with the weigh gain to get back to work.

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2 hours ago, crazyguy82 said:

I’m going to have to give up on the imipramine. It’s making some things worse. I’m quite angry a tiny bit manic. I partner said they are not doing any good.

Waiting for doctor to call me on the next medication. I think it maybe back to citalopram I know that works somewhat. Mirtazapine would be great but the weight gain is an issue. Needs must at the moment I might have to just deal with the weigh gain to get back to work.

Well my recommendation would be to talk to your doctor about escitalopram instead of citalopram. If citalopram worked for you in the past, escitalopram should work just as well, if not better by potency, and it should also arguably be more tolerable. It's also already available as a generic medication, so access to it in the UK vs citalopram shouldn't be difficult. And unlike some "me-too" medications, escitalopram has demonstrated improved benefit over citalopram, so it is worth a try.

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On 6/15/2020 at 8:50 PM, browri said:

Well my recommendation would be to talk to your doctor about escitalopram instead of citalopram. If citalopram worked for you in the past, escitalopram should work just as well, if not better by potency, and it should also arguably be more tolerable. It's also already available as a generic medication, so access to it in the UK vs citalopram shouldn't be difficult. And unlike some "me-too" medications, escitalopram has demonstrated improved benefit over citalopram, so it is worth a try.

Well the imipramine was a bit of a disaster. I was clearly super sensitive to it more than I expected. It’s made me feel so bad stopping taking it.

My consultant hasn’t even bothered to return my calls. I started calling on Friday. However my GP was happy to step in and she had no problem prescribing citalopram. We talked about Escitalopram but agreed it’s better the devil you know that the devil you don’t.

I really don’t want the psychiatrist to call as I have nothing to say. I have to stay under her for my other meds.

I haven’t taken citalopram in years it’s a morning med or evening? 

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3 hours ago, crazyguy82 said:

Well the imipramine was a bit of a disaster. I was clearly super sensitive to it more than I expected. It’s made me feel so bad stopping taking it.

My consultant hasn’t even bothered to return my calls. I started calling on Friday. However my GP was happy to step in and she had no problem prescribing citalopram. We talked about Escitalopram but agreed it’s better the devil you know that the devil you don’t.

I really don’t want the psychiatrist to call as I have nothing to say. I have to stay under her for my other meds.

I haven’t taken citalopram in years it’s a morning med or evening? 

Definitely evening. What dose are you taking?

EDIT: Scratch that. Based on my own experience from when I took it, I remember both citalopram and escitalopram were sometimes a little stimulating after taking them for the first week but really not by much. It's possible that in the beginning you may have to take it in the morning. Long term though, I think you'll find it's better in the evening.

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22 minutes ago, browri said:

Definitely evening. What dose are you taking?

EDIT: Scratch that. Based on my own experience from when I took it, I remember both citalopram and escitalopram were sometimes a little stimulating after taking them for the first week but really not by much. It's possible that in the beginning you may have to take it in the morning. Long term though, I think you'll find it's better in the evening.

20mg and a review after two weeks. It was 13 years ago I took it last I remember having some sleep issues. I’m hoping it may help with the imipramine withdrawals, I keep having those annoying brain zaps. I have got down to 200mg of Lamictal, not much trouble doing that. 

I think even at low dose imipramine was a very strong SRI. Serotonin withdrawal is never much fun.

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1 hour ago, crazyguy82 said:

20mg and a review after two weeks. It was 13 years ago I took it last I remember having some sleep issues. I’m hoping it may help with the imipramine withdrawals, I keep having those annoying brain zaps. I have got down to 200mg of Lamictal, not much trouble doing that. 

I think even at low dose imipramine was a very strong SRI. Serotonin withdrawal is never much fun.

Hopefully the 20mg will kick in soon. Make sure you let your pdoc know your gdoc prescribed the citalopram for you in the interim and see if your pdoc will just continue prescribing it if it does end up working for you. If you show them it works, then doctors often will follow their patients as long as the patient is honest/open.

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39 minutes ago, browri said:

Hopefully the 20mg will kick in soon. Make sure you let your pdoc know your gdoc prescribed the citalopram for you in the interim and see if your pdoc will just continue prescribing it if it does end up working for you. If you show them it works, then doctors often will follow their patients as long as the patient is honest/open.

I’m having an issue with the pdoc I’m very surprised. The receptionist called me to say either see my GP or wait until my next appointment. I take no messing with my mental health. I was told to call anytime if I needed help. I can’t wait for that conversation. 

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21 hours ago, crazyguy82 said:

I’m having an issue with the pdoc I’m very surprised. The receptionist called me to say either see my GP or wait until my next appointment. I take no messing with my mental health. I was told to call anytime if I needed help. I can’t wait for that conversation. 

Wow. That's crappy as all hell. So basically the pdoc is like either I treat you alone or you can go somewhere else. Oh and btw I'm of no use to you between appts. Haha. Like wow. I know some pdocs can be like that, but if I'm having an issue, I know I can call my pdoc and talk to him or move up my appointment.

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On 6/18/2020 at 3:15 PM, browri said:

Wow. That's crappy as all hell. So basically the pdoc is like either I treat you alone or you can go somewhere else. Oh and btw I'm of no use to you between appts. Haha. Like wow. I know some pdocs can be like that, but if I'm having an issue, I know I can call my pdoc and talk to him or move up my appointment.

That’s the NHS for you. I’m sure she is overworked. I was really annoyed but today I’m not much bothered.
 

My GP has no issues dealing with citalopram. I feel much better for being off the imipramine. I have the trembling and shaking a but significantly less than imipramine and fluoxetine. I didn’t have that the first time, it must be something to do with the combination of medication.
 

One thing is I often get a bit hot on meds. I’m wondering if it will show up in temperature checks at airports etc for COVID-19.

It will be mirtazapine all the way and the slide to obesity 🤨🤨🤨 if citalopram fails! 😂

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17 hours ago, crazyguy82 said:

Does anybody know if you were to increase Seroquel from 300-350mg is it likely to have a more stimulating effect? 

It may be incrementally more stimulating, but as a general rule, if Seroquel is going to be stimulating, it usually starts at around 150-200mg and increases until about 300mg. I can't confirm, but it is possible that maximal occupancy of of the norepinephrine transporter occurs around 300-400mg which is why the target dose for bipolar depression is 300mg.

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  • 4 weeks later...

For whatever reason I can’t tolerate and SSRI or SRIs they make feel really weird. It’s odd as I could tolerate citalopram either. It felt super strong and made me feel a bit high and had pain all down my spine.
 

Ended up increasing Lamictal to 350mg this made things much better. Also increased gabapentin to 1200mg. Doing well now. May look as a drug that increases norepinephrine as I’m feeling bit tied. I miss the stimulation from the moclobermide. 


 

 

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On 7/18/2020 at 10:30 PM, crazyguy82 said:

For whatever reason I can’t tolerate and SSRI or SRIs they make feel really weird. It’s odd as I could tolerate citalopram either. It felt super strong and made me feel a bit high and had pain all down my spine.

That's often a sign for bipolarity...

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On 7/18/2020 at 4:30 PM, crazyguy82 said:

For whatever reason I can’t tolerate and SSRI or SRIs they make feel really weird. It’s odd as I could tolerate citalopram either. It felt super strong and made me feel a bit high and had pain all down my spine.

Citalopram is an SSRI as well. And @Skeletor is right. If antidepressants (including SSRIs, SNRIs, tricyclic/tetracyclic antidepressants) make you feel kind of high or in too good of a mood. That can be a sign of bipolar disorder.

On 7/18/2020 at 4:30 PM, crazyguy82 said:

Ended up increasing Lamictal to 350mg this made things much better. Also increased gabapentin to 1200mg. Doing well now. May look as a drug that increases norepinephrine as I’m feeling bit tied. I miss the stimulation from the moclobermide.

This further confirms the bipolar suspicion. Lamictal and Seroquel are preferred agents in the treatment of bipolar disorder.

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5 hours ago, browri said:

Citalopram is an SSRI as well. And @Skeletor is right. If antidepressants (including SSRIs, SNRIs, tricyclic/tetracyclic antidepressants) make you feel kind of high or in too good of a mood. That can be a sign of bipolar disorder.

This further confirms the bipolar suspicion. Lamictal and Seroquel are preferred agents in the treatment of bipolar disorder.

Yes I thought the same but with the amount of Seroquel and lamictal I take I didn’t think it was possible to have that reaction. I kind of didn’t make a fuss as I didn’t want a bipolar diagnosis. I didn’t feel in the right frame of mind to talk about it at that time.

When I speak to the consultant next I will have the conversation. My prescription for Seroquel Is 400mg and I only take 300mg I can always increase that if I run into problems. 
 

I do have mind numbing apathy and no motivation I’m back in work Monday and I really have to make an effort to be interested!

Im not complaining my appetite has dropped loads. That’s unusual for me I have a good appetite. I need to loose about 8bs anyway. It’s very odd.

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  • 5 weeks later...

This is my new diagnosis. I don’t really understand it all can anyone help explain it?

 He provided again clinical evidence consistent for him suffering, at axis-I, recurrent depressive disorder (i.e. F-33 as per the ICD-10 diagnostic criteria) rather a bipolar affective disorder or cyclothymia, along with mixed anxiety and depressive disorder (F-41.2, as per the ICD-10 diagnostic criteria) as a differential diagnosis and having, in background or at axis-II, traits of an anxious (avoidant), as to some extent also of an obsessive, personality with ineffective coping skills in general under any added/acute life stress /pressures.        

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