Posted by bleauberry on February 2, 2014, at 15:37:33
In reply to Zoloft or Prozac - which has less apathy?, posted by thefly on February 1, 2014, at 14:46:09
My personal journeys with all the ssris favor prozac for the least apathy effect. Zoloft is next. Regardless, without attention to balancing NE with the serotonin, apathy to some degree is I think fairly predictable with basically pure serotonin meds.
I favor taking tca antidepressants such as nortriptyline or desipramine along with the ssri. That is a true dual mechanism antidepressant strategy and because NE is boosted as well as serotonin, and because DA is indirectly boosted by the boosted NE, the apathy is less likely to happen or at least significantly reduced.
I think one of the main keys is the dose size. If a certain dose causes apathy, is it working well in the other ways that you wanted? If not, then why take it? Aint workin, and causing apathy too?
The TCA+SSRI combo can allow lower doses of each as well.
I had considerable apathy on 20mg prozac. But depression was gone. The addition of 5mg zyprexa helped a lot for a short while. But apathy was still impeding a lot of my life. I tried an overseas med called adrafinil and it worked great for several years. I thought that triple med combo was a very good one.
As I look back though, even then, there was still some apathy present the whole time. I'm not sure that can be totally avoided. Someone else I know, however, took 60mg prozac for months and if that person had apathy, well, you couldn't tell, didn't look like any apathy to me.
Along the same lines, Modafinil. Ritalin or Adderall can do the job too, but their side effects and quirks can be challenging to work with.
> Hi, I am looking at either going on Zoloft or Prozac for depression. I have been on Zoloft once before at 50mg, and experienced periods of apathy but have not tried Prozac.
>
> The reason why I am thinking of trying Zoloft again is because there were minimal side-effects for me, however the apathy side-effect is a concern for me, as I lose interest in things and connection with my emotions, which I want to retain somewhat.
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> I am curious about Prozac because I have read that it causes less apathy in some people because it doesn't hit the serotonin reuptake as heavy as Zoloft, and also has some effect on 5HT2C which is beneficial.
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> I am also wondering which of these is better for energy? I know both are stimulating, but there were periods when I was on Zoloft, where I had fatigue in the afternoons. I am wondering if Prozac is better for this? And which one has more effect on acetycholine?
>
> Thanks all.
poster:bleauberry
thread:1060079
URL: http://www.dr-bob.org/babble/20140123/msgs/1060132.html