Posted by Hordak on July 26, 2019, at 12:10:34
I am 31 years old, I live in Germany. I have been diagnosed with MDD & Social Anxiety Disorder in 2017, although the disorder(s) undoubtedly persisted since way before being diagnosed with it. Here a brief description of myself before diagnosis: skinny, pale, agitated, motorically restless, jumpy, ruminating and difficulty making decisions, with rather typical depressive symptoms (reduced affect display, apathy, anhedonia to some degree, low appetite, avoidance, low self-esteem etc.). I've also had many psychosomatic ailments: reoccurring gastritis, reflux, pains that were not explainable by any "tangible" medical cause. Social anxiety with emphasis on speech- and presentation anxiety. Since the diagnosis in spring 2017 I have been taking Sertraline 50mg. I've also been on 75mg and 100mg, but that caused me unbearable agitation & motor restlessness AND too much weight loss, so I cut it down to 50mg.
I have mixed views when it comes to Sertraline: on the one hand I am quite annoyed with it because it sapped my creativity and basically made me not want to do anything, not feel anything. I just sit at the computer and watch youtube-videos and occasionally walk around, or eat, or go to the bathroom. I just don't have any drive to really do very much of anything, except what is needed for continued basic survival. I don't even want to do things that I liked. To put it bluntly: I can't get my *ss up, it's just all "blah" and "meh". I get less things done on Sertraline than without. It seems to me that Sertraline induces overall emotional flattening - reduced sadness, but also reduced joy, reduced motivation & ambition, reduced desire to socialize, reduced interest in everything. It is really disconcerting, because things happen that should bother me, and I'd be thinking "this SHOULD piss me off, but, meh.. whatever..". I felt at ease with my situation and no longer care. Appartement could be on fire and I would be indifferent about it. I don't think this is a mentally healthy state, especially in the long term. I need to care about things... (It seems that this is quite common with SSRIs...**** knows why these things are marketed for depression when they cause or enhance the very symptoms people are trying to get rid of. The apathy / indifference itself is like an additional mental illness. I know that many people have it as part of their depression which is pretty bad, but when you get it as a side-effect to medication to treat depression & anxiety, it is just another unnecessary problem you have to deal with.). My father died last summer due to Parkinson's terminal stage (Aspiration pneumonia) and I couldn't cry. My mind just was blank. To not be able to cry if someone close dies just kills me. I want healthy emotions. Maybe too much empathy & emotions aren't a good thing but neither is total lack of it.
Some people on Internet-Forums (Socialanxietysupport, Dr-bob Babble...) have mentioned that this is due to diminished noradrenergic and dopaminergic signaling / transmission, possibly due to elevated 5HT2 receptor stimulation caused by strong SRIs. They suggest that possibly an NRI with 5HT2 antagonism as add-on might be helpful. Many have mentioned tricyclics (Amitriptyline, Clomipramine, Imipramine) as better alternative. But I am unsure as to what extend is is true or false.
But I don't want to be too negative about Sertraline, because on the other hand there are definitely some positive aspects to it: It's a rather good anxiolytic and it has helped me with my anxiety and fears. It was also good in relieving my diverse psychosomatic ailments. It also stopped my ruminations and derealization symptoms. It's also quite good for cognition. At the beginning of the treatment it induced horrible insomnia, but right now I sleep quite well, maybe even too much. It also made me more emotionally stable and even-tempered.
I would very much like to hear you opinion on the subject. Are there antidepressants and anxiolytics that help with depression and social anxiety, but do not cause the aforementioned SSRI-"zombification"? What is your experience? I've already talked it over with my psychiatrist, but he is unwilling to try other antidepressant classes. He only prescribes SSRIs & SSNRIs (Venlafaxine, Duloxetine), and is rather afraid of combination-therapy. I am somewhat desperate and don't know what to do. (I am on 25mg since April 2019)
One important note: I am quite an agitated person with lots of "motor restlessness" / psychomotor agitation, resembling forms of many "akathisia"-like symptoms: rocking back and forth, lips biting, checks biting, skin picking, bruxism, fidgeting, pacing, fist clenching, toes clenching... (moderate in severity). I've been this way since I can remember. I've never taken anti-psychotics. In my case it is most likely an inborn / innate condition(?). Some people mentioned that it might be some form of "hospitalism", but my early childhood was pretty much okay. Nothing extraordinary good or bad happened, al least that I can remember. Sertraline made it rather worse, but definitely not better. What would be potentially good medications (medication classes) to calm me down and lessen my psychomotor agitation? I would also like to gain some weight! I am a skinny bastard and Sertraline unfortunately did make me loose some pounds... (62kg @ 175cm right now).
One other annoying side effect of Sertraline is heat intolerance. I've always loved warm summers and sauna, but since I am on Sertraline, I cannot stand heat anymore. I feel like I am overheating...
btw: I have an appointment with a new psychiatrist in about a month.... ;=)
I thank you for all your help, advice(s) and suggestions!
poster:Hordak
thread:1105412
URL: http://www.dr-bob.org/babble/20190513/msgs/1105412.html