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Re: Finally trying vortioxetine -- initial impressions

Posted by undopaminergic on December 16, 2022, at 4:37:54

In reply to Re: Finally trying vortioxetine -- initial impressions undopaminergic, posted by SLS on December 9, 2022, at 13:10:40

> Hi UD.


> > All in all the trial is off to a good start.
> I'm happy to hear that. I'll say a prayer or two for you. Even if there's no God, I don't see how it could hurt.

Thank you.

> I hope this stuff helps. I think it is a healthy posture to take.

What posture?

> 1. Just take the pill for a minimum of 4 weeks. If you feel even a mild, but discernible improvement at 4 weeks, go at least 2 more. If not, consider adding adjunctive medications.

There are dosage increases to be done before initiating adjunct medications. I'm only taking 5 mg/day, and 10 mg is the recommended starting dose.

I intend to remain on the 5 mg dose for at least 2 weeks, because the drug's half-life is 66 hours and it takes 10 days or more to reach steady-state.

Interestingly, it takes 7 to 11 hours after a dose to reach peak concentrations of the drug.

It is also worth noting that we did not cease the trimipramine (150 mg/day), but we added vortioxetine on top of it. I'm also on clozapine, sulpiride, and lamotrigine (200 mg/day).

> 2. Stop looking microscopically at how vortioxetine is affecting you day by day - or even hour by hour. You will only obsess - and perhaps abort the trial prematurely. Just take the pill and forget about it. Spend your time doing normal stuff that has nothing to do with your mental illness.
> Reduce your visits to Psycho-Babble. Doing normal stuff is the only way you can truly evaluate your degree of improvement in mood and function.

I cannot go back to living my life as it was before my burnout (which slowly took on the characteristics of a more typical depression). If I could, I would be in remission, which has actually happened once in the form of a (hypo)manic episode.

My normal routine nowadays includes keeping track of how I'm feeling. When I notice something is different, I note it in my diary. In connection with that, after initiating a new medication, it is difficult not to think about the possible involvement of the drug. At that point, I may be somewhat biassed insofar I attribute changes to the drug. However, I don't obsess.

For the time being, I haven't been very active on Psychobabble, in large part because I'm following the football (soccer) World Cup.

I agree that the best test to determine whether I'm doing better in terms of feeling and functioning, is to live life as normally as possible. Perhaps the most valuable observations one can make are objective measures, such as the level of success and time taken in completing different tasks.

> 3. Increase your brain stimulation frequently by changing your environment and performing varied - and especially novel tasks.

I'm confident that variety and moderation are good and healthy things, and I have long been striving to do different things that at best complement each other, and I seek tasks that are as stimulating as possible.

That said, there are a number of things I cannot do due to the illness. For example, due to the anhedonia, I'm not able to play computer games. Also, due to apathy and emotional numbing, it takes more (than it used to) to arouse me.

> 4. Go for walks.

I'm very big on walks, and I usually walk for more than 2 hours a day, except sometimes when I'm busy with something more urgent.

> 5. Perform 20 minutes of aerobic exercise at least a few days per week. Anaerobic exercise helps too, but only minimally.

I run, or more typically jog, intermittently during my walks. Sometimes I feel better afterwards, and I'm wondering if it's the endorphins, but I've never experienced "runner's high".

From what I keep hearing/reading, exercise is a panacea for all sorts of different ailments, including mental. It's not in question that it's beneficial in moderation (too much of it can lead to "sports" injuries, which I have experienced a few times).

> * The only reason to stop taking vortioxetine that I can think of, other than for lack of efficacy, is if significant treatment-emergent adverse events (side-effects) appear that do not show a trend towards dissipating.

Nausea is probably the most common adverse effect associated with vortioxetine, and I seem to get a touch of it, but it feels more like a positive case of butterflies in the stomach (as if I were excited) than aversive nausea.

> Don't do *anything* without talking to your doctor first unless there is urgency.

The doctors involved here are very slow and conservative, so I don't think there is any risk that I'll make premature changes.

> * If you are going to perform any research at all to improve your chances of getting well, change your focus. Spend less time researching pure neuroscience and more time researching the clinical application of psychiatry. Research various treatment modalities, including medication. Study observed phenomena and statistics when treating real people.

I enjoy both pure neuroscience and clinical psychiatry. A few days ago I read an article about the pro-cognitive effects of vortioxetine, and found it a bit inspiring. I've also read reviews from other users of this drug, and perhaps the most promising experience, although not frequent, is the lifting of "brain fog".

> * Just take the pills and don't give it another thought unless side effects become problematic.

That is much the same thing I commented on above. It would not be easy for me to ignore the fact that I'm trying a new treatment, and it would not be normal for me to do so.

> Good luck!!!

Thank you!





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