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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 6 to 30 of 61. Go back in thread:
Posted by LouisianaSportsman on April 14, 2014, at 21:53:18
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Louisiana Sportsman, posted by Chris O on April 14, 2014, at 21:03:20
Hey, Rich, I have NO IDEA how I missed your March post about Brintellix. Thank you so much for the pharmacology "porn". I will most definitely review those articles when I get a chance. I certainly appreciate you sharing those. Awesome, man.
I agree, Chris! It's so strange how medications effect Person A like such and Person B the completely opposite way. That's the problem with psychoactive medications, right? Your first paragraph couldn't be more accurate.
I can't believe that vortioxetine is WORSE than the notorious venlafaxine preparations in terms of sexual malfunctioning. Interesting, indeed.
May you compare it to Effexor's efficiency in terms of an antidepressant/anti-anxiety effect? Has any medication performed better than Brintellix for you thus far, and would you consider that as maintenance?
I was hoping that at least the antidepressant/anti-anxiety effect from vortioxetine would be aggrandized enough for you to perhaps, lets get real here, consider an impotence agent (I have no experience with them) such as a PDE5 inhibitor?
The best option with psychiatric medications would perhaps be amphetamine salts. I suggest that anyone take advantage of psychostimulant if they're seeing a psychiatrist if they don't have conflicting issues or health problems with them.
I think bupropion, amphetamine salts or a modafinil are beneficial at least off-label for most psych patients to take advantage of since "normal" people lack that opportunity.
What medications are you currently prescribed right now, Chris?
Posted by LouisianaSportsman on April 14, 2014, at 22:36:26
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect, posted by LouisianaSportsman on April 14, 2014, at 21:53:18
I read "Electrophysiological Investigations on the Role of Selected Serotonin Receptors and
the Serotonin Transporter on Serotonin Transmission in the Rat Brain" which is a study by Maurice Lecours who works at the University of Ottawa, Institute of Mental Health Research. Rich posted this study back in March:First of all, Chris, you might find this excerpt "interesting", haha:
"Clinical trials examining the use of vortioxetine for the treatment MDD have indeed demonstrated that vortioxetine separates from placebo, it is comparable to venlafaxine but with less aversive side effects, and it is effective at preventing relapse (Jain et al., 2013; Alvarez et al., 2012; Boulenger et al., 2012)."
Hmm...
But, what I found most interesting from the study were these following excerpts:
"These findings indicate that either the co-administration of an SSRI in addition to a 5-HT3 receptor antagonist or a multimodal agent that acts as a SSRI and 5-HT3 receptor, such as vortioxetine, could enhance 5-HT neurotransmission to produce AD and antiemesis effects, similar to that of litoxetine, after long-term administration."
To me it suggests that augmenting a SSRI may be a good idea because you got to keep this excerpt in mind:
"This study has demonstrated that selective 5-HT agents alone, such as escitalopram, and multimodal agents, such as vortioxetine, alter 5-HT neurotransmission through different receptors and exert different actions, via transporter and/or receptor activity, on the serotonergic system in the hippocampus consistent with other antidepressant strategies and with a unique pharmacological profile."
Additionally, I think you need to consider that compared to other SSRIs: "vortioxetine has a low occupancy for the 5-HTT, escitalopram was used at a dose of 5 mg/kg in order to better mimic the effects of low occupancy alone."
I'm suggesting, based upon these excerpts from the study, Chris, that maybe you should trial whichever SSRI worked best for you in the past to augment the pharmacological effects of vortioxetine? Why not the one they used in the study? (Lexapro) Maybe the combination of the two could theoretically provide a more potent antidepressant/anxiolytic effect?
Just a theory.
Posted by ed_uk2010 on April 15, 2014, at 13:36:52
In reply to Brintellix 20mg: Fairly strong sexual side effect, posted by Chris O on April 14, 2014, at 18:36:39
> Hello, everyone. I'm on Day 10 of 20mg/day of Brintellix trial. I've seen a few musings on the dr-bob boards regarding the sexual side effects of Brintellix.
Hi Chris,
Considering that the effects of vortioxetine 20mg seem fairly potent for you, I think it's well worth considering a dose reduction.
Posted by Chris O on April 15, 2014, at 15:37:50
In reply to Augmenting to Brintellix: Theory Based on a Study, posted by LouisianaSportsman on April 14, 2014, at 22:36:26
Hey, Sportsman:
Thanks for all the feedback. Wow, you know a lot more about antidepressant pharmacology than I do! I guess the gist of Brintellix for me thus far is ... it's still not a very strong antidepressant/anti-anxiety relief. I just had to spend part of the day with my mother (the cause of, basically, my f'ed up PTSD condition), and Brintellix, nope, it's not going to cut it. Nor is it giving me the energy I need to work, to get out of this hole of dependance that I always find myself in.
I visit my p-doc tomorrow. As I think I said before, I'll probably give this a 6 week trial (or whatever he thinks is fair), but at 2.5 weeks, it's still feeling pretty weak. I guess adding on other drugs is one option (you mentioned Stablon, a drug with which I have little familiarity, but the Wikipedia article makes it sound promising). I don't know. I appreciate your effort in communicating all this information to me.
Chris
Posted by Louisiana Sportsman on April 15, 2014, at 20:05:01
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » LouisianaSportsman, posted by Chris O on April 15, 2014, at 15:37:50
The stuff I earlier deliberated about is my hobby, Chris. For example, my dad knows all about firearms and ammo and stuff, and I'm sure he could "out-smart" me in that department and I can likewise "out-smart" him when it comes to psychopharmacology. He posts on forums about them like I do about my hobby so I guess he gets satisfaction from discussing it too.
BUT!
Chris, real talk, bro.
People are going to disagree with me for not being "politcally correct", but so be it.
My philosophy is: your time here on earth is limited, and you need relief from your depression and aforementioned PTSD condition *without delay*.
Look, do you think your PDOC is giving you SIX weeks for this medication that will FAIL you for YOUR benefit? No. He will just figure out what to do with you in ~3.5weeks.
Submitting this post now, so you'll see it ASAP, and consider this advice before your visit tomorrow.
I think you should demand an alternative treatment than vortioxetine because I would.
Posted by Louisiana Sportsman on April 15, 2014, at 20:48:18
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » LouisianaSportsman, posted by Chris O on April 15, 2014, at 15:37:50
To anyone who disagrees:
PDOCs, not so much on here which why I prefer this forum over any other, but more-so elsewhere have an almost "god-like" position.
Umm, OK, sure, I will admit that I didn't take the route the PDOC did in getting the credentials, but that's because I chose to do other things with my time. My advice should NOT EVER be taken over the advice over a patient's own PDOC who treats them, but anyone else, I don't care what degree you have, is fair game in terms of the advice game. Why should I bow down to anyone but the patient's PDOC? All I can do is give my opinion. Some forums seem to want to spank you for it. It's not I can write scripts. We're adults re.
And being a PDOC is not like some sort of revered talent or anything. I mean, pick up a book. They're human, I'm human, and I'm willing to bet that I actually know a lot more than a lot of them and vice versa. It's just how society is structured. I'm not sure why so many people would put so much confidence into a man they barely know based upon a degree from a university that they've never attended. They seem scared to even bring up counterarguments, alternative treatments, ask why this is being prescribed or what it does in depth or what you desire. It's like this man you just met is like royalty because he took some exams you didn't take.
My PDOC, however, she is awesome. I would never feel uncomfortable telling her ANYTHING. It says a lot about a patient-PDOC relationship when the patient feels comfortable enough to share the abuse of one of their medications and want to get off the script (Lyrica) and know that she would realize "hang on a sec, why would he bring this up if he wasn't genuine about wanting to get Lyrica? He's smart, he knows the game. D-amp must be therapeutic and not abusive for him." I feel like most patients would never ever tell their doctors what I told her if they were prescribed Dexedrine as well and people would say they were "stupid" if they did. That's very sad, but PDOCs have brought it upon themselves. If I admitted that to most PDOCs in the USA, I would have had my script of d-amp revoked FOREVER. I was later prescribed Neurontin by this doctor at a much lower dosage because I basically told her it was the best and that I thought gabapentin would be less abusive and that I would tell her if I abused it again. Guess what? I abused it again. Guess what? She writes Xanax XR to replace it with. Patients should feel comfortable talking about anything with their PDOC, and I felt like pointing out an extreme example. lol some people would probably stop going to their PDOC of many years if their insurance suddenly cut him or her off their coverage in a heartbeat, but not me...
Your PDOC may very well think 6 weeks is appropriate, but Brintellix is one of the faster working antidepressants. You should know rather it's going to be something that will work for you.
Significant sexual side effects with no positive anxiolytic response to compensate after 2.5 weeks? Let's get real. Your doctor is probably clinging on to six entire weeks because there may be a lack of ideas.
Looks like you need a MAOI since you've trialed all of the other options. I'm not sure Stablon is offerered where you live at, Chris?
Have you looked into the EMSAM (selegiline) patch? In terms of MAOIs, the side effect profile is less harsh and it doesn't have diet restrictions. If you remain on Brintellix, have you considered augmetation of a pramipexole to it? Both are good options.
Make sure you give the 12mg. EMSAM a chance since it acts differently at that dose.
If you don't want to fight with your PDOC, see if you can initiate Mirapex (pramipexole). It can be dosed up to 4.5mg./day and it can work in the lower dosage range too. Then with that on board, you can continue you it or not with EMSAM.
Posted by Louisiana Sportsman on April 15, 2014, at 21:09:36
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » Chris O, posted by Louisiana Sportsman on April 15, 2014, at 20:05:01
My suggestion is to essentially tomorrow:
*discontinue Brintellix 20mg.
*prescribption of EMSAM transdermal patch at 6mg. (0.25mg./hr.)
*prescription of Mirapex ER (if your insurance has a QDD limit on the ER; then use IR): #90 0.375mg. This allows you to be trialing a very effective 2.25mg. daily dosage or over-dosage on Days 21-30.
*initiate a low-dose benzodiazepine (e.g., Valium or Klonopin) to help with titration.
Good luck! Keep me posted.
Posted by Chris O on April 16, 2014, at 0:49:41
In reply to Re: Augmenting to Brintellix: Theory Based on a Study, posted by Louisiana Sportsman on April 15, 2014, at 21:09:36
Sportsman:
Hey, thanks again for that feedback. But I wasn't clear with respect to my p-doc situation. My current psychiatrist is extremely flexible and open. The 6-week thing with regard to Brintellix was just my guess-gestion, not his. I added the phrase "whatever he thinks is fair" as I trust his judgement in this area (how long to take something before giving up). Actually, my psychiatrist wanted me to try Nardil (or a TCA) over two years ago and I've been completely wimpy about it. I started the MAOI diet, like, 3-4 times, and every time I picked up the prescription, I never took it. So, the blame is on me here. Anyway, I'll let you know what happens. Not sure if I should augment with Brintellix as I am getting at least some antidepressant effect (which I haven't gotten for some time). At the same time, there's something missing.
Chris
Posted by SLS on April 16, 2014, at 6:52:32
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » Louisiana Sportsman, posted by Chris O on April 16, 2014, at 0:49:41
> Not sure if I should augment with Brintellix as I am getting at least some antidepressant effect (which I haven't gotten for some time).
That's encouraging.
> At the same time, there's something missing.
Let's hope that the antidepressant response grows more robust over time. If you are still missing something after a few more weeks, you might want to consider augmenting with desipramine or nortriptyline. There are quite a few other options, though. Wellbutrin, Remeron, Lamictal, and even low-dose lithium come to mind. Have you tried Abilify? It seems to work as a dopamine system stabilizer (DSS) via dopamine D2/D3 receptor partial agonism.
- Scott
Posted by ed_uk2010 on April 16, 2014, at 13:29:10
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » LouisianaSportsman, posted by Chris O on April 15, 2014, at 15:37:50
Sorry Chris, I thought you said you'd only taken vortioxetine for 10 days? Did you mean you'd been on 20mg for 10 days?
Posted by Chris O on April 16, 2014, at 19:34:07
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » Chris O, posted by SLS on April 16, 2014, at 6:52:32
Scott:
Thanks for the suggestions. As I told the Sportsman (and perhaps you too some time back; can't remember), I probably should have tried a TCA or MAOI inhibitor years ago, but I just keep wimping out on it, especially on Nardil. I started the MAOI diet at least three times in the past two years, got the Nardil prescription, but never started taking it. I took Wellbutrin with Celexa, gosh, it's 14 years ago now. I was teaching high school at the time, and that combo was working to a degree, but ... I did lose my job when I was on those meds, despite the fact that they were working. Just not strong enough, I guess.
I've never tried Lamictal or lithium or anything used to treat mood disorders because I've always thought my main condition was anxiety and depression, particularly an inability to stop ruminating. It's also a very physical tension for me. For instance, one way I can tell the Brintellix is working is that it is much easier for me to do certain stretches (and to exercise) while on it. This is something I noticed when my Celexa-Wellbutrin combo worked 14 years ago as well. I have not tried Abilify, nor have I tried anything in the amphetamine class. I guess everything is worth a try at this point.
I'll keep you posted.
Chris
Posted by Chris O on April 16, 2014, at 19:37:19
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » Chris O, posted by ed_uk2010 on April 16, 2014, at 13:29:10
Ed:
Yes, that's right, 20mg of Brintellix for about 12 days now. It's working, definitely. But ... I don't think it's strong enough. Something is off about it. I still feel like hiding, even though it's made things easier in my daily interactions. I've also lost a sense of the thing (let's call it my mother's destruction of my innermost being) that I was fighting inside. It feels like ... I'm allowing "it" (my mother's destruction of my innermost being) to win. Maybe I'm overstating it a bit. : )
Chris
Posted by SLS on April 17, 2014, at 0:06:43
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » ed_uk2010, posted by Chris O on April 16, 2014, at 19:37:19
> Ed:
>
> Yes, that's right, 20mg of Brintellix for about 12 days now. It's working, definitely. But ... I don't think it's strong enough. Something is off about it. I still feel like hiding, even though it's made things easier in my daily interactions. I've also lost a sense of the thing (let's call it my mother's destruction of my innermost being) that I was fighting inside. It feels like ... I'm allowing "it" (my mother's destruction of my innermost being) to win. Maybe I'm overstating it a bit. : )
>
> Chris
Do you feel like a broken man? I do. If anything, I have been broken by the depressive illness itself. My mother did a hell of a job on me, too. However, I became strong enough inside to have conquered most of the issues that arose because of that. The war I have waged against a severe form of bipolar depression has been too much for me after 30 years of failed treatments. I am not the same person. I know that I have had my spirit broken. I am not motivated to do many of the things I should be doing to take care of myself. I am passive and don't really care about anything. I sometimes wonder if Abilify 10 mg/day is producing this amotivation as a side effect, but I recall having more spirit 10 years ago while taking it at twice that dosage. Every man has his breaking point. I probably reached mine. However, I think I can repair myself if I were to feel well for an extended period of time.I know what you mean about hiding. At my worst, I hid from everyone, even if they were simply walking by the house and I could see them through the window. When I would see them, I would hurry to hide around a corner. I really don't understand why. I actually like people. This is the illness itself.
I intend to make Brintellix my next drug to try if I don't respond well to my current regime. Raising the dosage of prazosin has helped a great deal over the last few days. Since I have a history of relapsing after 3 days, this response has not yet proven itself.
Currently:
Parnate 100 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 450 mg/day
Abilify 10 mg/day
prazosin 40 mg/day
minocycline 200 mg/day
Good luck with Brintellix. It is probably the first drug you have tried that has serotonin 5-HT1a receptor agonism and 5-HT7 receptor antagonism. It binds to a few more serotonin receptors, but I am unsure as to their significance (5-HT1b partial agonism; 5-HT1d antagonism; 5-HT3 antagonism).
- Scott
Posted by LouisianaSportsman on April 17, 2014, at 1:58:17
In reply to Re: Augmenting to Brintellix: Theory Based on a Study, posted by SLS on April 17, 2014, at 0:06:43
, but I am unsure as to their significance (5-HT1b partial agonism; 5-HT1d antagonism; 5-HT3 antagonism).
- Scott
>
>Me too, Scott. I was hoping you would share your thoughts on my theory I posted earlier in this thread?
Posted by SLS on April 17, 2014, at 7:53:18
In reply to Re: Augmenting to Brintellix: Theory Based on a Study, posted by LouisianaSportsman on April 17, 2014, at 1:58:17
> , but I am unsure as to their significance (5-HT1b partial agonism; 5-HT1d antagonism; 5-HT3 antagonism).
>
>
> - Scott
> >
> >
>
> Me too, Scott. I was hoping you would share your thoughts on my theory I posted earlier in this thread?I would love to, except I wouldn't know where to look. Can you provide a link to your post here?
Thanks.
- Scott
Posted by Chris O on April 17, 2014, at 12:16:20
In reply to Re: Augmenting to Brintellix: Theory Based on a Study, posted by SLS on April 17, 2014, at 0:06:43
Scott:
Wow, thanks for that thoughtful bit of empathy. It's very helpful. Yes, I do feel like a broken man. I don't even feel like a man, to be honest. I am not able to be a "breadwinner" in any sense of the word, not even for myself. It's so pathetic. What's even more enraging is that women are still attracted to me, even at the ripe old age of 47. However, once they see my disorder, they generally flee flee flee. Unless they are more broken than me. And don't take responsibility for it. Or super controlling. Super super controlling. Like my mother was. And my wife is, to a degree. Because for controlling women, my issues work. Controlling women can completely manage me, even while they are simultaneously upset with my inability to provide. But if I provided, I would be making more of the financial and other decisions, and many controlling women cannot give up that aspect of control in their life. So, I suspect, if I ever do get better, my current relationship status would dissolve.
Personally, I don't think I've ever been well. My mother was/is a real piece of work--simultaneously overbearing and incredibly broken, completely codependent but never owning any of her damage. Very comfortable relegating all of my issues to something biological. Always asking what drug I am taking. I am getting better and telling her less and less about my life, but I am still so broken and she was basically the only person I had as a (terrible) means of support growing up. I really just wish one of these meds or combination of meds would make me feel good enough to break this bond for good. Essentially, I feel that my condition, while biological, is her "fault." (And my dad's, for not protecting me from her.) But no one in my family seems to own any of this. I figured out long ago that my only means of "escape" was making myself better. I just wish I could make myself better!
I tried prasozin for a couple of weeks before this latest Brintellix trial. It didn't seem to do much of anything for me. A little anxiety relief, but nothing much. I will probably try nortrityline or Nardil if Brintellix does not give me more relief. Or maybe I'll augment Brintellix with something like Wellbutrin to see what happens. I'm talking to my p-doc today.
I hope you can indeed, repair yourself, at some point. I understand what you're saying about needing an extended period of time of feeling "well" to do this. Without that extended period, I got lost inside, lost in projecting my anxiety and depression onto the outside world. It's truly torturous. It's even more torturous that so few people understand it, and fewer people (or substances) can do anything about it.
Your posts are always very helpful. I really appreciate your insights and sharing. Here's hoping for brighter days ahead. Always hoping.
Chris
Posted by LouisianaSportsman on April 17, 2014, at 22:13:56
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » SLS, posted by Chris O on April 17, 2014, at 12:16:20
How did the visit go, Chris?
Posted by Chris O on April 17, 2014, at 23:37:36
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » Chris O, posted by LouisianaSportsman on April 17, 2014, at 22:13:56
I'm going to up the dose of Brintellix to 30mg for the next week, then 40mg for two more weeks (or stay at 30mg--whatever feels better). My p-doc is totally open to what I want to do, but thinks it's good to try to get the maximum benefit from a single drug first before doing poly-pharmacology. I suggested Wellbutrin and he thought that was fine, but wanted to try to a higher dose of Brintellix first. In truth, it is helping me more than, probably, my last five or six trials (Vybriid, Serzone, Neurontin, Paxil, Prozac, Luvox, and a couple more). It's still not enough though. I don't feel like I can go out and get a job, function in the world like I'd like to. But I feel less like hiding, more able to look people straight in the face and talk to them. That's an improvement. And my paranoia has decreased fairly considerably. My GAD and depression tend to produce a strong paranoid streak, mostly due to my physical symptoms, I think. I'm always searching for the cause, asking myself, "What is wrong?" So, I'm going try a few weeks of upping the dose of Brintellix and go from there. Apparently, my p-doc has several other patients who have already done this, so ... I guess I'm not alone here. I'm just hoping it doesn't make my d*ck fall off. And at this point, that doesn't seem to be an exaggeration.
Hey, thanks for the concern. I really appreciate your and Scott's interaction with me on this post. I'll check back in when I have a sense of whether or not upping the dose of Brintellix is helpful.
Chris
Posted by SLS on April 18, 2014, at 6:40:09
In reply to Re: Augmenting to Brintellix: Theory Based on a Study » LouisianaSportsman, posted by Chris O on April 17, 2014, at 23:37:36
Good luck, Chris. I'm optimistic for you, even if you have to add other drugs to your treatment regime.
- Scott
Posted by Beckett on April 27, 2014, at 16:47:49
In reply to Brintellix 20mg: Fairly strong sexual side effect, posted by Chris O on April 14, 2014, at 18:36:39
Hi Chris,
First, how have things been going, and have you augmented? I wanted to throw my two cents in that Emsam is worth trying. I had a favorable response, and I thought it had a positive effect on anxiety, I was also on Xanax at the time, so it is difficult to tell.
May I also ask you about the blunting of feeling you described? Do you think it dampened the ability to experience pleasure across the board? I am hesitating to try any sort of ssri type therapy because I experienced such effect.
Posted by Chris O on April 28, 2014, at 17:35:55
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Chris O, posted by Beckett on April 27, 2014, at 16:47:49
Beckett:
Hey, thanks for checking in on me. You ask how have things been going? Eh, it's okay. I've been taking 30mg of Brintellix (up from 20mg for 2-3 weeks) for a couple of weeks now. I can't really say the effect on the "opening up" part of my anxiety/depression is any better. I know that it's taking the edge off the physicalized symptoms of my anxiety, but it's not complete enough, even at 30mg. It also makes me quite tired and fatigued (however, I also suffer from a fairly bad case of sleep apnea too--which is being so-so treated with CPAP--so it's hard to tell the definite origin of that "side effect.")
In terms of the blunting, yes, it's fairly strong and I would say Brintellix has dampened my ability to feel pleasure across the board. That's a very good way of putting it--"across the board." I just feel very "flat." Sexual feeling is the best way to metaphorically describe it: I have almost zero sexual desire, and very little pleasure the two times I have "tested it out" via masturbation. Blunted orgasm. Almost non-existent. (But also less fatigue after orgasm. Normally, I feel terrible fatigue after orgasm.) It's all very frustrating. In a way, what's happening with Brintellix in terms of dampening sexual feeling is good because my anxiety-disordered sex drive seems to get me nowhere as well. My "normal" anxiety-disordered sex drive seems very desperate and turn off-y to women. Brintellix takes the edge off that, but it's also, like, the opposite extreme. With Brintellix, I have no sex drive.
Anyway, I guess if I had to summarize, I would say Brintellix is giving me like a 4-ish (on a scale of 10) in terms of relief from some of my symptoms, but it's not enough to get me functioning in the world. I still have a "boxed in" feeling (though less than off Brintellix) that makes me hesitant to speak, act, make decisions, and live my life.
I appreciate the information about Emsam. My psychiatrist suggested that over two years ago. He thought it was weaker than Nardil though (in his experience with other patients), and suggested that the lower dosing that eliminates the food restrictions may have something to do with this. I am still totally open to it. What were your specific symptoms and how did Emsam treat them? How did it compare to other drugs you took? How long did you take it?
Hey, thanks again for checking in. This board is a godsend.
Chris
Posted by Beckett on April 28, 2014, at 23:04:15
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Beckett, posted by Chris O on April 28, 2014, at 17:35:55
Hi Chris,
Emotional blunting is a big problem. I'm sorry to hear that is your current experience. I have thought, (at least in regards to my own situation), that might be the way they decrease anxiety. I find AP's work this way on me, too.
You asked what am I treating. Recurrent depression (bipolar ll) and all kinds of anxiety. Social anxiety is most prominent likely leading to depression and further anxiety (GAD). My depression is very physical. My pdoc adds ADD to the list, and that creates anxiety, too.
I found Emsam stimulating in a good way unlike effexor, say. It's so easy to use which is why I would caution a recommendation. It didn't seem blunting to the degree of an ssri. I haven't tried any other MAOI, but I gather it is weaker. In my case it was enough to keep me out of the hole. I have used 6mg through 12mg patches. Only when my pdoc (at the time) pushed it past that did I feel the diet effect. No tap beer I've heard.
Have you tried any benzodiazepines?
Posted by Chris O on April 29, 2014, at 1:15:42
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect, posted by Beckett on April 28, 2014, at 23:04:15
Hey, Beckett:
Well, the physical aspect of your depression/anxiety is something I can totally relate to. I am tempted to say mine is almost completely in my body. It's like there is a wall of fear around me, a wall of tension. As I think I've told others on this board (Scott comes to mind), that "wall" is probably the result of my very controlling and mentally ill mother and the way she shaped my biology. I don't know about you, but I feel like I have no place inside of my being to go to "relax." When I stop being vigilant in fighting my anxiety, I end up in a place where my anxiety dominates me. I feel utterly humiliated and defeated. People often perceive this humiliated and defeated state in me as "calm". But it is exactly the opposite. This crappy sensation is slightly alleviated on the Brintellix though. But Brintellix alone is still not enough. I still feel frozen and fragile.
You mention ADD. I have never taken anything in the stimulant class as I always though those drugs would produce more panic in me. But in recent years, I've wondered if anything in the stimulant class would work for me. My psychiatrist does not think it will. I probably should at least try one of them to get a sense of how stimulants affect me. My intuition tells me they will produce panic and not relaxation. I already feel overstimulated, not under stimulated. But maybe I am not completely aware of what's going on inside of my neurons, either.
I tried Klonapin for about a year back in 2008. I took, if I remember correctly, at least 3mg a day. It just made me feel slightly drowsy, but the overall effect seemed weak to me. I could easily see doing a Stevie Nicks with Klonapin. I'm sure I could take 10mg a day and get not much of an effect. I would describe the benzo experience as just glazing over the surface of my mental health issues, not getting to the deeper roots. Very superficial feeling. SSRIs (when they have worked for me) are much better. I have not tried any antipsychotics. I have a hard time envisioning myself taking antipsychotics long-term. But I could be convinced if they altered my life in a positive and significant way.
Regarding Emsam, how long did you take it? At what dosage? And what overall improvements did you get (emotional, social, economic, etc.) from taking it? How did your behavior and inner sense of self change while on it?
Thanks again for the interaction. Really enriching for me.
Sincerely,
Chris
Posted by LouisianaSportsman on April 30, 2014, at 20:43:05
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Beckett, posted by Chris O on April 29, 2014, at 1:15:42
> Hey, Beckett:
>
> Well, the physical aspect of your depression/anxiety is something I can totally relate to. I am tempted to say mine is almost completely in my body. It's like there is a wall of fear around me, a wall of tension. As I think I've told others on this board (Scott comes to mind), that "wall" is probably the result of my very controlling and mentally ill mother and the way she shaped my biology. I don't know about you, but I feel like I have no place inside of my being to go to "relax." When I stop being vigilant in fighting my anxiety, I end up in a place where my anxiety dominates me. I feel utterly humiliated and defeated. People often perceive this humiliated and defeated state in me as "calm". But it is exactly the opposite. This crappy sensation is slightly alleviated on the Brintellix though. But Brintellix alone is still not enough. I still feel frozen and fragile.
>
> You mention ADD. I have never taken anything in the stimulant class as I always though those drugs would produce more panic in me. But in recent years, I've wondered if anything in the stimulant class would work for me. My psychiatrist does not think it will. I probably should at least try one of them to get a sense of how stimulants affect me. My intuition tells me they will produce panic and not relaxation. I already feel overstimulated, not under stimulated. But maybe I am not completely aware of what's going on inside of my neurons, either.
>
> I tried Klonapin for about a year back in 2008. I took, if I remember correctly, at least 3mg a day. It just made me feel slightly drowsy, but the overall effect seemed weak to me. I could easily see doing a Stevie Nicks with Klonapin. I'm sure I could take 10mg a day and get not much of an effect. I would describe the benzo experience as just glazing over the surface of my mental health issues, not getting to the deeper roots. Very superficial feeling. SSRIs (when they have worked for me) are much better. I have not tried any antipsychotics. I have a hard time envisioning myself taking antipsychotics long-term. But I could be convinced if they altered my life in a positive and significant way.
>
> Regarding Emsam, how long did you take it? At what dosage? And what overall improvements did you get (emotional, social, economic, etc.) from taking it? How did your behavior and inner sense of self change while on it?
>
> Thanks again for the interaction. Really enriching for me.
>
> Sincerely,
> ChrisHey, Chris!
Brintellix is doing what I expect out of a SSRI type medication. I don't really expect much from them to be honest, I prefer the medications I augment-- including AAPs such as Latuda, which is a lot stronger. I think adding a TCA like desipramine would be ideal for you, doesn't even have to be a high dose-- just start out with the initial.
I believe, with my intuition in my mind, Chris, that you should try dexmethylphendiate in conjunction with a benzodiazepine or pregabalin/gabapentin. I think you were see that that 4 --> 6.
Add on an AAP that works for you on to the Brintellix, and that 6 --> 8. (where I'm at with it)
Brintellix 30mg.
#60 Focalin IR 10mg.
#60 Ativan 0.5mg.
#60 Lyrica 100mg.
#30 Latuda 40mg.
#30 Desipramine 75mg.^^^
Augment this to the Brintellix. The anxiety will straighten out and you will gain a lot of energy an motivation.
AM: Focalin, Ativan, Lyrica
EVENING: Focalin. Ativan, Lyrica
Night: Desipramine Brintellix Latuda(food)Good luck!
Posted by Chris O on May 1, 2014, at 1:54:49
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect, posted by LouisianaSportsman on April 30, 2014, at 20:43:05
Thanks, Sportsman! Appreciate the feedback.
I'm going back to see my psychiatrist next week. I'll share your suggestions. That's quite a cocktail for me.
Not to get into a big discussion, but why desipramine vs. other TCAs such as nortriptylene? Why Latuda vs. other AAPs? And why focalin (which I've never heard of) vs. other stimulants?
Chris
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