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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 12 to 36 of 61. Go back in thread:
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
Posted by ed_uk2010 on May 2, 2014, at 14:54:02
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » LouisianaSportsman, posted by Chris O on May 1, 2014, at 1:54:49
Unless it's unavoidable, it's best to add one psych med at a time. Otherwise, you have little idea which med is doing what.
Posted by Chris O on May 2, 2014, at 15:58:48
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Chris O, posted by ed_uk2010 on May 2, 2014, at 14:54:02
Thanks, Ed. That's the opinion of my psychiatrist as well. I consider both of you wise men. Truth be told, I've barely scratched the surface of poly pharmaceutical use though. Really only one time in my 15 years of doing this did I take two drugs at once, and that was "only" Celexa and Wellbutrin. I've not explored much outside the SSRI class. And I'm suffering fairly roundly. So, I probably should challenge my risk avoidance in this area.
Chris
Posted by ed_uk2010 on May 3, 2014, at 4:44:54
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » ed_uk2010, posted by Chris O on May 2, 2014, at 15:58:48
>So, I probably should challenge my risk avoidance in this area.
Starting multiple meds at once would be OK if you knew in advance exactly how each med was going to affect you, and exactly how they were going to interact in you brain/body.... but you don't.
There are circumstances when it's a good idea eg. for someone who gets 'start up' anxiety with SSRIs, a benzo can be Rxed for a couple of weeks. But it most cases, starting a caseload of meds at the same time can leave you very confused about what's helping, what's not helping, what's making you feel worse etc. You risk ending up on a whole pharmacy full on meds without knowing what you actually need to be on.
Posted by ed_uk2010 on May 3, 2014, at 5:09:24
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » ed_uk2010, posted by Chris O on May 2, 2014, at 15:58:48
>I've not explored much outside the SSRI class. And I'm suffering fairly roundly. So, I probably should challenge my risk avoidance in this area.
I'm not sure exactly what you've tried in terms on non-SSRI ADs.
Desipramine is a rather unique TCA. It does not generally cause weight gain, loss of libido or drowsiness. It can improve depression. It may be useful against panic at low doses but probably not generalised anxiety. The initial dose should be low and increased gradually. It is not recommended in those with coronary heart disease. Side effects may include increased pulse rate, mild constipation and increased sweating. Some people feel a bit agitated initially but this is by no means universal.
Nortriptyline is perhaps a little more broad spectrum. It is mainly useful for depression but can help some cases of anxiety. Nortriptyline can cause a certain amount of drowsiness (especially initially) and weight gain. It may be a bit more calming than desipramine. It often causes dry mouth and some constipation. It is started at a low dose and increased according to effectiveness and tolerability.
Mirtazapine (Remeron). Mirtazapine is often used as an add-on to SSRIs and related antidepressants to improve response. It tends to cause drowsiness but this should decrease in time. Weight gain can be an issue to watch out for. None of the above meds I've mentioned generally cause sexual dysfunction. Mirtazapine is usually taken as a single daily dose in the evening.
Aripiprazole (Abilify). 5-10mg of Abilify is increasing popular as an add to to antidepressants if response to monotherapy is inadequate. Restlessness and nausea can occur initially but tend to improve after a short while. Apart from the effect at dopamine receptors, some of the pharmacological properties of aripiprazole overlap with Brintellix.
Posted by Chris O on May 3, 2014, at 17:38:24
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Chris O, posted by ed_uk2010 on May 3, 2014, at 5:09:24
I appreciate the sage advice, Ed. You are a great resource. My psychiatrist and I have batted around my trying a TCA or MAOI for over two years now. The reason I haven't done that thus far is me: I'm a risk averse in the extreme. I got a Nardil prescription twice and didn't start it. Notriptylene was his choice in the TCA class and in fact that was going to be my next drug if Brintellix didn't work. I don't know anything about Despipramine. Does it have the possibility of harming the heart, or is that just in people with heart disease that it is contraindicated? I tried Remeron once for a couple of weeks and got a really strange circular rash around my nose and eyelids. I probably should have continued that trial but stopped it due to the rash. I am open to trying Remeron again, though I dread the weight gain. Abilify (and all antipsychotics) scares me the most as I am scared of the blood sugar, weight gain, and heart risks. Do you think antipsychotics are "safe" to take long term (like, for the rest of one's life) if they are working?
Thanks for your feedback.Chris
Posted by burial on May 5, 2014, at 11:00:19
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » ed_uk2010, posted by Chris O on May 3, 2014, at 17:38:24
>Do you think antipsychotics are "safe" to take long term (like, for the rest of one's life) if they are working?
> Thanks for your feedback.
>
> Chrisi think you've answered your question. If it works, you'll want to take them as long as you need them. I take zyprexa and besides weight gain i don't feel any side effects, i just feel calmer
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