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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by vic80 on February 25, 2010, at 12:57:37
was given tianeptine (stablon) in december 2009 end for what to my GP appeared to be endogenous depression and anxiety. On his advice I saw a psychiatrist. I was diagnosed with anxiety and depression on Jan 08 2010. My prescription was a 10mg Escitalopram to be taken in the morning. I took this medicine as prescribed. The anxiety was taken care of in 10-12 days and in the 3rd week or so I felt its anti-depressive effect... I felt a little hyperactive, talkative and excited. This lasted for a couple of days, but the insomnia that came alongside made my situation bad. I had a bad bout of depression and also felt quite apathetic and strange in days to follow - anxiety was back too.
On 4th feb, Mirtazapine 15 Mg was added - as sleep aid and as anti-dep to augment Escitalopram. The Mirtazapine gave me good sleep no doubt, though initially I felt anger and agitation. In its 5-6th day my sadness started disappearing and a happy mood came over - mainly in the evenings. after 9 days on Mirtazapine-escitalopram combo - I felt suddenly like I have no emotions/feelings etc - it made me quite uncomfortable and wretched and I decided to cold-turkey on both meds. I think I dont know if stopping the drugs made much difference. I restarted Escitalopram on 20th Feb, and have been taking it for 5 days now. I do feel that emotionally I still feel blunted - I lack motivation - and have again started feeling dysphoric moods - without melancholic feelings - just very wretched and dumbed - i tend to blame it on some anger of not being able to feel all emotions - or perhaps(and hopefully) it is just my fear/belief that I have this so called emotional-blunting. I could call it lack of excitability - lack of full range of emotions.
I know it would be absurd to think, but could it be possible that the Escitalopram-Mirtazapine combo could have caused a permanent emotional-blunting effect?
I changed my pdoc yesterday - but he advised me to continue escitalopram 10mg for a week and added 0.25 mg clonazepam for anxiety (perhaps for my reporting of feeling irritable).
I have heard that benzodiazepines can worsen depression - cause dysphoria. This particularly makes me scared because past 2 days I have felt spells of wretched moods - adding clonazepam could worsen this?
I would like to know if Tianeptine could be added to Escitalopram in a hope to provide offset for emotional-blunting effect.I am in dire need to start a new life - not being able to be emotionally fully active would be surely unwanted. Plus my profession demands me to be creative and sensitive.
My escitalopram pattern has been:
8th Jan 2010 - 13 Feb 2010 - 10mg once daily
13th-19th Feb - None
20th onwards - 10mg once daily"PLEASE HELP
PS: could it be that its some learned assumption - I CAN have 'emotional numbing' - may be I have scared myself into believing so - perhaps - whenever I am to feel a strong emotion my sub-conscious tells my mind 'just keep it down' ??
Posted by metafunj on February 25, 2010, at 14:48:26
In reply to Tianeptine for escitalopram's emotional blunting?, posted by vic80 on February 25, 2010, at 12:57:37
You're not the first person on this thread to experience emotional numbing from Lexapro OR Remeron. Maybe some of those people can talk about their experience. Did you feel numb at all when you first took lexapro before taking Remeron?
I would wait a little while before making a decision. Atleast give lexapro the same amount of time to get the antidepressant effect you received from first taking it. Seems like Remeron was the problem for you, but lexapro can also cause numbness, but usually not that fast.
Taking Tianeptine with lexapro would be an odd combination since tianeptine makes the serotonergic transporters take more serotonin back into the cells, and lexapro blocks this process. I would think that tianeptine alone, would be better for emotions. Wish I could get some in the U.S.
Posted by bleauberry on February 25, 2010, at 17:00:42
In reply to Tianeptine for escitalopram's emotional blunting?, posted by vic80 on February 25, 2010, at 12:57:37
The best bet is to not take any medication that is likely to cause or worsen emotional blunting, which includes any medication that is primarily serotonin based. Of the ssris, I would say prozac is the least likely of the bunch, but they are all quite guilty.
A good strategy to battle depression and anxiety yet avoid emotional blunting is to avoid focus on any single neurotransmitter, but instead hit a combination of them. That includes things like SSRI+Nortriptyline, SSRI+Ritalin, Parnate, Nardil, Savella. Of the antipsychotics to consider adding to an antidepressant, abilify at very low doses would be reasonable.
I think more and more the emotional blunting effect of ssris is coming to public view. I've seen it showing up in magazine articles and TV shows for the first time, even though we've all seen it happening for years.
The moral of the story is...don't take anything that puts an unequal favor on serotonin. As for the anxiety and klonopin, a better option to handle temporary anxiety with the least depressive risk is xanax.
Posted by conundrum on February 25, 2010, at 22:18:38
In reply to Re: Tianeptine for escitalopram's emotional blunting?, posted by bleauberry on February 25, 2010, at 17:00:42
I agree with Bleauberry, sounds like you need some norepinephrine as well.
Posted by vic80 on February 26, 2010, at 2:16:53
In reply to Re: Tianeptine for escitalopram's emotional blunting?, posted by bleauberry on February 25, 2010, at 17:00:42
Hi guys,
Thanks for messaging back. I had given up on wanting to find solution to my problem. I am a novice in the anti-dep med department.... never having taken an psycho-active med before.
First off I do not know if my emotions are numbed: for example I do feel angry, irritated, worried etc - perhaps not excited or sad or happy at things that should be making me feel that way. Then again IF I AM CONSTANTLY OBSERVING/TESTING MYSELF FOR EMOTIONAL REACTIONS it would mean that emotions would definitely not turn out naturally. Its as though I am in some indoctrinated belief that I have emotional-blunting and nothing should make me very happy or sad etc.
When I cold-turkeyed on my 36day escitalopram and 9 day mirtazapine on 13th feb - I had gone literally crazy - feeling like I am absolutely in another world - absolutely detached - not able to think - people talking felt like they are talking in my head - felt like I am a ghost.
Restarting escitalopram on 20th (after a week of being off it) did make me feel less psyched out definitely... but along came utter irritation-agitation and internalized anger. ..since past 6 days I have noticed myself becoming utterly antagonistic/irritated/angry/withdrawn and nihilistic.. and as a bonus sui**de ideation is back to haunt me... I am taking this all as a sign of the ongoing depressive bout perhaps.... and have my family around to keep a check on me.
I have definitely done more damage to myself by constantly reading about side-effects/adverse effects of medicines and mental-disorders - online forums with users describing catastrophic experiences with medication.I guess my current state makes me want to get euphoric without the intoxicating/mind-altering effect - I have done cannabis many years ago - but in the past few years I get panic attacks when I try to get high - on alcohol or weed - so I am off these completely.
I feel mainly that whenever I feel a little good - it doesnt last for more than a couple of minutes - and then I am back in hell - full of disgust/agitation and utterly disinterested.
Could this be the effect of restarting escitalopram?
BTW how does Dopamine effect euphoria - moods?
I wonder if the brain produces more Dopamine to offset the extra serotonin brought about by the ssri meds - and it causes one to be agitated?Any views on use Rauwolfia to curb emotional numbing... I am terified of anti-psychotics...,... though it is quite presumptious of me to think I'd need any.
I guess I am in a fix - is it depression/dysphoria - bad mood thats making me agitated and disgusted OR is it my fixation with my supposed emotional numbing.....
I took the Hamilton Test online on my own and my depression score was just 18..
plus I do not feel much anxiety - just irritation and anger - disinterest - no motivation - feeling harrassed constantly... helpless -I have just another 3- days before I go back to my p-doc (from the govt. hospital I can afford right now) and he is quite not empathetic...
Sorry for my rants - just could not put it any other way.
Would 0.25 mg clonazepam (prescribed by the pdoc) help in lessening irritation/agitation etc? or would I feel like a stupid zombie...
Should I blame escitalopram for the anger-agitation-dysphoria-disinterest ?
I have 6 tabs of 12.5mg stablon remaining from my first prescription .. could they help in any way?
Posted by Brainbeard on February 26, 2010, at 6:52:34
In reply to Re: Tianeptine for escitalopram's emotional blunting?, posted by vic80 on February 26, 2010, at 2:16:53
Tianeptine taken long term has a net result on serotonin transmission similar to the SSRI's. There are differences, of course; tianeptine is also mildly pro-dopaminergic, and it lacks the sexual side-effects typical of the SSRI's. But the statement that tianeptine enhances emotions while SSRI's numb them has turned out to be more of a myth than a factual truth. Long term use of tianeptine can foster a same kind of emotional indifference as the SSRI's, in my experience and those of others. The numbness may be milder though.
Adding tianeptine to an SSRI may not be an effective strategy. Tianeptine is such a mild med that I suspect any SSRI would blow it right away in terms of having any therapeutic effect.
Taken in higher doses, tianeptine has a more pronounced prodopaminergic effect, which may lead to euphoria and stimulation. People who use it recreationally speak of taking at least 10 12.5mg tablets for creating this effect. If I take two or more tablets PRN, the drug has an immediate mood-lifting and mildly stimulating effect on me. Tianeptine also stimulates my libido, at least the mental part of it, but oddly perhaps, SSRI's do the same.
I agree with what has been said before about adding a noradrenergic drug or a drug that hits different neurotransmitters.
If you want to switch over to tianeptine, my advice would be to quit the escitalopram completely.
Posted by conundrum on February 26, 2010, at 7:47:12
In reply to Re: Tianeptine for escitalopram's emotional blunting?, posted by vic80 on February 26, 2010, at 2:16:53
Suicidal ideation is not good. You know its written on the box that these drugs can make people suicidal. If you think you're having a placebo effect from reading negative things on forums I suggest you stop for a few days and see if some of the worrying goes away.
Posted by desolationrower on March 2, 2010, at 1:45:05
In reply to Re: Tianeptine for escitalopram's emotional blunting?, posted by Brainbeard on February 26, 2010, at 6:52:34
htere was some evidence that taking sri +tianeptine was less helpful than either one on its own
-d/r
Posted by elanor roosevelt on March 8, 2010, at 21:20:28
In reply to Re: Tianeptine for escitalopram's emotional blunting?, posted by desolationrower on March 2, 2010, at 1:45:05
I took Tianeptine and after immediate success for a few days I found myself getting teary for no reason at all. However, I still used it on an as-needed single-dose basis for a few years bc I found it to be pro-social and pro-sexual
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