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Dr. Bob is Robert Hsiung, MD,
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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
Posted by porkpiehat on May 8, 2014, at 11:19:58
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Beckett, posted by Chris O on April 29, 2014, at 1:15:42
So what conclusion have you reached regarding the Brintellix??
Posted by Chris O on May 8, 2014, at 12:39:33
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Chris O, posted by porkpiehat on May 8, 2014, at 11:19:58
Porkpie:
Well, I'm going back to my psychiatrist today. I've basically been on 20 mg/day for 3 weeks, and 30mg/day for 3 weeks. It is providing some relief for my anxiety and depression. I'd say a 4 out of 10. It's creating a slight feeling of tension relief in my body. Sleep not really improved. Still wakeup often during the night. (I'm using CPAP for moderate sleep apnea, by the way. Sleep doctor assures me the machine is doing its job well.) Anyway, the other thing I notice with Brintellix is that there are withdrawals if I miss a dose. I actually just start to feel terrible and don't know why, but then when I take the Brintellix the feeling goes away. It doesn't seem to have any long-term buildup like other SSRIs (Prozac and Celexa when they worked for me.) So, I don't really know what I'm going to do. I cannot afford Brintillex so would have to take it via sample, if my psychiatrist even wants to hassle with that. I'll hash it out with him today and see where to go next. Honestly, it's nice to have something work, even if it's ever so slight. Side effects fairly minimal too (so far), beyond dampening of sexual desire and orgasm.
Chris
Posted by porkpiehat on May 8, 2014, at 14:04:01
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » porkpiehat, posted by Chris O on May 8, 2014, at 12:39:33
Maybe if you treat it as a booster to something that work(ed)(s) for you. My apathy and depression were getting bad so I added just 10 mgs of Celexa and poof...it got better. Maybe something similar would work for you?
did you notice much difference when you jumped from 20 mgs to 30? My appetite has all but disappeared and I've had a cold that keeps getting worse. Any non-mood symptoms on your end?
Posted by ed_uk2010 on May 8, 2014, at 14:14:04
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
>Does it (TCAs) have the possibility of harming the heart, or is that just in people with heart disease that it is contraindicated?
TCAs, at high doses (mainly in overdose), can alter the function of the electrical conduction pathways in the heart. This effect is temporary while the drug level is high, they do not 'damage' the heart. TCAs can also affect heart rate (which is often increased). In patients without any underlying heart disease, the possibility of abnormal heart rhythms is very low. If you are over 60 or have health condition(s) predisposing to heart disease such as diabetes, it may be prudent to have an EKG before starting a TCA.
>Do you think antipsychotics are "safe" to take long term (like, for the rest of one's life) if they are working?
No medication is 'safe' as such, it is about balancing the potential risks against the benefits. If you were to take a TCA or an AP and found it very helpful with minimal adverse effects, it would be well worth continuing it.
Posted by Chris O on May 8, 2014, at 14:27:59
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Chris O, posted by ed_uk2010 on May 8, 2014, at 14:14:04
Thanks, Ed! Great feedback.
Sincerely,
Chris
Posted by Chris O on May 8, 2014, at 14:45:48
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Chris O, posted by porkpiehat on May 8, 2014, at 14:04:01
What I noticed when I jumped from 20 to 30mg are two things: First, I feel out of it (anxious, I guess is the best description) if I miss the next 10mg dose. It is definitely some kind of withdrawal, similar to a (milder version of) Effexor. Second, it does not really open me up more, something I need. I feel "boxed in" by my anxiety. Brintellix does reduce the anxiety, somewhat. But it also has a bit of a dampening effect. Hard to describe exactly. I remember the first time I took SSRIs in the late 1990s, I felt more opened up, more able to talk and move in the world without worry. With Brintellix, that boxed in feeling is still there, despite less anxiety.
In terms of non-mood symptoms, other than the ones I mentioned above (and the sexual side effects), I haven't had any. The cold thing for you is odd. I thought maybe there was some slight irritation in my nasal passages when first taking Brintellix, but that went away very quickly. My appetite has also not changed much. Are you saying you added 10mg of Celexa to Brintellix? I didn't know you could do this.
Posted by SLS on May 14, 2014, at 7:58:16
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
Very accurate. Thanks.
- Scott
> 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 Beckett on May 21, 2014, at 18:42:15
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » porkpiehat, posted by Chris O on May 8, 2014, at 14:45:48
Hi Chris,
How's it going? My doc has suggested Brintellix for depression and panic. I'm holding off for now.
Posted by Chris O on May 22, 2014, at 1:38:18
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect, posted by Beckett on May 21, 2014, at 18:42:15
Hey, porkpie hat:
Thanks for asking. Well, it's ... so-so. I started augmenting the Brintellix with 300mg of Wellbutrin about 2.5 weeks ago. Something not right about this combination for me. Maybe the Wellbutrin is a little too stimulating. It's making it harder to concentrate or something. Also a bit more anxious again. At the same time, it mitigates some of the sexual side effects of Wellbutrin. A bit more desire, better orgasm, etc. (Not that this matters to me all that much at this point.) But in terms of the Brintellix, even at 30mg (or 40mg), it's not opening me up enough. I still feel walled in (though less anxious). And it seems to wear off (partially) after half a day or so. If I don't take my 10mg at night (after 20mg in the morning), I get some type of mini withdrawal effects. It seems like all SSRIs have been this way for me over the past ten years. (I had initial success with Prozac and Celexa in 1999-2000, but stopped taking it after a year and have never really had the same success with any of the SSRIs.)
I still think you should try it though. Other than the sexual side effects, I don't have any side effects at all. No weight gain, no dry mouth, no nausea, no nothing. And it does relieve my anxiety a little (maybe a 3.5 or 4 out of 10). The other drawback is the cost. Even with my insurance, it costs $350/month for a 30 10mg pills. With Takeda's "discount card," it's "only" $250. Gee, thanks for the "discount" Takeda. I just can't afford that. I've been going back to my psychiatrist for samples, but this is too annoying. I'll probably have to move on to something else over the next month. Anyway, I wish you luck. Let me know you fare with this drug if you decide to take it.
Chris
Posted by Beckett on May 24, 2014, at 16:04:40
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Beckett, posted by Chris O on May 22, 2014, at 1:38:18
On cognitive function:
http://www.ncbi.nlm.nih.gov/pubmed/24787143
On GAD:
http://www.ncbi.nlm.nih.gov/pubmed/24424707
Hope the links are good.
Posted by Chris O on May 26, 2014, at 23:45:44
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Chris O, posted by Beckett on May 24, 2014, at 16:04:40
Great links. Thanks. The GAD link perhaps mirrors some of what I am experiencing, even at 30mg. Not a huge reduction, though a mild-moderate one. But not enough for significant improvement in my life circumstances.
Thanks,
Chris
Posted by Gaucho_tche on May 20, 2016, at 9:04:07
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Beckett, posted by Chris O on May 26, 2014, at 23:45:44
Hello Pal. Im using brintelix and I feel exactly like you. How did you go in the last 2 years since last post?
Posted by Gaucho_tche on May 20, 2016, at 9:06:22
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect » Beckett, posted by Chris O on May 26, 2014, at 23:45:44
Hello Pal. Im using brintelix and I feel exactly like you. How did you go in the last 2 years since last post?
Posted by Chris O on May 20, 2016, at 10:13:32
In reply to Re: Brintellix 20mg: Fairly strong sexual side effect, posted by Gaucho_tche on May 20, 2016, at 9:06:22
I did an rTMS trail (35 treatments) in late 2014/early 2015. It was pretty much useless. That's my last trail of anything over the past two years. Since then, I've just been will-powering through it, albeit horribly as usual. My primary symptom is a strong physicalized anxiety. Perhaps I will get around to trying the MAOI Nardil one day. Others have had very positive outcomes with Nardil on this board. Oh, I did do a brief trial of Adderall in 2015, as I have never tried stimulant medication before. Surprisingly, despite anxiety being my primary symptom, it did have some positive (anxiety reducing) effects, but also many negative effects (strong withdrawal anxiety, racing heart, problems with erection/arousal), so I doubt stimulant drugs are a long-term viable solution for me. Hey, here' s hoping you find something that works for you.
Posted by Ruuudy on June 5, 2016, at 20:51:05
In reply to Augmenting to Brintellix: Theory Based on a Study, posted by LouisianaSportsman on April 14, 2014, at 22:36:26
> 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:
>
> https://www.ruor.uottawa.ca/en/bitstream/handle/10393/30400/Lecours_Maurice_2014_thesis.pdf?sequence=3
>
> 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.
A very good theory, indeeed!I hope that this thread will be resparked with my comment.
There's been renewed talk on Brintellix.
And I have just read these older posts about it.I'm wondering if Brintellix might possibly be a good choice of an augmenting agent for my fluoxetine?
Would there be a risk of serotonin syndrome combining the two drugs?Thanks!
Rudy
Posted by Chris O on June 6, 2016, at 9:27:37
In reply to Re: Augmenting to Brintellix: Theory Based on a Study, posted by Ruuudy on June 5, 2016, at 20:51:05
Hi, Ruuudy,
I'm Chris, the guy that LousianaSportsman was interacting with about this topic. I never did try to add another SSRI to Brintellix, so I can't give any feedback on the subject. After 6-8 months on 30mg of Brintillex a day and only slightly better than mild antidepressant/anxiolytic effects, I gave up. I don't know enough about the drug to say if it is safe to combine it with another SSRI. I guess you would have to ask your psychiatrist about that. Good luck.
Chris
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