Misc How to increase serotonin when on SSRIS? Or SSRI efficacy?

[ColoradoBoy90]

Taking 2 SSRIS + DXM seemed to help OCD and anxiety the most. My doctor has me cross tamper to one only, but when on two they seemed the most effective. So is it possible that maybe I am either ultra low on serotonin, or I damaged the serotonin system from all those meds. I also was taking: Adderall, Trazadone, mirtazapine, l-tryptophan, plus the two SSRI meds and DXM. So maybe they caused down-regulation of serotonin?
If so then I need to find a way to reverse that. I STOPPED DXM, Adderall, and Trazadone for weeks now but still not helping. So I do not get it.
Also: dopamine boosting worsens OCD, a lot. If I take Adderall which releases dopamine OCD worsens A LOT, and anxiety also. I only took it because I needed the energy boost, and being on it for 5-10 years I would sleep 18 hours a day without it. Same with taking l-tyrosine anxiety and OCD increases. Anything dopamine/noradrenaline boosting causes OCD and anxiety to worsen, even natural supplements that boost dopamine...


So my doctor is trying to get my Serotonin boosted heavily.
Now I am on 200mg Zoloft + 1gram to 1.5grams daily of l-tryptophan (the goal/theory is that l-tryptophan helps serotonin SYNETHIS while the SSRI works as a reuptake inhibitor, so they should have a synergy) and some studies have confirmed this. But it seems it is not enough for me... Heck I did not even have sexual side effects this entire time. So like my doctor thinks, I need to find a way to boost the SSRI. Besides l-tryptophan what else is there?
He said MAYBE serqueol or something similar even though they are bipolar or antipsychotic meds. But I guess they block dopamine and so far anytime I increase dopamine my OCD gets way worse. So it is a possibility that blocking dopamine would help to reduce OCD/anxiety a lot. But researching it is confusing as heck. It says that serequel and all others in its class ALSO work on blocking multiple serotonin receptors, not just dopamine.... Uhh... So that would seem like it could make OCD worse and also do the opposite of the SSRI? If it is blocking sertonin like I am assuming?
I need something to boost the SSRI, not do the opposite of it. Or am I misunderstanding how risperdal and serequel meds work???
Another option my doctor mentioned was: Lithium. Supposedly it can increase serotonin action and possibly boost an SSRI.


Any ideas? Or any ways to help SSRIS effectiveness increase? Or to help avoid their poop out effect? As SSRIS seemed to have basically saved me but they lose effectiveness so fast that I do not know what to do.
I am trying to AVOID relapsing onto Hydro and other pain meds, which is why I am trying to figure out the SSRI thing. As it is tempting to just take painkillers to try to numb the pain and reduce anxiety/OCD. I did that for 6 years and finally got free of it for almost a year.... I quit cold turkey about a year or so ago. But if I cannot figure out this SSRI thing I might be screwed.

 

[ColoradoBoy90]

If anyone has any ideas... Throw them out. I really do not want to relapse onto pain meds to try to numb OCD/anxiety away.

Paxil made me feel super confident, OCD reduced, etc after 1 pill and only 2 or so hours after taking! Not placebo as I was expecting nothing or negative effects if anything. This happened also on Prozac many years ago. Which through research seems to back up the low sertonin theory.

This study confirms it also:
/quote:
Antidepressants rapidly alter brain architecture, study finds

A single dose of SSRI antidepressants such as Fluoxetine, shown here, can change the brain's functional connectivity within three hours, a new study found. What was really surprising was that the entire brain would light up after only three hours. We didn't expect that.
/end quote.
It went on to explain they are not sure why SSRIS often take weeks to work, as this showed the SSRI altering the brain instantly. Basically all that came from the study they are hoping they can figure out how to make future antidepressants work just as fast.
But it confirms what many have said before, that SSRIS start to work instantly and some people feel it. My previous doctor showed me a study years before this one showing it started to alter sertonin transmission within 30-45 minutes. So it made sense why some felt a mood boost on first pill, then nothing after as the body is now used to it. Which sucks.
I also read that I guess SSRIS desensitize SERT autoreceptors which in turns makes the post-synaptic SERT more plentiful? Or whatever. Which is one explantation for delayed effect. But how do you prevent it from desentizing the post-synaptic receptors??? That?s the key..

From all the countless meds I have taken so far any sertonin boosting med helps OCD/anxiety/mood. In that order.
Any dopamine boosting one increases energy, motivation, mood, but also increases OCD and anxiety. Which increasing OCD (in me) is the cause of my depression. So I need OCD to be reduced as much as humanly possible, which is why trying to get SSRIS to work better and not poop out is critical.

 

[checktest]

Higher doses of ssris and ssri combos can be used in OCD. I know someone, actually a few, on clomipramine (the serotonergic TCA) and an SRI, which was slowly titrated as well. But those can be tricky and require close monitoring if you would relapse onto other drugs.

A subset of people respond to augmentation with buspirone, with its 5-ht1a business and some dopaminergic/adrenergic effects, varying at higher doses. Could be a candidate. It can be entirely useless and take a while.

Also, sometimes OCD can be stable on a dose of medication, without giving out, for a while. It can be easy to prejudge or read horror stories online.

While I wouldn't sign up for AAPs right away, and there are definite disadvantages, I do have to admit I know some people who respond well to augmentation. A friend responded entirely well to seroquel with great resolution of OCD-influenced delusions and religious tones, and helped her bipolar. Another one actually was worse on seroquel and was hyper, but she is bizarre and was similar with benzos.

Lithium can be good, though I heard the lower end may be better in OCD. I don't have access on my phone right now for good papers.

Prazosin can do some things with PTSD, and if excess adrenergic stuff heightens OCD, beta blockers are worth a shot. Clonidine can be weird with a2 autoreceptors, some people respond though.

 

[ColoradoBoy90]

Thanks for the input clomipramine is one I have looked up and it seems like an extremely potent SRI. Possibly the strongest of all outdoing even SSRIS like Paxil. But I also read that some people say the metabolite of clomipramine is a very potent noradrenaline reuptake inhibitor. One doctor online went as far as to call it equally potent in serotonin and noradrenaline action, which is very odd if true. Increasing NE like that normally worsens OCD/anxiety. So kind of confused on clomipramine.

I have researched clomipramine in the past and remember that even a mere 10mg (I believe 50mg is starting dose) resulted in equal or higher SERT occupancy than regular SSRI doses! It was in the 80% range at a mere 10mg dose so the insanely potent SERT occupancy it has may be the reason why it works so good for OCD. But since SSRIS like Zoloft/Paxil also occcupy 80% + of SERT would the TCA and SSRI be doing the same thing? Or even possibly competing against another? Or does a TCA have a different method of reuptaking sertonin then SSRIS?


Or does it reuptake sertonin in basically the exact same way SSRIS do? As I have heard of some people being on TWO different SSRI meds for bad OCD (like Lexapro + Zoloft for example) so was not sure if an SSRI + the TCA clomipramine was basically the same thing as taking two SSRI at once. Or if it is different since it is a TCA + SSRI.

I also take Benzos daily which I realized actually help OCD a lot. I have been on them for like 10 years so kind of stuck on them sadly. It will take years of tampering before I can get off them sadly. And if I even cut back by 1mg or so for one day? Normally my anxiety and ocd thoughts increase 10 fold. Taking a half a pill will normally resolve that within 30 mins or so. Which I never realized how potent Benzos are on OCD until recently when I tried to cut back on them. That just sucks

As for the lilthim lower dosages are better for OCD?

 

[Cloudboy9001]

Taking 2 SSRIS + DXM seemed to help OCD and anxiety the most. My doctor has me cross tamper to one only, but when on two they seemed the most effective. So is it possible that maybe I am either ultra low on serotonin, or I damaged the serotonin system from all those meds. I also was taking: Adderall, Trazadone, mirtazapine, l-tryptophan, plus the two SSRI meds and DXM. So maybe they caused down-regulation of serotonin?
If so then I need to find a way to reverse that. I STOPPED DXM, Adderall, and Trazadone for weeks now but still not helping. So I do not get it.
Also: dopamine boosting worsens OCD, a lot. If I take Adderall which releases dopamine OCD worsens A LOT, and anxiety also. I only took it because I needed the energy boost, and being on it for 5-10 years I would sleep 18 hours a day without it. Same with taking l-tyrosine anxiety and OCD increases. Anything dopamine/noradrenaline boosting causes OCD and anxiety to worsen, even natural supplements that boost dopamine...


So my doctor is trying to get my Serotonin boosted heavily.
Now I am on 200mg Zoloft + 1gram to 1.5grams daily of l-tryptophan (the goal/theory is that l-tryptophan helps serotonin SYNETHIS while the SSRI works as a reuptake inhibitor, so they should have a synergy) and some studies have confirmed this. But it seems it is not enough for me... Heck I did not even have sexual side effects this entire time. So like my doctor thinks, I need to find a way to boost the SSRI. Besides l-tryptophan what else is there?
He said MAYBE serqueol or something similar even though they are bipolar or antipsychotic meds. But I guess they block dopamine and so far anytime I increase dopamine my OCD gets way worse. So it is a possibility that blocking dopamine would help to reduce OCD/anxiety a lot. But researching it is confusing as heck. It says that serequel and all others in its class ALSO work on blocking multiple serotonin receptors, not just dopamine.... Uhh... So that would seem like it could make OCD worse and also do the opposite of the SSRI? If it is blocking sertonin like I am assuming?
I need something to boost the SSRI, not do the opposite of it. Or am I misunderstanding how risperdal and serequel meds work???
Another option my doctor mentioned was: Lithium. Supposedly it can increase serotonin action and possibly boost an SSRI.


Any ideas? Or any ways to help SSRIS effectiveness increase? Or to help avoid their poop out effect? As SSRIS seemed to have basically saved me but they lose effectiveness so fast that I do not know what to do.
I am trying to AVOID relapsing onto Hydro and other pain meds, which is why I am trying to figure out the SSRI thing. As it is tempting to just take painkillers to try to numb the pain and reduce anxiety/OCD. I did that for 6 years and finally got free of it for almost a year.... I quit cold turkey about a year or so ago. But if I cannot figure out this SSRI thing I might be screwed.

Pindolol is a weak partial 1A agonist that appears to substantially desensitize and/or downregulate 1A autoreceptors; thus, as autoreceptors inhibit serotonin release upon agonism, it appears to generate a true serotonergic action. Many studies have shown efficacy of 7.5mg/day (usually in 3 2.5mg doses) with SSRIs. One small study showed greater synergy of pindolol+(1A agonist) buspirone than pindolol+SSRI (https://www.nature.com/articles/1380554.pdf?proof=t).