Mental Health Is there a better antidepressant out there?

[supermoist]

So, I wanted to ask this here because I know blue-light has a lot of brilliant minds.

In a nutshell, I've had nasty depression since the last year of uni anxiety before that and it's generally just 'continued' post-uni and made me apathetic. I've found it difficult to get into the workplace and stay there since I usually end up having a breakdown. I'm going to try talk therapy again (on a waiting list) but I do wonder if I should try to find better medication.

So far my experience has been;
Citalopram - nothing, nada plus sleepiness.
Fluoxetine (prozac) - Nothing at the lower-doses. 40mg: Derealization with bouts of impulsiveness, bouts of depressive crashes, sleepiness.
Venlafaxine - Any dose up to 150mg. Immediate improvement in depression in days, sleepiness. Eventually pooped out. Also sped up time, made 3 years = 1 (!?).

Mirtazapine - Kinda working at 15mg? 8 weeks in and Bad BAD morning anxiety/terror/doom (+snappy) but generally a small, modest improvement over nothing. More energy but need 9 hours sleep, sometimes a mini-nap, also have to eat very carefully.


At this point I can't help but feel like I'm not really suited to mainstream antidepressants; I don't think my depression and anxiety has anything to do with serotonin deficiency. It could be psychological, it could be neurotransmission (dopamine-related?), it could even be something else like hypothyroidism, I don't know (last I was tested, everything was 'ok'). It's probably worth noting that psychotic depression is on my Mum's side... so there's a good chance of this being genetic or behavioural, or both.

I'm a bit complacent with MIRT, especially given the diurnal variation in mood and it doing nowt for anxiety... but I'm tempted to see if something like trazodone or a tricyclic might be better. Unfortunately my GP isn't so hot on combination therapy or MAOIs.

 

[HeadHigh]

Kanna is pretty good when it comes to mild to moderate depression

 

[Hodor]

There's Wellbutrin which is actually pretty mainstream, so I wonder why your doc hasn't tried it yet - it's a Noradrenaline-Dopamine Reuptake Inhibitor (well, mostly noradrenaline and only a tiny bit of dopamine so it's non-recreational), so it might be helpful for you.

Supposedly the new "Serotonin Modulators and Stimulators" (Vilazodone and Vortioxetine, though I think the former is not available in Europe) are pretty good too - they're basically SSRI's that also directly hit your 5HT1A serotonin receptor for an added anti-anxiety effect.

 

[supermoist]

Vortioxetine is available here but a lot of the less popular drugs are left alone by general practitioners (i.e. Moclobemide was a no-go as my GP doesn't have experience of it).

I think Wellbutrin would be absolutely perfect for me (though it can be anxiogenic) - just it was hastily taken off the market here. It launched as 'Zyban' for helping smokers quit; sadly suicides followed so it's been banned. A major pain in the bum if you suspect it's dopaminergic-related depression. As far as I'm aware it's possible to get it through a psychiatrist.

In general, I don't get the impression that GPs here are that great unless you want an S/NRI or mirtazapine. They might try a tricyclic if all else fails - otherwise it's the equivalent of a PDOC for combination therapy or a MAOI. It seems you essentially have to have a long history of TRD or a more disabling mental disorder in order to see a psychiatrist.

I'll visit my GP tomorrow because the morning Mirtazapine horror/terror is just... frightening.

 

[Hodor]

If it's available, you might also want to try Tianeptine ("Stablon", "Coaxil", "Tatinol", "Tianeurax"), which is a... actually, nobody really knows exactly what the fuck this stuff actually does. There is a mildly stimulating quality to it because of NMDA somethingsomething AMPA mumblemumble Adenosine... as well as a mild opioid buzz because it's also a µ-receptor agonist.

In some places where Tianeptine is unscheduled you can apparently order it in bulk from nootropics stores; however this might lead to addiction issues down the road because exceeding the one-size-fits-all dose of 37.5 mg/day to enjoy the opioid buzz can apparently be really tempting when you've got several grams of Tianeptine powder laying around.

 

[Phil.McKeer]

Ultra low dose buprenorphine is being studied for treatment resistant depression. It has worked in the trials and was even hypothesized to work in this manner when it was first isolated from thebaine.

I'm talking doses in the microgram range which can be tapered down to avoid any withdrawal syndrome upon cessation.

The studies I've performed in my own lab confirm that +/- <250ug's/day is a sufficient dose.

 

[Hodor]

Ultra low dose buprenorphine is being studied for treatment resistant depression. It has worked in the trials and was even hypothesized to work in this manner when it was first isolated from thebaine.

I'm talking doses in the microgram range which can be tapered down to avoid any withdrawal syndrome upon cessation.

The studies I've performed in my own lab confirm that +/- <250ug's/day is a sufficient dose.

I don't think his GP is going to hand out some Subutex to him willy-nilly, and I'm not sure OP is the kind of guy who can just go and cop his opioid of choice on the street.

That said, yes, low-dose Bupe sounds like an excellent antidepressant, and I really hope the combo drug containing both Buprenorphine and a strong µ-antagonist (so the bupe can no longer produce any euphoria at the µ-receptor, but will still stop your dynorphins - basically "bad endorphins" - from making you feel stressed out at the kappa-receptor) gets its FDA approval this year. Still, if the OP, like me, lives in Europe, we're going to have to hold out a while longer.

 

[supermoist]

That said, yes, low-dose Bupe sounds like an excellent antidepressant, and I really hope the combo drug containing both Buprenorphine and a strong µ-antagonist (so the bupe can no longer produce any euphoria at the µ-receptor, but will still stop your dynorphins - basically "bad endorphins" - from making you feel stressed out at the kappa-receptor) gets its FDA approval this year. Still, if the OP, like me, lives in Europe, we're going to have to hold out a while longer.

Bupe looks promising though yeah, I know it's not on option... despite me being the most compliant patient ever. I seldom take codeine for headaches and it often abolishes the brain fog and suddenly the tiredness disappears.

I'm giving up on the Mirtazapine. It's just not doing it for me and the morning terror is horrific. I think basically the next hoop for me to jump through is a tricyclic and at this point I'm at the end of my tether (feeling suicidal) so I'll take whatever I'm given. Though if I had any choice I'd go straight to an ensam patch.

 

[SKR]

Sertraline (Zoloft being one Brand Name) - best used for anxiety, panic disorder and depression. I was suffering serious "I'm going to definitely kill myself this week" anxiety and panic attack which was almost immediately improved with Sertraline. The day after my first dose had mostly removed that horrendous knot in my stomach but apparently that is unusual as like other SSRI's it's supposed to build up over at least a 2 week period. But it's possible that Sertraline can replace all those others all of which I have a box of in my medicine bag.

You have nothing to lose and it saved me after multiple mental breakdowns to be able to continue life and keep my job etc. Take care and good luck!

 

[AnythingEverything]

I am yet to find an anti depressant that makes me feel better enough to stay on it (and some are hell to get off.). Ive kind of given up but following this thread.

I saw you mentioned Zyban/Wellbutrin. Are you from Australia? I was prescribed Zyban last year 'off label' for smoking cessation, I did definitely want to quit smoking (which I did for a time) but I had looked a lot into bupropion and thought it would suit me well as an anti depressant for several reasons which is why I opted for Zyban over other other quit smoking meds.

I was absolutely PSYCHOTIC for the first 10 days the first time, the only time I've ended up in hospital with a severe panic attack etc etc, but after that I did find it worked well for me. I am not on it anymore but was able to get it for 3 months out of every 12 for smoking cessation on Pbs and then as long as I wanted off label through my suboxone dr but at full price ($180 from memory for 3 months worth.).

When I first started Suboxone I found it had some anti depressant effects, not like other opiates, but some. However after 3 years at a high dose its sucking the life out of me. I don't know how drs feel about sub as an anti depressant. I'd be in two minds. It's a hell of an addiction but so are some SSRI's and SNRI's, I would put desfenlafaxine withdrawal up there close to benzo withdrawal and that is saying something. For me, I've decided they're not worth it and im sticking with the therapy and dealing with the hard stuff route. Which sucks when you're suciical which I have been several times, but ultimately im hoping it's the best way. Best of luck.

 

[supermoist]

I am yet to find an anti depressant that makes me feel better enough to stay on it (and some are hell to get off.). Ive kind of given up but following this thread.

I saw you mentioned Zyban/Wellbutrin. Are you from Australia? I was prescribed Zyban last year 'off label' for smoking cessation, I did definitely want to quit smoking (which I did for a time) but I had looked a lot into bupropion and thought it would suit me well as an anti depressant for several reasons which is why I opted for Zyban over other other quit smoking meds.

I was absolutely PSYCHOTIC for the first 10 days the first time, the only time I've ended up in hospital with a severe panic attack etc etc, but after that I did find it worked well for me. I am not on it anymore but was able to get it for 3 months out of every 12 for smoking cessation on Pbs and then as long as I wanted off label through my suboxone dr but at full price ($180 from memory for 3 months worth.).

When I first started Suboxone I found it had some anti depressant effects, not like other opiates, but some. However after 3 years at a high dose its sucking the life out of me. I don't know how drs feel about sub as an anti depressant. I'd be in two minds. It's a hell of an addiction but so are some SSRI's and SNRI's, I would put desfenlafaxine withdrawal up there close to benzo withdrawal and that is saying something. For me, I've decided they're not worth it and im sticking with the therapy and dealing with the hard stuff route. Which sucks when you're suciical which I have been several times, but ultimately im hoping it's the best way. Best of luck.

I'm in the UK

I think that's the big risk with dopaminergics. They could either be the best thing ever or the worst thing ever. Considering my mother suffers from psychotic depression, I'm probably in the same camp as you. As for venlafaxine, I've actually been trying to make sense of why I responded to venlafaxine and short of genetic drug testing, I don't think there's much of a pattern that'll point me towards a better med. I've looked at binding profiles and whatnot but there's no glaring clues.

Like you, I had an unpleasant withdrawal from ven (the older sibling of desven). Almost two months on from stopping it the brain zaps have stopped (was still getting them on the mirtazapine). It's a great med but it's like the crack-cocaine of antidepressants; you feel better (a warm quiet mind) until you don't and then stopping or reducing them makes you hit a low, feel lonely/overwhelmed/tearful, have the zappies, a strange sensation on your tongue. It's like you've woken from a bad nightmare. The worst part is when I came off them it was if I awoke to the hard cold truth that I'd become so lazy and achieved very little in my time on them - I'd felt a bit disconnected from life and it was like time just went so quickly (but maybe it was because of the chemical happiness?). Perhaps I just started to enjoying life and trying to make the most of each day through the unpleasant side-effects (sleepiness, fatigue and headaches). Either way it poops out eventually like most of these treatments do.

I figure I'm just gonna see what the doctor thinks will be best and go for another round of trial and error. The obvious choices seem to be setraline, amitriptyline. Though there's some other tempting tricyclics like imipramine that looks less side-effect intense. As well as Duloxetine from the same class as VEN (that, said I hear a lot of bad things about Dulox - but you do with Effexor too). I'll just go with whatever they prescribe, can't know until I try...

Ps. Switch to vaping. Go sub-ohm, it's awesome!

 

[BigG]

I've struggled with depression for many years and have tried various SSRIs, SNRIs and Tricyclics all with zero effect....

For me it was a case of being depressed due to circumstances and a degree of PTSD due to work and i never found a pill to be any help with this....

What worked for me was finding an excellent councillor and being able to talk about my problems but mainly as my circumstances improved so did my depression....

Obviously this isnt the same for everyone and depression caused by a chemical imbalance rather than due to unfortunate circumstances may be more responsive....although many double blind studies on antidepressant drugs have shown then to be no more effective than a placebo....

 

[cdin]

I second tianeptine sulfate. I take 15mg sometimes, seems motivating/uplifting.

 

[MSK]

I was depressed all my life until I found psychedelics and dissociatives and I started to work on traumas I didn't knew I had. Since my monthly LSD mandatory trip, I didn't needed to come back to alprazolam daily use anymore

 

[jammin83]

microdosing psychedelics is your best bet IMO.

 

[XANAX XR]

I don't think his GP is going to hand out some Subutex to him willy-nilly, and I'm not sure OP is the kind of guy who can just go and cop his opioid of choice on the street.

That said, yes, low-dose Bupe sounds like an excellent antidepressant, and I really hope the combo drug containing both Buprenorphine and a strong µ-antagonist (so the bupe can no longer produce any euphoria at the µ-receptor, but will still stop your dynorphins - basically "bad endorphins" - from making you feel stressed out at the kappa-receptor) gets its FDA approval this year. Still, if the OP, like me, lives in Europe, we're going to have to hold out a while longer.

u talkin about samidorphan and buprenorphine?

 

[NoLiver]

The best would be to deny any Antidepressant your Doc wants to prescribe! It's your own decision but please inform exactly on what you're getting into, before taking ADs furthermore.

I think only when there is no other way out, it could and should be a short-term medication (up to 6 months). Because these medications will change your whole brain chemistry and it affects your other vitals also. There is a not to underrating danger of long-term damages and dependency, which exists definitely whatever your doctor says otherwise. It could be difficult to drop that meds.
Peoples character can change also in a bad way. There is a risk to get bipolar at this meds, too. High risk of negative sexual side-effects. ADs are able to convert people to pharmacy customers for their whole life...


There are alternatives in our nature, with anxiolytic and antidepressant properties. Some plants are equal to Benzodiazepines (read studies about that) without causing dependency and/or big problems when dropped. Maybe you know some of them already. Or you will laugh about that "tiny plants" but they can be very effective!

Like pharma-antidepressants you have to take some of them for a while to get the full effect. I suggest a mix of the following plants:

• Valerian roots - GABA-releaser and reuptake-inhibitor
• Passiflora - GABAergic and anxiolytic effects (compared with 30mg Oxazepam/d, when there were taken 45 Drops of the extract for 4 Weeks daily.)
• Hop cones - GABA-RI with sedating effects
• Melissa - GABA-RI and affects the cholinergic system -> mood lifting, nootropic and enhanced stress resistance
• Lavender - GABA-Agonist, can be boosted with Melissa

You could buy extracts or create your own tea-mix. Take it 2-3 times/day. If it's too sedating, take a lower dose during the day (or decrease Hop amount) and a "sleepy-dose" in the evening. It will increase your sleep quality. (Tested in a sleep lab in germany with Valerian/Hop. There was an effect even after taking it the first time.)


There are some other plants which could be useful if you need them, too:

• Mulungu (also called "vegetable valium") - anxiolytic and sedating effects. Can be used as a hypnotic. No dependency.

• Kratom (dependency risk! Contains Opioid.) - Allrounder. Mood lifter, painkiller, motivator and even anxiolytic to some people. At the beginning of your "treatment" you could feel euphoric. Effects are dependent to strain color, just inform about it. There are sedating and activating sorts.
• Colanut - body/mind stimulating, maybe mood-lifting because of theobromine
• Guarana - long lasting (up to 6h), more pleasuring caffeine, less nervous than coffee.
• Sida Cordifolia - contains ephedrine, "worst-case-medication", dependency risk, positive drug screenings.

If you want, get more information about "pythotherapy". Maybe you can find a useful "low-risk-medication" which is even healthy to your body, too.

You could also substitute with 5-HTP (will be converted into serotonine). The effect can be increased by taking curcumin (turmeric, curcuma) and the bioavailability can be increased by piperin (black pepper). A friend compared it to venlafaxine, even better.

If you think you need "more dopamine" try to take lots of tyrosine (like peanuts, soya..)

And continue the psychotherapy! In the long run, its more useful than a psychiatric and his/her meds. Check your life, change anything what's bad for you and you're able to change. Do anything that makes you feel good (except too much drugs) to collect positive memories.

Hope i was able to help you a bit. Good luck.

 

[XANAX XR]

The best would be to deny any Antidepressant your Doc wants to prescribe! It's your own decision but please inform exactly on what you're getting into, before taking ADs furthermore.

I think only when there is no other way out, it could and should be a short-term medication (up to 6 months). Because these medications will change your whole brain chemistry and it affects your other vitals also. There is a not to underrating danger of long-term damages and dependency, which exists definitely whatever your doctor says otherwise. It could be difficult to drop that meds.
Peoples character can change also in a bad way. There is a risk to get bipolar at this meds, too. High risk of negative sexual side-effects. ADs are able to convert people to pharmacy customers for their whole life...


There are alternatives in our nature, with anxiolytic and antidepressant properties. Some plants are equal to Benzodiazepines (read studies about that) without causing dependency and/or big problems when dropped. Maybe you know some of them already. Or you will laugh about that "tiny plants" but they can be very effective!

Like pharma-antidepressants you have to take some of them for a while to get the full effect. I suggest a mix of the following plants:

• Valerian roots - GABA-releaser and reuptake-inhibitor
• Passiflora - GABAergic and anxiolytic effects (compared with 30mg Oxazepam/d, when there were taken 45 Drops of the extract for 4 Weeks daily.)
• Hop cones - GABA-RI with sedating effects
• Melissa - GABA-RI and affects the cholinergic system -> mood lifting, nootropic and enhanced stress resistance
• Lavender - GABA-Agonist, can be boosted with Melissa

You could buy extracts or create your own tea-mix. Take it 2-3 times/day. If it's too sedating, take a lower dose during the day (or decrease Hop amount) and a "sleepy-dose" in the evening. It will increase your sleep quality. (Tested in a sleep lab in germany with Valerian/Hop. There was an effect even after taking it the first time.)


There are some other plants which could be useful if you need them, too:

• Mulungu (also called "vegetable valium") - anxiolytic and sedating effects. Can be used as a hypnotic. No dependency.

• Kratom (dependency risk! Contains Opioid.) - Allrounder. Mood lifter, painkiller, motivator and even anxiolytic to some people. At the beginning of your "treatment" you could feel euphoric. Effects are dependent to strain color, just inform about it. There are sedating and activating sorts.
• Colanut - body/mind stimulating, maybe mood-lifting because of theobromine
• Guarana - long lasting (up to 6h), more pleasuring caffeine, less nervous than coffee.
• Sida Cordifolia - contains ephedrine, "worst-case-medication", dependency risk, positive drug screenings.

If you want, get more information about "pythotherapy". Maybe you can find a useful "low-risk-medication" which is even healthy to your body, too.

You could also substitute with 5-HTP (will be converted into serotonine). The effect can be increased by taking curcumin (turmeric, curcuma) and the bioavailability can be increased by piperin (black pepper). A friend compared it to venlafaxine, even better.

If you think you need "more dopamine" try to take lots of tyrosine (like peanuts, soya..)

And continue the psychotherapy! In the long run, its more useful than a psychiatric and his/her meds. Check your life, change anything what's bad for you and you're able to change. Do anything that makes you feel good (except too much drugs) to collect positive memories.

Hope i was able to help you a bit. Good luck.

thank you for the post... might try those supplements in the first half of the post.

 

[tightlywound]

huh. it is hard because everyone's depression responds differently to different treatments. I find I only get much effect from antidepressants w/ norepinephrine action. my response to the usual SSRIs is so nonexistant that even after 6+ months on 40mg paxil (paroxetine) I felt no SSRI discontinuation syndrome, I never have felt anything CTing off long term SSRIs. I have been probably at least 75% of all the antidepressants that exist at one point or another, very few had any effect.

cymbalta (duloxetine, SNRI) worked to some degree for me for about 6 months, then worthless. no withdrawal symptoms CTing off that
viibryd (vilazodone, SSRI w/ very unique action, only one other antidepressant has similar action -- vortiofexine/brintalexx) worked GREAT for me for about 6 months, then it actually started making me feel WORSE. currently CTing off that and the withdrawals are fucking dastardly, you would never believe an antidepressant could put you through such misery.
wellbutrin (bupropion) I recently started on and it is working pretty damn well, kicked in fast too, after just several days I was feeling better.
buprenorphrine (not an antidepressant I know) really helped my depression and anxiety for a few months but nothing after that, now it's just a totally pointless addiction =/

maybe one of these may work for you?

 

[NoLiver]

you would never believe an antidepressant could put you through such misery.

One should believe in any of the numerous patients/users which share experiences like that. It proves, that these ADs aren't as harmless as some drs. tell - concealing many important facts.

And as you reported, the ADs which were effective lost this property after a while. Made the same experience with Mirtazapine - bad "coming down" suddenly after 5 Months of being high. These meds aren't really as well explored, as most patients believe.

It shows that it is not really a treatment especially in long-term use. Temporary suppression of symptoms with dependency risk and possibility of getting irreparable damaged.
Effects on a person are unpredictable, its an in vivo experiment with substances developed in legit drug labs, that even don't know by themselves, how some of these creations exactly work. A dealer is interested in selling large amounts. So the threshold of "disorder" will be reduced to spread these "feel better solutions" over the population. Anyone can get such a prescription easily, if he knows what to tell the psychiatrist to get a diagnosis.

People can also get bipolar, suicidal, even violent or there are other changes in personality and behaviour. Just drugs! Treat them like that, with caution...

There are worst-cases where treatment in hospital is necessary, sure. By seriously ill inpatients these medications can be a more human way instead of fixation or something. But should they provide them to almost everyone on the streets?

Just inform and decide by yourself. The brain can change itselve in a positive way if you get a good psychotheraphy. And every positive event/thought/input helps to cure depression slowly. You have to be patient and ready to investigate possible causes of depressive symptoms. Hard work which needs lots of time and energy from both: therapist and patient. It seems to be easier to go to a psychiatric fast-food-restaurant. Healthy stuff?