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Help me create the optimal (theoretically) combination of antidepressants/anti-GAD-medications.

Båtmannen

Bluelighter
Joined
Jan 18, 2015
Messages
271
Hello,

I'm 28 years old, and have been on antidepressants since I was 18. I've tried all sorts of medications except MAOI:s. I'm diagnosed with high functioning autism (or Aspergers), MDD, GAD, OCD and I think one more I've forgotten. Today I would be diagnosed with schizophrenia like symptoms due to my psychosis, but it's probably due to amphetamin use, although I've hold up for several weeks while ingesting 15 mg abilify per day and it's still there, but much weaker.

Today I'm on;:
300 mg Bupropion (which I have no intention of stopping)
67,5 (sic) mg of Mirtazapine (which works but together with methadone I don't have the discipline to keep the weight off; I'm at 253 lbs now)
15 mg of Abilify but I don't use it as I should because I want to use street amphetamine and Abilify is exceptionally good at blocking the D-receptors, but I plan on quitting, and will officially be on 15 mg:s, but iwll really take about up to 5 mg per dag (like 2,5 mg, as this seems to be the better range for depression - probably because at this amount it works as a weak agonist att D-receptors, while already occupying 70 % of D2, and I suppose 15 mg would occupy 90 % (the level of D-occupancy(/occupation?) seems to be following an inverse x^2-graph, hency my supposing about 15 mg)
4 mg trihexyphenidyl which I really don't need but use in higher amounts because of its ability to induce sleep)
100 mg of Methadone per day (this I will increase, and try to switch to Levomethadone due to it having higher affinity for the MOR-receptor, and because - if I remember correctly - it's also a 5-HT and NE reuptake inhibitor
Melatonine, 4 mg per day that I rarely take

Now, I'm trying to get Agomelatine added, and Mirtazapine removed. I fear they won't do this because I had very slightly too high ASAT-levels, but I will try. If I suceeed With changing to Agomelatine instead of Mirtazapine,, then I have no serotonergic effect of my antidepressant medications - should I try completely without something that is serotonergic? Other than Vortioxetine, it has never worked for me anyway. Not even MDMA (tried different sorts of Exctacy as well as pure MDMA) makes me euphoric.

Well, aripiprazole is a partial agonist of the most important receptor - 5-ht1a, although it also affects 5-ht2c in the same way, but much weaker, and probably won't be affected at all by 2,5 mgs.

I'm thinkinf of asking for Vortioxetine if they say no to Agomelatine, should I try and get in on top of what I already have, or discontinue Mirtazapine? The problem is....I want a girl friend, and your **** has to be working, and methadone makes this very problematic, but when on mirtazapine and bupropion it's manageable. No matter, I will just use exogenous testosterone to fix this.


What do you suggest/propose I ask for? And am I thinking correctly regarding what I've written?


best regards and I'm very thankful for all serious answers, even if you're not sure (hell - the combined world's research and doctors and pharmacologists can't solve problems like mine fully, so why should I or you? But please...try)
 

Phobos

Bluelighter
Joined
Oct 5, 2010
Messages
1,569
Hi there man, glad to see you posting again.
Are you still using amphetamine? If yes, how much?

The first thing I notice is that you weigh 253lbs and you seem to imply that you are overweight, so you need to be very careful about taking testosterone shots, and how you take them.
Fat converts testosterone to estrogen through aromatase, so you might suffer from elevated estrogen if you go on TRT.
You should be able to manage that with aromatase inhibitors and frequent, smaller injections though.
 

madness00

Moderator: NMI, MH, CD
Staff member
Joined
Aug 8, 2018
Messages
5,082
Location
New England
Thanks S.J.P.

And just to reiterate the rules of MH, please don't advise anyone to start or stop a medication. Simple explain what has worked for you in the past.

No one broke this rule, yet, just a forewarning.
 

Båtmannen

Bluelighter
Joined
Jan 18, 2015
Messages
271
Hi there man, glad to see you posting again.
Are you still using amphetamine? If yes, how much?

The first thing I notice is that you weigh 253lbs and you seem to imply that you are overweight, so you need to be very careful about taking testosterone shots, and how you take them.
Fat converts testosterone to estrogen through aromatase, so you might suffer from elevated estrogen if you go on TRT.
You should be able to manage that with aromatase inhibitors and frequent, smaller injections though.
hi and thanks.
My amphetamine use is lower, because I don't use 1 gram per shot anymore. I don't have any veins left..
.. so no kick. Now I want to quit... Just not strong enough. I told myself this is the last time I buy. I have a reason: I get my Metadonet home with me during weekends if I piss clean. And then I can come only 4 times a week etc. If I shoot my methadone... I don't think I will need other drugs. I have an artery I shoot in often. Burns like hell but no permanent problems. I must have a terrible oral BA because I got an high from taking 35 mg IV than 100 mg orally.
 

Båtmannen

Bluelighter
Joined
Jan 18, 2015
Messages
271
Thanks S.J.P.

And just to reiterate the rules of MH, please don't advise anyone to start or stop a medication. Simple explain what has worked for you in the past.

No one broke this rule, yet, just a forewarning.
But people can tell me what theoretically would be the best combination of antidepressants, yes?
 

Phobos

Bluelighter
Joined
Oct 5, 2010
Messages
1,569
hi and thanks.
My amphetamine use is lower, because I don't use 1 gram per shot anymore. I don't have any veins left..
.. so no kick. Now I want to quit... Just not strong enough. I told myself this is the last time I buy. I have a reason: I get my Metadonet home with me during weekends if I piss clean. And then I can come only 4 times a week etc. If I shoot my methadone... I don't think I will need other drugs. I have an artery I shoot in often. Burns like hell but no permanent problems. I must have a terrible oral BA because I got an high from taking 35 mg IV than 100 mg orally.
Dude... You have to stop any injecting now.
You have no veins left and you can only use an artery.... That's scary.
There is no point in telling you anything else, that has to be your priority.
No medication can make you feel better until you start loving yourself enough to stop doing artery shots.
 

Mycophile

Bluelighter
Joined
Mar 3, 2014
Messages
3,606
Hello,

I'm 28 years old, and have been on antidepressants since I was 18. I've tried all sorts of medications except MAOI:s. I'm diagnosed with high functioning autism (or Aspergers), MDD, GAD, OCD and I think one more I've forgotten. Today I would be diagnosed with schizophrenia like symptoms due to my psychosis, but it's probably due to amphetamin use, although I've hold up for several weeks while ingesting 15 mg abilify per day and it's still there, but much weaker.

Today I'm on;:
300 mg Bupropion (which I have no intention of stopping)
67,5 (sic) mg of Mirtazapine (which works but together with methadone I don't have the discipline to keep the weight off; I'm at 253 lbs now)
15 mg of Abilify but I don't use it as I should because I want to use street amphetamine and Abilify is exceptionally good at blocking the D-receptors, but I plan on quitting, and will officially be on 15 mg:s, but iwll really take about up to 5 mg per dag (like 2,5 mg, as this seems to be the better range for depression - probably because at this amount it works as a weak agonist att D-receptors, while already occupying 70 % of D2, and I suppose 15 mg would occupy 90 % (the level of D-occupancy(/occupation?) seems to be following an inverse x^2-graph, hency my supposing about 15 mg)
4 mg trihexyphenidyl which I really don't need but use in higher amounts because of its ability to induce sleep)
100 mg of Methadone per day (this I will increase, and try to switch to Levomethadone due to it having higher affinity for the MOR-receptor, and because - if I remember correctly - it's also a 5-HT and NE reuptake inhibitor
Melatonine, 4 mg per day that I rarely take

Now, I'm trying to get Agomelatine added, and Mirtazapine removed. I fear they won't do this because I had very slightly too high ASAT-levels, but I will try. If I suceeed With changing to Agomelatine instead of Mirtazapine,, then I have no serotonergic effect of my antidepressant medications - should I try completely without something that is serotonergic? Other than Vortioxetine, it has never worked for me anyway. Not even MDMA (tried different sorts of Exctacy as well as pure MDMA) makes me euphoric.

Well, aripiprazole is a partial agonist of the most important receptor - 5-ht1a, although it also affects 5-ht2c in the same way, but much weaker, and probably won't be affected at all by 2,5 mgs.

I'm thinkinf of asking for Vortioxetine if they say no to Agomelatine, should I try and get in on top of what I already have, or discontinue Mirtazapine? The problem is....I want a girl friend, and your **** has to be working, and methadone makes this very problematic, but when on mirtazapine and bupropion it's manageable. No matter, I will just use exogenous testosterone to fix this.


What do you suggest/propose I ask for? And am I thinking correctly regarding what I've written?


best regards and I'm very thankful for all serious answers, even if you're not sure (hell - the combined world's research and doctors and pharmacologists can't solve problems like mine fully, so why should I or you? But please...try)
Hey. I'm sorry to hear that you are having a hard time, and sorry that I don't really have any good advice.

However, you did mention a medication that I have heard some good things about, which is Vortioxetine, and I had a few questions about it.

Have you ever taken Vortioxetine, and if so, how has it helped you, and what does it usually help people with?

I have generalized anxiety disorder, OCD, some depression and Non-Verbal Learning Disability, which some people say might be on the autism spectrum much like your Aspergers, though if that is true it's not as severe I don't think as Aspergers.

I am on Klonopin and Lexapro, but i don't feel the Lexapro does much for me, and I do get some side effects from Klonopin like fatigue, and I think someone mentioned Vortioxetine to me when I asked about medications that might help with anxiety that aren't benzos, and if I remember correctly someone said it is probably the best SSRI for anxiety out there.

Do you feel that is the case?

Would you recommend it for someone with the kind of mental health issues I'm describing?

Anyone else who knows more about Vortioxetine also please feel free to answer.

Thanks.
 

Båtmannen

Bluelighter
Joined
Jan 18, 2015
Messages
271
Hey. I'm sorry to hear that you are having a hard time, and sorry that I don't really have any good advice.

However, you did mention a medication that I have heard some good things about, which is Vortioxetine, and I had a few questions about it.

Have you ever taken Vortioxetine, and if so, how has it helped you, and what does it usually help people with?

I have generalized anxiety disorder, OCD, some depression and Non-Verbal Learning Disability, which some people say might be on the autism spectrum much like your Aspergers, though if that is true it's not as severe I don't think as Aspergers.

I am on Klonopin and Lexapro, but i don't feel the Lexapro does much for me, and I do get some side effects from Klonopin like fatigue, and I think someone mentioned Vortioxetine to me when I asked about medications that might help with anxiety that aren't benzos, and if I remember correctly someone said it is probably the best SSRI for anxiety out there.

Do you feel that is the case?

Would you recommend it for someone with the kind of mental health issues I'm describing?

Anyone else who knows more about Vortioxetine also please feel free to answer.

Thanks.
The only time people around me reacted, was when I was on Vortioxetine. People started telling me that I smiled more than before, et cetera. Only after some time I realized it's very possible due to vortioxetine. However, it's not an SSRI. It's more powerful than SSRI:s. At least it should be, logically. However, this is one of my favourite analysis (don't know the plural version of analysis), and it puts vortioxetine below Escitalopram in both efficiacy (effect on depression) and acceptability (how many drop-outs there are, where "below" means more drop-outs).

***mode edit - Vortioxetine worked for me.*** (don't recommend people to take specific drugs)*** It made me start smiling for the first time in years. I didn't really notice it myself, but several others did.


Guys please. Now I'm on:

300 mg bupropion
25 mg Agomelatine
100 mg Methadone
(15 mg Abilify but I take 2,5 mg or none, except when my brain go batshit insane)



This means I have no serotonergic effect at all, or well, perhaps some from the Methadone (I think it block the SERT). What would be your next step? I think the obvious is to increase Agomelatine to 50 mg and try that, but I'm thinking about Vortioxetine as well.

Mirtazapin would be awesome, if it wasn't for my regular problems with obesity due to medications. I use food as a drug and I constantly goes up and down between below 200 lbs up to 275 lbs, depending on where I am at the moment,how depressed I am, what medications I use, et cetera.

If I had alot of money, I could just use that SNDRI that were used for a short time like 7 years ago, an antidepressant that completely removed all appetite. Or well, hGH or DNP for that matter. But what the...
 
Last edited by a moderator:

checktest

Bluelighter
Joined
Jun 9, 2013
Messages
181
Location
The Aether
Bupropion is a significant CYP2D6 inhibitor, which is relevant for a number of medications, including vortioxetine and abilify (essentially they suggest halving the dose for vortioxetine). I was on vortioxetine and bupropion in the past and didn't modify my doses but it would be good practice, especially with a lot of drugs.

Methadone has some significant QT risks at those doses, so hopefully you would get EKGs and such before adding some medicines like TCAs and higher dose citalopram. I think bupropion make actually reduces QT some but not sure where that lies. Mirtazapine has some possible risks. I don't want to consider cardiac effects with a gram of amphetamine added in there, but yeah...
Come to think of it, I don't know how well some would interact with that level of amphetamine. Vortioxetine has some B1 affinity and might not mesh with IV amp too well, throwing random thoughts out...partial 5-ht1b who even knows

Low-dose buspirone is an option for 5-ht1a agonism amongst other properties, but I can't personally say that it works all that well. I think some of that evaluation suffers from a comparison to benzodiazepines in anxiety, and that it has some use as an adjunct. It was somewhat helpful for me, nothing major

I was on vortioxetine and mirtazapine, and it worked well. Vortioxetine was more effective for me even than 70 mg of Parnate, an MAOI, but I believe that is uncommon.

Just want to throw out there getting evaluated for sleep apnea if you have fatigue/ daytime sleepiness or something that you might be trying to use the amphetamines for. High weight and methadone can contribute to sleep-disordered breathing. I helped out at a sleep clinic and a lot of new people came in from a local opioid clinic. Especially some skinny ones. I've been wanting to do a bigger post on it.

Take care out there, man.
 
Last edited:

Mycophile

Bluelighter
Joined
Mar 3, 2014
Messages
3,606
The only time people around me reacted, was when I was on Vortioxetine. People started telling me that I smiled more than before, et cetera. Only after some time I realized it's very possible due to vortioxetine. However, it's not an SSRI. It's more powerful than SSRI:s. At least it should be, logically. However, this is one of my favourite analysis (don't know the plural version of analysis), and it puts vortioxetine below Escitalopram in both efficiacy (effect on depression) and acceptability (how many drop-outs there are, where "below" means more drop-outs).

***mode edit - Vortioxetine worked for me.*** (don't recommend people to take specific drugs)*** It made me start smiling for the first time in years. I didn't really notice it myself, but several others did.


Guys please. Now I'm on:

300 mg bupropion
25 mg Agomelatine
100 mg Methadone
(15 mg Abilify but I take 2,5 mg or none, except when my brain go batshit insane)



This means I have no serotonergic effect at all, or well, perhaps some from the Methadone (I think it block the SERT). What would be your next step? I think the obvious is to increase Agomelatine to 50 mg and try that, but I'm thinking about Vortioxetine as well.

Mirtazapin would be awesome, if it wasn't for my regular problems with obesity due to medications. I use food as a drug and I constantly goes up and down between below 200 lbs up to 275 lbs, depending on where I am at the moment,how depressed I am, what medications I use, et cetera.

If I had alot of money, I could just use that SNDRI that were used for a short time like 7 years ago, an antidepressant that completely removed all appetite. Or well, hGH or DNP for that matter. But what the...
Well this makes me more interested in Vortioxetine if it worked for you, but why did you stop taking it then?

And why are you saying you think it is less effective than Lexapro?

Also, what class of meds does it belong to if not SSRIs?
 

Mycophile

Bluelighter
Joined
Mar 3, 2014
Messages
3,606
Bupropion is a significant CYP2D6 inhibitor, which is relevant for a number of medications, including vortioxetine and abilify (essentially they suggest halving the dose for vortioxetine). I was on vortioxetine and bupropion in the past and didn't modify my doses but it would be good practice, especially with a lot of drugs.

Methadone has some significant QT risks at those doses, so hopefully you would get EKGs and such before adding some medicines like TCAs and higher dose citalopram. I think bupropion make actually reduces QT some but not sure where that lies. Mirtazapine has some possible risks. I don't want to consider cardiac effects with a gram of amphetamine added in there, but yeah...
Come to think of it, I don't know how well some would interact with that level of amphetamine. Vortioxetine has some B1 affinity and might not mesh with IV amp too well, throwing random thoughts out...partial 5-ht1b who even knows

Low-dose buspirone is an option for 5-ht1a agonism amongst other properties, but I can't personally say that it works all that well. I think some of that evaluation suffers from a comparison to benzodiazepines in anxiety, and that it has some use as an adjunct. It was somewhat helpful for me, nothing major

I was on vortioxetine and mirtazapine, and it worked well. Vortioxetine was more effective for me even than 70 mg of Parnate, an MAOI, but I believe that is uncommon.

Just want to throw out there getting evaluated for sleep apnea if you have fatigue/ daytime sleepiness or something that you might be trying to use the amphetamines for. High weight and methadone can contribute to sleep-disordered breathing. I helped out at a sleep clinic and a lot of new people came in from a local opioid clinic. Especially some skinny ones. I've been wanting to do a bigger post on it.

Take care out there, man.
It sounds promising that you also liked Vortioxetine.

Can you describe what it feels like?

Did it help with general anxiety, social anxiety AND depression, and what about OCD symptoms?

I do take Dexadrine, though I probably won't continue to, so if I do try Vortioxetine then I will let my doctor know so I can make sure it's safe.

Yeah, I have been told to see a doctor to find out if i do have sleep apnea, and i should do it, but for several reasons I REALLY think I don't, but that doesn't mean it's not a good idea to find out for sure.

Do you know what class of meds Vortioxetine does belong to?
 

checktest

Bluelighter
Joined
Jun 9, 2013
Messages
181
Location
The Aether
Lowest Ki is still SERT (SRI) but I think serotonin modulator or some silly term is being used for vortioxetine 5-HT3/5-HT7/5-HT1A... effects. Heavily serotonergic agent. I think vortioxetine isn't really anything that special in general/for a lot of populations (nothing too remarkable for overall efficacy [case in point Cipriani listed above]), but it has been beneficial for me.

Less neurotic/ruminative/negative, helped my depression and social anxiety. Hard to say general, because I have less general anxiety when I am less depressed...mine seems to feed into itself when I am worse. I don't think it is notable for GAD in general, let alone FDA approved, but seems to help some individuals.

Definitely still some SRI feel, but kind of a different headspace. Almost a vague adrenergic / beta blocker effect, less fear / weird reactivity, but not quite like propranolol or something. I think some cognitive/functional changes are overstated in marketing, but it has been different for me from some drugs (sertraline, fluoxetine, escitalopram). How much of that may be due to depressive efficacy for me is unclear. I didn't get major nausea but it is quite common.

Absolutely not a panacea for many, but could be worth a shot if you have tried some other drugs. I'm biased by my own personal experience
 

Båtmannen

Bluelighter
Joined
Jan 18, 2015
Messages
271
Well this makes me more interested in Vortioxetine if it worked for you, but why did you stop taking it then?

And why are you saying you think it is less effective than Lexapro?

Also, what class of meds does it belong to if not SSRIs?
I stopped because ... I don't remember.

_I_ am not saying it is less effective than Lexapro
Well this makes me more interested in Vortioxetine if it worked for you, but why did you stop taking it then?

And why are you saying you think it is less effective than Lexapro?

Also, what class of meds does it belong to if not SSRIs?
I am not saying it. This Analysis is:


It's a very good one, as well, but I don't get the results in some cases. Like Vortioxetine.

It's classified as a Serotonin Modulator. Here are the binding affinities:



I want it back. Except I'm very sensitive sexually.... I want to be able to have a girlfriend, and every serotonergic substance F's that up for me.
 
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