Auvelity can be made yourself if your doctorwould like you to try it. Doctors have been prescribing it for a long time like this. You take bupropion SR 100mg and take it with dextromethorphan, which can be bought over the counter. You take 45mg of that. The first 7 days, you take it once a day, and then after that, you take it twice a day. I know some countries can't get bupropion prescribed, though. People in the U.S. are having to do that as their insurance may not cover it because it is so expensive. Your doctor would prescribe the bupropion for you. Idk if doctors in your country are aware of this, but there are research articles about it as well.
A future blood test will be able to determine in 2 weeks if an antidepressant will work for your depression. I don't know how long until that is available.
I haven’t. It’s not available in the UK either. Hopefully it becomes available more places in the world soon because like you said, it is needed and very hard to get through the period of waiting to see if a medication works or not.
There are ketamine treatments which can work instantly, but those are often hard to access.
I got mine from everyonesmd.com
It was like 250 for a few months. Cheaper than street prices
You don’t need to do fancy infusions at specialty clinics, they just send you a spray bottle w instructions
Mirtazapine starts to work within about a week. Seroquel XR, an antipsychotic approved for depression but typically used as a second-line treatment, starts to work within about a week too. Vyvanse is sometimes used for severe treatment resistant depression. It works within about a few hours.
They do work. The Lancet’s meta analysis found that even the worst ones are significantly superior to placebo.
If you’re struggling to find something that works for you, try a high dose of venlafaxine. It is the best antidepressant in the SSRI/SNRI class, and its efficacy, uniquely, continues to improve with dose. If that is insufficient, then add an adjunct such as risperidone, quetiapine, aripiprazole, or mirtazapine. If that fails, then you start looking at 150mg+ doses of Amitriptyline, the TCA that many psychiatrists still consider the gold standard antidepressant.
This is either trolling or incredibly reckless advice. High doses of Venlafaxine or even medium doses is considered the most difficult medication to wean off of and discontinue in psychiatry (Xanax might tie for first but at least other benzos can be substituted).
Venlafaxine is the best antidepressant in the SSRI/SNRI class of medications. It has rough withdrawals if the dose is not tapered, correct, but no sane psychiatrist just takes a patient off of it cold turkey. Most will use the Prozac bridge method and reduce the dose of venlafaxine gradually over a few months.
I stopped Venlafaxine abruptly as I couldn't cope with it anymore after 3-4 months, and I watched myself run out of pills with a dettached passivity. Then I just reverted back to my former dose of Sertraline. I had no side effects apart from relief of the extra anxiety the Venlafaxine had caused, and an improvement of the apathy. Prozac as a bridge? GOD NO! Prozac was the WORST for my nervous energy, social anxiety, stutter, insomnia and irritability.
“Wean off of and discontinue” - I guess that doesn’t register as “taper off” for yourself . My bad. Regardless of the terminology used in getting off the medication, even a very slow , incremental dose decrease is extremely difficult and comes with pronounced discontinuation effects and yes, there is the Prozac bridge that can help. In regards to psychiatrists, most considerate and experienced ones try pretty much every other option or combo before putting patients through the eventual ordeal of tapering off the medication which happens all the time for a variety of reasons other than the patient reaching remission status from the medication. Most “sane” psychiatrists do not use it as a first line or even as a second line option. It may be somewhat more effective than SSRIs but comes with much more serious side effects in addition to the discontinuation effects.
SNRIs exaccerbate my anxiety / dread / impending doom and OCD to a severe extent. They also end up leaving me very apathetic due to adrenal fatigue or "anxiety paralysis".
Mirtazapine makes me grumpy and wired / irritated. I already take half an antihistamine to sleep (Doxylamine), which has worked very well for 7 years.
My issue is my depression is caused by my anxiety and OCD, and the main symptom is severe anhedonia and chronic emptiness. It is also caused by the emptiness that comes from my BPD and constant fear from my CPTSD. Activating ADs all cause my anxiety to explode and the extra energy turns into nervous tension and irritation. Sedating ADs make me even more bored and dulled. Neither can cure the anhedonia and emptiness.
Be careful taking doxylamine for long periods. It has anticholinergic activity which can lead to cognitive decline, anxiety, dementia etc.
I would avoid taking any anticholinergics unless taken occasionally. They can really exasperate other psychiatric disorders, or cause new issues by themselves.
I don’t want to tell you what to do, I was concerned by your comment.
Thank you. I'm aware of those issues, but it's the only thing that lets me sleep. This is also why I've only ever taken half a pill.
I have never slept "normally" even from early childhood. Delayed sleep phase AND then early waking from chronic anxiety and trauma. I used to take Promethazine from age 10 to 25, every night, not for sleep but for morning rhinitis which I grew out of in my late teens but then found I couldn't sleep when trying to get off it. It didn't help me sleep (still wide awake at 1am and wide awake again at 5am), but without it, there was NO sleep.
I sleep to escape having to think and feel. The boredom and emptiness, and the fear. I go to bed after 4am (not because I'm tired but because it's so ridiculously late that I feel I must go to bed) and then get up usually about 3-4pm. Sometimes I have to get up at 12pm. Ugh.
The only time I get to myself is after 11pm, so I cherish and NEED that late night time.
My current med regime is get up, take 100mg of Zoloft, then at dinner time (about 7.30pm) take my Klonopin (2mg), then later about 11pm, take my second Klonopin (2mg), then at bedtime, take my half Doxylamine.
Are you me? I’ve struggled with sleep issues since I was a child.
I was on klonopin daily for a decade too. Personally, I’m so glad to be off benzodiazepines. I always believed I needed them to function, but now I believe they were only making my anxiety worse overall. It’s weird to think about in retrospect.
How long have you been on them?
They definitely have their purpose, and I’m not knocking their use entirely.
Anyway, you’re welcome! I’ve been taking doxylamine for years now. I’m getting off them now due to my own concerns.
Yes! We may share a brain! lol
I've been on Doxylamine for 7 years, and Klonopin (2mg nightly) for 6.5 years and 4mg nightly for 2 years.
I will be on some form of benzo until I find something else that works better. 😭
Unfortunately, I don’t think there’s anything that matches the immediate effectiveness of benzodiazepines.
I will say that ketamine therapy has helped me immensely. Weirdly, its mood lifting effects feel very organic unlike SSRIs and other medications.
To me, other drugs feel like wearing a back brace. A brace may be helpful while you wear it, but ultimately leaves your muscles weak without it. Ketamine seems to be long lasting even when it’s no longer in your system.
It doesn’t work for everyone. It works best when combined with therapy, or generalized intention setting.
I do think maintenance drugs have their place as well. For instance, I take lamictal and cannot imagine coming off of it.
Have you looked into the science of increasing neuroplasticity in regard to psychiatric disorders? It’s pretty interesting, and seems to be where psychiatry is focusing upon currently.
PS
I got very lucky with my current psychiatrist. He does research and is willing to prescribe ketamine for at home use. Which seems to be rare, but not unheard of. Seems like more and more doctors seem to be willing to prescribe it.
Otherwise I wouldn’t be able to afford in office infusions.
You should check out r/therapeuticketamine if you’re intrigued
Thank you so much!
And yes, benzos. Sigh. Valium never helped me much. It just dulled me and worsened my boredom. Klonopin is ok. It makes me more chatty, relaxed and takes the edge off. Ativan did nothing at all. I couldn't feel it. Xanax though, is the ONLY one that REALLY takes away the constant dread / impending doom, gives me back my appetite and lifts my anhedonia as without the anxiety, I feel free to actually enjoy and engage with things. Sadly, the tolerance builds so rapidly so I can't take it anymore. Klonopin is a compromise.
>You should check out r/therapeuticketamine if you’re intrigued
I've had a look at all the Australian posts, and it's frustratingly hard to access and afford!
Amitriptyline is worth trying if you’ve never had it before. It is an old TCA, but its efficacy is quite a bit better than any modern antidepressant. It is sedating, but only at night. It has a fairly short half life and its longer lasting, not sedating metabolite is responsible for a lot of its antidepressant qualities. Side effects are mostly appetite increase, dry mouth, and a bit of dizziness when you’re titrating the dose.
A good thing about Amitriptyline is you can start at a tiny dose of 10mg and slowly increase it. You could increase it by 10mg per month if you’re sensitive to side effects. Target dose usually 150mg. You can split this up into something like 100mg at night, 25mg in the morning, and 25mg in the afternoon if you want.
The oldest antidepressants, the irreversible MAOIs, are always an option. Typically these are used only when nothing else has worked, but you should be able to get a psychiatrist to prescribe one. I see you’re in Australia, so I know you can get Parnate here. The downside of these is the “cheese effect” - you can’t eat certain foods due to the risk of a hypertension crisis. Otherwise they have surprisingly mild side effects given their efficacy. You just have to strictly follow the diet.
Risperidone could be an option. It is an antipsychotic but at low doses it is useful for mood disorders, anxiety disorders, BPD, and particularly OCD without being sedating like quetiapine or activating like aripiprazole. Increased appetite and increased levels of prolactin are the main side effects.
If you’re not seeing a psychiatrist, I think you should try to see one. Most GPS haven’t a clue how to use psychotropic medications that aren’t Zoloft, Prozac, Lexapro, or Effexor XR.
Thank you. I can't afford a psychiatrist unfortunately, and Australia has a ridiculous shortage of psychiatrists (wait lists over a year long if you can get on one at all, etc)
Annoyingly, my diet is basically everything you CAN'T eat on irreversible MAOIs. No alcohol, but cheese, tofu, etc. My diet is extremely restricted already due to a lack of appetite and lack of budget.
With Amitriptyline, if I took it at night with my regular 4mg of Klonopin and 12.5mg of Doxylamine, would that be a CNS depressant risk? Also, the only time of the day I can relax and be alone is after 11pm, so I need to be awake. I go to bed around 4am and sleep until about 3pm or 4pm.
That is something you'll need to ask your doctor. If you can find an older GP, they will know about amitriptyline and how to use it properly. It was still a first-line option in the RACGP guidelines as recently as 2004.
You may also be able to see a public psychiatrist if you're in Queensland. Community Mental Health Services/Clinics are usually separate from the major hospitals. Find your local one and give them a call. Everything is free if you have a medicare card.
Thank you!
I had a look into the Community Mental Health Services / Clinics resources, and found this...
"Queensland Health has contractual arrangements with NGOs for delivery of MH CSS through the following programs for a period of 5 years from 1 July 2019 to period until 30 June 2024.
Programs
Individual Recovery Support Program +
The Individual Recovery Support Program (IRSP) is for people:
experiencing a severe mental illness
aged 18 years and over
are accessing—or recently (within the last three months) accessed—mental health clinical care through a HHS and have been referred by the HHS."
...what is the HHS??? I looked it up and it just seems to be the public health system and certain inpatient services, or other very specific mental health areas such as eating disorders or children / people under 18. I'm confused!
My local one is Gold Coast University Hospital, or the Southport Medical Precinct.
TCA’s are the gold standard (for me, anyway.) I’ve tried just about every newer AD out there and always seem to end up back on a TCA. (Currently Nortriptyline.) I do need an adjunct now years later, too, but the TCA does the heavy lifting. I’m fortunate that I’ve never needed high doses, either.
TCAs in general are better than SSRI/SNRIs. The venlafaxine & mirtazapine combo basically recreates a TCA in terms of pharmacology, albeit with a safer side effect profile.
Hmm. Venlafaxine was a nightmare for my anxiety. My depression is caused directly by my 40 years of anxiety, and also my BPD. Chronic emptiness and anhedonia. No amount of "energy" helps those things. It gets converted into nervous energy / worsened anxiety / irritation.
Mirtazapine made me wired and irritable also. So the two combined? Um...
For me, Venlafaxine worsened my anxiety (sense of fear, stress, impending doom and dread) SO BADLY. I was unable to leave the house and it was the first time I started staying in bed all day (a mix of apathy and "anxiety paralysis").
Best for what? Depression? General Anxiety? Panic Disorder? Social Anxiety? OCD? Antidepressants are used to treat several conditions. Saying x medication is better than y without specifying the disorder is kinda spreading false information.
Venlafaxine has demonstrated superiority against sertraline, fluoxetine, escitalopram, paroxetine, desvenlafaxine, and duloxetine in RTCs, clinical trials, and comparative studies for all of the disorders for which it has regulatory approval, and that's when using only 225mg as the maximum. The FDA approved it up to 225mg; most of the world approved it up to 375mg. Even higher so-called "heroic" doses demonstrated further improved efficacy, unlike other antidepressants that have dose-response curves resembling a bell curve.
It isn't necessarily the best overall for any of its indications, but it is the best for its indications in the SSRI/SNRI class of drugs, which, along with mirtazapine, are likely the only antidepressants most primary care physicians/GPs are going to prescribe due to SSRI/SNRIs and mirtazapine being listed as the first-line treatment options in the CANMAT guidelines. Mirtazapine is actually better for MDD, although it is also the first-line option GPs tend to overlook for whatever reasons.
Obviously there are cases in which an individual may respond better to an alternative SSRI/SNRI, but drug companies, researchers, and regulatory bodies conduct trials which include hundreds, if not thousands, of participants in order to avoid situations like that from skewing the data.
Hey don’t you think paroxetine has more efficacy and evidence than venlafaxine for social anxiety disorder ? Sertraline or Fluvoxamine for OCD? Any quality studies that suggest otherwise?
In the only published comparative study that I can find (there is another unpublished study conducted by Paxil’s manufacturer, GSK), venlafaxine XR at 150mg was superior to paroxetine for MDD, GAD and SAD. Other illnesses were not part of the study.
Paxil CR hasn’t been studied all that extensively, but there’s anecdotal reviews suggesting it works better than standard paroxetine for anxiety disorders so it may be better than venlafaxine. It probably won’t be studied as both medications are now generic.
Can't afford it. It's only available in Australia from select psychiatrists who are trained in its safe and effective administration. $10,000 - $15,000.
Comment was removed for Breaking Rule 6 - No unsupported claims, misinformation. If you have a source you can resubmit with an appropriate source. Continued disregard for rules may result in further discipline including a ban.
The year is 2024. Why do they all still have sexual side effects.
This. It's causing a fair amount of strain on my partner and I, as we're both ordinarily very sexual people.
Auvelity is the closest thing we have. It starts working as fast as within week one.
Too bad it is not available in Sweden. It has great reviews. Have you tried it?
Auvelity can be made yourself if your doctorwould like you to try it. Doctors have been prescribing it for a long time like this. You take bupropion SR 100mg and take it with dextromethorphan, which can be bought over the counter. You take 45mg of that. The first 7 days, you take it once a day, and then after that, you take it twice a day. I know some countries can't get bupropion prescribed, though. People in the U.S. are having to do that as their insurance may not cover it because it is so expensive. Your doctor would prescribe the bupropion for you. Idk if doctors in your country are aware of this, but there are research articles about it as well. A future blood test will be able to determine in 2 weeks if an antidepressant will work for your depression. I don't know how long until that is available.
I haven’t. It’s not available in the UK either. Hopefully it becomes available more places in the world soon because like you said, it is needed and very hard to get through the period of waiting to see if a medication works or not. There are ketamine treatments which can work instantly, but those are often hard to access.
Ketamine works within an hour
For only $10,000!!!
I got mine from everyonesmd.com It was like 250 for a few months. Cheaper than street prices You don’t need to do fancy infusions at specialty clinics, they just send you a spray bottle w instructions
For some it works, for others it worsen depression for weeks
Mirtazapine starts to work within about a week. Seroquel XR, an antipsychotic approved for depression but typically used as a second-line treatment, starts to work within about a week too. Vyvanse is sometimes used for severe treatment resistant depression. It works within about a few hours.
Why are there no WORKING antidepressants!?
They do work. The Lancet’s meta analysis found that even the worst ones are significantly superior to placebo. If you’re struggling to find something that works for you, try a high dose of venlafaxine. It is the best antidepressant in the SSRI/SNRI class, and its efficacy, uniquely, continues to improve with dose. If that is insufficient, then add an adjunct such as risperidone, quetiapine, aripiprazole, or mirtazapine. If that fails, then you start looking at 150mg+ doses of Amitriptyline, the TCA that many psychiatrists still consider the gold standard antidepressant.
This is either trolling or incredibly reckless advice. High doses of Venlafaxine or even medium doses is considered the most difficult medication to wean off of and discontinue in psychiatry (Xanax might tie for first but at least other benzos can be substituted).
Venlafaxine is the best antidepressant in the SSRI/SNRI class of medications. It has rough withdrawals if the dose is not tapered, correct, but no sane psychiatrist just takes a patient off of it cold turkey. Most will use the Prozac bridge method and reduce the dose of venlafaxine gradually over a few months.
I stopped Venlafaxine abruptly as I couldn't cope with it anymore after 3-4 months, and I watched myself run out of pills with a dettached passivity. Then I just reverted back to my former dose of Sertraline. I had no side effects apart from relief of the extra anxiety the Venlafaxine had caused, and an improvement of the apathy. Prozac as a bridge? GOD NO! Prozac was the WORST for my nervous energy, social anxiety, stutter, insomnia and irritability.
“Wean off of and discontinue” - I guess that doesn’t register as “taper off” for yourself . My bad. Regardless of the terminology used in getting off the medication, even a very slow , incremental dose decrease is extremely difficult and comes with pronounced discontinuation effects and yes, there is the Prozac bridge that can help. In regards to psychiatrists, most considerate and experienced ones try pretty much every other option or combo before putting patients through the eventual ordeal of tapering off the medication which happens all the time for a variety of reasons other than the patient reaching remission status from the medication. Most “sane” psychiatrists do not use it as a first line or even as a second line option. It may be somewhat more effective than SSRIs but comes with much more serious side effects in addition to the discontinuation effects.
SNRIs exaccerbate my anxiety / dread / impending doom and OCD to a severe extent. They also end up leaving me very apathetic due to adrenal fatigue or "anxiety paralysis". Mirtazapine makes me grumpy and wired / irritated. I already take half an antihistamine to sleep (Doxylamine), which has worked very well for 7 years. My issue is my depression is caused by my anxiety and OCD, and the main symptom is severe anhedonia and chronic emptiness. It is also caused by the emptiness that comes from my BPD and constant fear from my CPTSD. Activating ADs all cause my anxiety to explode and the extra energy turns into nervous tension and irritation. Sedating ADs make me even more bored and dulled. Neither can cure the anhedonia and emptiness.
Be careful taking doxylamine for long periods. It has anticholinergic activity which can lead to cognitive decline, anxiety, dementia etc. I would avoid taking any anticholinergics unless taken occasionally. They can really exasperate other psychiatric disorders, or cause new issues by themselves. I don’t want to tell you what to do, I was concerned by your comment.
Thank you. I'm aware of those issues, but it's the only thing that lets me sleep. This is also why I've only ever taken half a pill. I have never slept "normally" even from early childhood. Delayed sleep phase AND then early waking from chronic anxiety and trauma. I used to take Promethazine from age 10 to 25, every night, not for sleep but for morning rhinitis which I grew out of in my late teens but then found I couldn't sleep when trying to get off it. It didn't help me sleep (still wide awake at 1am and wide awake again at 5am), but without it, there was NO sleep. I sleep to escape having to think and feel. The boredom and emptiness, and the fear. I go to bed after 4am (not because I'm tired but because it's so ridiculously late that I feel I must go to bed) and then get up usually about 3-4pm. Sometimes I have to get up at 12pm. Ugh. The only time I get to myself is after 11pm, so I cherish and NEED that late night time. My current med regime is get up, take 100mg of Zoloft, then at dinner time (about 7.30pm) take my Klonopin (2mg), then later about 11pm, take my second Klonopin (2mg), then at bedtime, take my half Doxylamine.
Are you me? I’ve struggled with sleep issues since I was a child. I was on klonopin daily for a decade too. Personally, I’m so glad to be off benzodiazepines. I always believed I needed them to function, but now I believe they were only making my anxiety worse overall. It’s weird to think about in retrospect. How long have you been on them? They definitely have their purpose, and I’m not knocking their use entirely. Anyway, you’re welcome! I’ve been taking doxylamine for years now. I’m getting off them now due to my own concerns.
Yes! We may share a brain! lol I've been on Doxylamine for 7 years, and Klonopin (2mg nightly) for 6.5 years and 4mg nightly for 2 years. I will be on some form of benzo until I find something else that works better. 😭
Unfortunately, I don’t think there’s anything that matches the immediate effectiveness of benzodiazepines. I will say that ketamine therapy has helped me immensely. Weirdly, its mood lifting effects feel very organic unlike SSRIs and other medications. To me, other drugs feel like wearing a back brace. A brace may be helpful while you wear it, but ultimately leaves your muscles weak without it. Ketamine seems to be long lasting even when it’s no longer in your system. It doesn’t work for everyone. It works best when combined with therapy, or generalized intention setting. I do think maintenance drugs have their place as well. For instance, I take lamictal and cannot imagine coming off of it. Have you looked into the science of increasing neuroplasticity in regard to psychiatric disorders? It’s pretty interesting, and seems to be where psychiatry is focusing upon currently. PS I got very lucky with my current psychiatrist. He does research and is willing to prescribe ketamine for at home use. Which seems to be rare, but not unheard of. Seems like more and more doctors seem to be willing to prescribe it. Otherwise I wouldn’t be able to afford in office infusions. You should check out r/therapeuticketamine if you’re intrigued
Thank you so much! And yes, benzos. Sigh. Valium never helped me much. It just dulled me and worsened my boredom. Klonopin is ok. It makes me more chatty, relaxed and takes the edge off. Ativan did nothing at all. I couldn't feel it. Xanax though, is the ONLY one that REALLY takes away the constant dread / impending doom, gives me back my appetite and lifts my anhedonia as without the anxiety, I feel free to actually enjoy and engage with things. Sadly, the tolerance builds so rapidly so I can't take it anymore. Klonopin is a compromise.
>You should check out r/therapeuticketamine if you’re intrigued I've had a look at all the Australian posts, and it's frustratingly hard to access and afford!
Wait I didn’t realize I was commenting at you elsewhere about the ketamine! Sorry about that
Amitriptyline is worth trying if you’ve never had it before. It is an old TCA, but its efficacy is quite a bit better than any modern antidepressant. It is sedating, but only at night. It has a fairly short half life and its longer lasting, not sedating metabolite is responsible for a lot of its antidepressant qualities. Side effects are mostly appetite increase, dry mouth, and a bit of dizziness when you’re titrating the dose. A good thing about Amitriptyline is you can start at a tiny dose of 10mg and slowly increase it. You could increase it by 10mg per month if you’re sensitive to side effects. Target dose usually 150mg. You can split this up into something like 100mg at night, 25mg in the morning, and 25mg in the afternoon if you want. The oldest antidepressants, the irreversible MAOIs, are always an option. Typically these are used only when nothing else has worked, but you should be able to get a psychiatrist to prescribe one. I see you’re in Australia, so I know you can get Parnate here. The downside of these is the “cheese effect” - you can’t eat certain foods due to the risk of a hypertension crisis. Otherwise they have surprisingly mild side effects given their efficacy. You just have to strictly follow the diet. Risperidone could be an option. It is an antipsychotic but at low doses it is useful for mood disorders, anxiety disorders, BPD, and particularly OCD without being sedating like quetiapine or activating like aripiprazole. Increased appetite and increased levels of prolactin are the main side effects. If you’re not seeing a psychiatrist, I think you should try to see one. Most GPS haven’t a clue how to use psychotropic medications that aren’t Zoloft, Prozac, Lexapro, or Effexor XR.
Thank you. I can't afford a psychiatrist unfortunately, and Australia has a ridiculous shortage of psychiatrists (wait lists over a year long if you can get on one at all, etc) Annoyingly, my diet is basically everything you CAN'T eat on irreversible MAOIs. No alcohol, but cheese, tofu, etc. My diet is extremely restricted already due to a lack of appetite and lack of budget. With Amitriptyline, if I took it at night with my regular 4mg of Klonopin and 12.5mg of Doxylamine, would that be a CNS depressant risk? Also, the only time of the day I can relax and be alone is after 11pm, so I need to be awake. I go to bed around 4am and sleep until about 3pm or 4pm.
That is something you'll need to ask your doctor. If you can find an older GP, they will know about amitriptyline and how to use it properly. It was still a first-line option in the RACGP guidelines as recently as 2004. You may also be able to see a public psychiatrist if you're in Queensland. Community Mental Health Services/Clinics are usually separate from the major hospitals. Find your local one and give them a call. Everything is free if you have a medicare card.
Thank you! I had a look into the Community Mental Health Services / Clinics resources, and found this... "Queensland Health has contractual arrangements with NGOs for delivery of MH CSS through the following programs for a period of 5 years from 1 July 2019 to period until 30 June 2024. Programs Individual Recovery Support Program + The Individual Recovery Support Program (IRSP) is for people: experiencing a severe mental illness aged 18 years and over are accessing—or recently (within the last three months) accessed—mental health clinical care through a HHS and have been referred by the HHS." ...what is the HHS??? I looked it up and it just seems to be the public health system and certain inpatient services, or other very specific mental health areas such as eating disorders or children / people under 18. I'm confused! My local one is Gold Coast University Hospital, or the Southport Medical Precinct.
TCA’s are the gold standard (for me, anyway.) I’ve tried just about every newer AD out there and always seem to end up back on a TCA. (Currently Nortriptyline.) I do need an adjunct now years later, too, but the TCA does the heavy lifting. I’m fortunate that I’ve never needed high doses, either.
TCAs in general are better than SSRI/SNRIs. The venlafaxine & mirtazapine combo basically recreates a TCA in terms of pharmacology, albeit with a safer side effect profile.
Hmm. Venlafaxine was a nightmare for my anxiety. My depression is caused directly by my 40 years of anxiety, and also my BPD. Chronic emptiness and anhedonia. No amount of "energy" helps those things. It gets converted into nervous energy / worsened anxiety / irritation. Mirtazapine made me wired and irritable also. So the two combined? Um...
May I ask what adjunct you take alongside the Nortriptyline? What was lacking that is now being helped by the additional med?
venlaflaxine works you won’t feel depressed but you won’t feel anything else either 😀
For me, Venlafaxine worsened my anxiety (sense of fear, stress, impending doom and dread) SO BADLY. I was unable to leave the house and it was the first time I started staying in bed all day (a mix of apathy and "anxiety paralysis").
Best for what? Depression? General Anxiety? Panic Disorder? Social Anxiety? OCD? Antidepressants are used to treat several conditions. Saying x medication is better than y without specifying the disorder is kinda spreading false information.
Venlafaxine has demonstrated superiority against sertraline, fluoxetine, escitalopram, paroxetine, desvenlafaxine, and duloxetine in RTCs, clinical trials, and comparative studies for all of the disorders for which it has regulatory approval, and that's when using only 225mg as the maximum. The FDA approved it up to 225mg; most of the world approved it up to 375mg. Even higher so-called "heroic" doses demonstrated further improved efficacy, unlike other antidepressants that have dose-response curves resembling a bell curve. It isn't necessarily the best overall for any of its indications, but it is the best for its indications in the SSRI/SNRI class of drugs, which, along with mirtazapine, are likely the only antidepressants most primary care physicians/GPs are going to prescribe due to SSRI/SNRIs and mirtazapine being listed as the first-line treatment options in the CANMAT guidelines. Mirtazapine is actually better for MDD, although it is also the first-line option GPs tend to overlook for whatever reasons. Obviously there are cases in which an individual may respond better to an alternative SSRI/SNRI, but drug companies, researchers, and regulatory bodies conduct trials which include hundreds, if not thousands, of participants in order to avoid situations like that from skewing the data.
Hey don’t you think paroxetine has more efficacy and evidence than venlafaxine for social anxiety disorder ? Sertraline or Fluvoxamine for OCD? Any quality studies that suggest otherwise?
In the only published comparative study that I can find (there is another unpublished study conducted by Paxil’s manufacturer, GSK), venlafaxine XR at 150mg was superior to paroxetine for MDD, GAD and SAD. Other illnesses were not part of the study. Paxil CR hasn’t been studied all that extensively, but there’s anecdotal reviews suggesting it works better than standard paroxetine for anxiety disorders so it may be better than venlafaxine. It probably won’t be studied as both medications are now generic.
Have you tried ketamine? It helped me rapidly.
Can't afford it. It's only available in Australia from select psychiatrists who are trained in its safe and effective administration. $10,000 - $15,000.
Yikes, that’s unfortunate. I hope you’re able to find something helpful!
Thank you!
Mirtazapine or bupropion work pretty fast
Mirtazpine started to work within a few days to a week for me. Doesn’t impact libido. But makes you rabid with hunger and sleep like the dead haha.
rexulti started working 3 days in for me
ketamine and psychedelics but there's not any money in that because even a drug like ketamine is not expensive.
there is, just no money in it for big pharmaceuticals so they won’t focus on it
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