Antidepressants/SSRIs

Are they worth trying? Is there any way I can get them without going to therapy? I've been to two therapists and never got any real benefits from it. It's not worth the money. Can I get SSRIs from a primary care physician?

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mediafire.com/file/stl5ctg1ptogszt/MWTD.zip/file
mediafire.com/file/686p3ey8rl47lxc/Up_From_Depression.zip/file
thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext
bbc.co.uk/news/health-43143889
psychotropical.com/lancet-21-antidepressants-meta-analysis/
en.wikipedia.org/wiki/Tricyclic_antidepressant
nhs.uk/conditions/antidepressants/
en.wikipedia.org/wiki/Amitriptyline
en.wikipedia.org/wiki/Citalopram
bnf.nice.org.uk/medicinal-forms/tranylcypromine.html
bnf.nice.org.uk/medicinal-forms/amitriptyline-hydrochloride.html#PHP77784
bnf.nice.org.uk/medicinal-forms/citalopram.html#PHP77918
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They’re not all the same. You may need to try different ones, or you may need some other type of medication ( there are a handful of categories for depression/ anxiety or related ). Let a psychiatrist treat you, not a general physician or random people.

These 2 audio packs of mindfulness and affirmations could help, give them a spin:
mediafire.com/file/stl5ctg1ptogszt/MWTD.zip/file
mediafire.com/file/686p3ey8rl47lxc/Up_From_Depression.zip/file

took me over a year to find one that works. i'm pretty astounded by the results. it's not a happy pill that just makes me feel better, but i suddenly have the motivation to work on my problems and do shit with myself, whereas previously i would sit in front of my computer for hours and eat (gained so much weight this year fuck) or read as a form of escape for hours and hours a day.

I wouldn't do it. Gonna turn you into a sheep.

There is no way to tell without understanding your diagnosis and clinical picture the benefits or drawbacks of SSRIs. Generally a family physician, PA, or nurse practitioner can give you an Rx and manage uncomplicated anxiety/depression.

SSRIs have been found to have very good results for things like panic attacks (90% reduction in attacks), but more of a mixed bag as treatment for depression and anxiety. There can be a lot of trial and error to see if one works for you, and it can take a couple months for each to hit maximum effectiveness to actually determine if it is working.

Side effect profiles differ, but impotence and sexual desensitization while taking them is very common, aside from Wellbutrin and Buspar maybe (Not 100% sure [and I dont' feel like looking it up] and Buspar is more of an adjunct drug than a primary med).

Again, this would be better to go over with someone that knows your clinical picture because they will have the most knowledge on optimal treatment modalities.

Sup lads. I have recently been on mirtazapine (sometimes known as Remeron in the US). It's not an SSRI, it's usually called an "atypical antidepressant" because its mechanism is quite unique. It's about as modern as SSRIs (entering clinical use in the US in 1996).

The side effects are quite different. It doesn't have the sexual side effects of SSRIs, which makes it attractive to many people. But it does have two notorious side effects: sleepiness and an increase in appetite (unlike SSRIs, which can cause insomnia and a decrease in appetite).

The sleepiness is why mirtazapine is often prescribed to people who are finding it hard to sleep. But I've found it also makes me lack energy during the day (I feel awake during the day, and artificially happy since that's the main effect, but just lacking motivation and energy). The increase in appetite can be annoying for some, although it's manageable if you're careful with what you eat.

In the last few days, though, I decided (without a doctor's consultation, which is possibly a bad idea) to reduce my dose and then stop the tablets entirely. Because the lack of motivation and energy was annoying me.

Do you reckon this is a bad idea? It probably is. I probably should speak to my doctor.

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>I probably should speak to my doctor.
talk to the jew, but above all, use the artificial happiness to get active, make yourself really happy, so you can quit that shit once you get into a good routine. good luck bro.

Yeah maybe I should do that while taking the pills, but I just found myself unmotivated on the pills, and I thought I would think clearer without them, so I've sort of weaned myself off them. Which might be a bad idea, I dunno, whatever.

I tried managing my anxiety/panic attacks for almost a year without medication and it ended up coming back when I thought I was doing fine. Had been doing therapy which has helped but didn't take care of it completely. My last couple of panic attacks almost required trips to the emergency room and really scared my wife and kids. So after a lot of consulting I reluctantly went on an SSRI. Been on it a month now and I'm doing well. Not even close to having any panic or bad anxiety. The side effects the first few weeks kinda sucked. Tired, spacey, etc. It has put a, to use a NASCAR term, restrictor plate on my emotions. They only go so far which is good and bad I suppose. Sometimes I feel like a robot but I also feel more "at peace" emotion wise. I plan on seeing a psychiatrist to better manage this and make sure this is the medication I want. It is a bitch to get an appointment with one around here (that tells me I'm not the only one with a mental issue) so for now I'm consulting my primary care physician. I'm not sure what my future holds with this but for now I'm feeling much better. Good luck to you!

Interesting. You're making me think that maybe I shouldn't be going off my mirtazapine without the doc's advice. Oh well, I've done it now, and if I go back on it, I'm not going to be able to get up tomorrow morning, because it has that effect if you haven't been taking it consistently, so I think I'll just try my luck going without and see what happens.

They're only worth trying if you're willing to fuck up your dick while on them (and potentially even after quitting them). I tried paroxetine and sertraline and after 3 or 4 days of taking them I had problems.

I'm an AD researcher and have written a couple of papers, including my PhD thesis on the subject.

Sadly, there's still tons of misinformation about ADs from the public (and also physicians...).so I'm going to do a quick redpill for all of you.

>SSRIs
Generally, they are not great and were developed not for their superior efficacy to older drugs, but better tolerability/less sides.
Serotonin's role in depression is up for debate, especially when it's the sole neurotransmitter being targeted by an AD like most* SSRIs. In my view, and most other researchers/physicians.feel the same way,
Sertraline is the logical best (and should really be the ONLY) first choice for an AD prescription. The reason for this is that it's the only medication in its class that affects Dopamine to a fair extent, along with being quite a potent SRI (only Paroxetine is stronger in this regard, but only slightly). Interesting fact: Sertraline affects dopamine reuptake to a GREATER extent than even Methylphenidate (Ritalin) (Ritalin is a DNRI, Dopamine-Norepinephrine Reuptake Inhibitor). If you ever go in for an AD prescription from your GP, ask for Sertraline and ignore the others.

>SNRIs
This is such a dubious class of medication that it's really questionable as to why it even exists. This includes the likes of Duloxetine, Venlefaxine, etc. They're called SNRIs because they 'supposedly' affect norepinephrine as well as serotonin, but the evidence for this is poor.

Fact: They are weaker on Serotonin reuptake than SSRIs, and have basically ZERO EFFECT on norepinephrine. They aren't true "SNRIs" at all, just gimped SSRIs with dubious norepinephrine action. Try and avoid these if you can and skip to the next class of ADs, but if your doctor insists on putting you on one of these before they bump you up to the next class then go with Duloxetine as it is the strongest of bunch.and has the best claim of being an SNRI (but that's not saying too much)

2/2
>TCAs
Kind of an odd class today, but is saved by simply having Clomipramine which actually IS a true SNRI, The term 'TCA' is actually really FUCKING STUPID. It says nothing about the pharmacology of drugs but simply that they have a three ring structure, even though there are drugs in this class which couldn't be further from each other in-terms of mechanism of action. Fucking dumb as hell.

TCAs generally make you more sleepy than other medication (aside from Mirtazapine, which is BITCH in that regard) and there's really only 2 you'd ever be prescribed these days: Amitriptyline and Clomipramine. Ami is 'okay', but the real chad here is Clomipramine. It affects Serotonin reuptake even more than even Sertaline and Paroxetine, whiel also affecting norepinephrine to a similar extent. Also has a 100 fold less sedating effect compared to Mirtazepine and 10 fold less compared to Ami. Clomipraine should be your target if you get to this point.

>MAOIs
These are the final class of ADs you will be prescribed, and are the fucking chad and mother of all ADs. The irreversible MAOIs (Tranylcypromine and Phenlezine, but ESPECIALLY Tranyl) are the most effective antidepressants, hands down. They work by inhibiting the breakdown of ALL 3 neurotransmitters (Serotonin, Norepinephrine, AND Dopamine) to a fucking monstrous extent. Tranyl's effects are extremely similar to Amphetamine. Good luck getting this prescribed though, as doctors still consider these to be 'dangerous' even though that research is 50 years old. Modern evidence concludes they are in fact very safe, and should be prescribed FAR MORE given their vastly superior efficacy compared to SSRIs and even TCAs.

Which of these, if any, are effective in treating anxiety

*Work out.
*Have friends.
*Go outside.
*Appriceate the small things in life.
*Ignore everything you don't like in life.
*Ignore everything that upsets you.
*Have goals in life
*Learn an instrument.
*Build resiliency.
*Read
That is what a psychiatrist/family doctor will tell you. If he feels like your state of mind will bennifit from anti-depressants he will perscribe some. Where I live, in Canada, a family doctor (general practioner) is able to perscribe anti-depressants. (Which I think is stupid). But if you need to speak to a psychiatrist, you either way have to speak to your family doctor or visit a walk-in clinic.

Source: I am a general surgeon. Not a psychiatrist or family doctor.

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Sertraline is quite good for anxiety especially at higher doses. Easy to get as well.

And if Sertraline isn't strong enough, then Clomipramine is even better.

Because of these problems my friend tried maaany different antidepressants and finally found cymbalta which doesn't cause sexual problems

In my opinion amitriptyline

Just read these quickly, that's interesting stuff. Just looked up MAOIs, they look pretty hardcore. Also this idea of "irreversibility" looks pretty worrying. Although apparently the enzymes that they irreversibly inhibit are then renewed by the cells approximately every two weeks? According to Wikipedia. So maybe the irreversibility isn't something to worry about? Or is it?

Also that's interesting you recommend Sertraline the most - that is also what a few doctors have seemed to recommend to me as the first option. I tried it for a day or two but it gave me really bad nausea, so I stopped it, maybe stupidly. The only two antidepressants I have given a proper go are fluoxetine (Prozac) and recently I've been on mirtazapine. Fluoxetine, as another SSRI, should theoretically cause nausea, but I didn't have that problem at all.

Do you think fluoxetine is a bad one? I was thinking I might try and go back on it, because like you say, mirtazapine makes you sleepy. It's great for getting to sleep, but it's hard to wake up and be productive, and I also have been feeling weak and without energy. Whereas when I was on fluoxetine a few years ago, I was almost hyperactive. Yes, it did unfortunately have some of the sexual side effects, which is definitely very annoying, although it didn't totally ruin me in that regard, I don't think. I did still try and get with this hot girl at the time, so I wasn't completely dysfunctional in that regard.

Sorry for the long post. Thanks for your information though, it is interesting.

Yeah that all seems like sensible stuff.

I read something recently saying amitriptyline was found to be the most effective antidepressant. But it is also obviously much older than modern SSRIs, and I assume it's not often prescribed these days due to side effects?

See pic related for ranking antidepressants, which is taken from this study here:
thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext
And the news story I read that links to that study is here:
bbc.co.uk/news/health-43143889

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that study isn't as good as the media is playing it out to be. it has a fuckton of lfaws, like all other meta-analysis' of antidepressants, best just to ignore it completely. see here:

>psychotropical.com/lancet-21-antidepressants-meta-analysis/

Some key bits:
>It is concerning to predict that it is inevitable that prestigious publications such as this will tend to dictate the kinds of treatment than ordinary doctors will use. This [excessive reliance on guidelines] has already produced a blinkered and stultified approach to antidepressant treatment, which virtually excludes, inter alia, the use of drugs like tranylcypromine and clomipramine. I know few experienced psycho-pharmacologists who do not agree that clomipramine is superior to amitriptyline.

In my career as a psycho-pharmacologist I have seen hundreds of patients who have alternated between amitriptyline and clomipramine. I cannot remember many who responded better on amitriptyline, but I would estimate that 19/20 would have stated unequivocally that they were better on clomipramine, having had only a partial response to amitriptyline (the difference being sufficiently great that any increased burden of side-effects was usually accepted with little compliant). That methodology, A-B-A trial, represents a powerful methodology for comparing drugs, especially when subjects are already known to suffer from a ‘biological’ depression; by virtue of previous response to an established antidepressant (or ECT): they represent a ‘better’ and ‘purer’ (more homogeneous) sample.

The term 'irreversible' is pretty misleading, just means the medication keeps working even after you stop taking it until your body naturally restores its enzyme stores. Nothing to worry about.

Sertraline is the only SSRI worth its salt. It is honestly quite strong, even compared to TCAs. Nausea is common when first taking it, as well as sexual side effects.(unavoidable, your body releases a shitload of Serotonin when you are having sex/masturbating and approaching orgasm, so with your levels artificially inflated via medication it gets super fucking confused.)

You probably should give it a few weeks, ideally 6-8, before switching. The whole notion of "ADs take a few months to take effect" is actually bullshit. Most patients, around 70% so respond within the FIRST WEEK of treatment But you could be apart of the 30% which do not, which is why doctors recommend at least a month before switching, or ideally, bumping up the dose. Sertraline scales pretty well with dosage.

Fluoxetine is weak, far weaker than Sertraline. What really sets Sert apart is its Dopamine action, which has been neglected for far too long by pharma companies. They'll never mention it though, or develop any new drug affecting it because it has such a stupid, unjust reputation of being addictive and open to abuse thanks to shit like Meth and Cocaine (which act very similar to MAOIs). I'd go back on Sertraline if you can and give it a proper go, but if Fluoxetine worked for you then you could go down that route.

>amitriptyline and clomipramine
Both of them are pretty old drugs (from the early 1960s) with pretty bad side effects compared to more modern SSRIs (most of which are from the 1990s), right? I think this is why doctors usually prescribe SSRIs these days. But do you think they're wrong? Looking at the side effects for clomipramine, it looks worse than SSRIs.

The sides you get from TCAs are similar to SSRIs, TCAs are only more dangerous because they can be fatal in an overdose, where as SSRIs cannot. Passive side effect incidence are pretty much the same, with TCAs generally being more sedating (sans clomipramine)

>pop a pill, get healthy
are you seriously dumb enough to think thats how it works? well, obviously you are, but reality is different.

you still there user?

under what cathegory does trazodone fall?

anything I should know about it? thanks

It's in a unique class which isn't used too often anymore. Definitely off the radar and an atypical AD, but theoretically should be better than Mirtazepine. looking at its pharmacological profile. Shouldn't be too sedating either which is always a plus in my book. These off the wall ADs are hit or miss usually, work really well for some but do nothing for others

Thanks for these responses. I might bring it up with this health service person I'm seeing tomorrow, they might tell me to see the doctor.

I didn't know fluoxetine was considered weaker than sertraline. But fair enough. I guess that is consistent with what I've heard and read about sertraline being more commonly prescribed these days.

As for TCAs, I dunno, they sound a bit shit regarding the side effects. Wikipedia says that clomipramine causes: "dry mouth, constipation, loss of appetite, sleepiness, weight gain, sexual dysfunction, and trouble urinating". That sounds like the worst side effects of SSRIs (sexual dysfunction, loss of appetite) combined with the worst of mirtazapine (sleepiness, weight gain), plus some other shitty ones to make it even worse (constipation, trouble urinating).

Thank you for the responses though, I appreciate it.

the rate of incidence of side effects you listed are practically the same between SSRIs and TCAs, aside from Sleepiness. but everyone is different, you may get more sides on an SSRI over a TCA, or vice versa

In Germany most people get citalopram (celexa) as their first antidepressant (in the process of finding one...), but all the ppl I know who take/took it have/had sexual side effects.
Could it be possible that doctors prefer to prescribe SSRIs and not TCAs for financial reasons? TCAs are much older so there may not be many patents left..???

That's interesting. Wikipedia seems to say that too:
>Adverse effects have been found to be of a similar level between TCAs and SSRIs.
en.wikipedia.org/wiki/Tricyclic_antidepressant

Although my country's health service, the NHS, still suggests TCAs are worse for side effects:
>TCAs are an older type of antidepressant. They're no longer usually recommended as the first treatment for depression because they can be more dangerous if an overdose is taken. They also cause more unpleasant side effects than SSRIs and SNRIs.
nhs.uk/conditions/antidepressants/

Brit here. Yes I think citalopram definitely was the first one to get prescribed for us, too, at least it was a few years ago, because all of my family members got prescribed it at various points. These days though, in my recent dealings with a few different doctors, sertraline seems to have been mentioned by a lot of them as their first suggestion.

>Could it be possible that doctors prefer to prescribe SSRIs and not TCAs for financial reasons?
I doubt it. Firstly, Britain's National Health Service says that the reason for prescribing SSRIs is because of a better side effect profile. If cost was a factor then I am sure they would be honest about it, I am sure they wouldn't just lie to people. See:
>SSRIs are the most widely prescribed type of antidepressants. They're usually preferred over other antidepressants, as they cause fewer side effects. An overdose is also less likely to be serious.
nhs.uk/conditions/antidepressants/

>TCAs are much older so there may not be many patents left..???
If anything that should mean they're cheaper. So if cost were an issue, surely British doctors would prescribe the TCAs, and save the cost to the health system. Brits pay a flat fee of £8.20 (something like that) to pick up a prescription, regardless of the drug, in order to try and make it fair to everybody. So if the TCAs are cheaper, the NHS could save money. But they still prescribe the SSRIs.

Wikipedia says that amitriptyline costs $0.20 USD per dose. That's $5.60 for 28 doses, which is a typical month's supply (even if you say a month is 31 doses, that's still only $6.20). Meanwhile citalopram is apparently just under £20 for a month in the UK, or $50 - $100 in the US.

en.wikipedia.org/wiki/Amitriptyline
en.wikipedia.org/wiki/Citalopram

Age isn't a factor in the cheapness of a drug. It has more to do suppliers. Take a look at Tranylcypromine and how much it costs the NHS for a 1 month supply (actually you should double the price listed as the starting dose for Tranyl is 20mg, not 10mg)
bnf.nice.org.uk/medicinal-forms/tranylcypromine.html

£600+

This was the very first antidepressant made in the 1950s, and also still the most effective.Do you really need to wonder why the NHS wants to scare people away from this drug?

That one is unusually high.

Amitriptyline shows much lower prices - the lowest price is £0.65 (per tablet I guess?), and that's for 28 x 25 mg.
bnf.nice.org.uk/medicinal-forms/amitriptyline-hydrochloride.html#PHP77784

Citalopram, meanwhile, has a lowest price of £0.82, and that's only for 28 x 10 mg tablets, not 25 mg (I assume the starting doses for both drugs are 10 mg, since that's the smallest tablet size for each).
bnf.nice.org.uk/medicinal-forms/citalopram.html#PHP77918

>Do you really need to wonder why the NHS wants to scare people away from this drug?
You selected a drug that happens to have a very unusually high price. Like I showed, amitriptyline is actually slightly cheaper than citalopram, and yet citalopram is prescribed way more. And I would very much expect this is due to the medical reasons explained by the NHS.

Not everything is a conspiracy, you know.

Also:
>This was the very first antidepressant made in the 1950s
Age is usually a bad sign when it comes to drugs. Older antipsychotics, for example (like haloperidol), are usually not favoured anymore. Instead, more modern drugs like olanzapine, quetiapine, risperidone, and aripiprazole, are usually favoured. Again, this is due to more favourable side effect profiles.

Reduces symptons. Works better over a decade.

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Removed my ocd, panic attacks, social anxiety. Sadness, rage, fits.

Only problem i got in life is memories i hate.

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>Works better over a decade.
You're saying people should take antidepressants for a decade? I am certain that that is NOT what doctors recommend, apart from in very very rare circumstances. I was advised by my doctor recently to stay on them for six months before coming off, which I gather is a pretty typical recommendation.

Wellbutrin is not an SSRI.