Duckbruck: Agitation and restlessness is one symptom that is "supposed" to get better as 5ht2a downregulates.
Hasn't happened yet. Not sure what to think about it. Maybe a dose increase will mitigate this side effect? I've always been a motorically very over-active person: seesawing, moving my legs, feet, toes, lips biting, fingernails biting, bruxism and so on. I am not sure what this could be? Some form of hyperactivity disorder? I've been to a few doctors, but they were rather clueless to what this could be...
I was very interested in Nortriptyline and my plan was to augment the Sertraline with Nortriptyline according to the article from Gillman Blog, but Lundbeck has withdrawn it from the German (European?) market as of this year
Why the **** not withdraw everything from the market besides SSRIs, then it will be SSRI carousel forever and ever...
I've been also thinking about Mirtazapine + Bupropion, but I am uncertain if this combo is favorable to Mirtazapine + Sertraline.
Given this, you should try to get a Mirtazepine Rx and see how it does for your anhedonic symptoms. SSRIs tend to be more relaxing, feel good, and anxiolytic once they "kick in" over time but apathy is a side effect that usually remains. Re: the scholarly articles you linked, much of the praise regarding Mirtazepine applies equally to any med that is NOT an SSRI, e.g. most tricyclics are quite weak on serotonin. Anyway it is worth a shot. SSRI + Mirtazepine is usually better than just SSRI if you experience anhedonia. My view of Mirtazepine is overall not that great, but since most patients are forced on SSRIs, it can help to lessen the blow.
Yeahh, I guess this is the way to go. Sertraline on it's own isn't that bad. At least it is working to some extend, but augmenting it with Mirtazapine might lessen the side effects.
My appetite has come back
Current side effects that are stil bothersome:
# insomnia (unrestful sleep)
# and sometimes I have those hot flashes | heat intolerance
However, if you want to start afresh - I had a look at the statistics re: German prescribing and I was surprised to see tricyclics doing so well. It looks like Amitryptiline is commonly prescribed in Germany. This med is interesting for several reasons, it offers several rather unconventional mechanisms for curing depression, and it metabolizes into Nortriptyline, which is a great 5ht2a and 5ht2c antagonist, just a great med period. It is rather like having 2 medications for the price of one. I don't think it would worsen anhedonia. Moderately strong on antihistamine, it should be a sedating combo which may help with your agitation. Anticholinergic side effects may bother you, or they may not, but at least it won't make your preexisting symptoms worse.
I will keep that in mind.