SSRI (Escitalopram) OR SNRI (Venlafaxine): which goes best with a stimulant? - Social Anxiety Forum
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Old 03-15-2013, 11:17 AM   #1 (permalink)
 
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Default SSRI (Escitalopram) OR SNRI (Venlafaxine): which goes best with a stimulant?

when the goal is to let the stimulant do it's dopaminergic job the best. (NA, not so important for me)

There's some knowledgeable people here (or were at least), so I'd appreciate anyone who shares his/her informed opinion.

If you know someone with the necessary psychopharmaceutical knowledge, please also ask him/her and share his/her wisdom right here.

I've heard more than my share of conflicting opinions, so why not add some more and maybe even end up with a clear winner

I need to make this decision by Monday morning so I'd like to be as informed as possible
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Old 03-15-2013, 08:08 PM   #2 (permalink)
 
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I'm only theorizing here, but since serotonin is on a seesaw like mechanism with dopamine (for the most part) then something like an SSRI would be notorious at blunting the dopaminergic action of a stimulant.

Since Effexor has a greater affinity for serotonin than say, Cymbalta, I hypothesis that Cymbalta (with a more balanced ratio of Sert to NA reuptake would allow amphetamines to work better.

From what i understand, Effexor is strongest on Sert followed by NA and then at higher dosages DA.

So therefore, trying an SNRI that has a better ratio of Sert to NA may allow DA to work better...

However, i could see Effexor at the 300+ mark being more synergistic with amphetamine, due to the induction of its effects on DA. But, im guessing this would put quite a strain on the cardiovascular system and BP monitoring would be recommended.
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Old 03-16-2013, 12:49 AM   #3 (permalink)
 
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So high dose Effexor is the way to go here according to to you? 450-600 mg/day?
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Old 03-16-2013, 01:13 AM   #4 (permalink)
 
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I stopped Escitalopram few days ago, 10mg dose which is low but it still make feel more apathy than usual. I have not taken more "hard" drug such as amphetamine but i still consume caffeine which is also a stimulant and the caffeine is good enough to fight apathy and make me feel more motivated.

I'm assuming you are taking stimulant for motivation and attention issue. So i think that taking SNRI, which increase heart rate since it inhibit norepinephrine and taking stimulant together might be too much on your heart.
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Old 03-16-2013, 02:18 AM   #5 (permalink)
 
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I've tried them all together it was pretty much overload with adderall and effexor. Dexedrine and effexor caused anger. Ritalin you couldn't feel or notice it working. I was developing veriscose veins from to much NE. But then again I was probably also smoking and drinking on them as well. Give it a shot it may work for you.

Effexor also pretty much stop the the crash. I think NE is protective against the comedown maybe even neuroprotective against high DA. High NE seems to reduce depression thur modivation and staying busy. Where high DA can make you relaxed and lazy. Try it out.
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Old 03-16-2013, 05:16 AM   #6 (permalink)
 
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Quote:
Originally Posted by A Sense of Purpose View Post
I'm only theorizing here, but since serotonin is on a seesaw like mechanism with dopamine (for the most part) then something like an SSRI would be notorious at blunting the dopaminergic action of a stimulant.

Since Effexor has a greater affinity for serotonin than say, Cymbalta, I hypothesis that Cymbalta (with a more balanced ratio of Sert to NA reuptake would allow amphetamines to work better.

From what i understand, Effexor is strongest on Sert followed by NA and then at higher dosages DA.

So therefore, trying an SNRI that has a better ratio of Sert to NA may allow DA to work better...

However, i could see Effexor at the 300+ mark being more synergistic with amphetamine, due to the induction of its effects on DA. But, im guessing this would put quite a strain on the cardiovascular system and BP monitoring would be recommended.
Thanks for the info mate!

Effexor/Venlafaxine becomes an SNDRI at doses from 375 mg and higher. BUT, it BLOCKS DA, for the MPH (also a DRI) this would make no difference but would the Dexamphetamine not be limited more compared to Escitalopram?

So the options are:

1) Escitalopram 20 mg + 20 mg long acting MPH + 3x20 mg Dexamph

2) Venlafaxine (Effexor) dose is going to be either 375, 450 or 600 mg/day + 20 mg long acting MPH + 3x20 mg Dexamph

3) Variants with any of these 4

You'd go for option 2 metha?
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Old 03-16-2013, 12:17 PM   #7 (permalink)
 
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I would use escitalopram. Most stims. are competitive NE inhibitors at NET and the amps. will also effect VMAT inside the neuron. I wouldn't want to add an allosteric NE inhibitor, like an SNRI to that. The stimulant will basically nullify any actions of the NE reuptake inhibitor.
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Old 03-16-2013, 02:12 PM   #8 (permalink)
 
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I would use escitalopram. Most stims. are competitive NE inhibitors at NET and the amps. will also effect VMAT inside the neuron. I wouldn't want to add an allosteric NE inhibitor, like an SNRI to that. The stimulant will basically nullify any actions of the NE reuptake inhibitor.
Escitalopram 20 mg/day + Dextroamphetamine 20 mg 3x/day would be a feasible (long term) option?

Combination of MPH and DA is not wise or?
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Old 03-16-2013, 03:05 PM   #9 (permalink)
 
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Escitalopram 20 mg/day + Dextroamphetamine 20 mg 3x/day would be a feasible (long term) option?

Combination of MPH and DA is not wise or?
60mg of immediate release dex. is pushing it. I would go with Adderall XR or Vyvanse, or Focalin. Much easier on the body, not nearly as neurotoxic as quick release amps. I would use an extended release stim over a quick release any day. Vyvanse which is dexamp. attached to l-lysine to make it a slow release. It's a competitive inhibitor of DA, as well as NE. Lexapro 10-20mg for 5HT. Thats what I would do? I am actually looking into getting an extended release stim. through my pdoc. The big problem is no health insurance.
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Old 03-16-2013, 03:08 PM   #10 (permalink)
 
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Quote:
Originally Posted by Nivea View Post
I stopped Escitalopram few days ago, 10mg dose which is low but it still make feel more apathy than usual. I have not taken more "hard" drug such as amphetamine but i still consume caffeine which is also a stimulant and the caffeine is good enough to fight apathy and make me feel more motivated.

I'm assuming you are taking stimulant for motivation and attention issue. So i think that taking SNRI, which increase heart rate since it inhibit norepinephrine and taking stimulant together might be too much on your heart.
I would be taking it as an adjunct antidepressant.

Apathy was baaadddd on 40 mg Escitalopram, even when also taking a high dosed stim alongside it.
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Old 03-16-2013, 03:25 PM   #11 (permalink)
 
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60mg of immediate release dex. is pushing it. I would go with Adderall XR or Vyvanse, or Focalin. Much easier on the body, not nearly as neurotoxic as quick release amps. I would use an extended release stim over a quick release any day. Vyvanse which is dexamp. attached to l-lysine to make it a slow release. It's a competitive inhibitor of DA, as well as NE. Lexapro 10-20mg for 5HT. Thats what I would do? I am actually looking into getting an extended release stim. through my pdoc. The big problem is no health insurance.
We have neither of the 3 you mentioned.

The only way I'm able to get Dextroamphetamine Sulphate here in Belgium, is produced by our local pharmacist on a psychiatrist's request, x(xx) "gelules" in dosage x(x). It basically only exists as raw material here.

I would have preferred an extended release as well but it's IR or nothing
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Old 03-16-2013, 03:34 PM   #12 (permalink)
 
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How would a combination of the 2 stims work out btw? Both according to theory and in practice please!

Ritalin LA 20 mg 2x/day + Dexamph 5 mg 3x/day or something along those lines.
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Old 03-17-2013, 09:38 AM   #13 (permalink)
 
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So, methylphenidate primarily acts as a norepinephrine-dopamine reuptake inhibitor. Methylphenidate is most active at modulating levels of dopamine and to a lesser extent norepinephrine. It also binds to and blocks dopamine transporters and norepinephrine transporters.

So, it would be overkill IMO, to use 2 psycho stims that are both binders to DAT and NET. The only difference being that Dexamp. actually is transported into the cell. Where it also acts as a competitive inhibitor at the VMAT transporter. That is the key difference between a stim. like Ritalin and a true amp., like Dexedrine.

So, one or the other my man, Dexedrine does not have as much peripheral stimulation as Ritalin, IMO. It helps more with concentration. That is what I have noticed from trying the two. Plus, the lowest dose you can get away with therapeutically, the better.
http://stahlonline.cambridge.org/pre...e=Therapeutics

http://stahlonline.cambridge.org/pre...e=Therapeutics
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Old 03-17-2013, 10:08 AM   #14 (permalink)
 
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So, methylphenidate primarily acts as a norepinephrine-dopamine reuptake inhibitor. Methylphenidate is most active at modulating levels of dopamine and to a lesser extent norepinephrine. It also binds to and blocks dopamine transporters and norepinephrine transporters.

So, it would be overkill IMO, to use 2 psycho stims that are both binders to DAT and NET. The only difference being that Dexamp. actually is transported into the cell. Where it also acts as a competitive inhibitor at the VMAT transporter. That is the key difference between a stim. like Ritalin and a true amp., like Dexedrine.

So, one or the other my man, Dexedrine does not have as much peripheral stimulation as Ritalin, IMO. It helps more with concentration. That is what I have noticed from trying the two. Plus, the lowest dose you can get away with therapeutically, the better.
http://stahlonline.cambridge.org/pre...e=Therapeutics

http://stahlonline.cambridge.org/pre...e=Therapeutics
Again, thanks for the info! I'm 99% likely going to go with the Dexampetamine because it really does feel alot healthier (or less unhealthy) on basically everything.

Dexamp is the stronger dopamine-booster, does it boost NA stronger than MPH as well?
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Old 03-17-2013, 10:38 AM   #15 (permalink)
 
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Dexedrine effects NE more than Ritalin but keep the dose as low as possible. I do well on 7.5-10mg a day. Anything higher can cause anti-social symptoms with me and as always talk to your pdoc about all of these possibilities.
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Old 03-17-2013, 11:08 AM   #16 (permalink)
 
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Dexedrine effects NE more than Ritalin but keep the dose as low as possible. I do well on 7.5-10mg a day. Anything higher can cause anti-social symptoms with me and as always talk to your pdoc about all of these possibilities.
It's very unlikely that I'll not be on the max dosage of 60 mg, since I already am But sub-100 forever!
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Old 03-17-2013, 02:40 PM   #17 (permalink)
 
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Just read some stuff about Mirtazapine (a med I hated when I took it as a stand alone med):

"Main Thesis: SWIM believes that taking Mirtazapine (brand name Remeron) has increased his sensitivity to stimulants, Dextroamphetamine in particular, and believes that a number of pharmacological actions, described below, facilitate this phenomenon."

and bla bla bla

What interests me is that it apparently potentiates stimulants and reduces SSRI sexual dysfunction.

Escitalopram 30 mg + Dextramphetamine 20 mg x3 + Mirtazapine 15 mg

Would adding 15 mg Mirtazapine do all of it's tricks? Or is there a specific minimum dose needed?
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Old 03-18-2013, 01:43 AM   #18 (permalink)
 
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Originally Posted by Inshallah View Post
Just read some stuff about Mirtazapine (a med I hated when I took it as a stand alone med):

"Main Thesis: SWIM believes that taking Mirtazapine (brand name Remeron) has increased his sensitivity to stimulants, Dextroamphetamine in particular, and believes that a number of pharmacological actions, described below, facilitate this phenomenon."

and bla bla bla

What interests me is that it apparently potentiates stimulants and reduces SSRI sexual dysfunction.

Escitalopram 30 mg + Dextramphetamine 20 mg x3 + Mirtazapine 15 mg

Would adding 15 mg Mirtazapine do all of it's tricks? Or is there a specific minimum dose needed?
Doesn't for me personally, I take 15mg Mirtazapine for sleep, I hate the stuff but I have a long standing sleep disorder. It has no positive effect on the dex I take in the day beyond blunting it a little by causing brain fog/sedation.
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Old 03-18-2013, 03:00 AM   #19 (permalink)
 
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That story "SWIM" was telling on another forum sounded too good to be true
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Old 03-18-2013, 06:16 AM   #20 (permalink)
 
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Lol, most overrated antihistamine ever?
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