Social Anxiety Support

NicktheQuik · 11-08-2009, 08:54 PM

Or something different then SSRI's. I believe I have SA, maybe slight depression, and possibly add (I think Im getting tested for that soon) I was first prescribed celexa and was on that for about 3 months, but felt no change, other then being tired during the day.

I then moved to Zoloft, took 50mg for 2 weeks, and it's been about 2 weeks of 100mg. If anything, it's been worst then Celexa. I've been even more tired during the day, and I feel like I've just been unmotivated to do anything. I'm mainly looking into medication to help me speak more (to be more comfortable around friends and family), to help me get out more and to get a job. But I just don't feel like doing that at all.

I'll wake up, eat breakfast, and an hour or two later all I'll wanna do is get back in bed, and it happens almost everyday. I've taken Adderall a few times with my friend and it makes me talk A LOT more, and makes me more comfortable with people in general. I love it. Only problem is I doubt I'd be prescribed something like that for my problem, unless I guess I have add in the end.

Does anyone think I might be "SSRI immune" or something? I'm thinking my problem is a norepinephrine or dopamine problem, it's just it seems like my doctor (Who I'm seeing tomorrow night) might be hesitant to go in those directions.

TL;DR: I've been on 2 different SSRI's for about 4 months now, no effect except feeling sleepy during the day, and possibly even less motivated overall. I'm thinking my problem might be related to norepinephrine or dopamine.

jim_morrison · 11-08-2009, 09:36 PM

These side effects can definitely happen with SSRI's, and they certainly don't work for everybody, so I'd say that maybe it's time to move on to another class of antidepressants; SNRI's or mirtazapine will probly be the best option to try next.

arth67 · 11-09-2009, 12:00 PM

some have to try several different types of antidepressants before finding 1 that works for them .

Vini Vidi Vici · 11-09-2009, 12:12 PM

fortunately, SNRIs are usually gonna be more dopaminergic than SSRIs. Effexor and Cymbalta weakly inhibit the reuptake of dopamine, but they strongly inhibit reuptake of Norepinephrine. Ive read and seen in multiple places that Dopamine levels in the prefrontal cortex and other areas of the brain can sometimes actually be mediated more by the NAT than DAT. so blocking the NAT would raise norepinephrine and dopamine both...dopamine, not very strongly, but much more so than SSRIs.

if your problem is only dopamine/norepinephrine based, maybe Wellbutrin would work better than SSRIs. Wellbutrin causes alot of anxiety though...its kind of like really weak Adderral, with alot of stimulation.... but sometimes, when Wellbutrin is combined with an SSRI, the combination can work quite well. You would probably get more of a dopamine boost by combining SSRI+Wellbutrin, than you would with just a plain SNRI.

NicktheQuik · 11-09-2009, 04:09 PM

Hm, he gave me Remeron. I'm kinda surprised cuz I thought only really depressed people got prescribed this. I'm pretty skinny too to Im kind of excited to (hopefully) gain some weight from it. I know it wouldn't be a lot but Ill take anything.

How long does it take to really work, a month?

Guide 4 Dummies · 11-09-2009, 04:53 PM

Quote:

Originally Posted by Vini Vidi Vici

if your problem is only dopamine/norepinephrine based, maybe Wellbutrin would work better than SSRIs. You would probably get more of a dopamine boost by combining SSRI+Wellbutrin, than you would with just a plain SNRI.

Is the norepinephrine reuptake inhibition of Bupropion + its metabolites comparable to that of SNRI's such as Venlafaxine or Duloxetine, or a TCA such as Imipramine? Do you know of any study related to this? Just wondering.

BusterBluth · 11-09-2009, 04:53 PM

Quote:

Originally Posted by NicktheQuik

Hm, he gave me Remeron. I'm kinda surprised cuz I thought only really depressed people got prescribed this. I'm pretty skinny too to Im kind of excited to (hopefully) gain some weight from it. I know it wouldn't be a lot but Ill take anything.

How long does it take to really work, a month?

The first night or two you take it, you will (likely) feel spacey/drunk/disoriented within an hour for which I recommend you appropriately go straight to bed. It's a pretty powerful effect at first, and may carry over into the morning. Not to worry, this overwhelming sedative effect will (likely) soon go away, though I've found it still helps put me to sleep but without the others side effects. I've been pleased with the stability it's brought to my appetite.

Vini Vidi Vici · 11-09-2009, 05:56 PM

Quote:

Originally Posted by Guide 4 Dummies

Is the norepinephrine reuptake inhibition of Bupropion + its metabolites comparable to that of SNRI's such as Venlafaxine or Duloxetine, or a TCA such as Imipramine? Do you know of any study related to this? Just wondering.

i know Bupropion has a strong combination of NA Reuptake inhibition+ weaker NA release.....its gotta be nearly on par with the SNRIs. Both have been shown to be really strong NA reuptake inhibitors..... i found an affinity table, but its really hard to figure out the exact strength of both compared to each other. Its possible, but you would have to know the approximate starting dose, and the affinity for the NAT. one thing i do know is that both SNRIs and Bupropion caused significant insomnia for me, so they must be somewhat strong NAT blockers. if u r interested in the affinity table, heres the link --- http://en.wikipedia.org/wiki/Antidepressant (the table is about halfway through the article)

jim_morrison · 11-09-2009, 08:39 PM

Quote:

Originally Posted by Vini Vidi Vici

fortunately, SNRIs are usually gonna be more dopaminergic than SSRIs. Effexor and Cymbalta weakly inhibit the reuptake of dopamine, but they strongly inhibit reuptake of Norepinephrine. Ive read and seen in multiple places that Dopamine levels in the prefrontal cortex and other areas of the brain can sometimes actually be mediated more by the NAT than DAT. so blocking the NAT would raise norepinephrine and dopamine both...dopamine, not very strongly, but much more so than SSRIs.

Yeah thats right, As you can see here, an SNRI will boost serotonin, norepinephrine and dopamine, since dopamine is inactivated by norepinephrine reuptake in the prefrontal cortex, which largely lacks dopamine transporters, venlafaxine etc can increase dopamine neurotransmission in this part of the brain.

http://stahlonline.cambridge.org/pre...e=Therapeutics

The only SSRI which may increase norepinephrine and dopamine to some extent is fluoxetine because of it's 5ht2c antagonism.

RockiNToM · 11-10-2009, 04:43 AM

If you've only been on 2 (from what I can see from your first post) you could maybe try something more stimulating SSRI wise like Prozac. There is also Lexapro and Paxil but these can be just as sedating. However, having said that, meds work on everyone differently and Lexapro and Paxil might be more stimulating for you than they were for me.

SNRI wise, Effexor XR might be good for you. I think the sweet spot is 150mg where the norepinephrine kicks in and provides more stimulation.

Remeron I'm not sure about. For lots of people it's quite sedating - which you've already said you've been fed up with in Zoloft and Celexa.

Bupropion might be worth considering in augmenting what you're already on as this works on both norepinephrine and dopamine and you should hopefully get a more stimulating, energizing effect from that.

Vini Vidi Vici · 11-10-2009, 06:54 AM

Quote:

Originally Posted by NicktheQuik

Hm, he gave me Remeron. I'm kinda surprised cuz I thought only really depressed people got prescribed this. I'm pretty skinny too to Im kind of excited to (hopefully) gain some weight from it. I know it wouldn't be a lot but Ill take anything.

How long does it take to really work, a month?

yeah...my doctor said only super depressed people get it also. but the thing is,....its not really a super strong antidepressant by itself. it can greatly increase the effectiveness of SSRIs/SNRIs and alot of other antidepressants. you should notice some immediate effect-- (unlike SSRIs which take weeks to show any benefit) but over time, there is a possibility that the antidepressant effects would get stronger. but as far as only prescribing it to super depressed people...its a complete misconception about the drug.

jim_morrison · 11-10-2009, 08:34 AM

Quote:

Originally Posted by Vini Vidi Vici

yeah...my doctor said only super depressed people get it also. but the thing is,....its not really a super strong antidepressant by itself. it can greatly increase the effectiveness of SSRIs/SNRIs and alot of other antidepressants. you should notice some immediate effect-- (unlike SSRIs which take weeks to show any benefit) but over time, there is a possibility that the antidepressant effects would get stronger. but as far as only prescribing it to super depressed people...its a complete misconception about the drug.

I'm not sure why mirtazapine is reserved for severe depression either, but in his book, for treating clinical depression stephen stahl names SSRI's, SNRI's and NDRI's as 1st line treatments, mirtazapine and TCA's as second line treatments, and MAOI's or mirtazapine + SNRI as third line treatments.

NicktheQuik · 11-12-2009, 08:37 PM

Alright I think Im getting an SSRI discontinuation syndrome feeling.The "brain zaps" I guess. This happened when I stopped taking celexa for a few days, I did this because I was gonna switch to something else and didn't notice celexa doing anything, so I didn't think it mattered to just stop. After taking another pill though I felt fine, and the next day I started Zoloft which got rid of it all together.

I was on 50mg of zoloft for 2 weeks, then 100mg for 2 weeks. Now I've been on 30mg of Remeron for 4 nights, and today I've started to feel the "zaps"

Could this just be because of the switch to Remeron, and a lower dose? 100mg to 30mg? My doctor said I wouldn't have to taper off of the Zoloft so I haven't taken any since Monday (when I started Remeron)

jim_morrison · 11-12-2009, 08:44 PM

It sounds like it's due to zoloft discontinuation, it's never a good idea to stop an SSRI cold turkey. Remeron works differently, so it's unlikely that it will stop the brain zaps at any dose. At this point the best option may be to just wait it out, it should resolve itself within a week or two on it's own. If the symptoms become intolerable then talk to your doc about going back onto a low dose of zoloft and tapering off it more slowly.

NicktheQuik · 11-12-2009, 08:50 PM

Well I still have a lot of Zoloft and Celexa pills, would it be a bad idea to take small doses of either of those once a day for a weekish to help?

jim_morrison · 11-12-2009, 10:00 PM

A small dose should be fine, but might be best to ask your doctor first.

NicktheQuik · 11-12-2009, 10:21 PM

Does it matter when I take it? Like with the Remeron, or like space them out, one in the morning one at night?

I might go to my doctor if this becomes a problem, but I can't right now so I'm just trying to get all the opinions on it I can before doing so.

jim_morrison · 11-12-2009, 11:17 PM

Personally I would take it at the same time of day that you took it before you stopped.

NicktheQuik · 12-09-2009, 04:57 PM

Is it normal that my pills look different then the first time I got them? I've been on 30mg of Remeron for a little over a month now, and unfortunately don't really feel any different. But I just got a refill and the pills aren't the same.

This is what they looked like the first time, http://images.emedicinehealth.com/im...ne30mg-myl.jpg

And this is what I have now, http://images.emedicinehealth.com/im...ne30mg-tev.jpg

It says it's the same 30mg pill for Remeron, but I just wanted to check to make sure and see if there's a reason for them looking different.

11-08-2009, 08:54 PM	#1 (permalink)
NicktheQuik Status: SAS Member Join Date: Nov 2009 Posts: 18	SSRI's haven't worked so far, hoping to get SNRI. Or something different then SSRI's. I believe I have SA, maybe slight depression, and possibly add (I think Im getting tested for that soon) I was first prescribed celexa and was on that for about 3 months, but felt no change, other then being tired during the day. I then moved to Zoloft, took 50mg for 2 weeks, and it's been about 2 weeks of 100mg. If anything, it's been worst then Celexa. I've been even more tired during the day, and I feel like I've just been unmotivated to do anything. I'm mainly looking into medication to help me speak more (to be more comfortable around friends and family), to help me get out more and to get a job. But I just don't feel like doing that at all. I'll wake up, eat breakfast, and an hour or two later all I'll wanna do is get back in bed, and it happens almost everyday. I've taken Adderall a few times with my friend and it makes me talk A LOT more, and makes me more comfortable with people in general. I love it. Only problem is I doubt I'd be prescribed something like that for my problem, unless I guess I have add in the end. Does anyone think I might be "SSRI immune" or something? I'm thinking my problem is a norepinephrine or dopamine problem, it's just it seems like my doctor (Who I'm seeing tomorrow night) might be hesitant to go in those directions. TL;DR: I've been on 2 different SSRI's for about 4 months now, no effect except feeling sleepy during the day, and possibly even less motivated overall. I'm thinking my problem might be related to norepinephrine or dopamine.

11-08-2009, 09:36 PM	#2 (permalink)
jim_morrison Status: Super Moderator Join Date: Aug 2008 Location: Australia Gender: Male Age: 23 Posts: 1,298	These side effects can definitely happen with SSRI's, and they certainly don't work for everybody, so I'd say that maybe it's time to move on to another class of antidepressants; SNRI's or mirtazapine will probly be the best option to try next. __________________ Warning: I am not a trained medical professional. Any information provided by me is based on my own personal experiences and research and is not intended to be used as professional medical advice. Please contact a medical professional before taking any action that may be discussed on this board.

11-09-2009, 12:12 PM	#4 (permalink)
Vini Vidi Vici Status: altruistic philanthropist Join Date: Jul 2009 Location: Minnesota Gender: Male Age: 18 Posts: 723	fortunately, SNRIs are usually gonna be more dopaminergic than SSRIs. Effexor and Cymbalta weakly inhibit the reuptake of dopamine, but they strongly inhibit reuptake of Norepinephrine. Ive read and seen in multiple places that Dopamine levels in the prefrontal cortex and other areas of the brain can sometimes actually be mediated more by the NAT than DAT. so blocking the NAT would raise norepinephrine and dopamine both...dopamine, not very strongly, but much more so than SSRIs. if your problem is only dopamine/norepinephrine based, maybe Wellbutrin would work better than SSRIs. Wellbutrin causes alot of anxiety though...its kind of like really weak Adderral, with alot of stimulation.... but sometimes, when Wellbutrin is combined with an SSRI, the combination can work quite well. You would probably get more of a dopamine boost by combining SSRI+Wellbutrin, than you would with just a plain SNRI. __________________ Current Meds: Parnate 20mg + Dextroamphetamine 5mg 3x/day +Memantine 5 mg/day+ caffeine/nicotine + Lunesta 3mg + Diagnoses- Major Depression, OCD, Social Anxiety, GAD

11-10-2009, 04:43 AM	#10 (permalink)
RockiNToM Status: SAS Member Join Date: Jun 2009 Location: UK Gender: Male Age: 22 Posts: 492	If you've only been on 2 (from what I can see from your first post) you could maybe try something more stimulating SSRI wise like Prozac. There is also Lexapro and Paxil but these can be just as sedating. However, having said that, meds work on everyone differently and Lexapro and Paxil might be more stimulating for you than they were for me. SNRI wise, Effexor XR might be good for you. I think the sweet spot is 150mg where the norepinephrine kicks in and provides more stimulation. Remeron I'm not sure about. For lots of people it's quite sedating - which you've already said you've been fed up with in Zoloft and Celexa. Bupropion might be worth considering in augmenting what you're already on as this works on both norepinephrine and dopamine and you should hopefully get a more stimulating, energizing effect from that. __________________ Disorders: Dysthymic Disorder, Social Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder. Medications: Propranalol, Valium, Prozac, Celexa, Paxil, Zoloft, Roboxetine, Effexor, Mirtazapine. Current status: Medication free.

11-12-2009, 08:44 PM	#14 (permalink)
jim_morrison Status: Super Moderator Join Date: Aug 2008 Location: Australia Gender: Male Age: 23 Posts: 1,298	It sounds like it's due to zoloft discontinuation, it's never a good idea to stop an SSRI cold turkey. Remeron works differently, so it's unlikely that it will stop the brain zaps at any dose. At this point the best option may be to just wait it out, it should resolve itself within a week or two on it's own. If the symptoms become intolerable then talk to your doc about going back onto a low dose of zoloft and tapering off it more slowly. __________________ Warning: I am not a trained medical professional. Any information provided by me is based on my own personal experiences and research and is not intended to be used as professional medical advice. Please contact a medical professional before taking any action that may be discussed on this board.

11-09-2009, 12:00 PM	#3 (permalink)
arth67 Status: SAS Member Join Date: Aug 2009 Location: austral;ia Gender: Male Posts: 232	some have to try several different types of antidepressants before finding 1 that works for them .

11-09-2009, 04:09 PM	#5 (permalink)
NicktheQuik Status: SAS Member Join Date: Nov 2009 Posts: 18	Hm, he gave me Remeron. I'm kinda surprised cuz I thought only really depressed people got prescribed this. I'm pretty skinny too to Im kind of excited to (hopefully) gain some weight from it. I know it wouldn't be a lot but Ill take anything. How long does it take to really work, a month?

11-12-2009, 08:37 PM	#13 (permalink)
NicktheQuik Status: SAS Member Join Date: Nov 2009 Posts: 18	Alright I think Im getting an SSRI discontinuation syndrome feeling.The "brain zaps" I guess. This happened when I stopped taking celexa for a few days, I did this because I was gonna switch to something else and didn't notice celexa doing anything, so I didn't think it mattered to just stop. After taking another pill though I felt fine, and the next day I started Zoloft which got rid of it all together. I was on 50mg of zoloft for 2 weeks, then 100mg for 2 weeks. Now I've been on 30mg of Remeron for 4 nights, and today I've started to feel the "zaps" Could this just be because of the switch to Remeron, and a lower dose? 100mg to 30mg? My doctor said I wouldn't have to taper off of the Zoloft so I haven't taken any since Monday (when I started Remeron)

11-12-2009, 08:50 PM	#15 (permalink)
NicktheQuik Status: SAS Member Join Date: Nov 2009 Posts: 18	Well I still have a lot of Zoloft and Celexa pills, would it be a bad idea to take small doses of either of those once a day for a weekish to help?

11-12-2009, 10:00 PM	#16 (permalink)
jim_morrison Status: Super Moderator Join Date: Aug 2008 Location: Australia Gender: Male Age: 23 Posts: 1,298	A small dose should be fine, but might be best to ask your doctor first. __________________ Warning: I am not a trained medical professional. Any information provided by me is based on my own personal experiences and research and is not intended to be used as professional medical advice. Please contact a medical professional before taking any action that may be discussed on this board.

11-12-2009, 10:21 PM	#17 (permalink)
NicktheQuik Status: SAS Member Join Date: Nov 2009 Posts: 18	Does it matter when I take it? Like with the Remeron, or like space them out, one in the morning one at night? I might go to my doctor if this becomes a problem, but I can't right now so I'm just trying to get all the opinions on it I can before doing so.

11-12-2009, 11:17 PM	#18 (permalink)
jim_morrison Status: Super Moderator Join Date: Aug 2008 Location: Australia Gender: Male Age: 23 Posts: 1,298	Personally I would take it at the same time of day that you took it before you stopped. __________________ Warning: I am not a trained medical professional. Any information provided by me is based on my own personal experiences and research and is not intended to be used as professional medical advice. Please contact a medical professional before taking any action that may be discussed on this board.

12-09-2009, 04:57 PM	#19 (permalink)
NicktheQuik Status: SAS Member Join Date: Nov 2009 Posts: 18	Is it normal that my pills look different then the first time I got them? I've been on 30mg of Remeron for a little over a month now, and unfortunately don't really feel any different. But I just got a refill and the pills aren't the same. This is what they looked like the first time, http://images.emedicinehealth.com/im...ne30mg-myl.jpg And this is what I have now, http://images.emedicinehealth.com/im...ne30mg-tev.jpg It says it's the same 30mg pill for Remeron, but I just wanted to check to make sure and see if there's a reason for them looking different.