[BusinessSocks]

Hi all,

I've been lurking for awhile, reading about everyone's medication knowledge and experience. Now I've got a question of my own. I seem to recall seeing a thread (maybe it was here... maybe not) comparing the relative tendency of the different SSRIs and SNRIs to be either sedating/energizing. Can anyone comment on this?

Here's my deal... I've got case of mild narcolepsy to go along with my social anxiety. I don't get sleep attacks (thank god), but I'm often just really sleepy and feeling dopey. And stressful/anxiety-invoking situations tend to make this worse. It's hard to function socially when my brain is half-asleep.

I was on Wellbutrin for awhile, but my stress and depression started getting out of hand, so my doctor switched me to Pristiq (I'd had previous success on Effexor but w/ lousy side effects). Tried out Pristiq for about 6 or 7 weeks, but it didn't seem to do much of anything. Now I'm trying out Celexa. I'm only on week two, but my energy level has really tanked lately. I don't know if the Celexa is causing it or not.

I'll give it another couple of weeks to see if things improve. But if they don't, is there another SSRI that might boost the energy level a bit? Also, I've been taking the Celexa in the evening. Might dosing in the morning make a difference?

Thanks,
M.J.

 

[Medline]

Modafinil would probably be a very good drug for you.

 

[mirakaigh]

Everything seems to be too energizing for me but the worst has been Lexapro, it gave me A LOT of energy. Would be good for someone who actually needed that energy.

Celexa was much weaker and although chemically related to Lexapro, it caused sleepiness. I never took it in the AM due to that.

 

[BusinessSocks]

Zoloft?

Would it make sense to try switching from Celexa to Zoloft rather than adding Modafinil or Wellbutrin? I think I read that Zoloft tends to be less sedating than other SSRIs. Of course, I guess everyone's experience is different.

I'm just wondering if another SSRI might "agree" with me more. It doesn't help that I gained four pounds in a couple of weeks after starting Celexa...

 

[Medline]

I think adding Modafinil would be your best option.

 

[BusinessSocks]

I think adding Modafinil would be your best option.

Here's the thing about Modafinil, though... I was on it after I was first diagnosed with narcolepsy. It worked OK, I guess, at keeping me alert. However, I also experienced troubling anxiety from it.

Who knows, maybe the anxiety was a side-effect of my brain finally waking up for once. Or maybe it was an actual side-effect of the medication. Regardless, my sleep doc took me off of it and gave me Ritalin instead. Occasionally that will make me slightly jittery, but it doesn't seem to make me anxious.

So in general, I'd say I'm less hopeful that the Modafinil would be useful, considering my previous experience with it. Or maybe it will have a more positive effect in conjunction with Celexa?

Thanks for your advice.

 

[UltraShy]

Modafinil would probably be a very good drug for you.

Known by the brand name Provigil it sells for $11 per pill, yet seems to me to be about as potent as caffeine pills that sell OTC for 3 cents each. It can barely top caffeine as a stimulant IMO, yet the DEA thinks it needs to be a controlled substance.

 

[Medline]

I always got my generic Modafinil 200mg for 1$ / pill online, worked perfect. And it was definitely more useful than caffeine.

Or maybe it will have a more positive effect in conjunction with Celexa?

Sometimes antidepressants are "augmented" with stimulants like Modafinil/Ritalin to work better. But I can't assure you that Modafinil would help you this time, I didn't know you already tried it.

If you are still pretty sleepy and have low energy, couldn't your doc give you a script for Ritalin again? Or if you already are on Ritalin, maybe increase the dose a little bit or change to higher dosed Concerta? It should also help with the weight.

 

[euphoria]

Known by the brand name Provigil it sells for $11 per pill, yet seems to me to be about as potent as caffeine pills that sell OTC for 3 cents each. It can barely top caffeine as a stimulant IMO, yet the DEA thinks it needs to be a controlled substance.

I am not surprised modafinil didn't work with Xanax.

 

[BusinessSocks]

If you are still pretty sleepy and have low energy, couldn't your doc give you a script for Ritalin again? Or if you already are on Ritalin, maybe increase the dose a little bit or change to higher dosed Concerta? It should also help with the weight.

I actually still have the Ritalin... I've just been relying on it a lot more since starting the Celexa. So I thought maybe switching to a different SSRI might be worthwhile. I just hate having to take pills all day long. But maybe that's just something I need to accept.

I'm also on Xyrem, which I take at night and is supposed to help induce deeper sleep cycles. Maybe the Celexa is actually adversely affecting my sleep, and I should try taking it in the morning?

Thanks for your input,
MJ

 

[MissMay1977]

I think adding Modafinil would be your best option.

That and a little bit of Adderall and you should be good to go! :yes

 

[MissMay1977]

Known by the brand name Provigil it sells for $11 per pill, yet seems to me to be about as potent as caffeine pills that sell OTC for 3 cents each. It can barely top caffeine as a stimulant IMO, yet the DEA thinks it needs to be a controlled substance.

Why does the DEA think it needs to be a controlled substance? What is the DEA? Can we fire them and hire new DEA?

 

[Medline]

I actually still have the Ritalin... I've just been relying on it a lot more since starting the Celexa. So I thought maybe switching to a different SSRI might be worthwhile. I just hate having to take pills all day long. But maybe that's just something I need to accept.

I'm also on Xyrem, which I take at night and is supposed to help induce deeper sleep cycles. Maybe the Celexa is actually adversely affecting my sleep, and I should try taking it in the morning?

Xyrem is GHB and I guess you take 4.5g twice / night. I doubt Celexa can adversely affect your sleep when you take such a powerful substance as GHB at sleep inducing doses. I think when you take the Celexa in the morning you would be even more sleepy all day long. As far I understood it you take Ritalin often daily and hate to take so many pills. Have you considered taking "time-released Ritalin" instead (Concerta)? or Adderall (Amphetamine)?

 

[BusinessSocks]

Xyrem is GHB and I guess you take 4.5g twice / night. I doubt Celexa can adversely affect your sleep when you take such a powerful substance as GHB at sleep inducing doses. I think when you take the Celexa in the morning you would be even more sleepy all day long. As far I understood it you take Ritalin often daily and hate to take so many pills. Have you considered taking "time-released Ritalin" instead (Concerta)? or Adderall (Amphetamine)?

You know, I'm always surprised at what does and does not affect my sleep. Yesterday, because I was so damn sleepy and had to go to class after work, I took a leftover 100 mg dose of Wellbutrin in the afternoon (just curious to see how it would affect me) and skipped my Celexa dose. Then later I had a heck of a time falling asleep last night, even after taking the Xyrem (I'm on 3.75g doses, actually). I was up way later than I usually am, and today I feel fine after taking a single 5mg dose of Ritalin. So go figure that.

By the way, I've tried the time-released Ritalin, but I didn't like how it made me feel. That's why my doc put me on 5mg pills to take as needed. They seem to work fine, but like I said, I end up taking pills throughout the day. If that's what I've got to do, I'll do it. I'm just always looking for a better way.

 

[Medline]

If the Celexa makes your condition worse and the effect doesn't subside then you will have to change this medication. The question is which AD will probably be good for you? Lexapro is just the L-isomer of citalopram so chances are high that you will have the same reaction (but this must not be the case). From the SSRIs Zoloft is likely the next one you should try because it has good efficiency and tolerability.

Of course SNRIs are more energizing than SSRIs. As Effexor failed, you can forget about Pristiq too. Milnacipran would be an option, it's very energizing and useful for depression. Unluckily it's not a good drug for people with anxiety disorders IMHO.

You could also ask your doc about Adderall. It can give a lot of energy and some people on SAS say it helped them very much with their social phobia.

 

[Eleison]

Mirtazapine? Energising? Nope. It's a sedating anti-depressant. I've been on it nearly 3 years. I was previously on efexor, which was too ennervating for me.

 

[Medline]

I wrote Milnacipran not Mirtazapine.

 

[Eleison]

How did I misread that? Sorry...

 

[Medline]

No problem...

 

[BusinessSocks]

I think this is the thread that I'd read before about the sedating/activating effects of the different antidepressants:
http://www.socialanxietysupport.com/forum/f30/is-zoloft-activating-9572/

And the PDF that's referenced:
http://www.psychiatrist.com/brainstorms/br6301.pdf

According to one of the responders in that thread, although it's closer to the "energy boost" side in the PDF, Zoloft isn't likely to have any sort of dopamine effect except for when taken in high doses. So maybe it's unlikely to affect me much differently than the Celexa.

Anyway, I've got an appointment with my doctor tomorrow. I've given the Celexa about three weeks now. Maybe it's worth sticking with it in order to see if it gets better?