Welcome to Depression Regimens

Guanfacine at 1 mg and higher is super useful for me, but that dose is also a threshold that gives me significant insomnia. The kind where I fall asleep fine but wake up 2-5 hours into the night, and it’ll be another 4 hours from there if I can sleep again. This did not go down overtime.

But guanfacine is a really good med for me otherwise. Has anyone found any ways to treat that insomnia?

Hello. Please excuse my bad English (I'm Japanese and I'm using Google Translate to type this.)

I have a question about TCA. My CFS symptoms are so severe that all I can do is lie in bed while college students my age are dating or studying. However, when I take 10mg of Nortriptyline, my brain fog disappears and I am able to move again.

On the other hand, Nortriptyline significantly prolonged my QT and I ended up in the ambulance several times. It seems that TCA acts on Na channels and Ca channels, but is there any way to reduce the cardiotoxicity caused by TCA?

Is there a better way （example: taking electrolytes or taking beta blockers）？ My life is really being held back by cfs. I wish I had a heart that could take Nortriptyline and TCA. Is it realistically difficult to reduce the cardiotoxicity of TCA?

Also, I can move and be productive.when I take more noradrenaline, but my ADHD gets worse when my dopamine increases, but is this due to some kind of brain abnormality? If TCA cannot be used, are there any other recommended drugs for CFS that increase noradrenaline? SNRI etc.　(By the way, I am very sensitive to cyp2d6 drugs...)

Do you suffer from lower back pain and depression?

Researchers at Johns Hopkins University are seeking individuals with chronic low back pain and co-occurring depression to participate in a research study looking at the effects of psilocybin, a psychoactive substance found in naturally occurring mushrooms. The study will investigate the psychological effects of psilocybin, including whether or not it can help with chronic low back pain and co-occurring depression.

Volunteers must be:

• Between the ages of 21 and 65
• Have low back pain and depression as an ongoing problem (at least 3 months)
• No recent history of alcoholism or drug abuse

Principle Investigator: David B. Yaden, Ph.D.
IRB00385932

https://hopkinspsychedelic.org/backpain

I feel like a different person. I’m okay with it since I don’t dislike who I am…and I’m not depressed. I’m still tired and easily overwhelmed, I don’t have my stuff together. But I’m ready to start getting to know myself for possibly the first time in my life. I’m in therapy but wondered if there are books or other resources — or best of all, personal anecdotes — that anyone has for this next step. Thanks 🙏

I am currently on Trintellix/vortioxetine, and while I think it’s helping my depression, it’s not helping my anxiety (even with daily clonazepam that I’m on for neurological issues, not anxiety). I’m already on a lot of medication’s for chronic illnesses, so I’m hoping to switch to an antidepressant that helps depression and anxiety and kill two birds with one stone. I have depression, GAD, social anxiety, possible C PTSD (depending on who you ask), and obsessive thoughts related to food and my body (I have an ED).

My biggest issue with antidepressants in terms of side effects is them being too stimulating and causing insomnia- I’m really sensitive to that side effect and have gotten it from other psych meds in the past like rexulti, abilify. I was on venlafaxine for years (it was v helpful for anxiety) but had to be on multiple sleep meds at very high doses to counter the insomnia side effect (I already have sleep issues to begin with). I tried escitalopram and stopped after a week bc the increased insomnia and anxiety was unmanageable.

I know the obvious ones that come to mind for people with insomnia are mirtazapine and tricyclics, but I can’t risk the weight gain with mirtazapine and I’m worried about side effects from tricyclics.

I read a PubMed article that said that the SSRI that caused the least insomnia is citalopram (I’m afraid to take Paxil, because of weight gain as I already have an ED and body dysmorphia) and that the SNRI Least likely to cause insomnia is fetzima.

If anyone has any thoughts or advice for things to ask my doctor about, I’d really appreciate it! I’m in Canada by the way.

Thanks so much!!!

Hi. I was on amitriptyline 50 mg which was tapered to 25 mg for 10 days and stopped. I am feeling very light headed and dizzy. Looking for similar experiences..how long doesbit last?

I often experience an extreme kind of drowsiness that I have no choice but to lay down and fall asleep within a few minutes, even if I had slept 9 hours last night.

I am currently not under any medications.

I really couldn't figure it out for more than 20 years!

Hi there,

to those who have noticed sexual problems when taking SSRI/SNRI, which symptoms do you experience:

-not being able to orgasm

-genital numbing to sexually arousing stimuli

-not being able to get/keep an erection or only under certain circumstances (please describe below)

Please share your experience report

If you didn't know, SSRis and shrooms don't mix. The SSRIs block the shrooms from working. I stopped taking Prozac mostly because It made me feel flat. about 6 months later, I got into Magic Mushrooms and have been keeping that on the downlow from my doctor. Why? Well, I do pee in a cup every 6 months for my ADHD stuff. i figure if you tell the doc about it, I'd lose my ability to function at my job.

While my anxiety seems to be better, I do feel like my depression has never gone away. I asked the doc about non SSRI options and she said most would trigger anxiety, especially welbutrion. Ugg.

Hello everyone,

I've been taking Zoloft (sertraline) for 3 days now at a dose of 25 mg, and I'll be increasing to 50 mg next week. I've been reading a lot about potential side effects, especially PSSD (Post-SSRI Sexual Dysfunction), and I'm quite anxious about it. I'm also taking Abilify (5 mg) and Xanax (up to 3 mg per day, with 1 mg immediate release as needed).

I do not intend to take Xanax forever and plan to taper off eventually under medical supervision when the sertraline takes effect. Unfortunately, I've been taking Xanax for a while now. Currently, I'm taking 1 mg Xanax XR in the morning and evening, and 1 mg IR as needed.

Could anyone share their experiences with Zoloft? Particularly, I'm looking for reassurance about the side effects and any positive outcomes you've had.

Sorry if my English isn't perfect; I used ChatGPT to help me write this post as I'm not very confident with my English.

Thank you for your support!

By some chance effexor was acting as a sexual performance enhancer for me. This is contrary to most anecdotes and reports I hear about SSRIs/SNRIs

Some combination of settling my anxiety, delaying orgasm to some extent, etc. Not sure what the mechanism is. I assume the norephedrine might have something to do with it.

The ability to remain relatively calm in stressful or exciting situations probably helped.

I'm taking a "break" from it now for another reason, but if I want to stay off it I'll have to figure out how it was giving me those side benefits.

I've been on an SSRI before and it was not the same. There I got the typical blunting of highs & lows and difficulty achieving orgasm, and unsatisfactory orgasm that many people describe.

Hi,

why is dopamine so neglected in depression? Most of the antidepressants do not act on dopamine, unfortunately. But is it dopamine that many of us may need?

I just read a super interesting article on this topic: Desmolysium - The Brutal Neglect of Dopamine

The author makes great points about why dopamine is important in depression (quotes from the article).

• "These “anergic” or “atypical” features of depression are thought to be at least in part due to a relative dopamine deficiency. Unfortunately, conventional antidepressant treatment regimens barbarically neglect the crucial role of dopamine but mainly focus on serotonin and to a lesser degree noradrenaline."
• Treating these patients with SSRIs often exacerbates the issue, causing a state of so-called “amotivational syndrome”, perhaps in part because (excess) serotonin further suppresses dopamine signaling due to serotonin-mediated modulation of VTA neurons (midbrain dopamine neurons)
• The mesolimbic dopamine system mediates incentive salience (motivation), which is critical to vitality, curiosity, agency, libido, an ability to anticipate reward (to look forward to things), and a sense of urgency and importance.
• The author also explains the science of dopamine in detail, e.g., the role of dopamine in the mesolimbic and mesocortical systems, and why these systems are important for motivation and cognition - two issues many depressed people have.
• The author proposes a couple of strategies, including bupropion, selegiline, tranylcypromine, amineptine, SAM-e, and testosterone manipulation. He also mentions pramipexole. Also a couple of others.

Anyway, I can recommend the article, I learned quite a few things. Particularly the addition of low doses of selelgiline keep me intrigued. Also I want to check my testosterone now.

What do you guys think about dopamine and depression? And has elevating dopamine helped your depression? My psych never brought this up unfortunately but I will ask him next time.

Edit: Linked article

Somedays I feel like this like I am trying so hard In every area of this live yet not achieving anything. I would use this app like a daily diary. Cuz I am too lazy to write my thoughts on paper besides someone can discover my secret agenda. So here I'm gonna start a brand new journal of my deepest feelings and thoughts 💭 or banality as well. Still don't get why certain things are completely difficult to get for me. Do Not judge me. I have been through a lot of unfair events. Have you ever felt so lonely? Have you ever wanted to scape from your body and live in somebody else's? I've been feeling this since I was a kid. Isn't that bizarre? Guess I am weird..

I'm on 37,5mg Effexor XR since months. Within this time I upped my dose to 75mg an after some weeks my symptoms got worse: Alcolhol cravigs, irritability, anger, exhausted, feeling of emptiness, tiredness, trouble sleeping and so on. After I realized that all was getting worser I instant switched back to 37,5mg.

I also had this expierience with Sertraline (i think it was in 2015 or 2016). After I upped my dose to 50mg slightly everything was getting worser and worser. Upping to 75 oder 100mg had no positive effect. So I did stay at 50mg and tapered of after ~ an year.

Could this be some kind of hypomania? Or maybe serotonine syndrome?

These are my main symptoms and they make me nonfunctional. I cannot socialize and I have no life and I am consumed by these symptoms 24/7. And I am hopeless—especially since developing blank mind. That makes me more hopeless than even anhedonia

I do not have mood and appetite symptoms. Sleep I have early morning awakening.

My doctor has given me an ECT referral. Has anyone done it for just these symptoms

And also my symptoms are drug induced. I do NOT react well to most drugs and they in fact crash me, which is one reason I am even so desperate. I had a sudden horrific crash from Benadryl last month and still have not recovered. And over the past 2 weeks I even ended up with blank mind loss of inner monologue.

I cannot tolerate anything serotonergic, even MAOIs are blunting. Already have done TMS its useless for anhedonia and Ketamine did not work and also had erratic times where it would blunt my emotions more.

Who has done it for these symptoms?

Ive already tried a lot by the way. FMT even. And FMT did help day 1 I almost got to 85% but it did not stick and although there were some improvements in the next few weeks I ended up horribly crashinf from Benadryl. I got rid of caffeine blunting issues from the FMT.

Prior to FMT I had also done plasmapheresis and experienced some relief, that peaked at about the 5 week mark then went down although some lasted. This suggests a neuroinflammation component. I was then doing ok ish at least coping on a combo of Gabapentin 600 mg + Armodafinil 50-100 mg. Though I still didnt really have a life, no sexual pleasure, and lacked interest but at least had some emotion.

Just the fucking benadryl created a lot of havoc pretty much immediately 1 hour in as rhe sedation hit there was very bad anhedonia. A week later it hadn’t subsided so I got on Nardil 15 mg EOD out of desperation, it helped initially from the GABA effecr and the PEA stim effect. But 2 weeks into it my gut got worse, and I also started getting even more blunted on it and this is also when blank mind became noticeable.

If I had to sum up, I basically have a PFS/PSSD-like condition

Recently also I did an endoscopy and the doctor suspected fungal overgrowth in the upper gi tract/lower esophagus as he saw white stuff in the pics. He alsk saw that food was not moving properly, so some gastroparesis. Also the anasthetic for the endoscopy was Propofol, which right after a couple hours later I felt a major relief at least for anhedonia/blunting but only somewhat for blank mind, it felt like there was still some blockage despite anhedonia lessening. Blank mind is a newer symptom for me I got from crashes, and its the worst symptom. But my general responses seem to indicate that I respond to GABAergics, pure dopaminergic (limited NE), and endocannibinoid stuff. We do not have many agents like this unfortunately currently thanks to pharma constantly shilling SSRI/SNRIs/wellbutrin all which could destroy me according to my doctor.

Overall I have a gut-brain-immune axis dysfunction and it seems impossinle to correct everything that is wrong. And I feel hopeless. My symptoms constantly are agitating me especially the blank mind loss of inner monologue and personality even more than anhedonia/blunting. Im not able to get feedback from the environment as easily.

Conventional meds simply worsen things in this kind of perturbed PSSD-like state (PSSD also is linked to gut brain immune dysfunction)

The doctor is hence recommending ECT at this stage due to the Blank Mind distress and the fact that it seems like most chemicals create more problems and we do not yet have a pharmacological approach that completely avoids the serotonin and NE systems, and pramipexole also has risks of slowing the gut and causing SIBO in some parkinsons studies.

Zuranolone would have been ideal for me and my psych tried to prescribe it but FDA ruined it.

TLDR: I get severe blunting reactions to anything remotely serotonergic, including MAOIs. I also have an NE sensitivity altho that got better, wellbutrin is off the table due to the melanocortin anhedonia possibility and my doctor says it would be a big risk as he has seen severe anhedonic reactions to SSRI/SNRI/Wellbutrin in patients like me.

Gabapentin + Armoda or is the only safe thing but since blank mind its not effective and im just deteriorating.

Is ECT appropriate here? Lifestyle and exercise do not help my symptoms and im constantly agitated and obsessed about the time frame and thinking about “when will this resolve” is the thought 24/7 in my head. And blank mind is not resolving since it came. I cannot interact with people and that makes me suicidal.

My doctor says he has PSSD/PFS or covid and other drug induced anhedonia cases who he referred for ECT and it helped. The thing is on online forums there arent anecdotes of it so I wonder. He tells me it is the safest conventional treatment given the sensitivity of these conditions to severely crashing from small things

I’ve been to a lot of doctors in the decade+ since I was diagnosed. I’ve tried a lot of medications. I still haven’t found the drug that works just right for me.

I’m seeing a new psychiatrist this weekend, and I still haven’t given up on finding the right drug (even if I want to).

I wish I had a nice, organized list with pros and cons of all the drugs I was on, how long, what dosage, etc. but I just wasn’t that responsible at the time.

Usually when I go in for a new patient eval, they just kind of pick a random drug for me to try, I shrug my shoulders and say “sure, let’s give it a go.” Unless they bring up Latuda and I get shivers, haha. But this method clearly isn’t working for me.

So I actually have a couple questions, I’d appreciate any help:

• How do you approach new/switching medication with your doctor?
• How often do you switch medication? Have you ever?
• Do you feel like you found your “just right” medication? If yes, how long did it take for you to find it?

Like, the first thing you see while reading the classification is "dysthymia"(prolonged mid depression), anxious depression(based on symptoms) and major depression(based on severity), while some types (like apathetic) don't even exist

Imagine if people were only distinguishing apples as "red" or "big" or "sweet", ignoring that those are completely different criterias that can overlap(i.e red apple can be big) while also ignoring the existence of yellow or sour types of apples.

This is the state of modern classification system. Completely fucking ridiculous. Like, people couldn't classify depression types by different criterias, like "severity+symptoms+prolongation" (major anxious depression or minor apathetic dysthymia for example?)

Why wasn't something as simple as that implemented? Are they too dumb to properly classify depression types. What is fucking wrong with the whole world psychiatry?

How do you care about real life things again ? I don’t kno the best way to describe the feeling but for those of you that have situational depression and anxiety, This won’t apply to you. I have the type of anxiety depression that comes out of nowhere and doesn’t relate to the aspects of my real life. therefore, I can be at my favorite place with my favorite people, and everything could be good in my life and depression could be present. It has nothing to do with anything going on in my life. It just comes over me as If i have a chemical imbalance and a switch goes off in my brain and that’s it.

So for anyone who can relate to this or experiences anxiety and depression that isn’t related to any aspects of your real life, (family problems, marriage, death, financial hardship, bullying, living situation etc) pls lmk how you cope, and went about treatment… for some odd reason I feel like I’m the only person in the world that has this type of mental health problem since it doesn’t have a “reason”behind it. I know that’s not true but it makes me feel so insane for having it. I don’t hate myself or my life I love myself and my life, but I hate the waves of anxiety and depression I get that pertain to NOTHING and ruin my normal state of being.

Hi all,

For a number of years now, I've had this moderate, chronic anhedonia and depression which has been the bane of my life. Even to the point now where I dissociate because of how long it's been going on for. I've been on antidepressants in the past, with mixed success, but I want to avoid taking them as a rule if possible because I've relapsed every time I've taken them in the past. They also killed my sex drive.

I have ADHD, but taking ADHD medication in the past has led to some rough evening comedowns, so I've stopped taking them.

The truth is, my depression regimen and way of life is pretty much perfect. I eat incredibly healthily (vegetarian diet), I avoid ultra-processed foods, I gym 3 days a week, I run 5 days a week (averaging 50km per week), I meditate, I avoid pornography, I take vitamins (iron, b12, D, zinc), I go on walks with my dog, I avoid social media and too much screentime and I practise positive journaling. I have no historic trauma or anything bad in my life at all. It's a complete mystery, and it makes me angry feeling the way I do after I do SO much to try and improve my mental health. I've also undergone therapy, but without any negative thoughts or trauma to talk about, I found the experience hard to derive benefit from.

What else can I do? I've had blood tests for deficiencies and low testosterone, but everything has come back fine. I'm vegetarian, so I did think that might have something to do with it, but all my blood levels are fine, so I'm clearly not deficient in anything.

Thanks guys :)

Hello. I'm Japanese and I'm using Google Translate to create this sentence (so I'm sorry if my English is clumsy)

I suffer from chronic fatigue and heard that SNRIs are effective, but I am cyp2d6 poor.

Therefore, I would like to use Desvenlafaxine (as this drug does not inhibit cyp2d6), but I heard that it is in extended release capsules.

I'm not very sensitive to medicine in general, so I would like to start taking this medicine at a low dose, but will it be dangerous if I break the extended-release capsules?

Does this mean that the capsule itself has a sustained-release effect, or does the granule inside have a sustained-release effect? (If the latter is true, it would be a blessing to me because I would be able to try it at a lower dose.)

I am struggling with depression since 2020 and the trend I noticed is that antidepressants just do not work on me. I feel better like for a week or two after changing them and go back to rotting again. I've been hospitalized in march for the first time and was diagnosed with anxiety-depressive disorder (not sure about the anxiety though) and given trazodone 150mg dosage. Before that i was taking 150mg of Sertraline and after it didn't work i was prescribed with venlafaxine with the same dosage. Things have been a bit better after trazodone but i still can't live a normal life. I'm anxious before meeting with people thus socializing very rarely, struggle with motivation for things I love and sleep like shit. Maybe some of you have this? Should i still hope for meds to work or just try experimental things like shrooms?💀 Much appreciated.

Psych wants to put me on this drug for insomnia and to possibly see if it helped with my depression since I will not take SSRI/SNRIs again, but I’m concerned about weight gain.

How does that work? Does it just increase appetite? I obsessively weigh portions/track calories and macros for gym purposes and frankly don’t mind just not eating even if hungry if I’ve hit my goals for the day. Is it something to be concerned about if I’m cognizant of calories or is there some other mechanism at work that causes the weight gain?

I can't seem to find any examples online of people on antipsychotic medication being fit, is there anyone on here who takes abilify or other antipsychotics who is in great shape?

There's no clear definition of apathetic depression. There's no adequate threatment (giving shit ton of SSRIs does absolutely NOTHING). In my country they even banned every single stimulant that could actually help, ffs! And psychoatrists try to gaslight me into thinking that apathy is a "personality trait" that i should learn to live with(why the fuck would i even try to live with that???!??). Another psych diagnosed me with "schizoid personality" when I don't even fucking exibit any fucking schizo symptoms, based only on my fucking empathy! I absolutely fucking hate and despite today's state of psychiatry

I take fluvoxamine and am switching to fluvoxamine er and am wondering if this is even working for me

I can’t do weed as it gives me anxiety

Does anyone start to feel extremely tired after early waking hours and rest their head only to get imploded with never-ending thoughts about the agony, despair, confusion, absurdity of life? It's like I'm being reminded that it all amounts to a bunch of hocus pocus and therefore there is no point in lifting my finger to put in the effort. Some days I'm prone to this bed fall more than others but once it happens all I feel is fatigue and lethargy for the rest of my day. And naturally I start to feel extreme waves of wanting to end it all. I don't know how to stop this from occurring often because I have things I need to use my brain for.

My (34M) anxiety and depression hit in college after I'd had anxiety before, massively increasing with the onset of depression. Now that I have Lexapro and Lamictal to keep my feelings from dipping into those deep lows for no reason, I am left with severe anxiety and my maladaptive coping habits that keep me depressed. The idea is that I need to work on new habits and find a way to manage my anxiety. It is possible that I will be able to live a normal life with controllable anxiety (and some depression) that will both improve as I get myself into the world.