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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 25. This is the beginning of the thread.
Posted by sk85 on May 21, 2014, at 13:43:48
Asked my doctor to switch me from 50 mg Zoloft to 10 mg Brintellix due to sexual side-effects. The first 3 days I felt wierd (slightly jumpy and foggy, difficult to describe), not in the usual sense SSRIs can initally make you feel.
By day 3 I feel quite normal and motivated. Thinking is now quite sharp. Not the most powerful anti-anxiety effects but still good, not the most powerful antidepressant feeling, but still quite good. Maybe early to say as it's only the end of the first week. But most importantly no sexual side-effects. So in my opinion Brintellix is a step forward.-ikaros
Posted by phidippus on May 21, 2014, at 16:12:01
In reply to Brintellix seems to deliver what it promises, posted by sk85 on May 21, 2014, at 13:43:48
end of the first week? it takes 4 to 6 weeks for any antidepressant to exert its full effects.
Eric
Posted by Phillipa on May 21, 2014, at 18:11:13
In reply to Re: Brintellix seems to deliver what it promises » sk85, posted by phidippus on May 21, 2014, at 16:12:01
Not always when prozac new I didn't feel depressed just anxious and given 20mg and next day wallpapered a foyer had put off for three years. Day 2 anxiety, Day 3 panic so went off it. but the pdoc at the time said it was a remarkable response and begged me to stay on it. I refused and to this day wonder what would have happened had they had lower doses or did what he wanted and take a pill every three days. Phillipa
Posted by Beckett on May 21, 2014, at 18:45:09
In reply to Brintellix seems to deliver what it promises, posted by sk85 on May 21, 2014, at 13:43:48
Would you please post a followup as you go?
Posted by sk85 on May 23, 2014, at 15:25:33
In reply to Re: Brintellix seems to deliver what it promises » sk85, posted by phidippus on May 21, 2014, at 16:12:01
> end of the first week? it takes 4 to 6 weeks for any antidepressant to exert its full effects.
>
> EricYes, could be a inital placebo but I was on sertraline just before, so the timecourse could be altered...but I can't really say whether 50 mg of sertraline = 10 mg vortioxetine...I do know that 50 mg of sert wasn't really cutting for me anyway. It was just smthing that kept me out of the worst with a cost of SEs.
Anyway, Brintellix's procognitive effects are quite noticeable, my thinking is really more clear and I feel more confident if e.g I'm faced with an intellectual conversation with someone (I work at a university). But I do have to admit that its effect on mood is somewhat waxing and waning now. But I am also dealing with some external stress issues which can and are having their effects on their own as days go by. At least I'm feeling that I have the strength to tackle my problems. But yes, its true AD role cannot probably be evaluated before 8 weeks.
Posted by SLS on May 23, 2014, at 19:14:35
In reply to Re: Brintellix seems to deliver what it promises, posted by sk85 on May 23, 2014, at 15:25:33
Thanks for the updates. I may end up trying Brintellix. Good luck with it.
- Scott
Posted by Phillipa on May 23, 2014, at 21:08:30
In reply to Re: Brintellix seems to deliver what it promises » sk85, posted by SLS on May 23, 2014, at 19:14:35
I googled this med and the reviews sound good. No other med with same properties from psych med site? Phillipa
Posted by Beckett on May 23, 2014, at 21:56:35
In reply to Re: Brintellix seems to deliver what it promises » SLS, posted by Phillipa on May 23, 2014, at 21:08:30
Thank you for posting an update. My doc is talking about this med as well. Would you make a follow up post?
Good luck.
Posted by g_g_g_unit on May 26, 2014, at 1:56:02
In reply to Re: Brintellix seems to deliver what it promises, posted by sk85 on May 23, 2014, at 15:25:33
Yeah, sk85. Keep us posted. Curious what it does for your OCD, and also what it's like from an anhedonia/lethargy perspective.
Posted by sk85 on May 28, 2014, at 12:18:30
In reply to Re: Brintellix seems to deliver what it promises » sk85, posted by g_g_g_unit on May 26, 2014, at 1:56:02
> Yeah, sk85. Keep us posted. Curious what it does for your OCD, and also what it's like from an anhedonia/lethargy perspective.
I currently have my OCD symptoms quite in check. They certainly haven't changed going from sertraline to vortioxetine...i.e I was already doing OK in terms of OCD when on sertraline, despite having a lack of efficacy for depression and also the forementioned sexual SEs.
In terms of anhedonia, I don't feel much help from Brintellix (yet). Maybe just slightly. But over time I've come to the conclusion that anhedonia is a very complex and difficult aspect to deal with anyway. Pramipexole did seem to work for it, yes, but not in a very consistent way and I gave it up for other side-effects I ended up experiencing. I certainly seem to continue experiencing anhedonia, as I'm always finding an excuse to reach out for cigarettes to relax or "find pleasure".
What do you think about anhedonia being at least partly brought on by lack of skills to entertain oneself? That is being psychologically rooted. I've noticed that one of the core problems for me in experiencing more pleasure is that I just can't "relax" and rest..I'm always switched on to do something, but obviously this can't work indefinitely. There is a lack of balance...
Posted by g_g_g_unit on May 31, 2014, at 6:49:58
In reply to Re: Brintellix seems to deliver what it promises, posted by sk85 on May 28, 2014, at 12:18:30
> I currently have my OCD symptoms quite in check. They certainly haven't changed going from sertraline to vortioxetine...i.e I was already doing OK in terms of OCD when on sertraline, despite having a lack of efficacy for depression and also the forementioned sexual SEs.
>That's good to hear.
> In terms of anhedonia, I don't feel much help from Brintellix (yet). Maybe just slightly. But over time I've come to the conclusion that anhedonia is a very complex and difficult aspect to deal with anyway. Pramipexole did seem to work for it, yes, but not in a very consistent way and I gave it up for other side-effects I ended up experiencing. I certainly seem to continue experiencing anhedonia, as I'm always finding an excuse to reach out for cigarettes to relax or "find pleasure".
>I'm not sure if I was expecting Brintellix to help with anhedonia per se, but SSRIs are very good at leaving me in a hazy, emotionless, cognitively-defunct state. I am almost literally content to stare at a ceiling all day, unless I need to get up to shove some form of sugar/carbohydrate down my throat.
> What do you think about anhedonia being at least partly brought on by lack of skills to entertain oneself? That is being psychologically rooted. I've noticed that one of the core problems for me in experiencing more pleasure is that I just can't "relax" and rest..I'm always switched on to do something, but obviously this can't work indefinitely. There is a lack of balance...
>Perhaps you're right. I suffer from comorbid ADD and am sure that plays into things. I've read that inattention and anhedonia don't always go hand-in-hand .. and I find that when I'm adequately stimulated, things aren't wildly more enjoyable, but I experience this greater inherent interest in what I'm doing. Anhedonia, on the other hand, I associate with a lack of: spontaneity, joy, positive emotion, spontaneous emotion, emotional associations (with time, places, events, experiences). I was also operating at a diminished hedonic/emotional setpoint, in my opinion, but I used to get wild crushes on girls, enjoy being around people, felt moved by music, the seasons etc. While I can still intellectually enjoy certain things, most of that core human experience has vanished, seemingly for good. The last time I felt anything resembling true joy was on Parnate.
Posted by SLS on May 31, 2014, at 9:13:10
In reply to Re: Brintellix seems to deliver what it promises » sk85, posted by g_g_g_unit on May 31, 2014, at 6:49:58
Nice discussion, guys.
> > I currently have my OCD symptoms quite in check. They certainly haven't changed going from sertraline to vortioxetine...i.e I was already doing OK in terms of OCD when on sertraline, despite having a lack of efficacy for depression and also the forementioned sexual SEs.
> >
>
> That's good to hear.
>
> > In terms of anhedonia, I don't feel much help from Brintellix (yet). Maybe just slightly. But over time I've come to the conclusion that anhedonia is a very complex and difficult aspect to deal with anyway. Pramipexole did seem to work for it, yes, but not in a very consistent way and I gave it up for other side-effects I ended up experiencing. I certainly seem to continue experiencing anhedonia, as I'm always finding an excuse to reach out for cigarettes to relax or "find pleasure".
> >
>
> I'm not sure if I was expecting Brintellix to help with anhedonia per se, but SSRIs are very good at leaving me in a hazy, emotionless, cognitively-defunct state. I am almost literally content to stare at a ceiling all day, unless I need to get up to shove some form of sugar/carbohydrate down my throat.
>
> > What do you think about anhedonia being at least partly brought on by lack of skills to entertain oneself? That is being psychologically rooted. I've noticed that one of the core problems for me in experiencing more pleasure is that I just can't "relax" and rest..I'm always switched on to do something, but obviously this can't work indefinitely. There is a lack of balance...
> >
>
> Perhaps you're right. I suffer from comorbid ADD and am sure that plays into things. I've read that inattention and anhedonia don't always go hand-in-hand .. and I find that when I'm adequately stimulated, things aren't wildly more enjoyable, but I experience this greater inherent interest in what I'm doing. Anhedonia, on the other hand, I associate with a lack of: spontaneity, joy, positive emotion, spontaneous emotion, emotional associations (with time, places, events, experiences). I was also operating at a diminished hedonic/emotional setpoint, in my opinion, but I used to get wild crushes on girls, enjoy being around people, felt moved by music, the seasons etc. While I can still intellectually enjoy certain things, most of that core human experience has vanished, seemingly for good. The last time I felt anything resembling true joy was on Parnate.Nardil might work even better than Parnate for anhedonia. I wonder if intact serotonin function is necessary for the experience of pleasure. Unfortunately, any reduction in anhedonia produced by serotonin reuptake inhibitors is often nullified by the emergence of apathy and amotivation. Anhedonia and amotivation are often confused. Both result in a lack of positive, pleasurable experiences. Do you think Effexor and Pristiq are less likely to produce these unwanted effects? Speaking for myself only, I prefer to be on Effexor than Lexapro because I don't experience these things on Effexor, but do on Lexapro.
Perhaps anhedonia arises from the mind constantly numbing itself to any kind of stimulation in response to negative experiences and emotions - sort of like learned helplessness.
Combining anhedonia with anxiety could possibly result in depersonalization or derealization.
- Scott
Posted by Beckett on June 1, 2014, at 16:19:41
In reply to Re: Brintellix seems to deliver what it promises » g_g_g_unit, posted by SLS on May 31, 2014, at 9:13:10
I think much of what is discussed here is more amotivation, apathy, and emotional blunting, though these are elements of anhedonia, so yes, these experiences touch upon anhedonia. I agree that anhedonia is complex. True anhedonia, in my opinion, is neither frustrated emotion or hazy apathy but, instead, a stark absence, though it coexists with anxiety and depression often. As far as amotivation, it is this in the purest sense because with the absence of any desire one makes no effort to gain or achieve anything.
>Combining anhedonia with anxiety could possibly result in depersonalization or derealization.
Scott, did you come to this conclusion intellectually? It is amazingly spot on.
Posted by porkpiehat on June 2, 2014, at 10:45:11
In reply to Re: Brintellix seems to deliver what it promises, posted by Beckett on June 1, 2014, at 16:19:41
This thread has gone in just the right direction in my opinion...I think I'm at 2 months on Brintellix and it has done a good job quelling constant ruminations of persecution. I have even found it to be somewhat pro-sexual
However as an antidepressant I haven't gotten much from it, judging mostly from the lack of motivation and apathy. I would spend a lot of time with no reason to get out of bed, or drive to pursue my hobbies. Much like when I was on Prozac. I'm also getting little satisfaction/connection from being with people. After time this morphed into depression.
My doctor suggested that this is related to the increase in serotonin, while motivational chemicals like dopamine and NE remained lower. She prescribed me Vyvanse.
Now I'm doing all kinds of things, but my social anxiety has worsened a little and I'm also worried about the host of problems from taking a stimulant every day.
I'm at 20 mgs of Brintellix. I may try increasing because my other meds can reduce plasma levels of Brintellix. I expect an increase in the flattened feeling, however.
Posted by sk85 on June 2, 2014, at 15:34:47
In reply to Brintellix seems to deliver what it promises, posted by sk85 on May 21, 2014, at 13:43:48
To conclude my vortioxetine trial so far:
Pros:
-cognitive performance quite much improved
-no insomnia (I get that with SSRIs)
-no sexual SEs
-lowered performance and general anxiety
-no changes in appetiteNeutral:
-slight irritabilityCons:
-unimpressive antidepressant effect
-expensive
-again anhedonic (as mentioned above may have nothing to do with Brintellix)So overall I'm feeling like I need to increase the dose (very expensive idea) or augment with something to help with mood. Before Brintellix I had ravingly impressive AD effects with sertaline+pramipexole but became completely insomniac on it (also check out: http://www.ncbi.nlm.nih.gov/pubmed/16963794). I might consider trying this time vortioxetine and prami.
I also think I need to give this current dose still few more weeks, at least until 6 weeks. I also suspect I still might have some unaddressed bipolar symptoms that I'm going to take up with my pdoc next meeting. It's really difficult to pinpoint a mild bipolar case.
Posted by porkpiehat on June 10, 2014, at 12:18:42
In reply to Re: at 3+ weeks, posted by sk85 on June 2, 2014, at 15:34:47
> To conclude my vortioxetine trial so far:
>
> Pros:
> -cognitive performance quite much improved
> -no insomnia (I get that with SSRIs)
> -no sexual SEs
> -lowered performance and general anxiety
> -no changes in appetite
>
> Neutral:
> -slight irritability
>
> Cons:
> -unimpressive antidepressant effect
> -expensive
> -again anhedonic (as mentioned above may have nothing to do with Brintellix)
>
> So overall I'm feeling like I need to increase the dose (very expensive idea) or augment with something to help with mood. Before Brintellix I had ravingly impressive AD effects with sertaline+pramipexole but became completely insomniac on it (also check out: http://www.ncbi.nlm.nih.gov/pubmed/16963794). I might consider trying this time vortioxetine and prami.
>
> I also think I need to give this current dose still few more weeks, at least until 6 weeks. I also suspect I still might have some unaddressed bipolar symptoms that I'm going to take up with my pdoc next meeting. It's really difficult to pinpoint a mild bipolar case.
>
>
This is my experience exactly. By adding just 5mgs of Celexa back to the mix I am finding a returned energy to do things and interact with people. I've lowered Brint. by 5mgs in the morning. Vyvanse as needed.My doctor wants to switch me to Viibryd, thinking it has fewer post-synaptic actions that could be blanding me out and feeling isolated and uninterested around people.
Although a lot of people would term this mix as "voodoo," I'm hesitant to switch completely over to the Viibryd.
Posted by Beckett on June 20, 2014, at 23:32:04
In reply to Re: at 3+ weeks » sk85, posted by porkpiehat on June 10, 2014, at 12:18:42
So Brintellix enhances some aspects of cognitive ability. According to wiki, verbal fluency is inhanced most prominently. I wonder if it would balance the word retrieval problems created by lamictal.
Anyways, I have been thinking about anxiety, esp. social anxiety. Any opinions regarding effexor vs Brintellix on anxiety and SA?
And ska85, how is it going? (I hope you do not mind the alteration of your subject line.)
Posted by porkpiehat on June 23, 2014, at 10:42:26
In reply to Re: at 3+ weeks/Brintellix and anxiety, posted by Beckett on June 20, 2014, at 23:32:04
My two cents:
Brintellix is very helpful with SA and verbal competetence. I also take Lamictal and find it scatters me a lot.
The only issue with the SA is that it kills some of the spontaneity that can be useful and add color and enthusiasm to interpersonal relations.
Never taken Effexor myself.
Posted by sk85 on July 18, 2014, at 16:06:11
In reply to Re: at 3+ weeks/Brintellix and anxiety » Beckett, posted by porkpiehat on June 23, 2014, at 10:42:26
Haven't posted updates on this one for a while. Partly because my trial with Brintellix is been "dampered" with a lot of other therapeutics I have been trying to use. Still this has been noticed by me during the 8-9 weeks I have been taking vortioxetine:
Month ago tried augmenting with pramipexole and it did not provide the effects I got with it when on sertraline. Only the SEs, so stopped it.
Some more while ago I also purchased a CES (cranial electrotherapy stimulation) unit and experimented with for insomnia but was relatively disappointed as I quickly built a tolerance to its hypnotic potential and did not associate it with significant AD effects either. So, I more or less forgot it and left it aside.
Just out of curiosity I have been using it again while on 10 mg Brintellix. So I cannot say how it directly alters vortioxetine's performance.However, about two weeks ago I started noticing subtle changes for the positive. I have consistantly been less prone to anxiety. Depression has changed more to a certain indifference, not quite apathy, but just to a not-really-good-not-really-bad state. Motivation has been mediocre, anhedonia not very noticeable. Lately I have also become quite more sociable, but this I attribute to somewhat to the decrease in anxiety levels.
Sleep has been quite good all through the way, Brintellix certainly doesn't mess with it as do SSRIs.
Also, noticed that during the day I need less caffeine to get by and all sorts of addictive behaviours (be it smoking or OCD) are more manageable.Overall I can't really say that Brintellix is responsible for the changes. Perhaps the summer period is having an effect or perhaps the CES device is helping to kickstart things, but nevertheless I would not discontinue my 10 mg dose at the moment and would see it continuing.
On a side note. Reading on Brintellix pharmacology some of the things people have noticed make sense in the light how it appears to work. 5-HT7 activation has been reported to increase opioid analgesia:
https://www.jstage.jst.go.jp/article/jphs/116/4/116_11039SC/_article
Some aspects (or forms) of depression are characterized by increased opioid activity (excessive beta-endorphin levels; perhaps leading to long term desensitization and reduced responsiveness in this system):
http://www.ncbi.nlm.nih.gov/pubmed/1503128
Vortioxetine antagonizes 5-HT7 (that seems to be overactivated in depressed states) and perhaps this is a reason why some anecdotal reports and also my own experience during the first weeks was registering it as even bit dysphoric and not helping with sociability (a dip in opioidergic input). Over long term 5-HT7 blocking would however trigger adaptive more balanced opioid activity in the brain (re-sensitizing) and thus improve the already exhausted opioidergic state that is inherent to depression. This is just a speculation though, yet, if any of this is true then vortioxetine in some instances would be expected to kick-in slowly and requiring quite a bit time to reverse some of the damage that depression does to the brain.
Posted by sk85 on July 18, 2014, at 16:08:44
In reply to Re: at 8 weeks, posted by sk85 on July 18, 2014, at 16:06:11
Topic headline was missing
Posted by porkpiehat on July 18, 2014, at 17:18:41
In reply to Re: at 8 weeks, posted by sk85 on July 18, 2014, at 16:06:11
I think I might have to switch back to to Brintellix from Viibryd. Viibryd is much better for my mood and sex drive, but it messes with my sleep and makes me very tired for the second half of the day. I have to take stims to stay awake and now they are making me more and more edgy.
Brintellix had a great impact on cognitive functioning and my sleep was better. I had to add some Celexa to keep me out of the apathetic space.
Does anyone else hate having to make these decisions about which part of their lives they are going to have to sacrifice based on their med choices? Jeez Louise.
Posted by sk85 on July 29, 2014, at 7:13:14
In reply to Re: at 8 weeks, posted by porkpiehat on July 18, 2014, at 17:18:41
> I think I might have to switch back to to Brintellix from Viibryd. Viibryd is much better for my mood and sex drive, but it messes with my sleep and makes me very tired for the second half of the day. I have to take stims to stay awake and now they are making me more and more edgy.
>
> Brintellix had a great impact on cognitive functioning and my sleep was better. I had to add some Celexa to keep me out of the apathetic space.
>
> Does anyone else hate having to make these decisions about which part of their lives they are going to have to sacrifice based on their med choices? Jeez Louise.I can add that Brintellix in my experience does nothing to intefere with sleep. In fact while ago I was dependent on Seroquel/Mirtazapine to get some (at best mediocre quality) sleep while on Zoloft. I'm currently finally off of both of them and sleep like a baby (again this started to appear approx 1,5 months after taking it). Perhaps it's again that opioid normalization that vortioxetine might possess, because a normally functioning brain opioid system is necessary for deep sleep. Anyone who has ever done the low dose naltrexone trial with themselves can attest that once you block opioid receptors you will have the worst sleep ever.
All in all, it appears that Brintellix is a drug that works slowly and needs time to show benefit (!). This is in contrast with Lundbeck's advertising that it works within 1 week. Yes you do get some action during the first week, but this is just a passing thing.
Posted by porkpiehat on July 29, 2014, at 9:05:27
In reply to Re: at 8 weeks, posted by sk85 on July 29, 2014, at 7:13:14
I don't know anything about the opioid parts of the brain.
I've cut my Viibryd dose in half and found sleepiness and irritability cut back severely...but at the sake of concentration, cognitive effects, and the background worry/rumination. Mood and sleep are still good.
What are you thoughts on adding in Brintellix (small dose, maybe PRN) for the cognitive bennies, to the Viibryd?
Posted by sk85 on July 29, 2014, at 9:34:18
In reply to Re: at 8 weeks » sk85, posted by porkpiehat on July 29, 2014, at 9:05:27
> I don't know anything about the opioid parts of the brain.
>
> I've cut my Viibryd dose in half and found sleepiness and irritability cut back severely...but at the sake of concentration, cognitive effects, and the background worry/rumination. Mood and sleep are still good.
>
> What are you thoughts on adding in Brintellix (small dose, maybe PRN) for the cognitive bennies, to the Viibryd?I think it's worth a try. I don't know if it works PRN though. Report back if it does anything.
Posted by sk85 on September 26, 2014, at 14:34:24
In reply to Re: at 8 weeks, posted by sk85 on July 29, 2014, at 9:34:18
I'll keep it short:
Increased it to 20 mg 5 weeks ago. Felt much better for first 2-3 weeks, then felt a relapse in symptoms (somatic stress symptoms, social withdrawal, pessimistic mood and so on). No side-effects to report still. I'm seriously considering swithing at this point. Procognitive effects are still felt, but on its own the AD power is weak. Another option I'm considering is augmentation with low dose naltrexone.
This is the end of the thread.
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