Psycho-Babble Medication Thread 1110801

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Re: Trinellix feel like an SSRI?

Posted by undopaminergic on June 18, 2020, at 3:12:17

In reply to Trinellix feel like an SSRI?, posted by PCB on June 17, 2020, at 15:03:18

> Does Trinellix feel similar to SSRIs? I know it has a different mechanism.
>

It is a SRI, so it has partially the same mechanism of action.

-undopaminergic

 

Re: Trinellix feel like an SSRI?

Posted by Stargazer2 on June 20, 2020, at 23:09:03

In reply to Re: Trinellix feel like an SSRI?, posted by beckett2 on June 18, 2020, at 1:24:00

I have heard that Trintellix might be an option for people that have had Success on MAOs. Is that true of you?

 

Re: Trinellix feel like an SSRI?

Posted by beckett2 on June 21, 2020, at 10:13:34

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on June 20, 2020, at 23:09:03

> I have heard that Trintellix might be an option for people that have had Success on MAOs. Is that true of you?

Emsam is my only experience, and I did respond well. Medical issues kept me from continuing.

Do you know anyone doing alright on Trintellix? My impression is only a relative minority do well w/it.

 

Re: Trinellix feel like an SSRI?

Posted by Stargazer2 on June 21, 2020, at 11:56:19

In reply to Re: Trinellix feel like an SSRI?, posted by beckett2 on June 21, 2020, at 10:13:34

Beckett,
in your first post to this topic you said you took Trintellix so I thought you might have an opinion on it. I know nothing about it but wanted people to give their views on it.
SG2

 

Re: Trinellix feel like an SSRI?

Posted by beckett2 on June 22, 2020, at 0:09:36

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on June 21, 2020, at 11:56:19

> Beckett,
> in your first post to this topic you said you took Trintellix so I thought you might have an opinion on it. I know nothing about it but wanted people to give their views on it.
> SG2
>

Oh, I misunderstood. I thought maybe you knew people who had taken it since you mentioned the possible crossover of MAOI and trintellix responders. Are you thinking of trying it?

Trintellix is treating me well. Less body side effects, less apathy, and more mental clarity. The clear-headedness was almost immediate and noticeable.

Usually, I boost my experience w trintellix, and given the
size of this forum, I try not to be too repetitive and pushy :)

 

Re: Trinellix feel like an SSRI?

Posted by SLS on June 22, 2020, at 12:11:15

In reply to Re: Trinellix feel like an SSRI?, posted by beckett2 on June 22, 2020, at 0:09:36

For what it's worth, Andrew Nierenberg, MD at Harvard / Mass General likes Trintellix and has recommended it to a friend of mine who has a history of treatment failures.

Trintellix was a terrible drug for me, and I tried it twice. I was desperate.


- Scott

 

Re: Trinellix feel like an SSRI?

Posted by Stargazer2 on June 22, 2020, at 13:53:24

In reply to Re: Trinellix feel like an SSRI?, posted by SLS on June 22, 2020, at 12:11:15

How did your friend do on it?
Was your friend ever on MAOs and did he respond well?
I will keep it on the back burner in the even MAOs become unavailable as Im not convinced this is just a shortage. I flash back to Marplan going away in1994 with my complete meltdown and loss of years. 26 years later I am not so naive to believe what they are saying. A shortage can be a discontinue of supply chain or financials are the cause. Fingers crossed and a decent supply of Nardil but shortages all over the US now too. If you havent signed the petition make sure you do. Its on Facebook Group: Nardil/Phenelzinex

 

Re: Trinellix feel like an SSRI? Stargazer2

Posted by SLS on June 23, 2020, at 11:59:00

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on June 22, 2020, at 13:53:24

Hi, Stargazer.

> How did your friend do on it?

She just started it. I wish I had more information for you.

> Was your friend ever on MAOs and did he respond well?

I don't think she ever tried an MAOI, but I will find out the answers to both of these questions when I speak to her next.

> I will keep it on the back burner in the even MAOs become unavailable as Im not convinced this is just a shortage. I flash back to Marplan going away in1994


I think Marplan went away simply because the drug company failed to make a profit on it during a time when MAOI was a dirty word. When they reintroduced it, they charged much more for it as if it were an orphan drug. Some people take Marplan because it works better for them than Parnate or Nardil. It is a much milder drug as far as side-effects are concerned. It is chemically related to Nardil (hydrazine).

> with my complete meltdown and loss of years. 26 years later I am not so naive to believe what they are saying. A shortage can be a discontinue of supply chain or financials are the cause. Fingers crossed and a decent supply of Nardil but shortages all over the US now too. If you havent signed the petition make sure you do. Its on Facebook Group: Nardil/Phenelzinex

Can you post the link?

Thanks.


- Scott

 

Nardil Petition/ please sign/SLS

Posted by Stargazer2 on June 23, 2020, at 20:41:23

In reply to Re: Trinellix feel like an SSRI? Stargazer2, posted by SLS on June 23, 2020, at 11:59:00

Thank you SLS, here is the petition.

Nardil Petition

https://www.reddit.com/user/PsychoTropicalR/comments/hba832/nardil_we_need_action_now_read_how_your_voice_can/?utm_source=share&utm_medium=ios_app&utm_name=iossmf

 

Re: Trinellix feel like an SSRI? Stargazer2

Posted by SLS on July 2, 2020, at 1:02:23

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on June 22, 2020, at 13:53:24

> How did your friend do on it?
> Was your friend ever on MAOs and did he respond well?

I spoke to my friend for you. She never took an MAOI for a few different reasons. She is very sensitive to drugs, and began at too high a dosage of Trintellix. She didn't like the way she felt. She will most likely restart the Trintellix, but at 1/2 the dosage.

Where are you at in your decision-making process?


- Scott

 

Re: Trinellix feel like an SSRI?/SLS

Posted by Stargazer2 on July 2, 2020, at 8:12:31

In reply to Re: Trinellix feel like an SSRI? Stargazer2, posted by SLS on July 2, 2020, at 1:02:23

Well I guess Im in a holding pattern. Im not sure about the Nardil shortage but I have spoken to Pfizer about my fears of the drug going away and being left out to dry.
I guess my options could be Marplan first, as it worked pre-1994, before it went away. Then maybe Try Trintellix or Parnate, but I failed one trial on P years ago.
I would even go back to Ketamine and try and have that doctor advise on meds as I heard shes an expert but her psychopharmacology branch of her practice is full.
I just hope it is a shortage as Pfizer said it was. Greenstone the generic mfr. had to find local pharmacies to fill my last order but for some reason it was filled with Gavis not GS generic. The rep was kind of surprised about that.
Thats the current status here. Not really clear but not doing anything unless forced to.

 

Re: Trinellix feel like an SSRI?

Posted by Skeletor on July 5, 2020, at 16:20:51

In reply to Trinellix feel like an SSRI?, posted by PCB on June 17, 2020, at 15:03:18

Trintellix is basically = SSRI + Buspirone...

 

Re: Trinellix feel like an SSRI?

Posted by stargazer2 on July 7, 2020, at 13:55:47

In reply to Re: Trinellix feel like an SSRI?, posted by Skeletor on July 5, 2020, at 16:20:51

So would it be good for someone that never responded well to an SSRI? Buspar did nothing for me the one time I took it years ago. Its seems like it would not work for me as I have only responded well to Marplan and Nardil.
One other combo that worked fairly well was Celexa, Wellbutrin and Adderall. Not sure why.
I used to keep diaries of all of my med combos but I think I destroyed it out of frustration and to tell my pdoc what meds worked at what doses.
that got exhausting but it was quite a history. I think when I saw John Krystal at Yale who is a researcher in intractable depression, I summarized by history. It didnt matter cause he was as useless as I never knew a top scientist could be.
all I know is that this forum and my own research is the way I am still alive. I dont think many docs know what they are doing . I think it is still a dart game of throwing treatments at you until one sticks.

 

Re: Trinellix feel like an SSRI? stargazer2

Posted by SLS on July 7, 2020, at 20:50:59

In reply to Re: Trinellix feel like an SSRI?, posted by stargazer2 on July 7, 2020, at 13:55:47

> So would it be good for someone that never responded well to an SSRI? Buspar did nothing for me the one time I took it years ago. Its seems like it would not work for me as I have only responded well to Marplan and Nardil.
> One other combo that worked fairly well was Celexa, Wellbutrin and Adderall. Not sure why.
> I used to keep diaries of all of my med combos but I think I destroyed it out of frustration and to tell my pdoc what meds worked at what doses.
> that got exhausting but it was quite a history. I think when I saw John Krystal at Yale who is a researcher in intractable depression, I summarized by history. It didnt matter cause he was as useless as I never knew a top scientist could be.
> all I know is that this forum and my own research is the way I am still alive. I dont think many docs know what they are doing . I think it is still a dart game of throwing treatments at you until one sticks.

I agree. There isn't much for a doctor to go on except his experiences with his patients and those of his colleagues. A good doctor will have a feel for symptom clusters and illness history and might hit the bullseye more quickly.

Trintellix can't be compared to an old SSRI. It can't be compared to a combination of SSRI + anything else (not even buspirone). I'm glad that you have been partially responsive to a SSRI + Wellbutrin. Is Wellbutrin in any way a bad drug for you? Have you tried combining it with Effexor or Pristiq?

Everyone responds so differently to psych meds. For me, Trintellix didn't produce a hint of sedation or apathy. I lost weight on it. People experience an improvement in cognition with Trintellix, even if they don't respond to it as an antidepressant. There is no drug comparable to Trintellix with regard to its actions at serotonin receptors. Who knows what else it does. I would consider staying on Wellbutrin as you trial different drugs. It can even be combined with an MAOI, although I have never seen anyone benefit from adding it. Wellbutrin actually makes my depression noticeably worse.

Andrew Nierenberg at Harvard/Mass General is recommending Trintellix for treatment resistant depression. My experience with Trintellix was miserable, but that doesn't seem to be a very common story.


- Scott

 

Re: Trinellix feel like an SSRI?

Posted by Stargazer2 on July 7, 2020, at 22:32:44

In reply to Re: Trinellix feel like an SSRI? stargazer2, posted by SLS on July 7, 2020, at 20:50:59

Hi Scott,
I guess I wasnt clear on what Im currently taking. Im on Nardil 45, Ritalin 5mg, 1-3/day, Lithium 300 ER 1x/week and Seroquel 50@hs and DL-Phenylalanine, if youve heard of it. Its an amino acid that is a precursor of Dopamine and I think other neurotransmitters. Not sure but it is my miracle.

The Celexa-Wellbutrin-Adderall combo worked for maybe 2-3 years, not sure but I felt pretty good on it. Other than combo, most off my trials with ADs have been failures except maybe one or two others, but I dont think they helped too much. If they worked I would Have remembered them like the Celexa combo. Maybe Prozac and Paxil? Usually alone, not with anything else, although Im now thinking Lithium was added, Thyroid was added, its was too many drugs for too many years without much improvement. It was just wasted years and a life on hold for what seemed like 20 years. I really didnt have a good life as I tried to find something to help improve my dark negative thoughts.
Ive been on all 3 MAOs and Ensam. Only Nardil and Marplan worked. ECT in 2011 did my memory in very seriously. TMS was nothing to really be able to adequately assess, not a clear picture. IV Ketamine did something. I think it made me respond better to Nardil as my response had waned. But even on IV K by the end of 2 weeks my suicidality would start again.
I added DL Phenylalanine and my suicidality went away. Was it that or was it my brain synapses improved and my meds worked better? No clue. I dont date stop the DL-P.
Overall I think Im doing relatively well as long as Nardil continues to be available.
I am glad you are having some success on it too. I also gained weight but I have to live with some bad in order to not upset the tea cart. Adding another med like Metformin is not a risk to the formula Im willing to take.
Sorry so long. I dont know if more or less details helps others understand what I tried that may help them.
SG2

 

Re: Trinellix feel like an SSRI? Stargazer2

Posted by SLS on July 10, 2020, at 10:04:48

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on July 7, 2020, at 22:32:44

It is uncommon for someone to respond to only 45 mg/day of Nardil. The effective dosage range is 60-90 mg/day. A rule of thumb offered in the past was to titrate Nardil to a dosage of 1 mg/kg body weight.

"Our data show that a safe, effective phenelzine dose is 1 mg/kg body weight per day."

https://jamanetwork.com/journals/jamapsychiatry/article-abstract/491925


- Scott

 

Re: Trinellix feel like an SSRI?

Posted by Stargazer2 on July 10, 2020, at 20:38:54

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on July 7, 2020, at 22:32:44

I am aware of that but at 60 mg the weight gain was more than I was comfortable with if a lower dose would work. So thats my rationale for being on 45 when 60 might work better. Hell 75 or 90 might be better but I could be 50 pounds heavier because of it. My philosophy over 35 years of drug trials is lowest dose, no matter what the literature or insert claim.
Remember when Prozac 40 was the starting dose. Now many people start at 5 or 10 mg and 10 might be best for them.
The majority of my drug failures I believe were from starting on too high a dose and overshooting the best dose for me.

I actually cut back to 30 mg alternating with 45 mg in anticipation of a shortage. In one week I started to decompensate. Maybe Ill alternate 45 with 60 and see how I feel doing that.
Are you worried about a supply shortage?

 

Re: Trinellix feel like an SSRI?

Posted by Stargazer2 on July 10, 2020, at 23:02:57

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on July 7, 2020, at 22:32:44

I am aware of that but at 60 mg the weight gain was more than I was comfortable with if a lower dose would work. So thats my rationale for being on 45 when 60 might work better. Hell 75 or 90 might be better but I could be 50 pounds heavier because of it. My philosophy over 35 years of drug trials is lowest dose, no matter what the literature or insert claim.
Remember when Prozac 40 was the starting dose. Now many people start at 5 or 10 mg and 10 might be best for them.
The majority of my drug failures I believe were from starting on too high a dose and overshooting the best dose for me.

I actually cut back to 30 mg alternating with 45 mg in anticipation of a shortage. In one week I started to decompensate. Maybe Ill alternate 45 with 60 and see how I feel doing that.
Are you worried about a supply shortage?

 

Re: Trinellix feel like an SSRI?

Posted by SLS on July 13, 2020, at 16:22:27

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on July 10, 2020, at 20:38:54

> I am aware of that but at 60 mg the weight gain was more than I was comfortable with if a lower dose would work. So thats my rationale for being on 45 when 60 might work better. Hell 75 or 90 might be better but I could be 50 pounds heavier because of it. My philosophy over 35 years of drug trials is lowest dose, no matter what the literature or insert claim.
> Remember when Prozac 40 was the starting dose. Now many people start at 5 or 10 mg and 10 might be best for them.
> The majority of my drug failures I believe were from starting on too high a dose and overshooting the best dose for me.
>
> I actually cut back to 30 mg alternating with 45 mg in anticipation of a shortage. In one week I started to decompensate. Maybe Ill alternate 45 with 60 and see how I feel doing that.
> Are you worried about a supply shortage?
>


Believe me when I tell you that it is not my goal to take more of anything than I really need. I wouldn't take 60 mg/day if 45 mg/day would work just as well. You would know better than me how much weight gain is dosage-dependent with Nardil. However, I have tried decreasing my dosage of Nardil from 90 mg/day to 75 mg/day. I lost the improvement. Thankfully, I was able to recapture the response once I moved back to 90 mg/day.

I guess it comes down to cost versus benefit. If you have exhausted all other treatment alternatives, you might not conclude so quickly that under-dosing Nardil in order to mitigate weight gain makes sense. Do you have any other treatments lined up?

I would consider combining Wellbutrin with Effexor, Pristiq, or Trintellix. If there is any bipolarity in you or your family, I would also consider taking lamotrigine.


- Scott

 

Re: Trinellix feel like an SSRI?

Posted by Stargazer2 on July 13, 2020, at 21:12:51

In reply to Re: Trinellix feel like an SSRI?, posted by SLS on July 13, 2020, at 16:22:27

Scott,
I will probably not be taking any other drugs or combinations of drugs. Those days of wasted years are gone.
Im curious about your background because of your experience with suggesting what medications might be helpful for me. Im curious if you are a Doctor, A scientist or Just an intelligent patient. Maybe a combination of those things?
You could Psychobabble me if youd rather not say anything on/line.
When you say cost vs benefit what did you mean?
Also were you suggesting I take Nardil with Wellbutrin?
Would my doctor prescribe that with Nardil? I am not familiar with that combination. What about Effexor and Pristiq. Why would they be good for me?
When you asked if I have any other treatments lined up what were you referring to? I didnt know how much of my history you are familiar with.
Thanks Scott. I really appreciate your concern and suggestions.

 

Re: Trinellix feel like an SSRI?

Posted by SLS on July 14, 2020, at 0:57:27

In reply to Re: Trinellix feel like an SSRI?, posted by SLS on July 13, 2020, at 16:22:27

Also, I don't think it's a good idea to be constantly jumping up and down in dosage. For the most part, biological systems like stability and homeostasis. "Pulsing" antidepressants sometimes leads to treament resistance - at least to that drug.

There was a term that emerged in the 1990s, but I haven't heard it used very often. "Treatment discontinuation-induced treatment refractoriness". Robert Post first used it to describe what he saw in his patients who stopped taking lithium. This happened with a friend of mine. She responded very well to lithium monotherapy for years to treat her depression (possibly bipolar). She functioned well as a ER nurse, having graduated from UNC Chapel Hill. When she moved across the country, her new psychiatrist told her that it was time to discontinue the lithium. Why? I have no idea. Three weeks after her last dose, she relapsed into a severe anergic and anhedonic depression. As you guessed, reintroducing the lithium was useless. The antidepressant response could not be recaptured. "Lithium-discontinued induced lithium refractoriness". She has been going around the pharmacological merry-go-round for decades with very little relief. I wish I could convince her to go on Nardil along with either Wellbutrin or a TCA.


- Scott

 

Re: Trinellix feel like an SSRI? Stargazer2

Posted by SLS on July 14, 2020, at 1:45:30

In reply to Re: Trinellix feel like an SSRI?, posted by Stargazer2 on July 13, 2020, at 21:12:51

> Scott,
> I will probably not be taking any other drugs or combinations of drugs. Those days of wasted years are gone.
> Im curious about your background because of your experience with suggesting what medications might be helpful for me. Im curious if you are a Doctor, A scientist or Just an intelligent patient. Maybe a combination of those things?
> You could Psychobabble me if youd rather not say anything on/line.
> When you say cost vs benefit what did you mean?
> Also were you suggesting I take Nardil with Wellbutrin?
> Would my doctor prescribe that with Nardil? I am not familiar with that combination. What about Effexor and Pristiq. Why would they be good for me?
> When you asked if I have any other treatments lined up what were you referring to? I didnt know how much of my history you are familiar with.
> Thanks Scott. I really appreciate your concern and suggestions.

Although "pulsing" antidepressants can cause treatment resistance, alternating Nardil dose between 45-60 mg/day is a reasonable approach. I would space the doses out as evenly as possible unless insomnia becomes an issue.

I know you are sick and tired of the endless bumpy, up and down ride on an old rickety roller coaster not bring you to a better life right now. Do you need a break?

Taking lamotrigine is something to consider leaving in the background with or without Wellbutrin. Effective dosages usual fall between 200-300 mg/day.

I know absolutely nothing about your history, so I don't have any feel for what's going on.


- Scott

 

Re: Trinellix feel like an SSRI? SLS

Posted by Skeletor on July 15, 2020, at 7:02:57

In reply to Re: Trinellix feel like an SSRI? stargazer2, posted by SLS on July 7, 2020, at 20:50:59

>
> Trintellix can't be compared to an old SSRI. It can't be compared to a combination of SSRI + anything else (not even buspirone).

Why not?

 

Re: Trinellix feel like an SSRI? Skeletor

Posted by SLS on July 17, 2020, at 3:03:39

In reply to Re: Trinellix feel like an SSRI? SLS, posted by Skeletor on July 15, 2020, at 7:02:57

> >
> > Trintellix can't be compared to an old SSRI. It can't be compared to a combination of SSRI + anything else (not even buspirone).
>
> Why not?

Vortioxetine (Trintellix) is sometimes called multimodal. It inhibits the reuptake of serotonin/5-HT (like SSRIs) and binds to various receptors:

https://psychscenehub.com/psychinsights/vortioxetine-mechanism-of-action-2/

5-HT7 receptors have been the subject of study more recently with regard to depression.


- Scott

 

Re: Trinellix feel like an SSRI?

Posted by creepy on July 22, 2020, at 14:32:45

In reply to Trinellix feel like an SSRI?, posted by PCB on June 17, 2020, at 15:03:18

I get some relief on it, but mostly I get really heavy apathy. makes it impossible to get anything done. Bupropion helps for a month or two and then its like taking sugar pills.
Got nausea at first needed odansetron.


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