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Which antidepressants are 'less' activating?

Posted by Mtom on August 5, 2021, at 16:12:53

Which Antidepressant have users found to be the least Activating?

I tried sertraline (Zoloft) many years ago very briefly, shot my anxiety (which was not then pre-existing) through the roof.

Then for a long period of time my depression mostly resolved on its own (still mild but tolerable).

In more recent years, depression came back and I tried citalopram (Cipralex) and it did same even at very low doses extreme anxiety-agitation-jitteriness syndrome.

Then Escitalopram (Cipralex-Lexapro) similar but to a slightly less degree so stayed with it a while, starting on very low doses and increasing slowly hoping I would adjust, but didnt. And didnt get much if any antidepressant effect, although never got quite as high as usual therapeutic dose and any benefit might have been overshadowed by the anxiety-agitation. Still, I noticed mostly in retrospect that it did seem to help with my ruminating. But I was needing to take Benzos to offset the anxiety, so that was not good.

Doctor decided switch to another class. She ruled out SNRIs because she knows these can be activating even in people less sensitive than me so figured not a good choice for me. Same with Bupropion (Wellbutrin).

So tried Mirtazapine (Remeron). Definitely less activating although becomes increasingly more so if I take more than low doses. Also has other unpleasant side effects (e.g. brain fog, lethargy, nightmares and GI issues, all of which worsen if I increase dose). And is only very modestly effective for my depression and most of that is offset by the brain fog and lethargy (not fatigue, Im not tired or sleepy but just cant get myself moving). Plus I started ruminating again.

Were working under the assumption that I would likely have the same reaction to all SSRIs based on the above. But maybe theres an SSRI out there still worth trying? Still, I read that most people tolerate Escitalopram better than most other ADs, and I didnt. Shes taken Paxil off the table too due to recent studies showing high adverse affects plus apparently the most difficult to withdraw from.

Cant take antipsychotics because genetic testing indicated gene mutations which put me at greater risk of tardive dyskinesia with these.

I should add that when trying Sertraline many years ago, I had been taking St. Johns Wort for several months including the same day I took Sertraline (no effect from the St. Johns Wort to that point). My doctor at that time had not heard of St. Johns Wort (it was just starting to be talked about as an alternative treatment back then). So even though I told her I was taking it, she discounted it as meaningless. She also started me on the regular dose and Ive since found that due to my sensitivity to these medications, I must start on very low doses and titrate up as tolerated. The combination of St. Johns Wort and Sertraline may interacted to produce the extreme agitation and other effects that I experienced (fit the description of mild Serotonin Syndrome).

Still from what Im reading it seems most people tolerate Escitalopram the best of the SSRIs, its too bad for whatever is in my genetics that I dont.

Running out of options other than Tricyclics which most articles say have more and potentially dangerous side effects than newer ADs and my Doctor seems to want to avoid these.

But are they effective for depression? When I was much younger, a PDoc I was seeing did prescribe Amitriptyline for ongoing situational stress which was resulting in increasing anxiety attacks and insomnia and the start of mild depression with concerns that would worsen. I remember him telling me he was starting me on a low dose, and increased the dose just once. I also remember mild side-effects like sudden short term dizziness and nausea, both of which resolved after a few weeks. But I also had problems waking up in the morning and did gain a lot of weight quite quickly, more than I have with Mirtazapine. I also did start feeling better and stopped Amitriptyline after about 8 months and was fine. However I also addressed my situational stress at the same time (found a new job). So I dont know if the Amitriptyline actually did anything positive or not.

I know very little about the other Tricyclics except an impression that most of the others are less effective at relieving depression. True?

Be happy to hear from anyone who can share similar experiences..




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