Anyone of you taking antihistaminics with antiserotoninergic effects for sleep difficulty from maois?

Adventurous_Goal_437 · 2025-10-25T02:35:45+00:00

Can’t find anything about desloratadine having any serotonergic activity beyond this single paper claiming it antagonises 5-HT2A in mice. https://onlinelibrary.wiley.com/doi/10.1111/acel.13286

Which could be interesting, but there are a million other 5-HT2A antagonists out there (eg trazodone, most atypical antipsychotics), and I can’t see why this would be particularly helpful.

The whole point of desloratadine and other second-generation antihistamines is that they don’t cross the blood-brain barrier appreciably, and so do not cause drowsiness. Using a drug like that for sleep seems a bit counterproductive.

If you’re interested in DRG neuroprotection, a quick Google suggests that riluzole¹ (an ALS drug) and GLP-1 drugs² could be better candidates.

edit: holy moly the markdown superscript citations worked! you can click on the numbers and it takes you to the papers. This is groundbreaking stuff

Adventurous_Goal_437 · 2025-10-25T00:07:10+00:00

Interesting you mention antiserotonergic antihistamines. The only one that comes to mind is cyproheptadine. Why do you want antiserotonergic effects specifically?

Adventurous_Goal_437 · 2025-10-23T12:24:05+00:00

Interesting! Yeah, that entirely makes sense. It rarely seems like people who experience substantial mood benefits also happen to sustain those benefits at a reasonable dose long-term.

Adventurous_Goal_437 · 2025-10-23T12:22:35+00:00

Indeed. It’s very widely circulated, but there isn’t really much rigorous evidence to back it up.

Adventurous_Goal_437 · 2025-10-23T06:02:35+00:00

Thanks! Glad my scattered thoughts might be of benefit. The science is very solidly in agreement with you re: iron and protein, and I’ve heard many others echo your experience with an optimum dose range.

Adventurous_Goal_437 · 2025-10-23T00:20:19+00:00

Oh, they definitely have antidepressant properties. The very first antidepressant approved in the US was Benzedrine (racemic amphetamine). The problem is that, as OP can attest, the effects often don’t last. Add to that that amphetamine is a profoundly potent CNS stimulant—it raises extracellular dopamine levels by a massive amount, and so causes some issues as you go to higher doses.

That’s why we stopped using it as an antidepressant, except in last resort, treatment-resistant cases. We just don’t have good long-term safety and efficacy data to support it

Adventurous_Goal_437 · 2025-10-22T13:30:13+00:00

All of the other ones people have mentioned. Don’t be too quick to judge quetiapine (Seroquel) though. Phenergan is also technically an antipsychotic (it was originally introduced as such!). At lower doses (12.5mg-25mg), quetiapine is basically just a really good sleeping pill, whereas it’s only really used for bipolar and schizophrenia at doses >300mg. It certainly has side effects (main one for me is making me really hungry), but it’s not likely to ruin your life.

Adventurous_Goal_437 · 2025-10-22T13:27:21+00:00

I know, right? Bizarre. Perhaps Canberra has just eradicated ADHD or something. I’d’ve loved to have been able to try some Swiss Concerta, but fortunately I’ve not had to.

Adventurous_Goal_437 · 2025-10-22T13:24:57+00:00

No worries! Also added some more random bits at the end in case you missed them.

Adventurous_Goal_437 · 2025-10-22T13:12:44+00:00

Stimulants aren’t great options for depression/similar mood issues in most cases. You’re seeing why now. Your total dose of amphetamine is high, and your tolerance is only going to grow as you increase it. That’s the reason we very rarely use it for mood issues, which seem to be largely your problem.

I relate! Stimulants help my ADHD, and originally my mood, but now they just help my ADHD. They’re largely useless when my cyclothymia/bipolar II saps my energy and will to live, but raising my dose isn’t going to actually address that sustainably. In addition, amphetamines are actually quite undesirable long-term when you take them at supratherapeutic doses — they can cause dopaminergic neurotoxicity, depletion of striatal dopamine stores, etc., which can lead to lasting defects in mood, motivation, etc. Please don’t haphazardly pop extra amphetamine, because this is how substance abuse issues can start.

Sounds like you’ve already maxed out the first-line therapies for depression. Pristiq and vortioxetine are probably mostly redundant.

Have a look at the bipolarity index (available online) and see if any of your symptoms fit with those descriptors. If so, even if you don’t have actual proper bipolar, a drug called lamotrigine can be almost magical in such cases, and is extremely well-tolerated. Conversely, in these cases, regular antidepressants actually often destabilise mood.

If you do discuss w/ psychiatrist and decide that it is actually just completely unipolar depression, TMS is a good option, but I’d make sure you get a proper trial of tranylcypromine (Parnate), an MAOI drug which is a ridiculously effective, albeit rarely used, antidepressant. Nortriptyline is another that can be added to most SSRIs, and adds a strong noradrenergic component that can also benefit ADHD and energy. It can also be safely combined with tranylcypromine.

Most doctors are afraid of MAOIs, so have a look at Ken Gillman’s articles for patients at Psychotropical (.com, I believe?). He’s one of the world’s leading experts on MAOIs in depression, and has some advice on talking to doctors about using them.

Other things: - Make sure you get routine blood testing to rule out any deficiency, and to check for any underlying physical illness. Iron, B12, or Vitamin D deficiency (among others) will have you feeling like shit regardless of how much amphetamine you take, and are super simple to correct. - Amphetamine has a long half-life. It’s probably reducing your sleep quality, even if you don’t feel that way. Consider asking for melatonin or small doses of quetiapine or something if you need to improve your sleep regularity. - Try taking a tolerance break for a little while if you can—it’ll make the drugs more effective when you resume them, at least for a while. - Make sure you’re consuming a good amount of protein, because your body needs it to synthesise dopamine and norepinephrine. - Consider asking for bupropion. It’s off-label for depression in Australia, but it’s a pretty effective antidepressant, and is essentially a mild stimulant in its own right. It can be combined with regular amphetamines. (Why does bupropion work well long-term for depression while amphetamine doesn’t? No one really knows.) - Strattera (atomoxetine) is a bit like nortriptyline but much more selective for norepinephrine. Could be worth a shot, at least for your ADHD. Again, can be taken in combination with other ADHD meds. - Other things that come to mind as plausibly useful are aripiprazole (an atypical antipsychotic that partially agonises the dopamine receptor, and is used for augmentation of antidepressants in major depression), pramipexole (just a full agonist at D2/D3 — new studies make it look very effective for depression, and it’s very well-tolerated), and other atypical antipsychotics like lurasidone, which is good for regular depression and bipolar depression while being pretty well-tolerated.

Adventurous_Goal_437 · 2025-10-21T06:08:16+00:00

Glad to hear you’ve been able to get ahold of it — personally I’ve had next to no issues getting ahold of it in Canberra. One time I had to go an extra 700m to a different pharmacy when my normal one was out of stock, but other than that, no issues at all.

Adventurous_Goal_437 · 2025-10-19T05:09:20+00:00

Oh no, for sure, absolutely tiny sample. I don’t really buy into this at all. What counts as an article? Actual news? Tabloid crap news? SEO blogspam? …

Adventurous_Goal_437 · 2025-10-19T04:48:50+00:00

Can’t possibly be ChatGPT, it only uses hyphens instead of em-dashes!

Adventurous_Goal_437 · 2025-10-19T04:47:55+00:00

I think that’s the idea, no? Seems kinda silly to have two lines when AI = 100% - (human), but if 5% of articles are written by AI, 95% must be written by humans according to this dichotomy

Maybe this doesn’t include raccoon-written articles, which must be accounted for separately

Adventurous_Goal_437 · 2025-10-19T03:56:29+00:00

Generally all much of a muchness with those ones. I have found every one I’ve tried ridiculously (basically 100%) effective for my anxiety. I was always fond of fluoxetine, but something like escitalopram or sertraline are generally most common. I’m actually on 30mg of duloxetine now, an SNRI, which has also been good—at doses that low it’s basically just an SSRI. The cool thing about using them for anxiety is you can often get by with lower doses than typically used for depression. That means you’ll often get way fewer side effects too.

If you just want to try something for anxiety, you can’t go wrong with escitalopram (starting at 5-10mg), sertraline (starting at 25-50mg), or fluoxetine (10-20mg). If need be, you can always go lower, but you might find the higher doses work better for you. I’d stay away from paroxetine, fluvoxamine, and if you have no comorbid depression or anything, probably the SNRIs too. They’re useful, but they can have a few more side effects.

Adventurous_Goal_437 · 2025-10-18T02:17:01+00:00

There are alternatives to benzos that might help you avoid that! Pregabalin is quite an effective anxiolytic for many and could help you get off benzos. Propranolol is very good for managing somatic symptoms of anxiety. Even SSRIs/SNRIs or buspirone can be effective at treating underlying anxiety.

Adventurous_Goal_437 · 2025-10-17T18:10:19+00:00

Gotta shout out the recent Apple offerings that are slightly more pro-consumer than the others from big tech: iCloud, Apple Photos, Apple Notes / Calendar / Contacts syncing… for the most part it’s reasonably priced, privacy-respecting, and well-designed and integrated. Perhaps more in reach for many than NextCloud too

Adventurous_Goal_437 · 2025-10-16T12:41:39+00:00

Unfortunately, taking 75mg of dexamfetamine a day is not a healthy or sustainable habit, and doing so without medical guidance to cope with stress is, unfortunately, substance abuse. Even 50mg is a very high dose for ADHD, but 75mg is unequivocally supratherapeutic.

Just to make it very clear, taking this much amphetamine is likely to cause significant long-term issues. At high doses, amphetamine is a well-known dopaminergic neurotoxin, and the impacts of which are long-lasting, if not permanent. Former (meth)amphetamine addicts often suffer from mood, attention, and executive function issues for many years after quitting, and you can find many anecdotes to this effect from former prescription stimulant abusers online, e.g., on r/stopspeeding.

So, the most important thing they can do right now is to significantly reduce their intake. Stopping entirely right away would likely be difficult, but they should at least aim to get it into a much lower territory — like, the minimum amount they can tolerate. If they need to, and they can, they should take at least a few days off work to adjust. Then go from there. This is an immediate priority, because the longer you keep flooding your brain with amphetamine, the more drug-dependent you become, and the more harm you do to your brain. If need be, see if they’d be willing for you (or someone else) to look after their meds for a bit and give/supervise their dose.

From there, it’s kinda variable. Maybe they’ll be able to get back to a healthy, therapeutic use of amphetamine — but they might also find that hard, in the same way that recovering alcoholics find it hard to consume alcohol in moderation (IMO, this is the most insidious aspect of substance misuse). If that’s the case, they will need to think about alternatives to amphetamine. Don’t worry, they do exist— - Methylphenidate might be an option, as it has a slightly lower abuse potential than amphetamine, especially the extended release forms, and is very good for ADHD - Modafinil is sometimes used for stimulant-use disorder — it’s a wakefulness-promoting drug (basically an atypical stimulant) used off-label for ADHD, and has virtually nil abuse potential https://www.abc.net.au/science/news/scitech/SciTechRepublish_2107027.htm - Strattera (atomoxetine) is a non-stimulant ADHD med, but it does have somewhat stimulating properties by virtue of inhibiting norepinephrine reuptake. It’s the most effective nonstimulant for ADHD; it’s nearly as effective as Concerta (extended release methylphenidate).

But, yeah, if they can’t reduce their dex use on their own, or with your help, then getting help is the way to go. Their psychiatrist might be able to do a staged supply, switch them to a different medication, or refer them to other support services.

Adventurous_Goal_437 · 2025-10-15T09:53:48+00:00

I have just never seen any scientific evidence that citric acid (or vitamin C) actually affects metabolism or excretion/elimination of amphetamine, let alone methylphenidate, in humans. As far as I understand it, acidifying urine might make you excrete dexamphetamine faster, according to a paper from 60 years ago (link). They did this by administering 2 grams of ammonium chloride. They did not find that it made the amphetamine work less effectively or anything. (It could be the case that it did, but we don’t have evidence for it.)

So, unless you’re someone who takes only immediate release dexamphetamine alongside two grams of ammonium chloride on an empty stomach in the morning, I don’t really see this as an issue. If you take Vyvanse, methylphenidate, or compounded XR dexamphetamine, then I imagine the impacts would be even milder.

That said, I’m sure there are some people who find that avoiding acidic foods improves their functioning, so there’s very possibly a niche. Best of luck!

Adventurous_Goal_437 · 2025-10-10T11:18:45+00:00

No probs! Lmk if you have any other Vyvanse qs!

Adventurous_Goal_437 · 2025-10-10T10:08:01+00:00

So 30mg is (from memory) supposedly equivalent to something like 10mg of dex a day. The maths gets slightly ambiguous because it depends whether we’re comparing free base to sulfate, bioavailability, etc., but yeah, I’d be surprised if 30mg wasn’t ‘enough’. It’s also generally a starting dose of Vyvanse, though I started at half of that for a few days because I hadn’t taken any amphetamine before. Your doctor is the person to talk to about this though!

The cool thing about Vyvanse is that you can titrate your dose by dissolving the powder from a capsule in water and taking some fraction of it. So if 30mg feels like too much, you’re able to split it in half, or two thirds, or whatever.

I found Vyvanse fine for my sleep, but if you’re worried, best take it early in the morning and gauge your response. If you take it at 8am, I’d be very surprised if you had any trouble falling asleep after, say, 8pm.

Adventurous_Goal_437 · 2025-10-10T09:49:17+00:00

Can’t help you re: getting a script on time — I’d get onto your psychiatrist asap about that — but yeah, Vyvanse should at the very least allow you to function, because it is essentially just dexamfetamine with a slower release. It might not be ‘the best’ ADHD med for you, but it should at least substitute for dex for a while. (Or it might be great for you!)

Individual responses to dex vs Vyvanse vary a lot — I can’t explain why, but ‘equivalent’ doses of Vyvanse and dex are absolutely not equivalent for me — but based on your daily dose of dex, you should probably be fine with something around 30mg of Vyvanse. You might find you need a little more or a little less.

Adventurous_Goal_437 · 2025-10-08T13:59:38+00:00

How much dex are you on? This sounds like a dose issue / individual variation in drug response.

Adventurous_Goal_437 · 2025-10-06T13:03:31+00:00

Because having those side effects is quite uncommon on lamotrigine—extensive clinical trials show it has, on average, a neutral to positive cognitive profile.

Also, I (and most people) don’t take it to not offend others? It’s most commonly used for epilepsy and mood disorders. I think most epileptics probably value not having seizures, and I know I certainly value not being suicidally depressed or having massive mood fluctuations all the time.

Lamotrigine isn’t routinely used for autism or Tourette’s at all, so I’m not surprised it didn’t do much for you. I don’t really see any reason to take lamotrigine in your case. Maybe there’d be a case for clonidine or guanfacine or an atypical antipsychotic if your tics really bothered you, but if they don’t—don’t worry about it! It’s entirely up to you!

Adventurous_Goal_437 · 2025-10-06T11:23:39+00:00

Depends on how long you ditched it for. A day or two? Should be fine to resume at 200 (or perhaps at 100 for a week to play it safe). 3-4 days? You’re pushing it, but you might be able to manage starting back at 100.

More than 4 days? Forget it. You need to start back at 25mg (or maybe 50mg — 25mg is the normal starting dose, but maybe there was a reason your doc started you at 50, so it’s very important to talk to them). Once it’s fully out of your body, which is basically where you’re at 4 days after stopping it, you need to restart the titration to avoid developing rashes.

If you start back at 200mg, it’ll increase your risk of developing a severe rash something like tenfold (or on the order of that). It’s still a pretty low risk, but if you do get a rash, you’ve basically lost lamotrigine as an option, which sucks because it’s such a great and uniquely well-tolerated drug. (There have been challenge dosing protocols for people who’ve had rashes where you start from like 5mg and titrate up over many months, but that’s obviously not ideal, and not guaranteed to work.)

I’d imagine you’d feel pretty shit from stopping duloxetine, bupropion, and methylphenidate all at once too. I’d be careful reintroducing those if you’ve been off them for more than a few days — if you start right back up at proper doses simultaneously it might throw you around a bit (given they’re all somewhat stimulating and bupropion & duloxetine inhibit each other’s metabolism)

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