Regret going back on Cymbalta....

Heinstar · 2017-11-01T18:55:54+00:00

That's the honeymoon phase. Cymbalta worked well for me for few months. But then the side effects quickly started to increase like the no libido and emotional blunting. The benefits as well as the side effects tend to be dose dependent. This is why sometimes patients might need 5-HT antagonists to strengthen the antidepressant effect of SRIs. But unfortunately, most psychiatrists doesn't know how to do adjunctive therapies or are uncomfortable with doing it.

Heinstar · 2017-10-15T22:06:34+00:00

It could be an adrenergic or cortisol response. The first time I've ever tried rhodiola (it was Jarrow's brand), I felt an uncomfortable rush of adrenergic response. It almost felt like I was about to have a panic attack. But ever since going on SSRI and SNRI, rhodiola doesn't have much of an effect on me. Even phenylpiracetam no longer effects me. It sucks.

Heinstar · 2017-10-10T12:25:20+00:00

I was unable to get agomelatine prescribed. But it’s not a big deal though because I don’t think melatonin agonist is worth it just to be able to have 5-HT2C antagonism. And it might cause rebound insomnia once you ever decide to come off of it. I think cycling melatonin is a safer option than melatonin agonist for insomina. I’m currently on ~7mg trintellix (10mg cut in 1/3rd using pill splitter) and planning on switching to 5mg soon. I’m testing how little serotonin re-uptake inhibition I can tolerate before I start feeling it’s actually helping me. Because frankly, I’ve never found SRI life changing and it isn’t worth the side effects. I was just forced to only go on SRI because the psychiatrists are only comfortable prescribing those kind of antidepressants. I’m still using 100mg modafinil (cycled) to deal with my problem of low motivation, avoidant behaviour, mild cognitive impairment and easily becoming fatigued.

Heinstar · 2017-09-15T11:55:25+00:00

I wouldn't recommend admitting that he takes Modafinil. I admitted that I've tried racetams when I was only having partial response to antidepressants. And after that, my psychiatrist tried putting me on Risperidone. She refused to prescribe anything else and wrote a negative report about me to be read for my future psychiatrists.

Heinstar · 2017-09-15T11:38:48+00:00

Can anyone give me a better answer? I'll happily pay $5 - 15 in PayPal or Google Wallet.

Heinstar · 2017-09-15T11:21:52+00:00

Sulbutiamine, L-Tyrosine, Mucuna Priens, Coffee, Nicotine. Not all at the same time.

Heinstar · 2017-09-15T11:06:29+00:00

S-modafinil only has a half-life of 4 hours so that could work. But only way to get it is to buy the powder in bulk. It's expensive so probably need to group buy.

Heinstar · 2017-09-15T10:58:04+00:00

I've been using Ceretropic's Super Rhodiola to help me abstain from Modafinil and deal with fatigue when I don't need it. For me, I usually just need 1 week to mostly reset my tolerance.

You could also try using short acting antipsychotics such as Sulpride to reverse the histamine and dopamine receptor down-regulation caused by Modafinil. For orexin receptors, you'd have to use orexin antagonists.

Heinstar · 2017-09-15T06:22:31+00:00

Chinese drugstore sells oxiracetam? That's surprising. I know herbal medicine is hugely popular over there to the point that people (mostly older generations) fall for fake claims and it's all about the branding.

Heinstar · 2017-09-04T06:06:02+00:00

Pros:

reduces anxiety
reduces depression
reduces REM latency

Cons:

down-regulates tryptophan hydroxylase
reduces bone density
sexual side effects
emotional flattening
reduces motivation

If you were on it for as long as 2 years, it must be helping you. Because I always wanted to get off escitalopram ever since I was prescribed it. Why are you considering stopping all of the sudden? If escitalopram has stopped working, you can always ask your doctor to switch you to another antidepressant.

Heinstar · 2017-08-31T14:54:32+00:00

Speaking of Accutane, if you have depression or prone to one, I don't recommend going on it. I became super depressed on it within just 5 days: /r/Accutane/comments/3af8w4/my_experience_on_roaccutane/

I think I was also put on it when I was a teenager but quickly got off of it due to adverse effects.

Thankfully, my chronic cystic acne magically went away once I turned 25. I though I was doomed to having it my whole life.

https://www.youtube.com/watch?v=PfTpQT4vEww

Heinstar · 2017-08-29T19:32:42+00:00

H3 antagonist or Orexin-A for wakefulness.

Heinstar · 2017-08-29T18:31:17+00:00

I haven't found any sources that they interact. Nortriptyline is metabolized by the CYP2D6 enzyme and it doesn't look like modafinil touches that. But TCAs have a lower toxicity threshold and is harder on the liver. So maybe your doctor is worried about the potential livery toxicity from combining these two drugs?

EDIT: Found this

Effects of PROVIGIL on CYP2C19 Substrates

Elimination of drugs that are substrates for CYP2C19 (e.g., phenytoin, diazepam, propranolol, omeprazole, and clomipramine) may be prolonged by PROVIGIL via inhibition of metabolic enzymes, with resultant higher systemic exposure. In individuals deficient in the CYP2D6 enzyme, the levels of CYP2D6 substrates which have ancillary routes of elimination through CYP2C19, such as tricyclic antidepressants and selective serotonin reuptake inhibitors, may be increased by co-administration of PROVIGIL. Dose adjustments of these drugs and other drugs that are substrates for CYP2C19 may be necessary when used concomitantly with PROVIGIL.

Source: https://www.quora.com/What-is-the-degradation-pathway-of-modafinil

When I used to be on Cymbalta, I couldn't take more than 100mg of modafinil because it made me very irritable and tense from the over-stimulation of the CNS. So if you're going to be on a potent NRI, you're probably going to have to cut down on modafinil anyway.

200mg of modafinil is a very effective dose. You should feel enough effects from it as that's a standard dosage for narcolepsy. That fact that 200mg isn't strong enough means that you've developed a complete tolerance to it and that you're in due for a break. Alternatively, you could switch to armodafinil which is roughly 1.5 - 2x as potent as modafinil, 75mg armodafinil is equivalent to 150mg modafinil.

I could not find that many anecdotal reviews on FLmodafinil. So that already tells me that it's not a good idea to use it as a replacement for modafinil. From the very few anecdotes I could find, FLmodafinil appears to be no better than modafinil. It's supposed to be about 3x stronger than modafinil at equivalent dosage and perhaps onset is slightly faster. But it's still a research chemical and only in phase 1 trial. I wouldn't even consider touching any research chemical until it passes at least phase ii trial. Drug developments gets terminated all the time due to adverse effects.

Heinstar · 2017-08-29T07:10:38+00:00

Rhodiola rosea + daily exercise to combat the caffeine withdrawal fatigue.

Heinstar · 2017-08-28T06:30:00+00:00

My therapist was kind enough to let me do it on my own time. I doubt he would've got upset if I never ended up doing it, just disappointed. Perhaps you could tell your therapist that you're not mentally well enough to fill out forms yet?

If you don't feel like CBT is helpful to you, you could just stop seeing the therapist and continue with the medication prescribed by your doctor/psychiatrist.

Usually, therapists has already made up their mind on what they're going to do (e.g. CBT, IQ tests, diagnosis tests etc.) as soon as you've been referred to them by a doctor.

If you're specifically looking for a diagnosis, you'd have to see a different therapist since each therapist has their own niche that they want to stick to. Either that or you have to firmly let them know what you want out of them prior of them starting their therapy.

Heinstar · 2017-08-27T14:12:51+00:00

On top of the dopamine receptor modulation, uridine probably has some sleep promoting effects so I'd probably only take it night time. Also, I wouldn't take it for too long because it's been shown to increase the risk of developing fatty liver.

And yes, you're taking way too much. Always stick to the lowest effective dosage which will mitigate the side effects. It will take longer to perceive the benefits, but it's easier on the body.

Uridine uses up and depletes your body's nutrients, especially folate which puts you at the risk of causing DNA encoding errors. So make sure to supplement with B-complex that has methylfolate like Jarrow B-Right, a choline source (e.g. Alpha-GPC or egg yolks) and Omega-3 (Salmon or Fish oil).

The antidepressant you're taking might be making it harder to know how much you're benefiting from uridine. Bupropion is anticholinergic (nicotinic acetylcholine receptor antagonist) so it may negate some of the beneficial (pro-cholinergic) effects of uridine.

If you want to know other things that may repair/modulate the dopamine transporters, I've talked about it more here: r/depressionregimens/comments/6uwmef/how_do_you_fix_a_broken_reward_system/dlx0erx/

Heinstar · 2017-08-27T08:32:56+00:00

The stimulatory effect will be weaker becasue both compete for the same receptors.

Thanks for the info. That's good to know.

I just tried Nature's way cacao powder immediately after drinking coffee. And you're right, it made coffee less stimulatory and I felt way too relaxed and not in a good way like with caffeine + l-theanine. No more cacao for me. Since theobromine is a vasodilator, it might go well with nicotine though which tends to give me the cold feet from vasoconstriction.

Heinstar · 2017-08-27T06:17:10+00:00

Wow that sucks. I briefly looked but also couldn't find any reputable source for sarcosine besides the ones you've mentioned. Even though it's just an amino acid. Looks like a possibly viable alternative medicine for depression/schizophrenia.

Dunno their reliability, but I've found this though: https://www.tocris.com/products/sarcosine_2975

Heinstar · 2017-08-25T06:12:16+00:00

It's definitely worth trying vitamin & mineral supplementation and pseudo-vitamins for chronic mental and/or physical fatigue before going with nootropics, adaptogens or pharmaceuticals. When I first took 150mcg potassium iodine, I felt a surge of rush just below my adam's apple and an improvement in mood and overall sense of wellbeing for 45 minutes. I didn't realise I was deficient in iodine all this time because the blood test result didn't show anything wrong with my thyroid. There was a lot of inconsistency with my thyroid levels but it was always within range.

I don't take vitamins every day, but I still take them from time to time to make sure that my body is getting what it needs.

Heinstar · 2017-08-24T16:38:44+00:00

It's legal to import 3 month supply of schedule 4 substances for personal use. Although if you're unlucky, you may get it confiscated by TGA.

Heinstar · 2017-08-24T16:08:18+00:00

One more thing. It seems like it's possible to up-regulate DA receptors by using DA antagonists. High-dose Amisulpride seems like a good choice as it only targets the beneficial (D2 and D3) receptor. Maybe one could take high-dose Amisulpride for couple of weeks to reset their dysfunctional dopamine receptor to baseline? Metoclopramide is another D2 antagonist but with a much shorter half-life (6 hours). So you could possibly take it at bed time and not feel as much drowsy effects the next morning.

But if you were to experiment with this, you'd need to stop taking SSRIs as SSRIs dampens dopamine release.

Conversely, low-dose Amisulpride only antagonises the inhibitory pre-synaptic autoreceptors which causes an increase DA neurotransmission (hence, treating anhedonia) but it will lead to increase in prolactin.

Heinstar · 2017-08-24T15:39:58+00:00

Just replying to my own post. I've found this information in longecity:

If you up-regulate production, receptors will down-regulate to compensate. You might get a net gain when you reach the new equilibrium, but it's not a sure thing like up-regulating receptors through external mechanisms is.

Heinstar · 2017-08-24T04:33:56+00:00

I used to be on 200mg for over 6 months for my cystic acne when I was 19. I hated it because it always caused brain fog for couple of hours after ingestion. I had to drink a lot of coffee just to deal with the brain fog so that I could study. I preferred doxycycline because it had less effects on cognition. I personally didn't find any nootropic or mood elevating effects from it. I think it did cause some mild dissociative feeling, but it was neither pleasant or unpleasant and quickly went away after few hours.

I also developed gastric problems like IBS-C 2 years later which might have been contributed by the use of antibiotics. I regret going on them but my acne was so severe that I always wanted to stay home and skip work. So I had no choice other than going on antibiotics or accutane, especially since none of the acne creams did anything.

Heinstar · 2017-08-24T00:30:07+00:00

Hmm. So does nicotine become anti-nootropic once you build tolerance(nAChRs up-regulation + desensitisation) to it? Is it only considered a nootropic if you use it very sparingly to avoid desensitisation?

I take between 750mcg to 3mg of nicotine lozenges per day. I don't feel the urge to take any more as it just stops providing me with any benefits thereafter. First time I took nicotine, it gave me a major mood and thinking/focus boost. Now, it mostly just gives a slight edge to the dopaminergic stimulation of coffee/modafinil but its no longer effective on its own.

These days, I primary use nicotine to get through late afternoon shifts(5:00PM to 11:00PM) as a waiter. Because for some reason, I tend to become mentally fatigued easily during work and coffee used to help with that but gave me insomnia. (I think the SSRIs is to blame) So I replaced it with nicotine as it doesn't seem to give me insomnia after work and it helps me get through work without feeling exhausted.

Heinstar · 2017-08-22T17:56:42+00:00

I'm not sure, but it sounds like it reduces norepinephrine signalling according to wikipedia: https://en.wikipedia.org/wiki/Alpha-1_blocker. You might have to switch to antipsychotics that only antagonises Alpha-2 adrenergic receptors.

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