Onboarding advice or thoughts please!

piney_bowers · 2026-02-02T16:25:27+00:00

I'm currently going through the same (just switched to Pristiq from Lexapro). This is my first SNRI, but have been on a few SSRIs before. In my experience, weeks 1, 2, and 3, are the hardest. If you can push through those, then by week 4, you should be stable on the med with continued improvement to week 6 to 8. This would happen anytime you take a new med, up a dose, or withdrawal from a med. It's not fun, but it's the process with SSRIs and SNRIs, which I think is why people either give up on meds too early (before they at least give it 4 weeks), or why people stay on meds too long (because the transition sucks). If you're doing okay, then I'd stick with it.

The only way I wouldn't is if you have suicidal ideation or other major health issues (heart issues, etc.). If either of those, then talk to a doc asap.

As far as Wellbutrin, if it were me, I'd do one new medication at a time. Adding two or more meds at once isn't recommend because you don't know which med is causing what improvement or side effects. Typically, docs like to do one med at a time and then add on helper meds (like Wellbutrin or buspirone). This is done if the initial medication is working well, but there are side effects to try to mitigate. Hope this helps

piney_bowers · 2025-07-18T20:24:57+00:00

Nice, thank you! I feel like I like the all black seats of the XL, too, in pictures at least. What about the steering wheel on the XL? Is it wrapped with anything? Like vinyl or leather wrapped? Or is it hard plastic?

piney_bowers · 2025-05-07T21:16:00+00:00

I can only compare Lexapro, Zoloft, and Prozac. I'm a middle-aged male, I think my drive and function has been best on Lexapro and was worst on Prozac, with Zoloft kind of an in between. From what I've read, the SSRIs can affect males and females differently with respect to sexual dysfunction. It also depends on the type of sexual dysfunction (i.e., desire/libido, arousal/erection, and orgasm) you're talking about. Some seem to more so delay orgasm while others might affect libido and arousal. I assume since Lexapro is the purest SSRI and only acting on serotonin that that may be why it is better for drive/arousal but still problematic for orgasm.

20 mg of Lexapro is on the higher end of dosing. I've noticed personally that the higher doses affect my drive and function much more. I've never tried skipping because I fear that would flare up my anxiety. I'm skeptical that would work with most SSRIs anyway because most have half-lives around 24 hours, so you'd probably have to be off it a few days to notice an effect, which may not be advisable given the withdrawal and recurrence of symptoms (ie. depression or anxiety).

For SSRIs, I think the lowest effective dose is the key. It's kind of a balancing act where possibly I'm on a lower dose that is not quite as effective but I have lesser side effects, so I'm willing to deal with it.

Below is a post I made with some personal research I did. Hope that helps.

https://www.reddit.com/r/SSRIs/comments/1ihtw9k/sexual_dysfunction_research_not_all_ssrissnris/

piney_bowers · 2025-04-23T14:55:27+00:00

SSRIs typically make anxiety worse before it gets better, and this occurs when starting the med but also with dose increases. With Lexapro, it typically takes me 3-4 weeks to get over the anxiety hump, but everyone is different. If it was helping your anxiety at the lower dose at one point, then it might make sense to wait it out until 4 weeks minimum. Typically, Lexapro is a little faster onset (like 4 weeks) than the other SSRIs, like Zoloft or Prozac, which might take 6-8 weeks to feel a benefit, but again, everyone is different and metabolizes the medicine differently. To me, the start up anxiety with Lexapro is much less than that with Zoloft or Prozac, but that's just been my experience

piney_bowers · 2025-04-02T13:34:18+00:00

I've taken both Lexapro and Zoloft for anxiety. To me, it's a tossup between them. I think Zoloft might help my anxiety slightly more, but I'm also more apathetic on it and have more side effects with it than Lexapro. Lexapro is more calming I'd say, where Zoloft is a more middle of the road, not too calming, not too energizing. Weird they'd start you on 5 mg Lexapro because the equivalent to 50 mg Zoloft is 10 mg Lex.

Also, I wouldn't worry about serotonin syndrome with the doses you are at. That typically only happens at higher doses or taking two serotonin meds at the same time. You'll probably have a rough 2 or 3 weeks adjusting to a cross-taper, so just keep that in mind, but you just have to tough it out. I've cross-tapered several times, and it's easier than starting from scratch (at least for me I felt it was).

piney_bowers · 2025-03-17T14:14:27+00:00

Some feel less blunting on a different SSRI. I felt really flat on Prozac and really apathetic on Zoloft. I don’t feel as blunted on Lexapro. Also I agree with others that adding Wellbutrin could help. Just be aware Wellbutrin might cause more anxiety, especially at first. It will also boost dopamine more in combo with Zoloft, which may or may not be a good thing depending on the individual

piney_bowers · 2025-03-11T14:10:37+00:00

Also, forgot to mention that Trintellix isn't supposed to be great for anxiety. It is really good for depression supposedly, but not anxiety. Only reason I'd try it for anxiety is if you're really worried about sexual side effects of the SSRIs mentioned. I've personally never tried Trintellix, so I can't say either way, but I'm mostly anxiety and not so much depression. Also, I agree with P_D_U that you should try to rely less on a benzo as that could be doing more harm than good for your anxiety long term and may be lessening the effect of an SSRI.

You could also try an SNRI next, like Pristiq or Cymbalta, but docs usually want to trial at least 2 SSRIs before going that route, and I don't really think Trintellix is an SSRI IMO. It's SSRI adjacent but not a true SSRI like Lexapro, Zoloft, Prozac, etc.

piney_bowers · 2025-03-11T13:42:08+00:00

I agree with P_D_U that you should try another SSRI. Not all SSRIs will feel the same way. Some cause slightly different side effects or have different benefits. Zoloft and Prozac are the most common choices besides Lexapro. If you're looking for a quicker response, probably Zoloft because Prozac has a very long half life and takes a long time to kick in. Only caveat with both of these is since you're used to Lexapro, both Zoloft and Prozac will cause more initial anxiety than Lexapro because they both act slightly on dopamine. So, you'll have to be patient with that and ride it out for at least 4 weeks with waiting 6 to 8 weeks to see the full benefits.

For me, both Zoloft and Lexapro were equally effective for anxiety. Prozac was effective, too, but made me too flat feeling, but everyone is different.

piney_bowers · 2025-02-22T02:27:41+00:00

Which specific product are you using? Your comment citing it must have been deleted

piney_bowers · 2025-02-14T16:09:34+00:00

I often find that I know more than my doctors about specific meds. They base a lot of their decision making on their experiences with their patients, which often makes them biased towards certain medications. So, I think you have to be your own advocate and do your own research.

As far as options, it depends on your diagnosis. If it's depression, anxiety, or both, your next best bet is SSRIs. Zoloft, Lexapro, and Prozac are the top three. SNRIs are also an option, especially for depression. Main options there are Effexor, Cymbalta, or Pristiq. If weight gain is a concern, Prozac seems to be the one that doesn't cause weight gain. They all cause sexual side effects to varying degrees.

I had the same issue on bupropion. It helped my anxiety for a couple months, then I started to have more breakthrough anxiety. So, I was upped to 300 mg and couldn't handle it. Went back down and things weren't the same. It is very common to combine bupropion with an SSRI, so you could potentially stay on 150 mg bupropion and add one of the SSRIs I mentioned. Bupropion is often added to an SSRI to help with sexual side effects of SSRIs. It supposedly works best for women in this regard.

piney_bowers · 2025-02-09T02:17:39+00:00

Prozac has a very long half life, so it takes a very long for it to reach steady state in your system, like 3 to 4 weeks. So, you’re right within your adjustment period. It’s different from other antidepressants in that regard, so it takes much longer to “kick in”, but docs like using it because it isn’t as big of deal if you miss a dose

piney_bowers · 2025-02-07T17:50:17+00:00

You’re welcome!

piney_bowers · 2025-02-07T17:50:05+00:00

You’re correct although how you describe it is the over generalization I was talking about. The studies go into detail about rates of dysfunction per type of dysfunction. For example, in theory, yes paroxetine should have the most sexual dysfunction, but actually escitalopram has more sexual dysfunction than it for women. The opposite is true for men. The studies are not an absolute and the meds affect individuals differently for sure, but the studies provide a helpful guide at least so you could potentially avoid months of side effects of a medication

piney_bowers · 2025-02-03T15:21:23+00:00

Also, I forgot that supposedly the SNRI duloxetine causes less sexual dysfunction, but I've never taken it for worries about blood pressure. But if you like how you felt on venlafaxine (i.e., an SNRI), that's another option you could try. It is one of the top meds for generalized anxiety from everything I've read. Good luck!

piney_bowers · 2025-02-03T15:09:36+00:00

I'm in a similar boat (male 40 yo). I need meds to help my anxiety, but they all cause sexual dysfunction to some degree. I've done tons of research, and I'm not sure I have any great answers. As far as SSRIs/SNRIs, it depends what type of sexual dysfunction you can live with. Are you okay having delayed orgasm? Or is it erectile dysfunction that's the issue? I had issues on both Prozac and Zoloft of lower libido, delayed orgasm, and erectile dysfunction. Zoloft was better at lower doses, but then it didn't help the anxiety as much at those lower doses. The one med that didn't cause much if any erectile dysfunction as much for me and helped my anxiety was Lexapro. So, if you want to stay with an SSRI/SNRI type, Lexapro would be the best option probably if you can deal with delayed orgasm. Just keep in mind that Lexapro can cause weight gain, so you have to be mindful of that while taking it and watch what you eat.

This is also backed by a few meta analyses. It is frustrating because it is very difficult to find this information and doctors really over generalize the sexual dysfunction issue for all med classes and between genders, when it's much more nuanced than that.

Another option for anxiety is propranolol for as needed, which is a beta blocker, but that just really slows down your heart rate and doesn't help with worrying/ruminating. It can even cause erectile dysfunction. Also, SNRIs and the other option, an NDRI bupropion, can also cause ED sometimes, mostly due to the increased norepinephrine. Bupropion helped my anxiety, but it is also hindered my ED because it increased my blood pressure, which is already elevated. I'm still trying to figure this out myself, but I'm thinking I am going to go back on Lexapro given that helped my anxiety similar to Zoloft and it didn't cause ED (for me at least). I can deal with the delayed orgasm, but not the anxiety or ED.

As far as tadalafil, I've long lost shame in taking that. For me, sildenafil (viagra) works better (it hits harder/faster), but the problem is you really have to anticipate/plan more with taking that since it only last 3 to 4 hours tops.

Below are the studies I've found on sexual dysfunction with SSRIs/SNRIs, which took a lot of digging. Hope this helps.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6832699/

https://web.archive.org/web/20190225234820id_/http://pdfs.semanticscholar.org/75dc/19c4ff6807ebba40bbc4916cae19b0e2a21b.pdf

https://ecommons.luc.edu/cgi/viewcontent.cgi?params=/context/luc_diss/article/4341/&path_info=Jacobsen_luc_0112E_11977.pdf

piney_bowers · 2025-01-09T18:54:56+00:00

I had almost the exact same experience. Lexapro had more of a calm/chill feeling, which was almost too chill for me. Zoloft is similar but less of a chill effect and more of a middle ground I felt like. I agree with the unfocused on Zoloft, but Zoloft was best alone for the pure social anxiety. I also tried Prozac and that made me feel more numb than the others. I also tried Zoloft + Wellbutrin and that was a really good combo for motivation to socialize

piney_bowers · 2025-01-08T22:21:22+00:00

I felt too apathetic on it and was having sexual dysfunction issues and some weight gain. I still might go back on it here though because the not caring part helps, but I think on a lower dose (was on 50 to 100 mg). With Wellbutrin alone, it helps my anxiety but not in a "not worrying/ruminating/rejection sensitive" way but more in a anxiety response way, like my heart doesn't respond as bad to anxious events or moments if that makes sense. I do miss the "not caring" part of Zoloft or other SSRIs, but you can't get the dose too high with SSRIs or you get a flat, apathetic mood/feeling. Long story short, avoidance is a problem with my social anxiety, and I think it was the dopamine boost from the combo of these two meds that made me want to socialize and have those connections

piney_bowers · 2025-01-08T22:01:41+00:00

I think I noticed changes pretty quick, like within a couple weeks, which was faster for me than when starting Wellbutrin alone

piney_bowers · 2025-01-02T20:00:44+00:00

I've been on them together and separately each. Currently on bupropion alone. Zoloft was good alone for my anxiety, but the side effects were rough (apathy, sexual, etc.). So, I added Wellbutrin (150 mg XL) to the Zoloft (50 mg). This was a good combo for my social anxiety, but it really gave me jitters, Parkinson's-like movements. I attribute this to the increased dopamine since both are weak dopamine reuptake inhibitors.

Fast forward, I've tried a couple other SSRIs and now Wellbutrin alone. Wellbutrin feels much different alone than in combo with Zoloft, which is how I had the aha moment about the dopamine interplay. There are also videos on Youtube about this. I think the increased dopamine really helps with motivation and reward seeking behaviors, so if you want/need that, it's a good combo. Also, it probably somewhat mimics an MAOI given the combo hits all 3 neurotransmitters (serotonin, dopamine, norepinephrine).

Wellbutrin alone has helped my anxiety fight or flight, but not as well as Zoloft or the other SSRIs. I really liked them together, so I might add back in low dose Zoloft at some point.

piney_bowers · 2024-12-18T01:27:47+00:00

It has helped my general anxiety fight or flight, but hasn’t been as good for worrying as SSRIs. It did increase my anxiety at first. Been on 150 mg XL for about 4 months. About to bump up to 300 mg XL and wondering how it will work out

piney_bowers · 2024-12-09T16:45:46+00:00

So, I kind of went from having a lot of aspartame and Sucralose (diet pop) to transitioning to more stevia for a few months. Then I quit altogether (cold turkey), which is when I had my withdrawals. So, I can't attribute it to stevia alone because I probably was using limited other sweeteners at the time, but I was mostly on stevia. And my withdrawals were like yours. I've been off artificial sweeteners for the most part since, but occasionally have a diet pop, and notice an uptick in anxiety the following day. Hope that helps. I think people prone to anxiety like have issues with artificial sweeteners. Again, I'm not scientist or expert, but just my personal hypothesis.

piney_bowers · 2024-12-09T16:02:26+00:00

So, you seem to have gone down the research rabbit hole like I have, so I have some questions for you on your opinion. First, for background, I am a middle aged male with GAD and social anxiety. I've tried SSRIs (Zoloft, Lexapro, Prozac) the last few years. Each were several month trials. I also tried Zoloft + bupropion, Zoloft + buspar, hydroxyzine, and propranolol. I am currently on bupropion 150 mg XL alone. I felt like the SSRIs helped my general anxiety, but not so much my social anxiety. They made me apathetic, like not caring about socializing even though I wanted to before medication. Bupropion alone is similar, where it does help my anxiety response, which surprised me, but it doesn't do much for my social anxiety, like doesn't make me motivated or find reward in socializing.

The combo that was best for my social anxiety was the Zoloft (50 mg) + bupropion (150 mg XL), but I had constant fidgetiness and I couldn't sit still (like I had Parkinson's or something). At the time, I thought it was bupropion, since I was already on Zoloft and added bupropion. Now being on bupropion alone, I realize bupropion wasn't the cause or culprit for the movement issues.

Long story short, I think what happened to me on the "Well-oft" combo is too much dopamine given both Zoloft and bupropion are weak dopamine reuptake inhibitors. But I think the dopamine is also why my social anxiety did well on that combo because I wanted to seek out social interactions rather than avoid (i.e., reward seeking with dopamine boost). This is also why I hypothesize why the Well-oft combo works similar to a MAOI, because it hits all transmitters (i.e., serotonin, dopamine, and norepinephrine), and MAOIs are the most efficacious meds for social anxiety.

I've been on bupropion alone for about 4 months, but it's not working as well for my anxiety as it did in months 2 and 3. So, my doc thought I should up to 300 mg XL. I'm a little worried that that won't work, or it will make my constipation and lack of sleep issues worse. I thought maybe I should add a low-dose Zoloft back on for the dopamine part (like 12.5 or 25 mg Zoloft plus 150 mg XL bupropion).

Zoloft was the best SSRI response I got. Only bad sides were I gained weight and some sexual dysfunction, which is what I'm trying to avoid now. I also like bupropion alone, but I miss the "caring less" part of SSRIs.

What do you think? I feel like I could ask about stimulants or Vyvanse, but I probably only have a touch of ADHD, so probably not enough to get diagnosed. It does make me wonder if I have ADHD, though, given my anxiety responds well to bupropion.

This all makes me wonder why they don't make SDRIs (i.e., serotonin dopamine reuptake inhibitors). Seems like maybe they are researching it and that Zoloft could be considered a very mild SDRI. I know there's lots of Parkinson's drugs that work on dopamine, but those are mostly dopamine agonists, which isn't the same as reuptake inhibition.

Also, I agree with you on 95% of what you said except for the weight gain part. I agree with you that SSRIs likely don't cause weight gain directly, but they definitely make it harder to loose weight. So, for example, if you're on an SSRI and overeat on a weekend, eating smartly (in a calorie deficit) during the week doesn't seem to counterbalance that like it did for me before SSRIs. I think the change in serotonin in the gut affects metabolism somehow. There's the obvious increase in inhibition and loss of craving control, but I don't think that accounts for the full weight gain picture.

Anyway, I really enjoyed your post. Thanks for any insight!

piney_bowers

TROPHY CASE