Antidepressant Meds

Has someone got success stories with this transition?

The first year on Zoloft went good, I felt no extreme lows, didn't cried once. What I can't say about the next year. I won't say much, but felt like a crying mess at times. Although I had some conflicts in college, and was totally unsatisfied with the way I was living, I tend to think it had not as much to do with the reality of the situation as with the drug wearing off.

What's interesting is that despite the apparently disastrous mood I've had lately, Zoloft has still done a good job of removing my shyness and social awkwardness.

Some new research out of Amsterdam finds that running regularly with a group achieves the same anti-depressant effect as anti-depressant medication.

The catch: they study is inconclusive about solo running (perhaps not even studied). You must run in a group to get some certainty of the effects and you can’t slack off.

I looked up a few papers and tables and found different perspectives. Generally, citalopram is allowed in the range of 20-40 mg, and zoloft 50-200. In one table, it was stated that the starting dose of citalopram is 20 and zoloft is 50, which is quite logical. From that, I can infer that 100 zoloft is 20+20 = 40 mg of citalopram, but it looks quite doubtful because 40 is the max dosage.

Furthermore, I found one study in which citalopram and zoloft were compared in the ranges of 20-40 and 50-100 respectively. In another study, they were 20-40 and 50-150. I’m still a bit confused. I took 40 mg for a couple of days and it didn’t strike me with a surge of apathy, but I felt it definitely more potent than just 100 mg of zoloft.

What are antidepressants?

Antidepressants (ADs) are drugs that make you feel less miserable. They are supposed to cure depression, apathy, abulia, anxiety (where they overlap with anxiolytics), OCD and other mental woes. Sometimes they do, but they also come with various side effects.

SSRIs - selective serotonin reuptake inhibitors. There are six main SSRIs (fluoxetine, sertraline, citalopram and escitalopram, fluvoxamine, paroxetine). The most famous and prescribed drugs. Many people benefit from them and they are probably the best ones to start with. A common side effect of all serotonin ADs is the loss of libido, or in plain words, the inability to get it on.

(S)NRIs - more powerful ADs that regulate not only serotonin but also norepinephrine. Examples are venlafaxine, duloxetine, milnacipran. They work effectively, but their side effects/withdrawal are somewhat worse.

Tricyclics - one of the first antidepressants. Their chemical structure has three cycles with a tail, hence the name. They act as powerful SNRIs, but with additional effects on histamine, cholinergic and other receptors. Very effective, but have a lot of side effects and are very dangerous in overdose. In most countries are represented by amitriptyline, as well as clomipramine and imipramine. There are also doxepin, trimipramine etc.

SNDIs - act on norepinephrine and dopamine. Apart from bupropion there are not many of them.

MAOIs (monoamine oxidase inhibitors). Inhibit the enzyme that breaks down serotonin, norepinephrine and dopamine. There are two classes, reversible and irreversible (as well as affecting MAO-A and MAO-B)

• Irreversible MAOIs. Examples are phenelzine, tranylcypromine, isoniazid, isocarboxazid, selegiline. Some of the most powerful antidepressants, but also serious side effects. Absolutely not to be taken with SSRIs and other serotonin drugs because of the terrible serotonin syndrome, as well as cheese because of the tyramine syndrome (severe blood pressure rise).
• Reversible MAOIs - widely represented by moclobemide. Not the strongest ones, but their side effects are mild. With SSRIs, however, it is better not to mix.

Various antidepressants (mirtazapine, trazodone, vortioxetine, agomelatine, etc.). Act on different mechanisms and differently.