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mikrw33
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Member Since Jan 2013
Location: Madison, Alabama, USA
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Default Feb 20, 2024 at 11:57 AM
 
SSRIs and SNRIs in general tend to blunt your emotions. It's a result of increased serotonin levels and downregulated 5-HT2A/5-HT2C receptors, I believe. Serotonin and dopamine have an inverse relationship to each other's levels--when one goes up, the other goes down. Decreased dopamine and increased serotonin is what causes this blunted affect.

Of the SSRIs, both sertraline and fluoxetine are supposed to be least likely to cause this, but it still happens. Just not as badly as with citalopram or escitalopram. The SNRIs also tend not to cause this effect as badly, because norepinephrine reuptake inhibition increases dopamine in the prefrontal cortex. However, most SNRIs are more potent for serotonin reuptake inhibition over norepinephrine reuptake inhibition except for Fetzima (levomilnacipran).

Sometimes bupropion is added to SSRIs/SNRIs to combat this as well as other side effects (such as weight gain, sexual dysfunction, etc.), but bupropion can increase anxiety in some susceptible individuals, so it's not for everyone. Stimulants are an option to add on, but most doctors as wary of doing this.

The serotonin modulators and reuptake inhibitors, Viibryd and Trintellix, also supposedly have less of an impact on emotional "vibrancy." This is because they're both 5-HT1A partial agonists, which causes downstream dopamine release. Trintellix has additional mechanisms of action, such as 5-HT1B partial agonism, 5-HT1D antagonism, 5-HT3 antagonism, and 5-HT7 antagonism, which enhances the release of various neurotransmitters, including acetylcholine and histamine, which have a vigilance-promoting effect and pro-cognitive effect. But Trintellix and Viibryd are also not without their side effects, especially gastrointestinal side effects.

I wish you all the best in finding something that works for you!

__________________
Diagnoses: Tourette's Disorder, OCD, ADHD-PI, Bipolar I Disorder, Borderline Personality Disorder, Anxiety Disorder Unspecified

Medications:
Dyanavel XR 15 mg 30 mg/day
Lamictal 300 mg/day
Cymbalta 90 mg/day
Lunesta 3 mg/night
Dayvigo 10 mg/night
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