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What antidepressant are you on that minimizes fatigue

Discussion in 'General ME/CFS Discussion' started by Therunningman, Jun 12, 2018.

  1. Therunningman


    I am severe cfs. Mostly housebound. I find on cipralex aka Lexapro at 20mg very toxic to me. I have tapered down to 10mg but still it makes me fatigued and makes my PEM much much worse. I need to switch ssri.

    Yes I realize I’d probably be better off not on antidepressants. With severe CF I have major depression being trapped on a couch 12 hrs a day and cannot cope with this illness otherwise.

    Anyone found a ssri they can tolerate with the least fatigue ?
  2. Mary

    Mary Moderator

    Southern California
    @Therunningman - have you tried 5-htp? It helps the brain produce serotonin. I can't tolerate prescription anti-depressants but do well with 5-htp and it helps me with sleep. I had a friend who was on Lexapro and complained about side effects. I suggested 5-htp, she switched to it and found her energy was better and she felt better.

    Also make sure your vitamin D levels are optimal as well as omega 3's - low vitamin D and low omega 3s contribute to depression.
    adambeyoncelowe and Sancar like this.
  3. Therunningman


    Hi Mary.

    I actually have a 5htp supplement system recommended by my Natropath. He wants me to take it in conjunction with my ssri while I taper down my ssri. I still have not done this after a week or so due to a fear of seretonin syndrome. So I figured I’d try switching ssri first.
  4. Pink

    Pink Senior Member

    Tri state area
  5. Mary

    Mary Moderator

    Southern California
    Okay, although it seems your naturopath should be knowledgeable about how to avoid serotonin syndrome.

    I just wanted to give you a tip - if you are replying to someone, it's a good idea to tag them by putting the @ sign in front of their name like @Therunningman or @Mary, and that way they will get an alert that you have responded to them ;) Or if you hit reply to their post, or select the relevant part of their post, a reply menu will pop up, and they will get an alert as well.
  6. kangaSue

    kangaSue Senior Member

    Brisbane, Australia
  7. Hip

    Hip Senior Member

  8. keenly

    keenly Senior Member

  9. ukxmrv

    ukxmrv Senior Member

    No I've not found one I can tolerate but luckily I don't have depression so was able to try other things for pain.
    Really sorry you are suffering like this and feel so trapped. Quite understand and hope someone can suggest something that helps.
    adambeyoncelowe likes this.
  10. jpcv

    jpcv Senior Member

    SE coast, Brazil
    some people respond well to bupropion, wich is not na SSRI.
    Dr Lapp used to reccomend it and I know a patient who swears by it.
    I have never tried it.
  11. RebeccaRe

    RebeccaRe Moose Enthusiast

    I tried that when I first got sick. It didn't make a huge difference, but it might have helped a tiny bit. I didn't stay on it because any benefit I was getting was was so minimal that it wasn't worth the side effects (not severe side effects, but annoying).
  12. raghav

    raghav Senior Member

    I find Milnacipran very good. Milnacipran blocks reuptake of Norepinephrine and serotonin in the ratio 3:1, which no other antidepressant does. This ratio is the natural ratio of the two in the brain. I pair it with Armodafinil 150 mg which helps in giving me energy.
    adambeyoncelowe likes this.
  13. I use Zoloft (sertraline) and it has a neutral effect. It also helps with sleep, so that actually helps energy a bit.
    My good doc also says that it's usually well tolerated for ME/CFS patients.

    However, what's good for me might be not so good for you.

    At least in my area, you can now get genetic testing that will show which antidepressants might work well for you, vs. trial and error of trying drugs until you find the right one.

    I agree with the suggestions made on supplements - vit. D, omega 3s (aka pharmaceutical grade fish oil), and 5htp. I take the first two and used to take the last one.
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  14. hmnr asg

    hmnr asg Senior Member

    I tried zoloft which did nothing for my CFS.
    I tried Lexapro which also did nothing for my CFS, but the withdrawal caused a major crashed a month later (and this was repeated again when i got back and stopped again after a few months).

    Having said that, i think i crash less often when im on antidepressants. In other words, while being on an SSRI doesn't make me feel better, the frequency of major crashed is definitely reduced for me (it feels that way at least).
    In addition, antidepressants reduce my anxiety so i can rest better, so in that way i think they help with recovery of CFS during a bad crash.
    I also have terrible insomnia and OCD and when im not on antidepressants im just in a constant state of stress, which cant be good for CFS.
    Also when i go into a crash i feel so depressed and being on an SSRI helps a bit with that.
    So i guess antidepressants help, at least indirectly!

    The next one i want to try is Wellbutrin (Bupropion) which is supposed to give you energy and focus (if you dont have CFS), not sure if it would help anyone with CFS. But worth a try for me.

    Oh i also have a prescription of fluvoxamine and i haven't taken it yet but im planning on once I stabilize a bit (currently in a deep crash).

    Last edited: Jun 14, 2018
  15. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

    I found venlafaxine XR (Effexor) to be stimulating for several years. Now it does nothing, but it would be the one I would recommend to try.
    Sancar likes this.
  16. overtheedge

    overtheedge Senior Member

    5-HTP has had a good effect on me, I use it sometimes but I'm usually testing supplements and medicines and want to know what the meds i'm testing are doing and so don't test anything but that one med at a time otherwise I'd have taken a lot more 5-HTP in my time

    One of the reasons I've never tried Rx antidepressants has been because of the awful withdrawal effects that sometimes come with getting off of such medications, I asked my functional medicine doc what she thought about prescription antidepressants and she warned me that some of them can be really difficult to taper off of so I looked it up online and sure enough I found quite a few posts by people who had to go through some terrible stuff to change meds and others who cant get off their meds at all because the withdrawals are just too much. Depends on the drug though but if I ever do go after such an antidepressant I'll read about it in detail first

    I've found L-theanine to induce relaxation and overall good feeling, another thing like 5-HTP that I havn't used long term...yet but every time I've tried it Ive felt rather spectacular

    Here is some stuff from my digital notes, haven't tested much in these antidepressant sections so I can't really attest to the veracity of most of this stuff but maybe the data and the ideas about ways of testing and using these will help you folks out.

    From cfs treatment guide, 2nd edition
    Loss of appetite, like many upper GI problems, is most common during acute phases of the illness. The inability to eat, although sometimes misdiagnosed as "anorexia," is not due to an aversion to food but, in most cases, can be attributed to sympathetic nervous system arousal. Norepinephrine, which is released during sympathetic activity, suppresses the appetite. This is, in fact, how most appetite-suppressing medications work. It is very difficult to eat when one has no appetite, so during phases of sympathetic arousal, weight loss is very common. Herbs, such as kava, valerian, and skullcap, have a calming effect and can be drunk as teas throughout the day. Magnesium is a potent down regulator of sympathetic arousal and has a long track record as a CFS/ ME treatment. The amino acid taurine is neuroinhibitory, and can act to stabilize the autonomic nervous system. Acetyl-L-carnitine is probably the most effective supplement for increasing appetite. It has been marketed as a weight-reduction supplement, but when taken during acute stages of CFS/ ME, it has the reverse effect due to carnitine's important role in energy metabolism. Once energy is increased, appetite improves. Medicinal marijuana, although used to stimulate appetite in cancer patients, is not recommended. Patients report that it increases sympathetic arousal, worsening all related symptoms.

    From Treating and Beating Fibromyalgia and CFS:
    for increasing GABA: L-theanine has been shown to increase Alpha waves, which are associated with meditative states of mind. Individuals taking Ltheanine report feeling calm and relaxed. Research with human volunteers has demonstrated that L-theanine creates its relaxing effect in approximately thirty to forty minutes after ingestion. Recommended dose of L-theanine is 100– 200 mg. taken as needed, or two to three times a day on an empty stomach.

    Most people will notice an improvement in mood symptoms within a couple of weeks of starting 5-HTP. However, a minority find that after being on 5-HTP for several weeks or months, their improvement starts to taper off. This is most likely due to an increased awareness of deficiency in their other neurotransmitters— such as norepinephrine, GABA, or dopamine. If this happens to you, add 200– 1200 mg. of SAMe once or twice daily on an empty stomach. I have a small percentage of patients who don’t notice much improvement on 5-HTP. If this happens, I recommend that they add St. John’s Wort to their 5-HTP therapy.

    Always treat deficiencies in the calming amino acids ( 5-HTP, GABA, or L-theanine) first before supplementing the energizing ones (L-phenylalanine, DL-phenylalanine, or SAMe).

    (for depression) The ideal dose of St. John’s wort is 300 mg. of standardized 0.3 hypericin. I usually don’t start my patients on St. John’s wort initially, though. They begin the Jump-Start Program and the appropriate amino-acid replacement therapy based on their Brain Function Questionnaire. If they aren’t responding as quickly as I’d like, I’ll add St. John’s wort.

    Below are from online posts, if i remember correctly some of the things the posters say conflict with one another, was hoping to sort it out if I ever tested out 5-HTP more thoroughly, if anyone has found stuff here to be true or false I'd love to hear about it

    The "maximum safe dosage" span for 5HTP is generally regarded to be 12 weeks (with daily supplementation), mostly because after this it has been shown to lose efficacy. There haven't been any studies that have definitively shown any adverse effects when 5HTP is taken daily for longer than 12 weeks, but this doesn't mean that they are not completely out of the question or that the 5HTP will continue to work for you as well as you would like after these 12 weeks. My recommendation would be to try and avoid using the 5HTP when you feel it is not necessary and to take short breaks (1/2 to a whole week) every once in a while. This should help keep the 5HTP from losing its efficacy and it, in theory (assuming you don't currently experience any adverse effects), should also help prevent any inconvenient side effects from developing down the road.

    The problem today with 5-HTP-selling companies bypassing doctors and going to laymen, is that a lot of health enthusiasts with problems who are enthusiastically taking 5-HTP are NOT taking Carbidopa, but they ARE taking a lot of B6 in one form or another. Yet without Carbidopa, more than a few milligrams of extra B6 per day would be expected to insure that most dietary 5-HTP gets turned into serotonin before it can get into the brain.

    It has been shown that excessive 5-HTP can cause heart valve damage much in the same scenario as the naturally occurring carcinoid syndrome.

    At present, it is not recommended to take 5-HTP supplements for more than 12 weeks at a time without a break. Long term use of 5-HTP (up to a year) has been done in controlled clinical studies. However, use for this amount of time is not currently recommended for the general public, unless directed by a doctor.

    5-HTP should not be mixed with herbs that are natural relaxants or supplements that work by increasing serotonin levels.

    Kava, catnip, hops, and valerian fall into the first group; l-tryptophan, SAM-e (S-adenosylmethionine), and St. John’s wort fall into the latter.

    Why 5-HTP Is Not a Long-Term Solution
    Another factor to consider is that 5-HTP is not intended for long-term use.

    When taken for more than a few months, it loses its effectiveness.

    This is due to a see-saw effect between serotonin and other brain chemicals. (22)

    While 5-HTP is boosting serotonin, it happens at the expense of other neurotransmitters, specifically dopamine, norepinephrine, and epinephrine. (23)

    So prolonged use of 5-HTP will ultimately have you trading in one brain chemical balance problem for another.

    5-HTP is converted to serotonin by aromatic L-amino acid decarboxylase (AAAD). The problem is that enzyme is found in your stomach and periphery. If you do not inhibit it in your stomach, then a portion of your 5-HTP will get converted to serotonin in your periphery. Since serotonin cannot cross the blood brain barrier, it will remain in the periphery and can cause issues with your heart valves and digestion.

    Taking vitamin B6 with your 5-HTP just speeds up this process. Ideally you would take a B6 supplement in the morning, then dose your 5-HTP at night to avoid this.

    To inhibit AAAD, you should always take EGCG (green tea extract) with your 5-HTP. EGCG has been shown to be a good inhibitor of L-amino acid decarboxylase.

    You also need to take into consideration that AAAD is also responsible for creating dopamine from L-DOPA. If you are constantly saturating that enzyme with 5-HTP, your dopamine levels can fall. So I would only suggest 5-HTP short-term, or dosed along side an L-tyrosine supplement.

    So either 5-HTP with EGCG, short-term.

    Or 5-HTP with EGCG and L-tyrosine long-term.

    from article #2 "In summary, there is no evidence to implement 5-HTP intake as a cause of any illness." nonetheless, PwnX's statement about cardiac fibrosis is true in theory. 5-HTP increases blood serotonin levels much more than L-Typtophan and SSRIs. although no case of cardiac fibrosis has been directly linked to 5-HTP use, extended use of 5-HTP makes it more probable..

    Every time I took 5HTP, I felt like shit afterwards. Combined with the fact that it can be deadly when taken with alcohol, I stopped taking the stuff soon after I started.

    Some people report that the benefits of 5-HTP wear off with time (after several weeks or months of use) while others are able to take 5-HTP for years without any problems and ongoing beneficial results. The only way to know this is to try it!

    after several days or weeks of use is that you start feeling tired, and in that case (according to Ray Sahelian MD, author of 5-HTP: Nature's Serotonin Solution) this is a sign you should probably take a break from 5-HTP for a week or two. (Dr Sahelian recommends taking a break of a week every 1-2 months, regardless, simply as a precaution against any this type of adaptation and any other possible longer term effects.)

    Dr Sahelian specifically says he is not aware of any reports in the medical literature of anyone who has encountered a life threatening, toxic, or other serious adverse effect from using 5-HTP. That seems to be pretty generally agreed, though you might encounter some reports of previous safety issues with L-Tryptophan, also a popular serotonin supplement.

    The entire cardiac fibrosis thing is theoretical, AFAIK it has never been observed directly. Just take it with EGCG if you are afraid, it might even potentiate it.

    I have been on 5-HTP off/on for 2 years now. I find it an incredible help with my depression battle. I react very badly to SSRIs (foggy mind, weight gain, suicidal thoughts etc.) so I sought an alternative. This stuff is incredible. I normally start feeling the positive effects within 48-72 hours, and it continues to increase for 7-10 days when it balances out and I'm at the ultimate level.

    I am taking 300mg per day (100 in the morning, 100 early afternoon, and 100 before bed) and find that ideal and it is as listed on the bottle. I was experiencing some of the side effects noted on this blog with the first batch I bought which was in capsule form. I then found an enteric coated version, which dissolves in the small intestine versus the stomach, and have not had any further problems. For anyone else in Canada: The Life Brand enteric coated tablets from Shoppers Drug Mart are by far the best I have found. For those outside of Canada: look for an enteric coated version, and I all but guarantee you'll get all the benefits without the stomach upset etc.

    A side tip: 5-HTP metabolises more efficiently with a normal to high level of B vitamins in your system. If you are finding that you're not getting the effects you need or expect, try taking a B-50 or B-100 complex as well, and it will give a boost to your results that is noticable (a multi-vitamin is fine too, so long as it has a decent about of B-vitamins).

    I have been using 5-HTP for the past few years (50mg tablet per day), especially during the winter months, and overall it's been perfect for me. Definite side effects in the first couple of weeks but not after that. Recently though I started taking the 5-HTP patches instead because it feels like the tablets are wearing off. The patches are much better for me as the 5-HTP lasts steadily through the day and the effect seems to last much longer.

    Another thing, I don't think it is mentioned above but I've read that Rhodeola, the adaptogen, has decent serotonin focused effects so anyone already taking serotonin type meds might want to avoid it
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  17. perchance dreamer

    perchance dreamer Senior Member

    My sleep doctor told me that Wellbutrin can cause REM to occur at the wrong phase of the sleep cycle.
  18. Sing

    Sing Senior Member

    New England
    Tyrosine at 500 mg in the morning before any food and give it at least a half hour, is what I use. That can lift Seasonal Affective Disorder off me in the winters. It is the dopamine precursor. Why it is important not to eat with food is that it doesn’t compete well and will be turned into some other amino acid. I learned about the value of Tyrosine over 20 years ago from someone in the Depression field, who never mentioned it in talks because it is a very cheap supplement. Twice that dose could be ok too. The only possible side effect, according to one doctor who had patients on it or who had tried it is a slight tendency towards a headache.
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  19. Learner1

    Learner1 Administrator

    Pacific Northwest
    Most psychiatric meds either deplete nutrients needed for mental health (like folate) or they damage mitochondria, or both. Either is likely, in the long run, to increase fatigue.

    Though there are genetics that can predispose one to various mental health issues, environmental triggers have a large role to play, like food allergies/intolerances, micribiome imbalance and leaky gut, heavy metals and nutrient depletion, especially of B vitamins, amino acids, and certain lipids.

    Three good books thst describe these issues and what one can do about them are:

    A close family member had a serious mental illness and was cured by an excellent ND using the approach you were saying your ND is recommending, along with avoiding food allergies and fixing the gut. It was far more effective than the 9 psychiatric drugs that 20 MDs prescribed that almost caused a suicide.

    And these approaches are also helpful in improving ME/CFS, though I'd be careful with tryptophan - there are many other effective strategies.

    Best wishes...:hug:
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  20. valentinelynx

    valentinelynx Senior Member

    Bupropion (Wellbutrin) is a commonly used antidepressant that has stimulant-like properties. I was taking it many years ago, while in medical school, and thought it's primary effect was it's stimulating one.

    As someone mentioned already, venlafaxine (Effexor) along with other SNRIs (serotonin-norepinephrine reuptake inhibiitors), such as desvenlafaxine (Pristiq), duloxetine (Cymbalta), and milnacipran (Savella) tend to have a more stimulating effect. I believe this effect varies with dose, however. At lower doses, I think you get more norepinephrine effects and stimulation, and higher doses can cause more sedation. Again, I used to use Effexor, for many years. It had a curious effect sometimes of stimulating me for a few hours and then causing profound drowsiness. I'm sure there is a tremendous amount of individual response to these kinds of medications. I had to stop taking Effexor because of this class of drug started to cause hypertension in me (a common side effect).

    A third class of antidepressants that is distinctly stimulating are the norepinephrine reuptake inhibitors (NRIs). Drugs in this class are used for ADHD and narcolepsy due to their stimulant effects. These include atomoxetine (Strattera) and reboxitine (Edronax—not available in the US, but I ordered some to try). I found these too stimulating: they caused me anxiety. But this is a common problem for me—stimulants tend to make me anxious. Bupropion (see above) is a norepinephrine-dopamine reuptake inhibitor and also works on nicotine receptors (and is used to help with nicotine cessation).

    Hope that is of some benefit.

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