Exactly, stops you from going to pee thus helps me massively to sleep through cause i pee like a horse normally, not every 20-30 minutes but just drink a lot and with a SGTL2 in play you will just urinate more frequently in general
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bananafeet
Member
You know that continuously peeing could mean your kidneys are not shutting off because you're not hitting the proper sleep stages. I had that issue before I started CPAP machine.
Might be unrelated....
Yep good point but they are fine, i just pee a lot and have a small bladder unfortunately. Prostate is also good togo
I've only ever been on tirzepatide while on mirtazapine, but it works just fine for me on a low dose of tirzepatide. That's interesting that you've noticed a difference. Is it quite a marked one?
bananafeet
Member
Yes. Hunger is still there and the stomach doesn't get totally stopped.
But it's still early days. I'll leave a comment when I spend a month at 3mg per week (previous highest dose of sema).
I think it would probably counter the effects of GLP1 more than GIP. But that's just me bro sciencing. Be good if other people give it a whirl.
bananafeet
Member
Great lecture on PMDD. I find that any video over 6 years old in YouTube is great. The older the better.
Everything turned to shit on YouTube recently.
View: https://youtu.be/-5ras3wcbAc
I know this is female specific, but the neurology carries over.
Everything turned to shit on YouTube recently.
View: https://youtu.be/-5ras3wcbAc
I know this is female specific, but the neurology carries over.
bananafeet
Member
View: https://youtu.be/2Nydy3PeRdE
It seems MAOI's can be used to lower blood pressure. I wonder if it has any benefit for bodybuilders who have mood disorders/hypertension AND high blood pressure.
I am looking into these two compounds:
Phenelzine
Tranylcypromine
There are less sexual dysfunction with this class of drugs which is relevant to me because I still get some sexual dysfunction on sertraline. Mirtazapine helps but any dose of sertraline north of 50mg is touch and go.
The atypical antidepressants or antidepressants that have less sexual side effects usually don't work too well in more severe cases of depression.
Caveat: I have not personally used these drugs, but I have researched them extensively.
Phenelzine is notorious for causing sexual dysfunction, if you search through user experience reports on forums, Reddit, etc. Of course, the people who don't experience SD don't complain about it on the internet, but it is reported significantly more than tranylcypromine.
Tranylcypromine seems more like a mixed bag, like any other antidepressant.
Talking of hypertension, you need to be aware of the risk of hypertensive crisis if you consume tyramine rich foods, such as cured meats and aged cheese. So you have to be aware of your diet. A workaround to this is to take nortriptyline, which eliminates the risk, according to Dr Gillman.
Also, you absolutely cannot take sertraline or any other SSRI while on an MAOI, or it will cause potentially fatal serotonin toxicity.
If you want to know more, Kenny G is the world leading expert on them. He knows what he is talking about and debunks many myths and untruths about them on his website
PsychoTropical Research by Dr Ken Gillman
Critical independent evaluations in psycho-pharmacology - Expert commentary on Monoamine Oxidase Inhibitors and Serotonin toxicity
www.psychotropical.com
bananafeet
Member
Yeah copy. Guess I'll give Vortioxetine a spin first then. Thanks for the info bro.Caveat: I have not personally used these drugs, but I have researched them extensively.
Phenelzine is notorious for causing sexual dysfunction, if you search through user experience reports on forums, Reddit, etc. Of course, the people who don't experience SD don't complain about it on the internet, but it is reported significantly more than tranylcypromine.
Tranylcypromine seems more like a mixed bag, like any other antidepressant.
Talking of hypertension, you need to be aware of the risk of hypertensive crisis if you consume tyramine rich foods, such as cured meats and aged cheese. So you have to be aware of your diet. A workaround to this is to take nortriptyline, which eliminates the risk, according to Dr Gillman.
Also, you absolutely cannot take sertraline or any other SSRI while on an MAOI, or it will cause potentially fatal serotonin toxicity.
If you want to know more, Kenny G is the world leading expert on them. He knows what he is talking about and debunks many myths and untruths about them on his website
PsychoTropical Research by Dr Ken Gillman
Critical independent evaluations in psycho-pharmacology - Expert commentary on Monoamine Oxidase Inhibitors and Serotonin toxicity
That bloke gives some great info on dopamine. Seems like the discussion around depression isn't complete without it. Anti depressants are actually anti anxiety meds due to the dopamine issue.
gainslol
Member
Zolpidem (Ambien) has an interesting use.
It's a sleeping pill but it has this paradox where sometimes it can wake some people up from a coma.
View: https://medium.com/beingwell/the-strange-paradox-of-how-a-sleeping-pill-can-awaken-you-from-a-coma-b01263c537d4
It's a sleeping pill but it has this paradox where sometimes it can wake some people up from a coma.
View: https://medium.com/beingwell/the-strange-paradox-of-how-a-sleeping-pill-can-awaken-you-from-a-coma-b01263c537d4
gainslol
Member
There's also Cimetidine the old heart burn medication, it can remove stubborn warts and reduce the pain of shingles.
And Sumatriptan, the migraine drug, for sexual function. In some people it causes spontaneous ejaculation though, you may want to skip it during family gatherings.
And Sumatriptan, the migraine drug, for sexual function. In some people it causes spontaneous ejaculation though, you may want to skip it during family gatherings.
Although he's an expert on MAOIs, there are some things he doesn't really know what he's talking about. For some reason he really has a hate hard-on for mirtazapine. He thinks it's just an antihistamine and is unaware of its noradrenergic potency and serotonin receptors blocking properties
One other MAOI worth considering is selegiline. If you take it in a high enough dose orally, or sublingually, it becomes a full MAO-A and MAO-B inhibitor, and there are very few reports of sexual dysfunction. If you take a low dose <10 mg, it is a selective MAO-B inhibitor which can increase dopaminergic transmission modestly while avoiding the need for dietary restrictions or SSRI contraindications. This could be enough to give you a little dopamine lift
The other dopaminergic option is bupropion which, again, modestly increases transmission. Not just dopamine, but noradrenaline as well. I am prescribed it myself in conjunction with mirtazapine, and I do notice the mood lifting and motivation increasing effects of it
Interesting. I'm definitely going to look into sumatriptan to see if it has any evidence of improving delayed orgasm/anorgasmia
bananafeet
Member
I watched pretty much all his videos. He's a fellow aussie. Well he lives in my state at least but was obviously raised in Britain.
He gives the entire history of these drugs. I think he has a bit of a skewed view on things which he admits because he was given basically the most hopeless and treatment resistant cases.
The drug you mentioned buproprion I have on hand, I haven't taken it because it can false positive on drug tests as amphetamines. It's probably impossible to get prescribed off label because in Australia it's only indicated for smoking cessation. The interesting thing about buproprion is that its used with a SNRI to get the full range of catecholamine/neurotransmitters increased and is called "Californian Rocket Fuel" which is obviously a head nod to hydrazine the first antidepressant which was a rocket fuel.
Anyway I will keep the MAOIs as a last option. I have noticed at 25mg of sertraline and 60mg of mirtazapine my sexual dysfunction is pretty much gone. I don't like taking that much mirtazapine so I will lower it and see what happens. A final point on Sertraline is that it appears to be the only dopaminergic SSRI, which is probably why it's so popular and doesn't have the "parkinson like" side effects the others do.
This dopamine issue is probably why I like tren and cabergoline. I also wonder if masteron is dopaminergic because I do like that steroid too.
This guy also states that Selegiline is basically not worth the trouble and that's why it's not popular.
It's interesting that all these medications are basically out of production or in limited production but still available from India.
If you're concerned about drug testing, tranylcypromine will also show up as a false positive for amphetamine. Selegiline actually metabolises into trace amounts of levoamphetamine and levomethamphetamine. However, a false positive should not be an issue because it will be picked up as such when sent on to the lab. The levorotatory enantiomers of amphetamines will also get a pass at the lab because they are available in over the counter nasal spray medicines for congestion. They only care about dexamphetamines.
Bupropion is also only indicated for smoking cessation here in the UK too. A GP wouldn't prescribe it unless they are experienced in using it for other indications. Mine is prescribed off label by my psychiatrist without any issue though.
In theory, lowering mirtazapine to 45 mg should be fine, as 5-HT2 receptors are already fully saturated at that dose. But theory and reality are often completely different. I would be interested to know the result of your experiment.
At normal doses, the dopamine transporter occupancy of sertraline is negligible and would have almost no therapeutic effect. It has several orders of magnitude greater binding affinity to the serotonin transporter. That's just a load of marketing guff.
Dr Gillman is correct that selegiline is a less potent MAOI than tranylcypromine or phenelzine, but I would wager it's still far better than other antidepressants. I will soon be trying low dose MAO-B selective selegiline for myself to see what its dopaminergic effects are like and also for its neuroprotective properties.
bananafeet
Member
I've had numerous different sources say the complete opposite about Sertraline. Some say it increases dopamine other say it doesn't.
There is a study in rats showing it was the only SSRI to meaningfully increase dopamine: Sertraline increases extracellular levels not only of serotonin, but also of dopamine in the nucleus accumbens and striatum of rats | 10.1016/j.ejphar.2010.08.026_SciHub
"Only sertraline administration increased extracellular dopamine levels compared with vehicle, fluvoxamine, and paroxetine administration in the nucleus accumbens and striatum. This result is the firstreport of in vivo experiments, although it had been anticipated fromthe in vitro experiments. Fluvoxamine and paroxetine administrations had no effect on extracellular dopamine levels.Previous reports described that sertraline has the moderate affinity for dopamine transporters (Sánchez and Hyttel, 1999;Owens et al., 2001) and has the ability of dopamine reuptake inhibition (Goodnick and Goldstein, 1998). It is likely that this dopamine reuptake inhibition by sertraline is one mechanism bywhich dopamine increases in the nucleus accumbens and striatum. Muneoka et al. (2009) reported a tendency for acute administration of sertraline to increase dopamine in the nucleus accumbens tissue, but that finding was not statistically significant."
Anyway my experience with Sertraline is as follows:
50mg solo - delay orgasm
100mg solo - delayed weak orgasm, reduced sensation
150mg solo - impossible to orgasm, no sensation
12.5mg Sertraline + < 30mg Mirtazapine - restored sexual function, brain zaps and agitation around 18 hour mark
25mg Sertraline + < 30mg Mirtazapine - restored sexual function
50-100mg Sertraline + 30mg Mirtazapine - delayed orgasm, orgasm weaker, less sensation
100-150mg Sertraline + 30-60mg Mirtazapine - very delayed orgasm, less sensation
I'm going to try 25mg Sertraline + 7.5mg Mirtazapine. It seems as tho as soon as the Sertraline hits a certain dose it over competes or overpowers Mirtazapine.
I noticed lowering Sertraline also reduced my sleep quality. Emotional blunting goes hand in hand with the anorgasmia. Seems to be related.
I think Vortioxetine is one of the only other sane choices out of these medications?
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Results of in vitro and animal studies often do not translate to humans. As far as I'm aware, there are no human in vivo dopamine transporter occupancy studies of sertraline. Sure, it's possible that there could be some meaningful dopaminergic effect, but I wouldn't pin your hopes on it.
The additional 5-HT1A partial agonism of vortioxetine is what ameliorates delayed orgasm. You can think of it (and vilazodone) as an SSRI with buspirone built in. You can replicate the effect by adding buspirone to your sertraline if it's more convenient, less expensive or more available to you. As I mentioned in an earlier post, I have personally used buspirone to not only reverse delayed orgasm, but also increase sensitivity. But that's just me, it may work differently for you. But, to answer your question directly, vortioxetine is certainly a sane choice to consider. You may, however, still require mirtazapine in order to block the 5-HT2 receptor meditated effects.
Do you mean that when you added mirtazapine to sertraline to reduce delayed orgasm it also reduced emotional blunting? And still retained full antidepressant efficacy? That is a very interesting finding indeed. It would imply emotional blunting could be linked to 5-HT2 agonism.
Also, what is the minimum dose of sertraline that has produced meaningful antidepressant effect for you? I've been curious for a while if low dose SSRIs produce any therapeutic effect. There is a widely held theory that a minimum ~60-80% receptor occupancy threshold must be reached before any effect is felt at all.
bananafeet
Member
I really need the anti anxiety effects. I would say that with Sertraline to get the best anti anxiety effects it's around 150mg in me. Smallest effective dose is somewhere between 25 and 50mg per day....
Yes I've personally found the emotional blunting and anorgasmia/reduced sensation are one and the same. It's like you either choose your brain to work or your sex organs.
I totally forgot about buspirone... It's a great option.
Thanks mate for that info, much appreciated and very interesting.
Yeah, if you can get it, definitely give buspirone a go – it should help with both anxiety and anorgasmia.
bananafeet
Member
No worries. I've switched to AM dosing of Sertraline so I can sleep through the brain zaps of a lower dose. Also keep in mind the sexual stuff is also the reflex. It's hard to explain but the reflex to orgasm is pushed further and further away as the dose increases. I've read this is related to dopamine and the spinal cord reflex.
I think there is a conspiracy by big generics to keep us with old, out of patent, cheap drugs instead of fancy new expensive ones.
Jokes aside. Apparently pharma companies don't bother researching new products because the SSRIs are so cheap and effective. In Australia Vortioxetine was rejected from PBS funding because there is no side by side comparison with older drugs. So they basically said sorry we won't fund this when cheap generics are available. The pharma company obviously won't study it along side existing SSRIs for obvious reasons. The PBS doesn't really care if my sex life is optimal unfortunately.....
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