Desperate for help with choosing antidepressant.

[THP]

Hi all,

I'm a 30 year old guy suffering from terrible depression certainly approaching, if not already, moderate-severe. I experience derealisation to varying degrees everyday. I am exhausted all the time, anxious, shy, lack any motivation and am pretty house bound (and have been for two months now after symptoms have intensified.)

I have resisted medication for so long, other than a short trial with Agomelatine. I was on it for four weeks and found it didn't do a great deal other than mute orgasm (something it's not supposed to do.)

My doctor is suggesting SSRIs. I am TERRIFIED of weight gain. I am very conscious of my body and work out with weights most days to keep in shape. It is an obsession, one which I hope will reduce to a hobby following treatment, but I know me and if I put on weight I will be even more unhappy than I am now, which is a scary thought.

Of course I am also concerned about sexual side effects during treatment and the notion of 'post SSRI sexual dysfunction' worries me even more.

Escitalopram, Sertraline and Fluoxetine are the three medications suggested. Researching all of these drugs online is quite alarming, with suggestions of affects on Testoterone, gynecomastia etc.

Which should I choose in your opinion, taking into account my concerns? And are those concerns irrational fears blown out of proportion by my anxiety and internet propaganda?

Thanks so much for any help and apologies for the slightly hurried and anxious message. I have searched for information on this forum before posting this message but thought some advice specific to my condition would be unbelievably helpful. I'm in a pretty distressed state.

[adreno]

You are not likely to see weight gain, gyno or sexual dysfunction with a low-moderate dose of those SSRIs you mention. I take 10mg fluoxetine, and have none of those.

On the other hand, depression is very detrimental to your health, so I suggest you treat it as soon as possible. An SSRI is an excellent place to start.

[FunkOdyssey]

5mg of escitalopram here and I also have none of the sides you are concerned with.

[Sanction]

And are those concerns irrational fears blown out of proportion by my anxiety and internet propaganda?

5-10 mg of escitalopram has minimal side effects for most people.
Your anxiety is certainly out of proportion to the actual risks.

You won't get lifetime anorgasmia from a 12 week trial of low-dose escitalopram. If the drug doesn't work after 3 months, quit.
If the drug works for you, even a little, then you will be saving your brain cells from degeneration.

[THP]

Thanks guys.

From anecdotal, as well as clinical evidence, it seems Prozac has the lowest risk of weight gain. Is there much difference between that and Escitalopram and would a low dose Prozac be effective?

[Ronnie2011]

Thanks guys.

From anecdotal, as well as clinical evidence, it seems Prozac has the lowest risk of weight gain. Is there much difference between that and Escitalopram and would a low dose Prozac be effective?

5mg of fluoxetine(prozac) was shown to be as effective in depression as 20mg. At higher doses 5-ht2c antagonism may come into play which increase dopamine in certain parts brain. Fluoxetine can also make you more social , you say you are ultra shy . Bear in mind that SSRIs can reduce motivation with long term use but at 5mg that may not be a problem. You say you are anxious and prozac and other SSRIs can increase anxiety in the first few weeks before causing it to diminish/disappear. I would say fluoxetine starting at 5mg a day with something for sleep/anxiety(dont become hooked on it) will help you in a couple weeks and you can raise dose if neccesary for more depression/anxiety relief and any OCD/BDD tendancies you have. Well done for continuing to exercise while suffering, does cardio help your anxiety at all? Good luck

[Sanction]

Is there much difference between that and Escitalopram and would a low dose Prozac be effective?

There is so much individual variation in response to these meds that it's probably impossible to predict yours.
However, at low doses of either of esc or prozac I don't think you'll see any major effect on weight.

You can keep trying to find certainty by combing the internet or M&M for hours and years. The only way you'll know for sure is to take the medication for several weeks and see what happens.

[THP]

5mg of fluoxetine(prozac) was shown to be as effective in depression as 20mg. At higher doses 5-ht2c antagonism may come into play which increase dopamine in certain parts brain. Fluoxetine can also make you more social , you say you are ultra shy . Bear in mind that SSRIs can reduce motivation with long term use but at 5mg that may not be a problem. You say you are anxious and prozac and other SSRIs can increase anxiety in the first few weeks before causing it to diminish/disappear. I would say fluoxetine starting at 5mg a day with something for sleep/anxiety(dont become hooked on it) will help you in a couple weeks and you can raise dose if neccesary for more depression/anxiety relief and any OCD/BDD tendancies you have. Well done for continuing to exercise while suffering, does cardio help your anxiety at all? Good luck

Exercise is great for me, including cardio but not transformative and effects wear off quickly. It helps to keep my body fit and healthy so that I'm at least relieved of stress about my appearance. Weight gain on the SSRIs would really distress me.

[THP]

There is so much individual variation in response to these meds that it's probably impossible to predict yours.
However, at low doses of either of esc or prozac I don't think you'll see any major effect on weight.

You can keep trying to find certainty by combing the internet or M&M for hours and years. The only way you'll know for sure is to take the medication for several weeks and see what happens.

I realise I will never uncover a definitive answer, but rational experience is a great help. Many internet messages boards are alarmist vis a vis SSRi weight gain. I suspect many of them just felt better and ate more. But there is so much anecdotal evidence on respectable sites such as M&M that it's hard to ignore.

I think I'll go with the 5mg or 10mg Fluoxetine option and see how it goes. I'm very worried I don't mind admitting.

[Sanction]

I realise I will never uncover a definitive answer, but rational experience is a great help. Many internet messages boards are alarmist vis a vis SSRi weight gain. I suspect many of them just felt better and ate more. But there is so much anecdotal evidence on respectable sites such as M&M that it's hard to ignore.

I think I'll go with the 5mg or 10mg Fluoxetine option and see how it goes. I'm very worried I don't mind admitting.

Many years ago I actually lost most of my bodyfat on Prozac, probably because I was more active, and Prozac's GI effects put me in the bathroom much more often.

[THP]

Many years ago I actually lost most of my bodyfat on Prozac, probably because I was more active, and Prozac's GI effects put me in the bathroom much more often.

Thanks. Just little anecdotes like that really help.

[THP]

Saw my Doctor. He suggests trying 10mg of Fluoxetine for some weeks. Is this a low enough dose (and is it easy on the sexual sides?) or should I try 5mg first? 5mg seems very low and I'm desperate for remission. Has anyone found 5mg effective?

[kassem23]

Saw my Doctor. He suggests trying 10mg of Fluoxetine for some weeks. Is this a low enough dose (and is it easy on the sexual sides?) or should I try 5mg first? 5mg seems very low and I'm desperate for remission. Has anyone found 5mg effective?

Just give 10mg a whirl, it's a low dose to start with.

[THP]

How often does Post SSRI Sexual Dysfunction occur do we know? Scares the life out of me.

[adreno]

How often does Post SSRI Sexual Dysfunction occur do we know? Scares the life out of me.

I suspect this only occurs when people experience sexual dysfunction on the drug, but continue taking it for years.

[FunkOdyssey]

The irony is that the neurotic anxiety that causes all of this irrational worry about SSRI side effects is precisely what an SSRI would treat if you could man up and take one. We've seen it here repeatedly over the years with people contemplating SSRI therapy.

[THP]

The irony is that the neurotic anxiety that causes all of this irrational worry about SSRI side effects is precisely what an SSRI would treat if you could man up and take one. We've seen it here repeatedly over the years with people contemplating SSRI therapy.

I agree with you, and realise that at least 75% of my concerns are probably related to my anxiety and OCD. I've started the Fluoxetine at 10mg today. I have officially 'manned up.'

[THP]

I agree with you, and realise that at least 75% of my concerns are probably related to my anxiety and OCD. I've started the Fluoxetine at 10mg today. I have officially 'manned up.'

....oh, and I do appreciate the replies and advice. It helps settle my poor frazzled brain during this start up period.

[Grorboj]

some brief dot points -

- your symptoms seem way past the point of worrying about sexual side effects, weight gain etc. You need to get back on track before you worry about this stuff
- weight gain doesnt happen on all drugs and to all people. I found any weight gain can be offset by smarter eating (like cutting down on sugar, bread, pasta etc). Don't, however, also start a hardcore diet at the same time as SSRI. Focus your energy on the most important thing
- most side effects go away in a few months
- be prepared to get a little worse before you get better, as your brain adjusts. I felt terrible when starting fluoxetine - but it ended up being the best SSRI for me. I have found a definite correlation between how bad you feel at start up and how effective the drug will eventually be
- don't just focus on medication as this disempowers you. Also focus on exercise, sunlight, socialisation, meditation, sleep etc

good luck

[THP]

All seems ok so far.

I've looked around this forum, and others, but I wondered what the general consensus is on SSRI affects on Prolactin, Test and hormones in general? Seems they do alter levels, but does this have any meaningful effect on a persons functioning?

Also, should I be able to continue weight training and cutting fat just as easily on Fluoxetine, taking into account the possible hormone changes?