Posted by Brainbeard on July 29, 2009, at 16:13:22
In reply to 5HT Receptors, posted by Meltingpot on May 17, 2009, at 11:35:34
Hello there,
Answering your real question is too difficult for me without tedious research, but..
I've been on Seroxat too. The withdrawal was so bad that I promised myself never to take an SSRI anymore. Still, seversal years later, my p-doc pursuaded me to try fluvoxamine (Luvox). It was a completely different SSRI! I have also tried clomipramine and Prozac, and am on sertraline (Zoloft) now. I have learned meanwhile that the SSRIs are actually drugs with very different chemical profiles if you go into the details. They all do SRI, but after that, the roads depart. This is why trying another SSRI can always help.
An attempt at summarizing the different pharmacological and experiential profiles:
* paroxetine/Seroxat/Paxil: strong SRI, also anticholinergic effects (dry mouth!) and H1-antagonism; some affinity for dopamine receptor and also noradrenergic effects; both sedating and activating, can induce (hypo)mania; of all the SSRIs the most likely to induce weight gain in the long term
* fluvoxamine/Luvox: stronger affinity for 5HT3-receptor, which means more initial nausea but more eventual anti-anxiety and anti-OCD (at least in theory..); most sedating of the SSRIs.
* sertraline/Zoloft: some affinity for dopamine reuptake pump, Stahl has even called it a SDRI; activating profile; strong SRI -> strong serotonergic side-effects (sexual, nausea, diarrhoea)
* citalopram/Celexa: one enantiomer is highly selective for 5HT, the other one is counterproductive; affinity for H1 receptor; can lead to faster weight gain; reportedly good for depression + anxiety
* escitalopram/Lexapro: most selective of the SSRIs (only Celexa's good enantiomer); very strong SRI, yet a good side-effects profile; like Celexa, reportedly good for depression + anxiety
* Prozac/ fluoxetine: least selective of the SSRIs; is actually a more potent 5HT2C-blocker, thereby raising dopamine and noradrenaline levels; metabolite is stronger SRI than mother-drug and has an exotic long half-life of more than a week; very strong 2D6-inhibitor -> drug interactions!!; both activating and sedating.
I found fluvoxamine to be too apathizing, until I added the clomipramine. Paxil/Seroxat made me hypomanic and fat, eventually, and the withdrawal depression was worse than my initial complaints. Prozac was pretty cool in low doses (5-10mg), but it made me gain weight fast. I'm on low dose Zoloft right now, just 25mg, and I think it's not bad - though I combine it with low dose Geodon, Buspar, the occasional modafinil, selegiline, amisulpride and tianeptine, and daily bits of imipramine and amitriptyline.
I think the SRI most subjectively close to Seroxat might actually be Effexor, but that drug seems to have an even worse withdrawal syndrome.
poster:Brainbeard
thread:896245
URL: http://www.dr-bob.org/babble/neuro/20090701/msgs/909188.html