Antidepressants that don't induce 3α-HSD

I was wondering if anyone is aware of antidepressants that DON’T induce 3α-HSD (which lowers androgens on a cellular level). I’ve been on Buproprion for close to 2 years at this point, continuing it even after PFS as I did not want to stir things up too much.

I’m not sure of it’s efficacy at this point as I haven’t gone without it after PFS, but I feel like I need something to add to the cocktail to help combat my depression.

I’m currently considering, in this order:

  • Agomelatine (Valdoxan): An atypical antidepressant that acts on melatonin receptors as well as antagonizing 5HT2C and 5HT2B, which increases dopamine and noradrenaline. It’s been shown to be useful in delayed onset sleep disorder, doesn’t affect REM cycles and increases Slow Wave Sleep, something I haven’t had to worry about for a while until a recent head injury. This, to me, looks like the best option currently.

  • Mirtazapine (Remeron): Another atypical antidepressant that is an antihistamine, anti-adrenergic and serotonin antagonist (antagonizing 5HT2C as well as other serotonin receptors). This should help me sleep albeit with bad quality sleep, some members report doing well on it and it could help but I’m not too sure of this one.

  • Vortioxetine (Trintillix/Brintillex): Belonging to a new generation of antidepressants known as serotonin modulators, this is one I consider high risk but I’ve seen some decent success with. I’m not very sure of this considering it does have sexual side effects and has the possibility of worsening my condition long term, but my doctor recommends it based on the fact that it’s been shown to improve cognition in depressed individuals. He has however, god bless him, been very open to my suggestions for what medication to use, so he would be ok with prescribing me other medication as long as I have evidence/rationale to back it up.

If anyone has experience with any of these antidepressants or has had success with other ones, I’d appreciate your input.

IMO with PFS I’d avoid SSRIs and SNRIs. I first had side effects (genital numbness, anhedonia) from short term prozac and cipralex use which lasted years until my first use of finasteride, but I never made the connection and I kick myself every day for that. Anyway the point being, I’d avoid these drugs and explore the other options before even considering them. Any decent pdoc will be open to that, and if yours isn’t, you should find one who is.

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Tried that, did not find it to be effective. Took it before going to bed to help with sleep. Ymmv, I guess you could give it a try.

In any case, super interesting question you are posting here. Maybe someone will come up with some good research to answer. If you do, please post the pubmed link so it will render nicely (great feature of this site).

Do you remember the dose you used? I did use Mirtazipine as a sleep aid before PFS and found that it was much more useful for sleep at low dose. There isn’t a lot of literature to support this, just a bunch of anecdotal reports but when I had used it at this dose (7.5mg) it was impossible to stay awake.

Study about using Mirtazapine as a sleep aid for transient insomnia:

Hey Borax -

In the same boat - cognition, anxiety, depression sides and currently on buproprion. If you have the resources, maybe give neurofeedback a try. I’ve had some success with neurofeedback, and has been nice to have another measurable component to my symptoms against which I can measure progress.

PM me if you’d like to know more.

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Hey guys,

Mirtazapine appears to induce 3α-HSD, although to what degree I am not sure. Just thought I’d drop that here for any serious PFS cases considering it. I might use it as a temporary sleep aid, if so I will report my results.

Vortioxetine is the best choice.
You shouldn’t experience any relevant sexual side effect unlike citalopram/escitalopram.
However the best ssri is paroxetine but side effects are broad.

Which AD do you take? Does it help significantly? If so, with which symptoms?

I took escitalopram because I could not sleep.
I interrupted escitalopram after treatment with clomiphene and anastrozole, I only take lorazepam and oxatomide and now I can sleep very well (8+ hours without interruptions).
However escitalopram is very good for treat anhedonia, emotional blunting, anxiety, slurring speech, memory loss, depression, insomnia, complacency.
The only side effect is a very low libido and a ejaculation problem (it’s very difficult ejaculate, you can have sex with an amazing woman for hours without ejaculate lol).
Vortioxetine is useful like escitalopram but libido remains good.

Have you tried Vortioxetine?

Yeah. It’s very good.

why do you take clomiphene and anastrozole? im considering the first to increase my testostere-production, i reached a new low of 4ng (freeT 10 [10-40]). for how long have u been taking lorazepam?
back to topic: when i was on mirtazapine only, i was several times 5ng total T, rather low E2 and 2,3 tu 2,6 TSH.
when i reduced mirtazapine and added agomelatine TSH dropped to 2 and total T increased towards 6ng.
physically mirtazapine was rather feminizing to me. but mentally its good, i d say nootropic.
agomelatine is like the opposite in me: better shape, but the cognition is less sharp (less deep calculation-skill in chess). though i feel more connected to people in an emotional way (what is this?,oxytocin?,some inderect e2 boost via serotonin??)

Interesting.
I took clomiphene and anastrozole to restart natural testosterone production.
They worked well.
I take lorazepam every night before go to bed.

How long did it take for Vortioxetine to start working for you? Did it help with depression/anxiety? Were they really bad to begin with?

About a week.
It helps a lot with depression and anxiety but also it works great for anhedonia and emotional blunting.
Depression, anxiety and palpitation are awful side effects. You need to treat them asap.
In my case vortioxetine works with a few drops.

ok, i might try clomiphene too.
since when are you taking lorazepam? no tolerance? does your doc say its ok in the long run? because 1mg of this benzo helped me once too, doesnt make me fell buzzed the next day.
what do you guys think of bupropion? is it androgenic? i used it, gave me much more drive, spontaneous erection but also higher bloodpressure and tinnitus well…i had my lowest measured T lever on it.

A few drops? Vortioxetine comes in tablets of 5mg, 10mg and 20mg if I recall correctly.

I have vortioxetine in oral drops (trade name Brintellix).

About 2 years. I have developed no tolerance.
Before clomiphene and anastrozole protocol I ned 2,5 mg of lorazepam to sleep. (now 1,25mg)
For doc it’s ok maybe I could develop some amnesia and memory recall impairment but anxiety, racing heart, depression and insomnia are the worst and they can destroy you very quickly.

thats a nice doc. in my area they are the kind of dogmatics who rather prescribe you 4 ADs than just 1 benzo.even if a good sleep only could fix the problem.
did he prescribe you clomifene too?

Yeah but it’s a off-label treatment.