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.