Need advice on medication suggestions for psychiatrist appointment l

Hi guys,

This year has been terrible for my mental health. My depression has worsened and my anxiety and panic levels are at an all time high to the point where I feel like I’m losing my mind. After unsuccessful trials with supplements I finally made an appointment with a psych. I’m sure I’ll be having to take some type of medication, and assuming he’ll probably suggest some type of ssri or srni. Is there any type of medication like this that isn’t as dangerous for us to take? Wellbutrin is not an option as I’ve taken it twice and it’s made my anxiety worse. At this point it seems like I’ll have to take an ssri but worsening of some of my sexual symptoms seems a fair trade for easing the intense anxiety and unease I’ve felt for months now.

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I don’t know how bad your symptoms are, and I don’t know what the right or wrong medications are, but could you benefit from any non medication based treatments?

I’m not trying to offer advice based on anything but the fact that some people find themselves posting here because of anti depressant use. It might be beneficial to consider what alternatives there are if you haven’t already. If you have, apologies for wasting your time.

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yeah try working on diet, look at your vitamin D levels, use cronometer to hit all your basics like calcium, magnesium, b vitamins, potassium, etc. everyday. i feel loads different based on if i eat right or not.

The only anti depressant I would ever consider taking is Amitriptyline. It’s an older style TCA not a selective serotonin reuptake inhibitor. It helps with sleep , chronic pain, depression and anxiety … they will come straight at you with the SSRIs or SSNRIs though, you know the drill

No one on here has ever had issues with it?

You’re not wasting my time, thanks for the reply. I’m very anti medication after propecia but I’m at the point where I think I really need it. Anxiety is so bad I can’t function at work everyday. I think I’ll suggest mirtazapine since a lot of people on here mentioned it helping somewhat. I do see there’s one case of a guy with pssd from it but it still seems safer than SSRIs

I am sorry to hear it’s got so bad for you, LIAustin. I assume you’ve tried meditation, yoga and exercise. If you haven’t tried it with a coach, it might be worth a look. I would look into that before medication. Can you reduce your stress levels at work?

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There are actually pretty many medicines to take. Mianserin, brintellix, agomelatin, mood stabilizers, amitriptyline obviously ect. We havent written so much about them though. We should.

My advice is to be honest and tell about your worries with impotence etc and just let the doctors be doctors and find a medicine which is directed towards your specific problems.

Mirtazipene worsened my PFS and brought new perm sides. Prior to knowing I had PFS I was prescribed paraoxetine which helped for a few years. It raises allopregenolone, lowered levels are what brings on the suicidal thoughts and social problems. I’m not endorsing it at all. Don’t be pushed into a corner. I felt this when I was hanging on to my career and my marriage. I tried numerous SSRIs early last year and each one made me worse. Exercise mindfulness talking therapies, gardening, taking in nature and doing things you once enjoyed help distract. Stay strong

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I just want to update this thread to let y’all know how I’m doing. I’ve been on 5mg lexapro for a month now and I’ve actually had increase hair shedding/itch plus a fuller penis and stronger erections. I don’t know why this would be the case because it supposedly lowers androgens according to this site

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Well, if the theory goes that the (disclaimer: I am not a doctor/scientist/anything else) body is put into a state of androgen silencing VIA over stimulation, it makes sense.

This is a gross oversimplification but it is as I understand it.

Initial crash =
Lower androgens with medication (via 5ar inhibition) -》body adapts to lower androgens, increases sensitivity -》 remove 5ar inhibition -》 androgen levels rise = androgen sensitivity is too high for the body to handle, body “switches off” androgen receptors. PFS.

The bit I don’t understand is where you are now. If the drug you’re taking lowers androgen levels(how, I don’t know) then it makes sense TO ME, that your body would, in it’s oversensitive state find that it can work with the level of androgens better than it was able to before.

So, why can’t we all just lower our androgen levels and be happier? Because unfortunately that is really the exact mechanism that got us here - we are (differently) prone to adaptation under the conditions induced by finasteride and other substances.

In some cases you can expect absolute disaster, we don’t know how to tell if you’ll respond favourably, have your entire life turned upside down or gradually get worse.

Sorry it’s not a happy reply.

You can do some more reading here:

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Thanks for the reply @Greek I wouldn’t be taking this medication unless I felt I absolutely had to. It just got to the point where life was unlivable so I had to do something. Hopefully I don’t end up worse off than I was but it’s been a month so far and increasing my dose has actually made me feel better so I hope I can Maintain how I am feeling. It seems we all react very differently to everything (for example when I took propecia a second time last year my sexual symptoms were all the same but mental problems popped up this time) so I can’t say that everyone will react this way if they feel they need to try some psychiatric medication. Just wanted to share my reaction since I held off so long because of horror stories I read on the site

Just to be clear, I think you’re a good guy and am definitely not criticising you for what you feel you have to do, you’ve been dealt a shitty hand, just like the rest of us. Same team.

The only reason I have to put that stuff up is because some other guy may attempt to emulate you and it may not go so well. Anyone who knew then what they know now would not be here. And part of that is that the risks are not accurately conveyed. By letting people know what the potential outcomes are, we hopefully avoid someone causing themselves problems.

I know I don’t need to tell you that, I’m just explaining, just like you did. We’re all good as far as I’m concerned, if I ever end up in Austin I hope we can get a drink. :slight_smile:

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Hell yeah Brother! I’ll continue to update this thread as I hopefully progress.

Just wanted to update on my progress. I was still noticing the benefits from lexapro (I’m still confused if antidepressants decrease androgen receptor density or androgens themselves?) but as far as mentally it annihilated my anxiety but left me feeling more depressed and demotivated so my doctor switched me to Trintellix. Right now I’m taking both meds (half the dose I was taking of lexapro) in an attempt to taper off lexapro and get on Trintellix and I seem to be back at pfs baseline. I’m almost wondering if it would have been better to stay on lexapro and get the sexual benefits or if it would have worn off anyway. What’s weird is the benefits I was getting (increased penile sensitivity, better erections, higher libido, increased ejaculation force and harder muscles) is the same as if I smoke ALOT of thc in a day. Not sure what the common ground is between the two, if I’m raising estrogen or decreasing AR count or what. Would like anyone’s input.

I saw this thread just now and mate in your next appointment and if youre done with your current course.

Bring up the topic of MAOIs. I have not tried them but a lot of people on r/anhedonia find them helpful.
Do check it out and it might be a good topic to discuss with your doc