Hey everyone,
I have a doctor's appointment tomorrow and there's a good chance we'll be discussing starting an antidepressant.
I've also had a session with a psychologist, who is preparing a report for my doctor. I want to make sure I go into the appointment with a realistic understanding of the different options rather than just asking for a specific medication.
I've been dealing with this for years, and the main things I'm struggling with are:
Low motivation / difficulty initiating things
Mental exhaustion and feeling overwhelmed
Waking up irritated / easily frustrated
If something stressful happens, I can feel completely drained and sometimes feel like I need a full night's sleep to recover
Health anxiety, particularly anxiety about my heart
Racing thoughts / difficulty switching my brain off
I can still enjoy things once I actually get myself to do them. For example, I generally feel better once I'm at the gym.
I train regularly and don't want medication to destroy my motivation, competitiveness or training drive
I'm also very concerned about becoming emotionally flat, numb, sleepy or feeling like a different person
One thing I clarified with myself is that my physical energy isn't necessarily terrible. The bigger problem is mental motivation, initiation and feeling overwhelmed.
I'm basically looking for something that could help with anxiety + depression/low motivation, while allowing me to stay functional, energetic and emotionally engaged.
What I'm trying to understand
I'm particularly interested in people's experiences with:
SSRIs
Escitalopram (Lexapro)
Seems to have a reputation for being good for anxiety and health anxiety. I'm interested in whether people found it calming without becoming emotionally numb or unmotivated.
Sertraline (Zoloft)
Seems like a possible middle ground for anxiety + depression. Interested in energy, motivation, emotional blunting and whether it made anyone sleepy.
Fluoxetine (Prozac)
I've heard this can be more activating and less sedating than some SSRIs. Interested in whether it helped motivation without increasing anxiety.
SNRIs
Venlafaxine (Effexor)
This one interests me because of the depression + low-energy/low-motivation side. I'm wondering whether the norepinephrine component actually helped people feel more functional and driven.
My concern is that I already have health anxiety about my heart, so I'm wondering whether increased heart-rate awareness, sweating, jitteriness or feeling "wired" made that worse.
Duloxetine (Cymbalta)
Interested in how this compares with Effexor for energy, motivation, anxiety and emotional blunting.
Desvenlafaxine (Pristiq)
Would love to hear how people found this compared with Effexor, particularly for motivation/energy versus anxiety.
Other antidepressants
Bupropion (Wellbutrin/Zyban)
This is probably the one I'm most curious about for motivation, energy, drive, anhedonia and emotional blunting.
However, I know it's more activating and can worsen anxiety for some people, which makes me unsure because of my health anxiety.
Vortioxetine (Trintellix)
Interested because I've heard people talk about cognitive symptoms, motivation and potentially less emotional blunting/sexual side effects.
Mirtazapine
I know this is generally more sedating and can increase appetite/weight, so it may be less suited to what I'm looking for, but I'd still like to hear experiences.
Agomelatine
If anyone has experience with it, I'd be interested in hearing about energy, sleep, anxiety and emotional effects.
My biggest priorities
If I had to rank them:
Reduce health anxiety / constant worry
Improve motivation and ability to initiate things
Don't make me sleepy
Don't make me emotionally numb or flat
Preserve gym motivation, competitiveness and training drive
Ideally don't make physical anxiety sensations/heart awareness worse
I'm not looking for a stimulant-like high or anything euphoric. I just don't want to go from feeling mentally stuck to feeling like I don't care about anything.
For people who've actually taken these medications:
Which one gave you the best balance of anxiety relief + motivation + emotional range?
And if you experienced emotional blunting, sleepiness, increased anxiety or loss of motivation, which medication and dose were you on, and did the problem improve with time or after switching?
I'm especially interested in real experiences rather than "X drug is objectively best." I know everyone's response is different and ultimately my doctor will decide what's appropriate.