Hi All, I’m after some input as to antidepressants and interactions with rapa for clinical depression. Does anyone have any recommendations for discussion with doctor and researching appropriateness? That doesn’t cause other side effects like weight gain.
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Matt Kaeberlein mentions that rapamycin has been used for depression with ketamine in the Attia, Sabatini and Kaeberlein discussion on rapamycin.
*Impact on mental health: fascinating results of Matt’s survey of people who use rapamycin off-label go to [1:56:00]
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People have discussed rapamycin and ketamine in the past here…
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Looking for something a little less hard core and mainstream.
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Cohen
#5
I used to be on vortioxetine. I liked it, it has helped me to stop paroxetine. No side after a few days
KarlT
#7
The interaction between Sirolimus and SSRI’s is minimal, especially when Rapa is taken weekly. I take both and have not had any problems.
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Jonas
#8
Are SSRI neuroprotective? Is duloxetine a better SSRI?
Cohen
#9
I think that fluoxetine could have neuroprotective effects. Duloxetine is an SNRI.
Cohen
#10
The earliest antidepressants are paradoxically the most effective, particularly for atypical and treatment-resistant depression. However, there is a risk of orthostatic hypotension if the dosage is increased too rapidly, and you might get very high blood pressure if foods high in tyramine are consumed. This risk might be exaggerated, as modern food processing typically results in much lower tyramine levels compared to the 1960s.
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I believe fluvoxamine (Luvox) is one of the only SSRIs that doesn’t cause weight gain.
In most people SSRI doen’t cause weight gain.
Cohen
#13
Measurements:
Prescription data determined initiation of treatment with sertraline, citalopram, escitalopram, fluoxetine, paroxetine, bupropion, duloxetine, or venlafaxine. The investigators estimated the population-level effects of initiating each treatment, relative to sertraline, on mean weight change (primary) and the probability of gaining at least 5% of baseline weight (secondary) 6 months after initiation. Inverse probability weighting of repeated outcome marginal structural models was used to account for baseline confounding and informative outcome measurement. In secondary analyses, the effects of initiating and adhering to each treatment protocol were estimated.
Results:
Compared with that for sertraline, estimated 6-month weight gain was higher for escitalopram (difference, 0.41 kg [95% CI, 0.31 to 0.52 kg]), paroxetine (difference, 0.37 kg [CI, 0.20 to 0.54 kg]), duloxetine (difference, 0.34 kg [CI, 0.22 to 0.44 kg]), venlafaxine (difference, 0.17 kg [CI, 0.03 to 0.31 kg]), and citalopram (difference, 0.12 kg [CI, 0.02 to 0.23 kg]); similar for fluoxetine (difference, −0.07 kg [CI, −0.19 to 0.04 kg]); and lower for bupropion (difference, −0.22 kg [CI, −0.33 to −0.12 kg]). Escitalopram, paroxetine, and duloxetine were associated with 10% to 15% higher risk for gaining at least 5% of baseline weight, whereas bupropion was associated with 15% reduced risk. When the effects of initiation and adherence were estimated, associations were stronger but had wider CIs. Six-month adherence ranged from 28% (duloxetine) to 41% (bupropion).
Conclusion:
Small differences in mean weight change were found between 8 first-line antidepressants, with bupropion consistently showing the least weight gain, although adherence to medications over follow-up was low. Clinicians could consider potential weight gain when initiating antidepressant treatment.
https://www.acpjournals.org/doi/10.7326/M23-2742
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