Milnacipran - completely stopping my brain fog

[hurray]

How about:
- Levomilnacipran (if I can get it here, which is different to milnacipran)
- Venlafaxine

Have any members had success with either of these (I don't see much in the search history for these, from anyone that has had success).

Given levomilnacipran's similarity to milnacipran, I would be fairly surprised if it didn't work in my case.

It is the levorotatory enantiomer of milnacipran, and has similar effects and pharmacology, acting as a serotonin–norepinephrine reuptake inhibitor (SNRI).

https://en.wikipedia.org/wiki/Levomilnacipran

I've tried duloxetine and venlafaxine, there's a bit about them on page 3 of this thread:

https://poiscenter.com/forums/index.php?topic=3312.30

They did have some effect on my POIS, but the side-effects were so strong for me that I couldn't tolerate them. They stay in your system for about 24 hours, and its very easy to become dependent on them. I wouldn't recommend them to anybody.

[Laotzu1980]

Ok, thanks for that reply Hurray.
I gave Amitriptyline another try, without taking any other vitamins this time, and with food as well, and the result is actually not bad. Today is my first day of POIS, and it is actually manageable. I would say symptoms are at least 60% better, and I can communicate with others relatively well.
Actually last time was similar; the reason I did not notice it fully is due to one side-effect of the drug being that it makes you really tired and groggy. I slept about 11 hours last night, best sleep in a long time (people use this drug for insomnia too) but it has kept me tired and groggy the next day (still, 5 pm now). There is definitely a noticeable reduction in brain fog, concentration, social anxiety, and the headache is less than usual.
The fact that it does help quite a lot with symptoms is uplifting, and it does lead me to believe that this 'type' of drug may be the correct one (for me), so Milnacipran or other SNRIs may be helpful too. Overall far better today than normal POIS. Having such a good sleep may also be at play here, and it could even be the sleep more than the drug, but either way it is the drug that helped to have such a good sleep.
Let's see how tomorrow (POIS day 2) goes.
That's all for now. Thanks again for everyone's help, and all suggestions for drugs to trial are welcome.

[hurray]

Ok, thanks for that reply Hurray.
I gave Amitriptyline another try, without taking any other vitamins this time, and with food as well, and the result is actually not bad. Today is my first day of POIS, and it is actually manageable. I would say symptoms are at least 60% better, and I can communicate with others relatively well.
Actually last time was similar; the reason I did not notice it fully is due to one side-effect of the drug being that it makes you really tired and groggy. I slept about 11 hours last night, best sleep in a long time (people use this drug for insomnia too) but it has kept me tired and groggy the next day (still, 5 pm now). There is definitely a noticeable reduction in brain fog, concentration, social anxiety, and the headache is less than usual.
The fact that it does help quite a lot with symptoms is uplifting, and it does lead me to believe that this 'type' of drug may be the correct one (for me), so Milnacipran or other SNRIs may be helpful too. Overall far better today than normal POIS. Having such a good sleep may also be at play here, and it could even be the sleep more than the drug, but either way it is the drug that helped to have such a good sleep.
Let's see how tomorrow (POIS day 2) goes.
That's all for now. Thanks again for everyone's help, and all suggestions for drugs to trial are welcome.

Good news with regards to your amitriptyline results.

I've said some negative things about duloxetine and venlafaxine (and deservedly so), but their effect on my POIS was what led me to try milnacipran. I remain convinced that it is the norepinephrine reuptake inhibition component of milnacipran that nullifies my POIS symptoms.

If milnacipran hadn't worked for me, I would have gone on to try other sNRIs (selective norepinephrine reuptake inhibitors, as opposed to SNRIs, which are serotonin-norepinephrine reuptake inhibitors) and NRIs.

[Laotzu1980]

For sNRIs, Wikipedia only shows these 2: Reboxetine and Atomoxetine. You mean you would have tried those?

Atomoxetine is sold under the brand name Strattera and was first approved for medical use in the United States in 2002.[1] Its indication is for the treatment of attention deficit hyperactivity disorder (ADHD) in kids over 6 years of age, adolescents and adults.[2] Atomoxetine selectively inhibits norepinephrine reuptake by blocking the presynaptic norepinephrine transporter(NET) in the brain. Research has suggested that it also inhibits the reuptake of serotonin by binding to the selective serotonin transporter. However it is not known whether the therapeutic effects of atomoxetine is due to its blockage of the NET or both norepinephrine- and serotonin transporters.[1]

Reboxetine is the active ingredient, sold under the brand name Edronax.[3] Reboxetine is a selective norepinephrine reuptake inhibitor and acts by binding to the NET and block the reuptake of norepinephrine in the extracellular fluids. Its indication is for acute treatment of depression or major depression disorder. Reboxetine was first approved for marketing in Europe in 1997, however, in the United States its application for approval was rejected.[4]

[hurray]

For sNRIs, Wikipedia only shows these 2: Reboxetine and Atomoxetine. You mean you would have tried those?

Atomoxetine is sold under the brand name Strattera and was first approved for medical use in the United States in 2002.[1] Its indication is for the treatment of attention deficit hyperactivity disorder (ADHD) in kids over 6 years of age, adolescents and adults.[2] Atomoxetine selectively inhibits norepinephrine reuptake by blocking the presynaptic norepinephrine transporter(NET) in the brain. Research has suggested that it also inhibits the reuptake of serotonin by binding to the selective serotonin transporter. However it is not known whether the therapeutic effects of atomoxetine is due to its blockage of the NET or both norepinephrine- and serotonin transporters.[1]

Reboxetine is the active ingredient, sold under the brand name Edronax.[3] Reboxetine is a selective norepinephrine reuptake inhibitor and acts by binding to the NET and block the reuptake of norepinephrine in the extracellular fluids. Its indication is for acute treatment of depression or major depression disorder. Reboxetine was first approved for marketing in Europe in 1997, however, in the United States its application for approval was rejected.[4]

I've tried atomoxetine with no success. However, one poster called Cornelius claimed that his POIS was cured, and he took Strattera. Unfortunately, some people reacted negatively to his claims, and he ended up deleting his post and leaving the site. His thread is still here:

https://poiscenter.com/forums/index.php?topic=226.0

I would have tried reboxetine at some point had milnacipran not been so effective for me. Amitriptyline and Ritalin both have an NRI component, as do many other medications.

[Laotzu1980]

Okay, got it. Thanks. It looks like Reboxetine will be next on the list then to try, if it's available here. Thanks for the link too, I will check out the Cornelius post now.

[Laotzu1980]

Today the neurologist prescribed 4 different medications to test as a pre-pack only.
I will do a thread search, but if anyone has any experience with the below meds, please feel free to comment (I will not treat it as medical advice, but will show the doctor anything relevant). Unfortunately the meds I was hoping for (Levomilnacipran, Reboxetine, Atomoxetine etc, were not in stock at the hospital).

I have been given to test, separately (testing one at a time), 1 hour before O, the following:

- Venlafaxine (this one I asked him for)
- Propranolol (Beta-blocker)
- Topiramate (brand Topamax)
- Valproate (Depakine brand)

Since there was about a 40% improvement in cognitive symptoms with the Amitriptyline, he suggested to try taking an extra half or whole pill to see if it makes more difference. Given that I only tested it at a relatively small dose of 25 mg, so I may give that a try again too.

Surprisingly he read some article about POIS in the few days I had seen him last to try to understand more about it, so that was at least something. He even had it open and prepared on his iPad when I arrived, without knowing I would visit him today.

Will report back.

[Quantum]

Surprisingly he read some article about POIS in the few days I had seen him last to try to understand more about it, so that was at least something. He even had it open and prepared on his iPad when I arrived, without knowing I would visit him today.

Will report back.

A very dedicated neurologist.  He must be an intelligent and kind person

Let us know about the results of your different tests!

[Laotzu1980]

Thanks Q. Will report back. 

[Laotzu1980]

Just logging result.

Venlafaxine (75 mg), taken 1.5 hours before O, has done nothing, as it seems now (the following morning). In extreme POIS, so will be 4-5 days before I try the next option.

[Laotzu1980]

Hurray, what was your experience with Venlafaxine? I am surprised it did absolutely nothing for me considering the Amitriptyline had about a 40-50% symptom reduction. You mentioned the Venlafaxine (among others) led you to Milnacipran, so I wonder how much it helped you?
Did you ever try a Beta-blocker? Since there was some help with the Amitriptyline, I may try the Propranolol Beta-blocker he gave me combined with Amitriptyline (small dose of 25 mg). My blood pressure is high, so a Beta-blocker may be useful.

[hurray]

Hurray, what was your experience with Venlafaxine? I am surprised it did absolutely nothing for me considering the Amitriptyline had about a 40-50% symptom reduction. You mentioned the Venlafaxine (among others) led you to Milnacipran, so I wonder how much it helped you?
Did you ever try a Beta-blocker? Since there was some help with the Amitriptyline, I may try the Propranolol Beta-blocker he gave me combined with Amitriptyline (small dose of 25 mg). My blood pressure is high, so a Beta-blocker may be useful.

Outside POIS, venlafaxine had strong mental side-effects for me. It put me in a kind of stupor where I wasn't fit to drive. It was difficult to gauge my mental state on venlafaxine, but I did notice that my POIS felt different on venlafaxine. SSRIs hadn't helped me in the past, and venlafaxine is 30 times more selective for serotonin than norepinephrine. I figured maybe the norepinephrine component had helped, tried milnacipran which is equally selective for serotonin and norepinephrine, and to my surprised it worked.

I've tried propranolol without success, but hopefully you'll have more luck.

You mentioned having high blood pressure, milnacipran is known for raising blood pressure. If you or somebody else decides to try milnacipran in the future, be very very careful and do it under a doctor's supervision, as you know high blood pressure can increase the risk of having a stroke.

[Laotzu1980]

Thanks for that Hurray, and for the warning. I am conscious of the blood pressure side effect of these meds and am careful, taking only the lowest doses.
Anyway I won't touch Venlafaxine again, as it did nothing for me.
Next test will probably be to combine the Amitriptyline, of which there was a noticeable reduction in symptoms, with the Beta-blocker Propranolol, which lowers blood pressure and heart rate - so it will be interesting.
Will report back. Glad to know you still have success with Milnacipran. 🙂

[Muon]

https://scholar.google.nl/scholar?hl=nl&as_sdt=0%2C5&q=anti-inflammatory+antidepressants&btnG=

[berlin1984]

I'm curious if anyone has felt those interactions with sodium like me:

I don't feel good at all today. Headache, weakness, brain fog ...

I started Milnacipran ca 6 days ago. (still doing Safran, Ashwagandha).

The can-not-stand-and-need-to-sit-down feeling that normally goes OK after eating salty snack + sugary isotonic drink did not go away.

Now I read on the internet that Milnacipran and SSRIs/SNRIs can create salt deficiency (sodium deficiency, hyponatremia)

https://www.hilarispublisher.com/open-access/use-of-milnacipran-in-a-patient-with-hyponatremia-under-the-cover-of-fludrocortisones-2165-7920.1000308.pdf

I feel slightly better after taking an electrolyte mix and also taking some salt separately. 
I won't take the second 25mg Milnacipran dose today.

Thanks

[hurray]

I'm curious if anyone has felt those interactions with sodium like me:

I don't feel good at all today. Headache, weakness, brain fog ...

I started Milnacipran ca 6 days ago. (still doing Safran, Ashwagandha).

The can-not-stand-and-need-to-sit-down feeling that normally goes OK after eating salty snack + sugary isotonic drink did not go away.

Now I read on the internet that Milnacipran and SSRIs/SNRIs can create salt deficiency (sodium deficiency, hyponatremia)

https://www.hilarispublisher.com/open-access/use-of-milnacipran-in-a-patient-with-hyponatremia-under-the-cover-of-fludrocortisones-2165-7920.1000308.pdf

I feel slightly better after taking an electrolyte mix and also taking some salt separately. 
I won't take the second 25mg Milnacipran dose today.

Thanks

I've sometimes wondered if lack of salt is one of the factors that influences my POIS. I generally have some food before O, mostly meals including salt, but I don't specifically eat salt to stop POIS.

Interesting to hear that you're trying milnacipran, I hope that you have some success with it. It sounds like you're taking it every day? I've tried that and it works, but I prefer taking it "on demand".

[Laotzu1980]

Glad there is another member trialing it.

Berlin:

- did you take it every day or only before O?
- how many O's did you have within that 6 days?
- how many hours before O did you take the pill?
Off memory Hurray reported that even taking it a few hours before left him with some symptoms.

[berlin1984]

I'm taking it because I thought it could help my orthostatic intolerance. I told the doctor that Safran and Ashwagandha (and salt and fluids) already help but I want to try something stronger.
I asked for an antidepressant, he reluctantly wanted to give me another one but I managed to get Milnacipran because I was thinking about the forum here and thought maybe it also fixes POIS 
I think he has no idea about orthostatic intolerance (I did not use this word to describe it) actually.

I am trying to take it daily 25mg.
I had only one trial orgasm where I took an additional 25mg 2h before masturbation.
To be honest it does not change my POIS problems on day after (pain/anxiety when waking up, superb fatigue in evening after) much. At this moment, at least the pain clears up nicely with coffee and the anxiety with Aswgagandha and Safran.

So I don't think Milnacipran will be so useful to me.
I'm now more thinking of getting this doctor to prescribe me propranolol. I'll follow up in the relevant thread, might take some time because I'm also evaluating other things :-(

I'm even at a point where I say POIS is only a minor part of my problems, if I can fix the big problems then POIS might fix automatically with it or is easily manageable for me.

[hurray]

I'm taking it because I thought it could help my orthostatic intolerance. I told the doctor that Safran and Ashwagandha (and salt and fluids) already help but I want to try something stronger.
I asked for an antidepressant, he reluctantly wanted to give me another one but I managed to get Milnacipran because I was thinking about the forum here and thought maybe it also fixes POIS 
I think he has no idea about orthostatic intolerance (I did not use this word to describe it) actually.

I am trying to take it daily 25mg.
I had only one trial orgasm where I took an additional 25mg 2h before masturbation.
To be honest it does not change my POIS problems on day after (pain/anxiety when waking up, superb fatigue in evening after) much. At this moment, at least the pain clears up nicely with coffee and the anxiety with Aswgagandha and Safran.

So I don't think Milnacipran will be so useful to me.
I'm now more thinking of getting this doctor to prescribe me propranolol. I'll follow up in the relevant thread, might take some time because I'm also evaluating other things :-(

Very interesting, thanks Berlin. From an anti-depressant perspective, I'd say that SNRIs like milnacipran act more powerfully than straight SSRIs, in my experience at least. Something to consider if the side-effects are hard to tolerate. I couldn't live with venlafaxine or duloxetine. I've tried taking milnacipran for a few weeks at a time and it takes away anxiety without dulling my thoughts or turning me into a happy vegetable 

UK doctors generally start off with something like sertraline (SSRI).

I'm even at a point where I say POIS is only a minor part of my problems, if I can fix the big problems then POIS might fix automatically with it or is easily manageable for me.

This seems like a really good insight. We're a POIS forum, so most of what we write about is based around POIS.  But many of us have other health conditions beside POIS. Even if we meet our ultimate goal of stopping POIS, many other problems may remain. Or as you say, fixing the other problems could lead to POIS being cured.

[hosien2008]

Milnacipran is not available in Iran. Is there a similar drug?