I remember being told to watch out for side effects when switching from an SSRI (Trintellix) to a RIMA (Manerix), which is essentially a de-fanged MAOI. Younger psychiatrist kept pushing for the brand-new SSRI, I kept pushing back. Never mentioned anything else despite my attempts to open the discussion, and my own research (and in fact, experience thanks to darknet markets) over years.

Eventually "agreed to disagree" (I hate this expression), I moved on from that place where I was stagnating in pain, and found a sensible knowledgeable psychiatrist who happens to be much older, and we made the switch.

It's hard to understate how much of a change that was in my life. I try not to be bitter about any fresh new psychiatry grad on the block, but I really hope they get their shit together as a collective and observe what their own patients (and their older peers) seem to know better than them.

No matter how much tyramine I ingest (which is supposed to be a no-no on MAOI/RIMA) the worst side effects I suffer can't even get anywhere near what the SSRI would TYPICALLY do to me.

On Trintellix: morning headaches, being unable to have any caffeine, becoming lactose intolerant, frequent cramps and diarrhea. Depression very very mildly alleviated. Transition period when stopping the meds: 2 weeks. Cost of monthly refill: $110 CAD.

On Manerix: some cramps if I ingest gigantic amounts of tyramine (I'm french, I'm talking cured meats+cheese plates and red wine bottles in the same meal). Could be back to coffee and milk with no headaches nor cramps within a couple weeks. Depression mostly alleviated. Transition period when stopping the meds: 2-4 days. Cost of monthly refill: $30 CAD.

Oh and the kicker? Manerix is actually one of the few antidepressants that actually has a chance to "increase libido" as a side effect!

I'm glad someone wrote a good article on what I've been hoping to articulate in different places over time, thanks for the share.