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Re: Effexor Tolerance - Mark

Posted by Elizabeth on May 10, 1999, at 9:25:34

In reply to Re: Effexor Tolerance - Mark, posted by Mark on May 10, 1999, at 2:09:47

> The difference between addiction/withdrawal and
> discontinuation is important. Addictive
> substances like Ativan and Dexedrine (very
> often used in psychiatry) exhibit tolerance
> (you need more drug for the same effect)
> and nearly immediate withdrawal symptoms that
> can be dangerous.

Hmm. It depends which effect you're talking about when you say people develop "tolerance" to them. To the best of my knowledge, the anxiolytic and antipanic effects of Ativan and the anti-ADD effects of Dexedrine generally persist without dosage creep. People using these drugs to get high will probably develop tolerance to the euphoria, though. Tolerance also builds up to sedation from Ativan and to appetite suppression from Dexedrine (again, if I recall correctly). But then again, one also can develop tolerance to the side effects of antidepressants; for example, nausea from Luvox, or elevations in systolic BP from Parnate (personal experience).

In regard to withdrawal syndromes: I won't debate Ativan, as it's true that it can cause seizures if discontinued abruptly. But about Dexedrine -
you might be interested to hear a quote that is kind of funny in retrospect. I had stopped taking Parnate because of an apparent adverse reaction. About two days later I saw my psychiatrist. He said: "You look awful! You look like someone who's coming down from a cocaine binge!" I thought this was a wacky thing to say, and I did some reading about cocaine and amphetamine withdrawal syndromes. The descriptions I read sounded very familiar. Not only did they resemble my Parnate "discontinuation syndrome," they also resembled the severe and refractory depression I developed after Nardil pooped out (except that I didn't have REM rebound as long as I stayed on Nardil, obviously - though that would have been the least of my troubles).

There are a couple of reports in the literature of people abusing large doses of MAOIs with no apparent cardiovascular problems, BTW. One assumes they had even nastier withdrawal symptoms, comparable to - well, perhaps to the sort of thing one experiences when coming down from a cocaine binge. I also imagine that for people who take moderate doses of Dexedrine, missing a day might be similar to what happens when I skip a day of Parnate (not horrible, but not pleasant either).

And as for treating the "symptom" versus the "disorder:" I disagree. I don't believe you can make this generalization. I think Ativan or Xanax is a fine treatment for panic disorder since they treat both the core symptom of panic attacks and the peripheral symptoms of anticipatory anxiety, phobic avoidance, etc. Similarly, it seems to me that Dexedrine a reasonable treatment for attention deficit hyperactivity disorder, in that it helps people with attention problems, hyperactivity, and impulsivity. (It's also a good treatment for narcolepsy.) I also found buprenorphine (which I'm guessing you would probably class as an "addictive" drug even though it has only a mild and delayed withdrawal syndrome - and of course opiate withdrawal is a classic example of "unpleasant but not life threatening") to be a very good treatment for major depressive disorder (except for the side effects, which were nasty). Am I misunderstanding what you mean when you say that antidepressants treat "the disorder?"

Well anyway, I don't think the difference between "addictive" and "nonaddictive" substances is as clear-cut as one might like.




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