Posted by Cam W. on January 5, 2001, at 7:07:51
In reply to Re: Cam...what say you., posted by stjames on January 5, 2001, at 1:50:06
> > James, buddy - I thought you might drag me into this one ;^)
>
> Well, I could spend a lot of time finding primary supporting docs
> or I could just ask you ! What is not important is that I am right or wrong.
> What is important is that information I post is correct, this issue weighs on
> me from time to time. This is a good post, I would like to use it in the tips
> section.
>
• James, feel free to use any of my posts in the tips section; except the one's where Dr.Bob is giving me sh**.
;^)
>
> > Now, when one starts taking a serotonergic antidepressant (SSRI - remember, for simplicity sake, we are talking about a subtype of depression that responds to a serotonergic antidepressant) the amount of serotonin in the brain (between nerve cells) increases. This causes a chain reaction of events to occur. Beta-receptors are downregulated; postsynaptic serotonin receptors are changed; amounts of different neurotransmitters begin to return to normal, etc. These changes take time to occur, as the body readjusts to a more "normal" complement of serotonin. In the meantime, the serotonin added to the system acts like excess serotonin, due to the compensatory changes of the other neurotransmitter systems, as well as changes to the complement of various serotonin receptors. The start-up side effects are caused by serotonin being added to a compensated (depressed) system (kinda like throwing gasoline on a fire - throw enough on and the fire goes out - I know it's a bad analogy, but I hope you get the picture). As time passes (2 to 8 weeks), the neurotransmitter systems readjust to pre-depressive levels and hopefully the depression has resolved. Then you need to stay on the antidepressant for another 9 months to retrain the body to work at this "normal" level, again.
>
> James here.....
>
> I have read that reuptake happens almost at once after starting an AD, if this alone improved mood AD's would work by the first week. It is common to think you just need
> more serotonin but the process to the end result is far more complex than that, which accounts for the time lag in improved mood.
>
• Then you start adding in the hormone axis and the 50 to 100 other neurotransmitters (neuomodulators, neuropeptides, transcription factors, secondary messengers, receptor subtypes, etc, etc). All of these systems (and some that have not be elucidated, yet) must be taken as a whole to see the entire picture. A reductionist view, whereby you look at one or two neurotransmitters &/or receptors (eg serotonin, norepinephrine reuptake) tells you very little of what is actually happening. This is what the drug companies peddle, though; I believe for simplicity sake (and lack of full scientific knowledge).
>
> > Full effect of an antidepressant, depending on one's body chemistry can take a long time. I believe that everyone taking an antidepressant will have ongoing improvement past the point of what is considered response, or even remission. Where this improvement stops is, at this point unknown (except that it is probably very individual in every person).
>
> James here.....
>
> Over 16 years I have found some times you need less or more. Sometimes you need something different. There is no way to know how much is enough, therefor how normal you can feel, so I keep upping the dose till I discover the correct amount. Several times I thought I was doing excellent only to find an improvement at a higher dose. There is no way to know the full possible effect and side effects unless you have been there. There is also danger in being less than well. I have been through several breakthru depressions in the last 10 years that are significant as I do not leave the house. Looking at my chart my doc saw a pattern of 300 mgs Effexor after a depression, then over years the dose moved to 150 mgs with a depression a year or so after. Perhaps we ( I say we because I was mostly the one who lowered the dose; but my doc supports this) were helping cause these depressions. may only concern about Effexor is that it is a powerful SSRI, esp. at 300 mgs, which does me no good. My mood responds to meds than effect the noradergeneric system. I am waiting for the next SNRI to be on the market.
>
• Maybe also wait for a drug that effectively regulates CRH (CRF) or some other component of the HPA axis. Or, better still, a drug that can directly modify aspects gene transmission. I believe that the next ten years are going to be exciting. I have all but given up on the serotonin/norepinephrine interactions as mechanisms for antidepressant action (but then again, I seem to have a short attention span). Currently, these drugs are the best we have and without them depressed people did worse, so I guess we should be lucky we have them.
>
> > Also, during that year psychotherapy (which I also think is essential in "curing" a depression) can actually work because one is able to understand what the therapy is trying to do. Depression affects attention and cognition. In most cases, antidepressants are need to "put the floor under one's feet" (as was so aptly said by someone on this board) so that the depressed person is able to work with the therapist on what caused the depression in the first place.
> >
>
> James here....
>
> With me I did psychotherapy first and then meds. I wish I would have done them together.
> With me there is no doubt there is an underlying medical condition that needs to be treated for my mood, attention and cognition to function correctly. Also I have no doubt that the psychotherapy made a big difference. I now have better tools to works with now that I am not depressed. I fully believe that in some people psychotherapy alone may be enough. We also know short term use of meds and therapy is more effective than either alone for those that don't have chronic issues. I think everyone should do 3-6 months of therapy. Therapists have a global view of behavior than no one can hope to have.
>
• Too true, my friend.•Keep me thinking guys; you're the best thing to happen to my career since a research prof took me under his wing 18 years ago (Dr.David F. Biggs, a therapeutics prof, taught me how to think). - Cam
poster:Cam W.
thread:50902
URL: http://www.dr-bob.org/babble/20001231/msgs/50947.html