Posted by Cam W. on June 9, 2001, at 15:12:59
In reply to Re: Response to Cam, posted by gilbert on June 9, 2001, at 14:35:10
> - Yes, I have heard of several suicide deaths from from overdoses of benzodiazepines mixed with alcohol, resulting in respiratory depression. Also, more people have died from taking taking overdoses of benzodiazepines alone (granted, it is rare), while people who have taken massive overdoses of SSRIs alone have recovered without any problems. There have only been a few deaths reported in which someone has died from ingesting overdoses of SSRIs alone, but less than 10 worldwide (I believe).
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> I can overdose on most of my blood pressure meds and certainly taking a bottle of beta blockers won't keep you breathing too long but no stigma with those. Also very very hard to predict how many suicides take place because of use of either of the above mentioned drugs. I think spontaneous suicidal ideation is a listed side effect on most ssris. Now a toxic dose of the drug did not kill them but what about the drugs effect on their decision to take their own life. This will not show up in a toxicology report but we all know the web is full of this data....some of which are not Christian Scientists sponsored web sites.....LOL
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• SSRIs do not induce a change in a person's thoughts toward suicide. I believe that the suicidal tendencies are in place before the person takes the SSRI. The drug alleviates some of the depressive symptoms, including increased energy, where the person is more able to act on their suicidal thoughts.
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> > As to considering the side effects profiles, the top ten side effects listed for any SSRI usually describe the start of side effets of these drugs, and disappear within 2 weeks in a vast majority of people.
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> If that were true this board would be non existent. Look at these posts week after week month after month almost all are side effect related most of which are long time users of ssris
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• The people on this board are no where near the number of people who take SSRIs and we tend to hear much more from people who are having problems with the SSRIs. Besides, the long term side effects that we hear about on this board are pretty much the same handful, as with any effective antidepressant (sexual dysfunction, apathy, lack of energy, etc.).
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> > The body has adjusted to a lack of serotonin by altering the mix of the other neurotransmitters. With an increase in serotonin, as a result of taking an SSRI, one must expect that the body would have to readjust the mix of other neurotransmitters, hence, the start up side effects.
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> Are you sure this is what happens. The med research I have read isn't even really defining how other neurotransmitters are effected. They don't even know why wellbutrin works. If the predictable of brain chemistry were so certain we could just dose by body weight and everyone would have the same results. SSRI's have such an array of effects on people certainly the same cannot be said for other classes of drugs not to the same extent. Very unpredictable...physically and emotionally not to mention spirituallly.
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• I am absolutely positive that the concentration of other neurotransmitters change when you change one of them. This has been shown time and again in many of the geek journals (eg check out some of the journal articles under the neurotransmitter section of http://www.neuroscion.com ). I do not believe that this change in neurotransmitter &/or concentration of specific receptors results in alleviation of depressive symptoms and a reconnection of the HPA axis, but is one part of a more wholesale changes that results from this initial increase in a specific neurotransmitter. I think that there is something going on inside the cells with second messengers relaying different information to produce variations in what mRNA is produced and thus what signals, (in the form of proteins, enzymes) that cell sends out. This could have something to do with the altering of the sensitivity of ACTH receptors in the adrenal gland; perhaps changes in concentration and sensitivity of glucocorticoid receptors; &/or changes in adrenal gland corticosteroid output. Also, hypothalamic changes in the output of CRH or pituitary output of ACTH could mediate the renormalization of the HPA axis, thus alleviating depressive symptoms. There is no need to stop here, though. Other endocrine systems are probably involved. It would be silly to think that altering on neurotransmitter would effect all of the changes that occur when one goes from a depressive state to a euthymic state. The body does not work in such a reductionist way. Play with one part of the system and you are playing with all of them.
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> > If the depression/anxiety did not result in a decrease of serotonin and you add an SSRI, then, yeas, you are going to get side effects associated with excess serotonin. These side effects are similar to the start-up side effects and really, the only way to tell the difference is (sometimes) the intensity of the side effect and if the side effect does wane over 2 to 3 weeks.
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> Cam I really respect your intelligence and committement to this board but this whole lack of seratonin theory came to be the most popular theory once the ssris came into play. Look at the efficacy of lithium isn't it like thirty some percent for unipolar depression. All the other mood stabilzers and now all of a suddeen the anti pyschotics are back with a vengeance soon we will have a new thoery to supprot use of these meds it gets to be like squeezing the stepsisters foot into cinderellas slipper...if by chance the drug works then we come up with biochemical theories to explain why the slipper should fit... I really think we just don't know why some of this works. How does lithium effect seratonin. To belay every new physiological disorder with a mental twist to seratonin deficiency is getting old. OCD, Depression, Panic, Social anxiety, PMDD, Agressive Behaviour, Sexual Preditors, on and on. It seems to me the seratonin pharmacuetical companies have really done their jobs. That is not to say they have not helped millions I know they have.
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• Yes, lithium does cause changes in in neurotransmitter signalling. Lithium interferes with the phosphoinositol pathway, which changes intracellular calcium ion levels (at the nerve cell wall and from the endoplasmic reticulum), thus changing the responsivity of the cell membrane to electrical signals. Basically, lithium calms the cell from firing sporatically and evens out the flow of electricity down an axon.
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> > Let's compare side effets profiles (in no particular order):
> >
> > Rivotril™ (clonazepam - Klonopin™ -U.S.)
> > Most Common - CNS depression in approx, 50% of people, respiratory depression, aggressiveness, argumentative behavior, hyperactivity, agitation, depression, euphoria, irritability, forgetfulness, confusion, nystagmus, unsteady gait, slurred speech, dysarthria, vertigo, palpitations, gynecomastia, hallucinations, muscle weakness, low back pain, increased appetite, nocturia, hypersecretion in upper respiratory tract, urinary retention, enuresis....
> >
> > Prozac™ (fluoxetine)
> > Start-up side effects - headache, nervousness insomnia, anxiety, emotional lability, nausea, tremor, dizziness, diarrhea/constipation, myalgia, flu-like sympoms, anorexia.....
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> > Long-term side effects - decreased libido, anorgasmia, increased appetite, excessive sweating, fatigue, twitching, change in accomodation, acne, back pain, joint pain, dry skin, urinary tract infection, painful menstruation....
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> > Choose your poison. (ref. Compendium of Pharmaceuticals and Specialties, 2000).
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> Last but not least Cam we all know the side effect profiles you have just listed are not the real world just a sample of some people at some point in time with questions asked by the drug companies marketing people. Look at the change in ssri sexual dysfunction from what is listed. It is the way the questions are asked and by whom. Anyone who has tried differernt classes of drugs can tell you from personal experience the side effect lists are bogus. As for side effects dissapating over time there has been some very serious side effects associated with long term ssri use in "some" individuals. I don't want to scare people who are having success with them God Bless Them I would be willing to take the risk as well if they worked for me. They are not benign to overdose either. I know most people who overdose do so on a mix of narcotics and benzos or booze and benzos not just benzos. You can OD on booze and Luvox too if you try. The whole point is that once again it sounds like you justify ssri use based on brain chemistry and a chemical imbalance.... if it were that simple they would draw blood diagnose and dose us up. That benzo use is just a mask for symptomolgy. What about gaba shortage...Now I have also worked with addicts and alcohlics for a good 20 years and most people still kill themselves the good old fashioned way.....on booze. Slowly or quickly.
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• Agree with everything that you are saying, but depression is a set of disorders which have a common manifestation, the depressive symptoms. Some people react to medications and their depression becomes worse. Obviously the breakdown of the HPA axis is at a different point than in someone for who that medication works. Depending upon the reaction, this should be a clinical marker to help the doc to decide on which drug to use next. This type of clinical deciding is still in its infancy, but is being used more and more by astute psychopharmacologists.
poster:Cam W.
thread:65576
URL: http://www.dr-bob.org/babble/20010605/msgs/65929.html