Posted by 3 Beer Effect on June 4, 2002, at 14:15:26
In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11
People get an Apathetic effect to SSRIs in the long term because Serotonin & Dopamine act basically like a "see-saw" to keep each other in balance. When Serotonin is raised for a couple of months, eventually Dopamine is either (downregulated?) or depleted. If this see-saw affect did not happen, then the person would have too much serotonin and dopamine & would probably have a manic switch/episode.
The only SSRI that has some Dopamine reuputake inhibition is Zoloft, & while this degree of dopamine potentiation is not that high, it is much higher than the other SSRIs & even higher than Wellbutrin SR (but the "hydroxybuproprion" metabolite of Wellbutrin SR is the "real drug" of Wellbutrin SR & is probably much more powerful than Zoloft and inhibiting the reuputake of Dopamine). So if you must take an SSRI Zoloft would be the least likely of the SSRIs to induce apathy, but if it did, it would take longer than the other SSRIs to do so. (As posted before, the starting dose of Zoloft 50 mg/day is generally ineffective- 75 or 100 mg are more effective & roughly comparable to the starting dose of Prozac (20 mg=80 mg of Zoloft).
I believe that norepinephrine is not affected by this serotonin/dopamine see-saw effect.
The two best anti-depressants that would prevent this effect would be Wellbutrin SR & Desipramine.
The metabolite of Wellbutrin SR, hydroxybuproprion is basically a powerful Norepinephrine/Dopamine reuputake inhibitor with little effect on Serotonin, which would eliminate both depression & apathy but can in some cases cause anxiety.
Desipramine is the most potent Tricyclic in potentiating norepinephrine, & also according to the charts has the least amount of tricyclic/anticholinergic side effects. Compared to Dexedrine which had a potency on norepinephrine of 2, Desipramine had a potency of 110, more than even Vivactil/Protriptyline (100)! Norepinephrine is associated with ambition, drive, getting things done etc.
I've never tried Desipramine, but atleast on paper it looks like a great medicine- It has less affinity for the antimuscarinic/anti-cholinergic receptor than Paxil! It also has the lowest incidence of anti-histamine & other traditional tricyclic negative side effects of all the tricyclics, BUT it does have a higher affinity/more side effects on all these measures than Wellbutrin SR or any of the SSRIs. So it probably will have more side effects than Wellbutrin SR. One suggestion i've heard is to buy the brand name Norpramin if you can afford it because it supposedly is less toxic (be sure your doctor writes Norpramin & not Desipramine or the pharmacy won't give you the brand name).3 Beers......
poster:3 Beer Effect
thread:108571
URL: http://www.dr-bob.org/babble/20020602/msgs/108647.html