Posted by Racer on October 18, 2005, at 18:50:52
In reply to SSRI + Low Dose Antipyschotic for TRD, posted by CK1 on October 17, 2005, at 22:54:37
Actually, the whole SSRI poop-out thing is pretty much to be expected -- more a question of "when" than "if," regardless of unipolar/bipolar. My pdoc told me that at a recent conference, everyone was saying that anyone who's experiencing anxiety as well as depression was "really" Bipolar II. He disagrees, saying that anxiety and depression can be comorbid without the one being hypomania. What I'm getting at is that diagnoses in psychiatry are a little more amorphous than we might like to think. ;-]
SSRIs seem to poop out after a couple of years, which is maybe related to the way the body uses serotonin. While we're hoping that the serotonin in the brain sticks around a bit longer, it's also sticking around longer in the digestive tract, where most of the serotonin in the body is used. Whether that's true or not, what is known is that SSRIs tend to poop out for most people given 'enough' time. How long it takes varies from person to person, but it's not unexpected that it will happen.
You mention that you tried four other SSRIs, but did you try any of the TCAs before heading to an MAOI? I just wonder, since there are a few other options that come up here a lot, and I kinda worry about seeing that your doctor seems to have jumped from step 1 to step 7 in terms of medication choices. It also doesn't sound as though you've tried augmenting the SSRIs, rather than switching to a class of drugs that comes with some kinda annoying lifestyle restrictions.
Med_empowered knows much more than I do about the atypical antipsychotics, so I'll trust that his information is correct. I hope you'll look into some of the other options, like TCAs, Effexor, Cymbalta, Wellbutrin, Remeron, etc.
Good luck.
poster:Racer
thread:568393
URL: http://www.dr-bob.org/babble/20051017/msgs/568635.html