Posted by bleauberry on September 8, 2009, at 12:50:39
In reply to Increasing SSRI/SNRI above the 'regular' doses., posted by Jay_Bravest_Face on September 7, 2009, at 23:35:36
I have feel that SSRI/SNRIs do more than the simple mechanisms implied by their names.
For example, at 50mg Zoloft has already reached nearly 98% occupancy of serotonin reuptake sites. So it would not make sense that any higher dose would do any additional good. But obviously, some people do better at 100mg or 200mg. So something else is going on there. We know Zoloft has weak affinity for dopamine reuptake as well, so perhaps that is at play. But from what I've read, that really doesn't even begin to have any appreciable effect until at least 200mg.
But who knows. Researchers talk about these meds they got it all figured out. They don't.
I read one account of a lady requiring minimum 40mg Lexapro to stay well, but she did best at 60mg. The serotonin reuptake sites were already completely saturated at a far lower dose, so what was the higher dose doing? Something else. Serotonin was already maxed out. But what? Dunno. Obviously something.
Maybe it is a completely different mechanism at play, such as manipulating gene instruction, and has nothing at all to with neurotransmitter sites.
I'm sure individual liver metabolism is a player. Some people build up blood levels quickly, while others tend to excrete quickly. I am not sure that particular mechanism plays that big of a role however.
Body weight is probably a consideration. 120mg Prozac is a heck of a lot for someone weighing 120 pounds, but doesn't look so astronomical if the person is 240 pounds.
I know nothing of the topic, but with most meds there is some sort of binding with proteins. Who knows, maybe some people just need more of a dose to overcome unusually aggressive protein binding.
Me, I'm just the opposite. Tiny eensy weensy doses feel like atomic bombs.
poster:bleauberry
thread:916056
URL: http://www.dr-bob.org/babble/20090902/msgs/916092.html