Posted by bleauberry on March 19, 2011, at 5:51:48
In reply to antidepressant side effects!, posted by poser938 on March 18, 2011, at 22:22:07
Well, no offense intended to the doctor, my opinion differs from that of your doctor. The numbness is not a side effect. It is a direct effect. Some have called antidepressants emotional anesthetizers. Sure they can get rid of the lows, but goodbye highs also.
That is not always the case. But we see it I think more frequently than not.
The numbness is thought to be the squashing down of the excitatory neurotransmitters (dopamine/norepinephrine) by one of the inhibitory neurotransmitters....serotonin. There has even been some speculation that the excess serotonin caused by antidepressants is taken up into dopamine and/or norepinephrine receptors. True or not I don't know.
Some doctors, such as at psychotropical.com, attest to best results with antidepressants that balance the neurotransmitters. The only way to do that is with combinations, such as SSRI plus TCA. As in Zoloft + Nortriptyline. While it is claimed that effexor and cymbalta are SNRIs, they really aren't. They are predominantly serotonin with very little respective action at norepinephrine. Balancing reduces or eliminates the numbness.
Stimulants are sometimes used to reverse the numbness. That follows the same theory as above....the stimulants add more norepinephrine and dopamine to the excess serotonin.
The only two balanced antidepressants are clomipramine and milnacipran.
Numbness can also be helped by lowering the dose. Lower doses can work. They just take longer.
I suspect that one reason a doctor might think that the numbness is a side effect that goes away, is because over time...months...as the patient becomes acclimated to the numbness they don't notice it any more. It's still there, but they've just gradually become accustomed to it so it is a part of them. Then maybe they take a little interest in a new hobby or something....not the same kind of gusto they would have had otherwise....but nevertheless it could "appear" the numbness is gone. I think with some detailed deep questioning, it would become obvious the numbness is still there and is a major handicap to enjoying life abundantly.
During years of prozac my doctor had me fill out the depression diagnostic survey questionnaire each visit. I scored very well...no depression on any of the topics except one....the question about "interest in activities and hobbies"...which I always scored the worst possible. All the others....sleep, appetite, pain, fatigue, mood, etc...were all real good. He claimed the lack of interest was not a concern since my test showed I did not have depression any more. He couldn't have been more wrong. i was not depressed during my prozac years, but those years were completely lifeless. Numbness impacts everything....productivity at work, interest in hobbies, interest in friends, interest in God, normal chores, getting projects done, deadlines, love relationships, sexual attraction, sexual ability, everything. So in my view, it is a huge concern. It's hard for me to decide which is worse....depression or numbness. The numbness is obviously gentler to handle, but nonetheless just as debilitating in every day life as depression is.
My own hunch is that if someone gets numbness on a SSRI or so=called SNRI, then serotonin is not their primary problem and serotonin should not be the main target. Some people become fully alive and motivated on SSRIs. They indeed probably need the serotonin. But when numbness happens, it is just the body's way of saying, "hey, too much serotonin!". In that case, the meds should be other than ssris, or other meds of norepinephrine/dopamine focus added to lower doses of ssris.
poster:bleauberry
thread:980707
URL: http://www.dr-bob.org/babble/20110220/msgs/980722.html