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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by ed_uk on December 5, 2004, at 4:49:30
Hi,
Several years ago I took paroxetine (Seroxat/Paxil). I eventually discontinued it because it was causing severe drowsiness, fatigue and apathy. When I eventually did stop the paroxetine completely the fatigue and apathy continued for months. Has anyone else had a similar experience?
Regards,
Ed.PS. I know I'm posting a lot today but this board has got way too quiet and needs a bit of stimulating to get it going again.
Posted by linkadge on December 5, 2004, at 10:54:11
In reply to Apathy and SSRIs, posted by ed_uk on December 5, 2004, at 4:49:30
I have SSRI apathy, but I don't care enought to fix it. :)
Linkadge
Posted by theo on December 5, 2004, at 11:23:04
In reply to Apathy and SSRIs, posted by ed_uk on December 5, 2004, at 4:49:30
> Hi,
>
> Several years ago I took paroxetine (Seroxat/Paxil). I eventually discontinued it because it was causing severe drowsiness, fatigue and apathy. When I eventually did stop the paroxetine completely the fatigue and apathy continued for months. Has anyone else had a similar experience?
>
> Regards,
> Ed.
>
> PS. I know I'm posting a lot today but this board has got way too quiet and needs a bit of stimulating to get it going again.
How long did you take the Paxil and what dose?I don't disagree that Paxil can make you tired but obviously there are underlying problems if you are off Paxil and still feeling this way.
Posted by ed_uk on December 5, 2004, at 15:13:53
In reply to Re: Apathy and SSRIs, posted by theo on December 5, 2004, at 11:23:04
Hi theo,
I used to take paroxetine 40mg/day. I took it for a couple of years- the drowsiness and apathy increased with time. After being SSRI-free for about 6 months the apathy had lessened but I developed OCD. I started citalopram and increased the dose until it was effective. I now take 60mg/day. If I reduce the dose I feel a bit less apathetic but more anxious. Apathy is less distressing than OCD/anxiety but causes problems in its own right. In some cases, the long term consequences of amotivation can be worse than the long term consequences of anxiety.
Other people have also reported that SSRI-apathy can take a long time to wear off after discontinuation. Perhaps some of the drug-induced changes in the brain are quite persistent.
Regards,
Ed.
Posted by linkadge on December 5, 2004, at 16:02:21
In reply to Re: Apathy and SSRIs » theo, posted by ed_uk on December 5, 2004, at 15:13:53
OCD is when you care too much, and Apathy is when you care too little. It is possible to optimize the dose so that your not obsessive yet you can still get into things you enjoy.
Linadge
Posted by ed_uk on December 5, 2004, at 16:13:50
In reply to OCD / Apathy spectrum, posted by linkadge on December 5, 2004, at 16:02:21
> OCD is when you care too much, and Apathy is when you care too little. It is possible to optimize the dose so that your not obsessive yet you can still get into things you enjoy.
>
>
> Linadge
Hi Link,Ahh.... If only it was that simple. Doses sufficient to control OCD invariably make me apathetic. Even small doses make me a bit apathetic but don't reduce my OCD at all.
Regards,
Ed.
Posted by Peddidle on December 5, 2004, at 16:20:39
In reply to OCD / Apathy spectrum, posted by linkadge on December 5, 2004, at 16:02:21
All the psychiatrists/therapists I have seen since my original diagnosis of OCD have agreed that I do not have it. In fact, the zoloft makes me so apathetic, they all say I coul use some symptoms of OCD! :)
I can't say I really disagree, which is why I tried to get off the zoloft...got down as far as 50mg and the withdrawal became to much, so I had to go back up to 100mg.
Posted by linkadge on December 5, 2004, at 22:43:39
In reply to Re: OCD / Apathy spectrum » linkadge, posted by ed_uk on December 5, 2004, at 16:13:50
Well I understand it is a bit more complicated than that.
It you wanted a pure anti-ocd agent it would probably be a 5-ht2a/c receptor agonist.
The problem with agonizing the 5-ht2a/c receptors is that you reduce dopamine release in the fronal cortex and neucleus accumbens, and hence apathy.
Downregulation of the 5-ht1c receptors can also produce apathy.
There was an article about serotonin and romantic lovers. Romantic lovers had overall lower serotonin. It was proposed that romance was a state dependant induction of "obsessive behavior".Ie. there is a bit of a link between "obsession", and intrinsic motivation.
Did you ever notice how the AD's that don't have sexual side effects are usually not good anti-OCD agents, and that the AD's that have the sexual side effects are the better anti-OCD agents.
The more I enjoy sex, the more I obsess about it. When I don't enjoy it, I forget about it. Or perhaps it is the other way around.
The point I am trying to make is that there is a bit of a link between the obsession breaking effects of the SSRI's and the anhedonic effects.
Atypicals are often used as adjunctives in OCD. They block dopamine receptors in the neuclues accumbens (pleasure centers) and hence break obsession, and also induce anhedonia (dose dependantly)
Linkadge
Posted by theo on December 6, 2004, at 6:58:56
In reply to Re: Apathy and SSRIs » theo, posted by ed_uk on December 5, 2004, at 15:13:53
I'm getting ready to start a low dose of Paxil CR (12.5mg) and see if it is effective.
I'm currently taking Keppra (250mg twice daily), and Lamictal (100mg at bedtime). My doc gave me samples 2 weeks ago of Paxil CR 12.5mg and I'm having a hard time getting my nerve up starting it!
I'm busy in a family matter and am afraid if I start it, I may get to emotional and give in or be passive and not stand my ground. Get into a passive mode. I'm also currently job seeking and with my luck, I would swallow my first pill and get a call for an interview! It usually takes a few days for me to adjust from the initial weird feeling you can get from starting SSRI's.
This is the end of the thread.
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