![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by Sarah T. on June 13, 2005, at 4:48:11
I am one of those people who does poorly on SSRI's. The more selective they are, the more apathetic and immobile I become. I am interested in hearing from anyone who has actually improved on SSRI's. By improvement, I mean BOTH improvement in mood AS WELL AS improvement in the ability to move towards one's goals (increased motivation, drive, etc). Has anyone who takes SSRI's ever really seen this sort of improvement? I get the impression that many people who don't get worse on SSRI's, don't actually improve that much either. Rather, the improvement seems to be primarily a reduction of anxiety. The anxiolytic properties of SSRI's are not to be dismissed because, for many, anxiety is a significant component of their depression, and once anxiety is alleviated, depression may lift as well.
So, my question is, does anyone actually improve on SSRI monotherapy? Improvement, to me, means improvement in mood/outlook/hopefulness, etc. AS WELL AS the ability to bring about obvious, "measurable" improvements in one's personal and professional life.
Again, I'm referring to SSRI monotherapy, without augmentation by stimulants or dopaminergic antidepressants.
Posted by ed_uk on June 13, 2005, at 7:25:18
In reply to SSRI's - question, posted by Sarah T. on June 13, 2005, at 4:48:11
Hi Sarah,
I find SSRIs anxiolytic, but not antidepressant. They help my OCD but make me apathetic. My drive is reduced. It's almost as if I'm surrounded by a protective bubble, shielding me from the world. A veil comes down over my eyes. This can be good but it can also be bad. I can't seem to look to the future, I can't work towards a goal, I feel like sleeping. Sadly, I don't have much choice, treatment for OCD is c*rap. At least if I was depressed I'd have some options. On an SSRI, my life is at a standstill, I cannot move forward, I cannot see the future. I am stationary, a bit like a plant.
Kind regards,
Ed.
Posted by Maxime on June 13, 2005, at 9:22:43
In reply to Re: SSRI's - question » Sarah T., posted by ed_uk on June 13, 2005, at 7:25:18
Prozac worked for me as an antidepressant. It worked very well. I was able to finish my thesis and find work and move on. Then it pooped out.
Maxime
> Hi Sarah,
>
> I find SSRIs anxiolytic, but not antidepressant. They help my OCD but make me apathetic. My drive is reduced. It's almost as if I'm surrounded by a protective bubble, shielding me from the world. A veil comes down over my eyes. This can be good but it can also be bad. I can't seem to look to the future, I can't work towards a goal, I feel like sleeping. Sadly, I don't have much choice, treatment for OCD is c*rap. At least if I was depressed I'd have some options. On an SSRI, my life is at a standstill, I cannot move forward, I cannot see the future. I am stationary, a bit like a plant.
>
> Kind regards,
> Ed.
Posted by SLS on June 13, 2005, at 10:19:41
In reply to Re: SSRI's - question » Sarah T., posted by ed_uk on June 13, 2005, at 7:25:18
> Hi Sarah,
>
> I find SSRIs anxiolytic, but not antidepressant. They help my OCD but make me apathetic. My drive is reduced. It's almost as if I'm surrounded by a protective bubble, shielding me from the world. A veil comes down over my eyes. This can be good but it can also be bad. I can't seem to look to the future, I can't work towards a goal, I feel like sleeping. Sadly, I don't have much choice, treatment for OCD is c*rap. At least if I was depressed I'd have some options. On an SSRI, my life is at a standstill, I cannot move forward, I cannot see the future. I am stationary, a bit like a plant.
Have you tried Nardil? It might attack the OCD and depression both. Also, a small dosage of Risperdal is supposed to have anti-OCD effects. Since a SSRI effectively puts you in a straight-jacket, you might want to try some of these other things. In addition, I don't think clomipramine has the same degree of liability for producing apathy, and many of its startup effects fade with time.
- Scott
Posted by ed_uk on June 13, 2005, at 11:21:52
In reply to Re: SSRI's - question » ed_uk, posted by SLS on June 13, 2005, at 10:19:41
Hi Scott!
>Have you tried Nardil?
I would like to try it but it doesn't seem that reliable for OCD from what I've read. Perhaps I'd need a high dose.
>Also, a small dosage of Risperdal is supposed to have anti-OCD effects.
Perhaps I should try it. I'm kind of scared of APs though after my Thorazine experience!
>clomipramine.....
Yes, I'd be interested in trying clomipramine. Not sure I could handle the anticholinergic side effects and sedation though, I hope it wouldn't 'zonk me out' as much as dothiepin and amitriptyline did! I somtimes think I should return to Prozac or try Zoloft. I've never tried Zoloft. Celexa's not great but it doesn't make me as drowsy as Paxil did.
Kind regards,
Ed.
Posted by SLS on June 13, 2005, at 15:32:56
In reply to Re: SSRI's - question » SLS, posted by ed_uk on June 13, 2005, at 11:21:52
I found Zoloft to be almost free of cognitive and affective side effects, even at 200mg. It was real clean.
With clomipramine, I think you'll find that the anticholinergic side effects will diminish with time. Go low and slow. Aside from the potential of heart block or arhythmias in vulnerable individuals, I would say that it is constipation that can become an important issue with some people. The rest are more nuissances than anything else. I would go for this drug if I had OCD unresponsive to SSRIs. I would also go to it if SSRI induced apathy and amotivation became significant factors in quality of life.
- Scott
Posted by ed_uk on June 13, 2005, at 16:21:05
In reply to Re: SSRI's - question » ed_uk, posted by SLS on June 13, 2005, at 15:32:56
Hi Scott!
I think I might ask for Zoloft at my next appointment.
>I would say that it is constipation that can become an important issue with some people.
I've only been back on Celexa for a short while and I'm already a bit constipated. I seem to get constipated really easily. I might buy some Fybogel :-)
Kind regards,
Ed.
Posted by BUCKEYE FAN on June 13, 2005, at 17:41:32
In reply to Re: SSRI's - question » ed_uk, posted by SLS on June 13, 2005, at 15:32:56
I went back on Zoloft last September...50 mg per day.
It seemed to do its job through the winter and Spring...but over the last 2 weeks I find myself depressed again.
I have heard some mention "poop-out"
Is this a real happening, documented by medical
proof...and of course EXPERIENCE by others on this Board..or is it just imaginary? ( No offense intended....I just wonder why I suddenly
feel this way again)BF
Posted by Phillipa on June 13, 2005, at 18:23:58
In reply to Re: SSRI's - question » SLS, posted by ed_uk on June 13, 2005, at 16:21:05
The only time SSRI's worked for me was the first two go rounds. First l0mg paxil but with xanax and alchohol. The Luvox with ativan and chloral hydrate. None of them ever touched my anxiety. I must be a freak of nature! Fondly, Phillipa
Posted by gromit on June 13, 2005, at 18:40:14
In reply to SSRI's - question, posted by Sarah T. on June 13, 2005, at 4:48:11
> I am one of those people who does poorly on SSRI's. The more selective they are, the more apathetic and immobile I become.
Same here, for me they cause reduced motivation and pleasure, apathy, fatigue. These are problems I have already, these are the main problems I'm hoping meds can help! Oh, and by the way sex is out so now my wife can feel inadequate too. One difference between us, Lexapro, which is supposed to be the most selective wasn't that bad. It didn't help but it sucked less.
I know that for most people these drugs do work, in a year or so they can stop taking them and move on. I'm happy for them, really, but at the same time I f*rt in their general direction.
Rick
Posted by KaraS on June 13, 2005, at 19:04:17
In reply to SSRI's - question, posted by Sarah T. on June 13, 2005, at 4:48:11
> I am one of those people who does poorly on SSRI's. The more selective they are, the more apathetic and immobile I become. I am interested in hearing from anyone who has actually improved on SSRI's. By improvement, I mean BOTH improvement in mood AS WELL AS improvement in the ability to move towards one's goals (increased motivation, drive, etc). Has anyone who takes SSRI's ever really seen this sort of improvement? I get the impression that many people who don't get worse on SSRI's, don't actually improve that much either. Rather, the improvement seems to be primarily a reduction of anxiety. The anxiolytic properties of SSRI's are not to be dismissed because, for many, anxiety is a significant component of their depression, and once anxiety is alleviated, depression may lift as well.
>
> So, my question is, does anyone actually improve on SSRI monotherapy? Improvement, to me, means improvement in mood/outlook/hopefulness, etc. AS WELL AS the ability to bring about obvious, "measurable" improvements in one's personal and professional life.
>
> Again, I'm referring to SSRI monotherapy, without augmentation by stimulants or dopaminergic antidepressants.
>
Hi Sarah,
I have often wondered the same thing. I remember reading a post here not that long ago (wish I could remember who wrote it) in response to a similar question as yours. She said that for about a year and a half she had tons of energy and motivation on Effexor. She got her house all cleaned up and felt wonderful. (I'm including Effexor in here since it's mostly an SSRI and seems to fit the pattern we're discussing.) Then at about the 18 month mark, she developed the typical apathy and amotivation.Maybe the SSRIs can help with a full recovery but then there's a good chance that down the road they will poop-out. Does the poop-out at that point mean that the AD stops working and/or that dopamine is depressed and so the amotivation appears then?
I know that for me, I have never really had any motivation on an SSRI (possibly for a month on Prozac - not sure). I don't expect that any one of them alone could ever give me drive or complete sustained recovery from my anergic depression.
Kara
Posted by linkadge on June 13, 2005, at 19:37:59
In reply to Re: SSRI's - question » Sarah T., posted by KaraS on June 13, 2005, at 19:04:17
I did find that clomipramine did not cause the apathy, but it made me dumb. Dumber than I though was actually possable. It was a marvalous antidepressant, but you're right - we have a life to live too, and if the side effects make living impossalbe, then the drug is no good for us.
Linkadge
Posted by Cairo on June 13, 2005, at 19:38:31
In reply to Re: SSRI's - question » SLS, posted by ed_uk on June 13, 2005, at 16:21:05
Just switched my daughter from Lexapro to Zoloft. Lexapro caused extreme fatigue, apathy, cognitive issues. So far Zoloft seems somewhat stimulating: more energy, definitely less cognitive dulling, less apathy. The only thing I'm a little worried about is that she seems a bit more irritable at times though other times she's perfectly happy. May be that we're not up to correct dosage yet (she's only on 50mg), but I worry that that the stimulating effect may be too much for her. Can't take stimulants due to worsening anxiety and Strattera induced depression in her.
Cairo
> Hi Scott!
>
> I think I might ask for Zoloft at my next appointment.
>
> >I would say that it is constipation that can become an important issue with some people.
>
> I've only been back on Celexa for a short while and I'm already a bit constipated. I seem to get constipated really easily. I might buy some Fybogel :-)
>
> Kind regards,
> Ed.
Posted by linkadge on June 13, 2005, at 19:46:40
In reply to Re: SSRI's - question, posted by BUCKEYE FAN on June 13, 2005, at 17:41:32
Yes, unfortunately. More and more doctors are admitting that these drugs do infact poop out.
Basically from a statiscal standpoint, we (as a nation) are consuming much more of them at higher doses. I suppose we could be getting more depressed :)
The longer we have been exposed to them, the more we see their effects fade.There are many many possable explainations as to why the antidepressant properties of a drug seem to stop, but in the end, nobody has been able to offer a conclusive explaination.
Personally, I don't think I ever recovered fully from that first time celexa pooped. I basically woke up to the realization that my life was just as intollerable as it once was.
Don't even think about stopping the drug at this point though.
Linkadge
Posted by linkadge on June 13, 2005, at 20:19:29
In reply to Re: SSRI's - question, posted by Cairo on June 13, 2005, at 19:38:31
I have heard that zoloft/trazadone combination can work very well.
Does she suffer any insomnia on the zoloft?
Linkadge
Posted by BUCKEYE FAN on June 13, 2005, at 20:46:09
In reply to Re: SSRI's - question » BUCKEYE FAN, posted by linkadge on June 13, 2005, at 19:46:40
> Yes, unfortunately. More and more doctors are admitting that these drugs do infact poop out.
> Basically from a statiscal standpoint, we (as a nation) are consuming much more of them at higher doses. I suppose we could be getting more depressed :)>
> The longer we have been exposed to them, the more we see their effects fade. >
> There are many many possable explainations as to why the antidepressant properties of a drug seem to stop, but in the end, nobody has been able to offer a conclusive explaination.
>
> Personally, I don't think I ever recovered fully from that first time celexa pooped. I basically woke up to the realization that my life was just as intollerable as it once was.
>
> Don't even think about stopping the drug at this point though.
>
>
> LinkadgeFunny you put that last line in Linkadge...because that is exactley what I am considering doing.
I have grown weary of this merry-go-round of Zoloft and Xanax.
I rue the day I allowed the Doctor to talk me into taking them.
I am not blaming him...he was doing his job, what he was trianed to do....but I resisted for so long because KNEW inside they were not a permanent answer.Well......here it is 6 years later and I have not gone a single day without Xanax.
I have managed to stop the anti-depressants for as long as 3 months once...only to start up again
when a "depressive episode" happened. (Im guessing they still call it that )Anyways...Im babbling.
I do know this.....I started on Xanax for Panic Attacks 6 years ago...on an as-needed-basis (ha!)and SOMEHOW I allowed anti-depressants to be thrown in the Mix.
Now I am trapped...my motivation is gone..and my once energetic, high powered personality is dulled by prescription drugs.
At least the Panic Attacks are gone....right?
BF
Posted by KaraS on June 13, 2005, at 21:09:14
In reply to Re: SSRI's - question, posted by linkadge on June 13, 2005, at 19:37:59
> I did find that clomipramine did not cause the apathy, but it made me dumb. Dumber than I though was actually possable. It was a marvalous antidepressant, but you're right - we have a life to live too, and if the side effects make living impossalbe, then the drug is no good for us.
>
>
> Linkadge
What about taking cholinergic medication along with the clomipramine (i.e. Aricept or galantamine)?
Posted by linkadge on June 13, 2005, at 21:13:55
In reply to Re: SSRI's - question, posted by BUCKEYE FAN on June 13, 2005, at 20:46:09
No, in reality you're not totally messed up.
I have been on high doses of SSRI's 60mg of celexa. Getting off of them is hard. But you can survive, and find ways to feel good.
I think they can sometimes push your brain too much in one direction. It needs time to rebound and recharge.I blameded myself a lot when I stopped celexa, because when I started it again it didn't quite work the same way. But, in reality, I was just remembering the best times, and trying to assume that they "always were".
Thats what it is all about sometimes. Not really feeling good *all the time*, but having hope. Hope that there will be reward in choosing a particular path.
Our brain is wired to convince ourselves of our fantasies, it will give us just enough to convince us that the grass is truely greener on the other side of the hill. WHen it works properly, we will fight to get on the other side.
Paradoxically, after a little while, we will fight just as hard to get back to the original side.
It's really just a journey to find a spark to keep the fire going.
Good LuckLinkadge
Posted by linkadge on June 13, 2005, at 21:26:03
In reply to Re: SSRI's - question » linkadge, posted by KaraS on June 13, 2005, at 21:09:14
I would have *loved* to do so. Unfortunately my doctor is very "old school" and would have probably tried to blame the cognative problems on depression or anxiety. I don't think he would be keen on the idea.
As well, if I am clever enough to do all this reasearch to bring to him on how aricept can negate the cognative side effects of clomipramine, then he'd get to thinking that I am not dumb enought to need it in the first place.
I just gave up.
Linkadge
Posted by Glydin on June 14, 2005, at 8:27:40
In reply to SSRI's - question, posted by Sarah T. on June 13, 2005, at 4:48:11
I have had great success on an SSRI thus far. That isn't something you hear frequently, it would seem, but I do know of others in my real world who declare the same. I have noted improvement in all aspects of my emotional status, thus making for a better me, a better life, and better overall functioning.
Posted by yesac on June 14, 2005, at 10:54:53
In reply to Re: SSRI's - question, posted by gromit on June 13, 2005, at 18:40:14
> I know that for most people these drugs do work, in a year or so they can stop taking them and move on. I'm happy for them, really, but at the same time I f*rt in their general direction.
I totally hear you-- I feel that way too. I think that probably you are right that for *most* people the drugs work. In my opinion, those are the people who aren't here on this board. Those are the smiling people on the Wellbutrin commercials saying that they are so happy they feel like themselves again. I think that those people are a different sort than the people here on Babble. We are the ones who the drugs *don't* work for +/or who have horrible unbearable side effects and just can never seem to find the right drug. We're the ones who actually have to see psychiatrists instead of just getting the prescriptions from our family doctors and then going on our merry way!Just my 2 cents!
Posted by linkadge on June 14, 2005, at 15:43:38
In reply to Re: SSRI's - question » gromit, posted by yesac on June 14, 2005, at 10:54:53
"for *most* people the drugs work"
I don't think this is true. Perhaps, for most of these people the drugs are placebo's, and work in that manner. Some peole's depression is very situational, and improves over time by itself. I think people like the idea of having something to attibute their improvement to, just like rabit's feet, q-wray bracelets etc. It gives them a sence of controll. So when things naturally get better, they feel control over the situation by attributing it to the antidepressant.I mean I know that I start to wonder why the drug companies need to work so hard to try and prove their drug is better than the placebo.
Linkadge
Posted by Cairo on June 14, 2005, at 16:23:46
In reply to Re: SSRI's - question, posted by linkadge on June 13, 2005, at 20:19:29
Linkadge,
I think you meant this for me. My daughter has a sleep phase shift: difficulty falling asleep, but sleeps throught the night, though I question her quality of sleep. Her sleep study showed some mild apnea. Tried trazodone awhile back, but stopped it b/c we thought it might be causing memory issues. Turns out it was the Lexapro we started at the same time, but didn't know it then and never tried trazodone again.
A specialist we consulted wants to add low dose Seroquel as an adjunct for social phobia, but our local doc absolutely refuses to prescribe it stating that it will make her fatigue worse (that said before we switched to Zoloft).
As her SP is only 20-30% helped by SSRI, do you think Seroquel would be worth a trial, especially since it would help sleep, rather than adding a sleep med? We've an appointment with another pdoc soon who will hopefully be more open to trying things and not on the SSRI bandwagon so much.
You've always been so helpful on this board. Thank you.
Cairo
> I have heard that zoloft/trazadone combination can work very well.
>
> Does she suffer any insomnia on the zoloft?
>
>
> Linkadge
Posted by linkadge on June 14, 2005, at 20:41:02
In reply to Re: SSRI's - question » linkadge, posted by Cairo on June 14, 2005, at 16:23:46
I personally would avoid seroquel unless it is a disorder of psychosis. All of the antipsychotics can cause memory and learning problems. I found it very hard to learn the next day when I took seroquel. It can sap energy too. But so can insomnia, which is the catch.
Zoloft seems to work well for kids. Be sure not to get the dose too high. I think low doses can work wonders, but too high a dose can cause problems. They're strong drugs, and kids often don't need a whole lot to benfit.If insomnia, and anxiety are the key issues, then trazadone might be worth another whirl either on its own or with the zoloft.
If you do end up trying seroquel take as low a dose as possable, and take it early in the evening.Linkadge
Posted by Sarah T. on June 14, 2005, at 23:39:51
In reply to Re: SSRI's - question » Sarah T., posted by Glydin on June 14, 2005, at 8:27:40
Hi Glydin,
Which SSRI are you on? Which one has been best for you? Can you elaborate?
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.