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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by ed_uk on November 26, 2005, at 23:41:46
Hi!
Your attitude to SSRIs has changed so much. In 2003 you wrote.........
'I hated the person I was. I just couldn't find any restraint, to both my emotions and my mood.
SSRI's really helped dampen my emotion, they stoped the songs going through my head like a broken record. They helped me to sleep. They mainly helped me because for the first time I was laughing, and that really relaxed me.'
Do you think you could still benefit from an SSRI?
Ed
Posted by linkadge on November 26, 2005, at 23:41:47
In reply to Linkadge, posted by ed_uk on November 26, 2005, at 17:10:25
Curses, babble archives !! :)
Anhow, I don't think I could go back to SSRI's at this point. When I look back at the whole picture, I had good times on SSRI's but then I had absolutely rotten times on SSRI's. Its kind of how I feel off them. I have good times, and I have absolutetly rottent times.
I had times on the drugs when I couldn't laugh, and times off the drugs when I could laugh my head off.
I don't want to completely discredit that post, but I think that it was me wanting to atrribute the good times to the meds. Because that way, I felt more in controll. I wanted to feel that I could forget all the bad things, becuase they were pre-SSRI.
In reality, some of the worst times in my life were when I was on the drugs. I felt if they could't prevent me from going my lowest, then they weren't much good.
Linkaddge
Posted by Phillipa on November 26, 2005, at 23:41:47
In reply to Re: Linkadge, posted by linkadge on November 26, 2005, at 18:42:18
Link watch out for Ed! He's not working tomorrow. He's everywhere today. Your friend, Phillipa PS miss our talks at night when you were on nightshift.
Posted by Jakeman on November 27, 2005, at 0:08:35
In reply to Linkadge, posted by ed_uk on November 26, 2005, at 17:10:25
It's back to the much debated question. Do they work in the long-term? I had a good 2 year run on SSRI's. Then the sexual dysfunction crept in, along with unrelenting insomnia. During that good period I managed to get a Masters degree and had a decent social life. Now I'm having trouble finding anything that works.
warm regards ~Jake
Posted by Jedi on November 27, 2005, at 5:53:29
In reply to Re: Linkadge, posted by Jakeman on November 27, 2005, at 0:08:35
> It's back to the much debated question. Do they work in the long-term? I had a good 2 year run on SSRI's. Then the sexual dysfunction crept in, along with unrelenting insomnia. During that good period I managed to get a Masters degree and had a decent social life. Now I'm having trouble finding anything that works.
>
> warm regards ~JakeHi Jake,
I believe the long term use of SSRIs and SNRIs caused an apathy syndrome in me. It is hard to separate this from my primary depression because I am atypical with a certain level of apathy and anhedonia when I am depressed. Anhedonia(the inability to experience pleasure) can cause serious problems with your sex life. There has been research showing the atypical antipsychotics providing some relief to this syndrome, as an augmentation to SSRIs.
Take care,
JediJ Psychiatr Pract. 2004 May;10(3):196-9.
SSRI-induced apathy syndrome: a clinical review.
Barnhart WJ, Makela EH, Latocha MJ.
Department of Behavioral Health and Psychiatry, North Colorado Medical Center, Greeley 80631, USA.The authors review the literature pertaining to selective serotonin reuptake inhibitor (SSRI)-induced apathy syndrome. A literature search of Medline and International Pharmaceutical Abstracts from 1970 to the present was performed for relevant articles. Twelve relevant case reports and one open-label treatment trial were identified. An amotivational, or apathy, syndrome has been reported in a number of patients receiving SSRI treatment over the last decade. This adverse effect has been noted to be dose-dependent and reversible, but is often unrecognized. This phenomenon has caused significant negative consequences for adults as well as social and academic difficulties in adolescents.
[Efficacy of atypical antipsychotics in depressive syndromes.]
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15738862&query_hl=3Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12019662&query_hl=3
Posted by linkadge on November 27, 2005, at 10:57:02
In reply to SSRI induced apathy syndrome, posted by Jedi on November 27, 2005, at 5:53:29
Yes, apathy was a killer. The SSRI's make a noticable difference for the first little while, but then yes, I did become apathetic.
Linkadge
Posted by Jakeman on November 27, 2005, at 13:33:33
In reply to SSRI induced apathy syndrome, posted by Jedi on November 27, 2005, at 5:53:29
>
> Hi Jake,
> I believe the long term use of SSRIs and SNRIs caused an apathy syndrome in me. It is hard to separate this from my primary depression because I am atypical with a certain level of apathy and anhedonia when I am depressed. Anhedonia(the inability to experience pleasure) can cause serious problems with your sex life. There has been research showing the atypical antipsychotics providing some relief to this syndrome, as an augmentation to SSRIs.
> Take care,
> Jedi
>
> J Psychiatr Pract. 2004 May;10(3):196-9.
> SSRI-induced apathy syndrome: a clinical review.
> Barnhart WJ, Makela EH, Latocha MJ.
> Department of Behavioral Health and Psychiatry, North Colorado Medical Center, Greeley 80631, USA.
>
> The authors review the literature pertaining to selective serotonin reuptake inhibitor (SSRI)-induced apathy syndrome. A literature search of Medline and International Pharmaceutical Abstracts from 1970 to the present was performed for relevant articles. Twelve relevant case reports and one open-label treatment trial were identified. An amotivational, or apathy, syndrome has been reported in a number of patients receiving SSRI treatment over the last decade. This adverse effect has been noted to be dose-dependent and reversible, but is often unrecognized. This phenomenon has caused significant negative consequences for adults as well as social and academic difficulties in adolescents.
>
> [Efficacy of atypical antipsychotics in depressive syndromes.]
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15738862&query_hl=3
>
> Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12019662&query_hl=3
>Jedi,
Thanks for those articles, great information. I asked my last psyciatrist to prescribe a small doze of olanzapine with an SSRI, even though I am afraid of the side effects. He refused. Right now I trying to find a better doctor. Have you tried this combination?
warm regards ~Jake
Posted by Meri-Tuuli on November 27, 2005, at 14:55:59
In reply to SSRI induced apathy syndrome, posted by Jedi on November 27, 2005, at 5:53:29
Well said Jedi! I too suffer from atypical depression and yes! the SSRIs just made it sooo much worse. Particulry Celexa and Effexor. I didn't even realise the extreme apathy it caused til I became a regular on this board.
Meri
Posted by ed_uk on November 27, 2005, at 16:42:56
In reply to Re: Linkadge, posted by linkadge on November 26, 2005, at 18:42:18
>Curses, babble archives !! :)
You posted so many postive things about SSRIs!
How are you feeling at the moment?
Ed
Posted by linkadge on November 27, 2005, at 17:06:22
In reply to Re: Linkadge » linkadge, posted by ed_uk on November 27, 2005, at 16:42:56
Good days and bad days. Not too much different.
Linkadge
Posted by ed_uk on November 27, 2005, at 17:22:09
In reply to Re: Linkadge, posted by linkadge on November 27, 2005, at 17:06:22
Link, you're a darkhorse!
Ed
Posted by ace on November 27, 2005, at 21:25:09
In reply to Re: Linkadge » linkadge, posted by ed_uk on November 27, 2005, at 17:22:09
how about that for a bold statement.....
SSRI's are a joke...they were made on the most STUPID postulation -- all affective disorders are 5-HT related....Yeah right!
Ace
Posted by rjlockhart on November 27, 2005, at 21:40:47
In reply to Re: SSRI's are lame. Old drugs rule. Period., posted by ace on November 27, 2005, at 21:25:09
ace you made me laugh.
SSRI are like placebo's with side effects ROFL.
They need to come up with some real antidepressants, not just some crap that doesnt do much. Something that does elevate mood but is not to a point of abuse.
Thats my put.
Posted by med_empowered on November 28, 2005, at 2:57:21
In reply to Re: hehe that was funny., posted by rjlockhart on November 27, 2005, at 21:40:47
I read something that was interesting..about how, since psychiatry is so mixed up with Big Pharma now, psychiatry's "theories" often jive with Big Pharma's marketing ploys. So...look at it in the case of depression :
TCA era--depression is caused by low levels of certain chemicals. Tofrani (elavil, whatever) helps elevate these.
SSRIs--depression+anxiety are largely due to low-levels of serotonin. Prozac (or whatever) boosts these to a normal level, resotring functioning.
Cymbalta (effexor, new ones)--depression is caused by low levels of **several** neurotransmitters, Cymbalta increases levels of--- (triple-reuptake indibitors may soon hit the market).
Basically, the idea is that there was a swing towards "clean" drugs--drugs that just hit serotonin, for instance--and now there's a swing back to what would have been called "dirty" drugs but are now called "multi-target" drugs, or whatever. Same thing with the atypical antipsychotics--one of their selling points is that they tend to hit LOTS of stuff, not just the D2 like the old drugs...but they're not called "dirty" drugs, like TCAs are...no, they're called "multi-targeted" drugs, or whatever term is being used now.
Interesting theory.
Posted by rod on November 28, 2005, at 11:33:03
In reply to Re: Linkadge, posted by linkadge on November 27, 2005, at 17:06:22
> Good days and bad days. Not too much different.
>
> LinkadgeI think thats true for many of us...
At least I have had some *transient* responses to durgs, which turned out to make me worse on the long term. But I didnt always followed up and made clear it didnt last.
Thats why I see most posts here with a grain of salt...
so long
Rod
Posted by ed_uk on November 28, 2005, at 13:36:59
In reply to SSRIs..thumbs down.., posted by med_empowered on November 28, 2005, at 2:57:21
>Basically, the idea is that there was a swing towards "clean" drugs--drugs that just hit serotonin, for instance--and now there's a swing back to what would have been called "dirty" drugs but are now called "multi-target" drugs, or whatever. Same thing with the atypical antipsychotics--one of their selling points is that they tend to hit LOTS of stuff, not just the D2 like the old drugs...but they're not called "dirty" drugs, like TCAs are...no, they're called "multi-targeted" drugs, or whatever term is being used now.
So true. Haloperidol (Haldol) is a pretty 'clean' drug in terms of it's receptors affinities ie. it's a potent selective D2 antagonist. Unfortunately, 'clean' drugs are not always better.
Ed
Posted by linkadge on November 28, 2005, at 17:31:43
In reply to Re: Linkadge » linkadge, posted by rod on November 28, 2005, at 11:33:03
My biggest problems on meds was the fact that the side effects were eventually making my overall state much worse.
So I start out on an SSRI. Insomnia takes its toll on mental health. Cogntivie side effects take their toll in work. Sexual side effects take their toll on self esteem and mental heath, the list goes on.
Eventually, I just end up feeling fried.
Posted by linkadge on November 28, 2005, at 17:38:33
In reply to Re: SSRIs..thumbs down.. » med_empowered, posted by ed_uk on November 28, 2005, at 13:36:59
So lets suppose that serotonin promotes neurogenesis, and that this is the mechanism for antidepressant action.
Well, other neurotransmitters promote neurogenesis too. There are noradenergic and dopaminergic mechanisms to neurogenesis too. So if you thrust the system too far one way, you may not be doing yourself good.
I have a hard time explaining to my doctor, that if a drug makes me dumb then I am eventually going to face the depressing effects of poor performance in school. Serotonin says "I can be satisfied no matter what the outcome", but in reality, that is only partially true.
Linkadge
Posted by med_empowered on November 28, 2005, at 18:56:05
In reply to Re: SSRIs..thumbs down.., posted by linkadge on November 28, 2005, at 17:38:33
I'm kind of displeased with the state of psychiatry in general. All this emphasis on "symptom control" and altering the neurotransmitter-of-the-month really serves to dehumanize the person (first into a patient, then into walking, talking symptoms) and de-contextualize the problem at hand. Instead of whole people with personalities and whole lives behind and ahead of us, mental patients are reduced to malfunctioning serotonin systems or hyperactive dopamine systems or what have you. This approach is not only not helpful, it is utterly counterproductive and degrading. When you factor in the lack of evidence for most psychiatric theories--I mean, there isn't yet a test to show us depression or anxiety or even schizophrenia--it seems like this is being done more out of disregard for patients and the human experience in general than out of clinical/scientific necessity. I guess before you can subject people to potentially harmful/unpleasant drugs, ECT, and involuntary hospitalization, its necessary to strip them of their humanity and define them as "the other"--the un-well, the irrational, the "crazy"; after all, how else could subject someone to problems such as TD, NMS, apathy, weight gain, drug-induced diabetes, etc. unless you regarded them as somehow "less than human" ?
Posted by ace on November 30, 2005, at 7:25:12
In reply to Re: SSRIs..thumbs down.., posted by med_empowered on November 28, 2005, at 18:56:05
It;s time the psychopharmacologists got their intellectual heads out of the sand.
SSRI's have a very low success rate....TCA'a and MAOIs are much more successful.
We need more drugs that strike more neurotransmitters, both in agonistic and antagonistic ways....we will still have to use the 'old dart board' but, I think the aiming will be closer than with SSRI's, which i believe have many many downfalls...including horrendous withdrawal for a large subset of the psychiatric community...in a diition their is more evidence that morphological changes in receptors result from SSRI's....there's no evidence of this with the gold old drugs.
The only new drugs which I think are good are the new AP's.
Ace
Posted by linkadge on November 30, 2005, at 10:40:18
In reply to Re: SSRIs..thumbs down.., posted by ace on November 30, 2005, at 7:25:12
"a diition their is more evidence that morphological changes in receptors result from SSRI's....there's no evidence of this with the gold old drugs."
I don't think that the toxicity of the older drugs has been studied as much as it has with the newer drugs. I know, for instance, that if your PEA levels get too high it can be neurotoxic.
Linkadge
Posted by sjb on November 30, 2005, at 11:46:27
In reply to Re: Linkadge, posted by linkadge on November 28, 2005, at 17:31:43
Linkadge,
God, ain't that the truth. I have no motivation, lack of energy, etc. I just don't know what to do about the meds. Haven't seen PDoc in ages causes its the same 'ole same 'ole. I'm on 450 Wellbutrin XL and 40mg Prozac daily and have been for a long time. I've been taking mental med for over 10 years now and, although they've helped trememedously at times, I just think I'm fried and will never accomplish anything meaningful.
Posted by linkadge on November 30, 2005, at 17:47:31
In reply to Re: Linkadge, posted by sjb on November 30, 2005, at 11:46:27
"Fried" is the key word.
I think they can age you prematurely.
I know, I'm going to get heckled for my unsubstatiated claims. Oh well. I am not a scientist, all I have to go on is intuition.
Linkadge
Posted by Jakeman on November 30, 2005, at 20:49:47
In reply to Re: Linkadge, posted by linkadge on November 30, 2005, at 17:47:31
> I know, I'm going to get heckled for my unsubstatiated claims. Oh well. I am not a scientist, all I have to go on is intuition.
>
>
> LinkadgeI just have to go back to my point that they do help some people, even long-term (based on patient reports). So we can't dismiss ssri's out of hand.
I recently did a trial with Stablon. I had a great response, after about 3 days. But then it severely disturbed my sleep, I could only get very light fragmented sleep, maybe REM sleep, but no refreshing sleep. So I felt "fried" the next day. I gave it up.
warm regards ~Jake
Posted by linkadge on November 30, 2005, at 22:45:12
In reply to Re: Linkadge » linkadge, posted by Jakeman on November 30, 2005, at 20:49:47
They may work for reasons other than what we had hypothesized. While that is good in the sence that they work, it also opens ones mind to the long term implications.
Some people do ok on them long term, and thats good, but we need to keep our eyes on any adverse changes associated with long term use.
Linkadge
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