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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by addinbc on March 23, 2006, at 4:18:11
Hello all;
This is a really interesting article! I thought I'd put it out there for people to take a look at and discuss.
I think more effort should be made by psychiatrists/psychopharms/neurologists etc... to look at the results of long term SSRI use. What the author of this article talks about describes me to a "T"! And yet I have never heard of such a thing before.
I am starting Reboxetine tomorrow, so I'm hoping that this theory is correct, and Reboxetine will help me with my energy level and motivation!! :)
Here's the link:
http://www.primarypsychiatry.com/article.php3?id=42&html=yesLet me know what you think!
Posted by Meri-Tuuli on March 23, 2006, at 5:19:31
In reply to A very interesting article re: SSRI long term use, posted by addinbc on March 23, 2006, at 4:18:11
It certainly is an interesting article.
Exactly describes me too, after a year on celexa. And I thought that the apathy, tiredness etc were just a side effect of celexa!!
I guess thats way the MAOIs are so effective. And people augumenting their SSRIs etc with other agents.
I've tried reboxetine - its pretty powerful stuff. It was pretty good, didn't touch the mood, but helped with concentration and things like that. It made me slightly nutty according to my friends. But I stopped because it must of affected my hormones somehow - my periods completely stopped and I got bad acne. It also made my heart beat more intense/quicker. I didn't get panic attacks at all. Which was a definate plus. Good luck!
So according to that article, a multi neurotransmitter approach works best (and makes sense!)
I wonder what the combination of celexa, reboxetine and wellbutrin would be like? Or effexor + wellbutrin?? I suppose alot of people (well in the states anyway!) augument their SSRIs with a stimluant..... which maybe one way of doing it.....
Hmmm interesting.
Posted by linkadge on March 23, 2006, at 9:07:23
In reply to Re: A very interesting article re: SSRI long term use, posted by Meri-Tuuli on March 23, 2006, at 5:19:31
yeah, I liked the lines:
The treatment of depression with SSRIs essentially may create a functional imbalance of the primary monoamine neurotransmitters with serotonin excess and norepinephrine or dopamine deficiency. Stimulation of serotonin (5-HT2A) receptors in the mesocortical centers may reduce dopamine activity there and cause apathy and decreased libido.7 Serotonin excess may suppress norepinephrine and dopamine activity in other pathways, which may explain why asthenia and its related symptoms of apathy and amotivation are commonly seen as residual symptoms of depression in long-term treatment and as the most common features of antidepressant tachyphylaxis. Treatment of an anxious, depressed patient with an SSRI commonly results in a fatigued, emotionally flat person who still suffers some of the disability associated with depression.
Posted by john berk on March 23, 2006, at 9:20:20
In reply to Re: A very interesting article re: SSRI long term use, posted by linkadge on March 23, 2006, at 9:07:23
That was an extremely interesting link, one i wish i had at my disposal yesterday when i attempted to reason with my pdoc on my prozac induced lowered sex drive, apathy, and complacency. i have better control of my ocd now, at the expense of my motivation, something i never had a problem with in the past, pre-prozac/ocd relapse i worked 40 hours and ran 6 miles most evenings, now i barely make my part-time job, and run twice a week with much effort, not in performance, but in desire to actually walk out the door.
am i totally naive, or does raising other brain chemicals to match raised serotonin, not just bring us back to point "A", only now with more meds in our systems and empty wallets.i know certain AD's hit all the main player chemicals, but since i am on only 20 mgs. prozac, and feel so apathetic, i beleive i may try the alternative route, hmmmm, st. john's wort, or sam-e, that is the question....john
Posted by john berk on March 23, 2006, at 10:31:00
In reply to Re: A very interesting article re: SSRI long term use, posted by john berk on March 23, 2006, at 9:20:20
I'm sorry if my last post sounded too sarcastic,
i know meds are necesary in most cases, i had a really bad day with my pdoc, i wanted to come off or decrease prozac, and we had a slight disagreement, but it really makes me question exactly where research and treatment of depression and other mental health issues are headed, and whether we are being mislead over the efficacy of pysch drugs. i hope everyone has a good day...john
Posted by linkadge on March 23, 2006, at 11:20:47
In reply to Re: A very interesting article re: SSRI long term use, posted by john berk on March 23, 2006, at 9:20:20
Yeah, thats a good question. Does raising the other chemicals just bring us back to square one?
Well is it a chemical deficiancy, or a chemical imballence? Theres not a whole lot of proof for either. I've heard some suggest that this is actually how SSRI's work, ie by creating apathy, etc.
In terms of OCD, raising dopamine might bring back the symptoms.
I think that SSRI's work for OCD by essentially reducing frontal cortex dopamine output, which is like a mini lobotomy in a certain way. It will kind of reduce motivation, drive, focused attention etc.
Linkadge
Posted by linkadge on March 23, 2006, at 11:23:18
In reply to Re: A very interesting article re: SSRI long term use, posted by john berk on March 23, 2006, at 10:31:00
Theres no reason you can't reduce the dose yourself. I just got fed up with my doctor at one point. I knew I needed to reduce the dose to get some relief from the apathy, but oh no, I might relapse.
Prozac has a long half-life, some people just take it every other day.
Linkadge
Posted by bart on March 23, 2006, at 12:59:52
In reply to A very interesting article re: SSRI long term use, posted by addinbc on March 23, 2006, at 4:18:11
good stuff!!!!
Posted by JaclinHyde on March 23, 2006, at 13:49:49
In reply to A very interesting article re: SSRI long term use, posted by addinbc on March 23, 2006, at 4:18:11
Being on an MAOI, everyone should know what I think of the article ;-) I agree with what I understand him to be saying. Serotonin alone is not the problem for the majority of people out there. You have to hit the other neurotransmitters as well.
JH
Posted by JaclinHyde on March 23, 2006, at 13:54:46
In reply to Re: A very interesting article re: SSRI long term use » john berk, posted by linkadge on March 23, 2006, at 11:20:47
That is exactly what happened to me: added Wellbutrin to the mix and my OCD (hypochondria) came screaming back into the picture. I could not and would not tolerate that again so back to MAOI's I went. Now it is gone along with the depression and any residual anxiety.
JH
Posted by john berk on March 23, 2006, at 15:29:10
In reply to Re: A very interesting article re: SSRI long term use » john berk, posted by linkadge on March 23, 2006, at 11:23:18
Thanks Linkadge, i did exactly what you mentioned, i skipped today's dose, i'll take it tomorrow, i have lost too much faith in my 15 minute medical "monarch",I have to begin to use my intuition, i'm just stone tired!! i tryed adding buspar and wellbutrin at different times but both were too stimulating for me, buspar made me straight up angry for some reason.
i always referreed to my prozac expeirence as my "chemical lobotomy", [half-jokingly of course, lol], i am happy ocd has given me a breather, but is it my low dose [20 mgs. prozac], cbt, or just time, who knows, but i do know the side-effects are very real. thanks again for your input link...john
Posted by Phillipa on March 23, 2006, at 16:17:40
In reply to Re: A very interesting article re: SSRI long term use » linkadge, posted by john berk on March 23, 2006, at 15:29:10
I knew these drugs didn't work. For over 30years I only took benzos and what really worked for me was excercise and a career I believed in. I cut down on luvox again last night and will continue until I'm off all AD's . And that addition of extra valium I don't need at night so that's getting lowereed too. We'll see what happens oh and I'm jogging a bit again. I think we all have to do what's right for us but a poopout is worse than if nothing had ever worked. And wellbutrin just made me appear manic. Love phillipa
Posted by linkadge on March 23, 2006, at 18:25:04
In reply to Re: A very interesting article re: SSRI long term use » linkadge, posted by john berk on March 23, 2006, at 15:29:10
Its not that I am trying to get you to go against your doctor, but I have found that in my own experience it is necessary to shift things around and get a feel for what drugs are actually doing what.
I don't agree with blindly following the doctors instructions. They're not the ones who have to live in your body.
In my case at least, drug hollidays *always* resulted in a little more insight as to how I wanted to manage my meds.
Linkadge
Posted by linkadge on March 23, 2006, at 18:27:37
In reply to Re: A very interesting article re: SSRI long term use, posted by Phillipa on March 23, 2006, at 16:17:40
Just take it slowly. My saying is that if an adjustment is the "right decisision" then it will be the right decision tomorrow, and the day after that.
If you rush to come off a med, then you can go through withdrawl which will clutter your interpretation of your underlying mental condition.
Take Care.Linkadge
Posted by Caedmon on March 23, 2006, at 19:28:29
In reply to Re: A very interesting article re: SSRI long term use » john berk, posted by linkadge on March 23, 2006, at 11:20:47
>I think that SSRI's work for OCD by essentially reducing frontal cortex dopamine output, which is like a mini lobotomy in a certain way. It will kind of reduce motivation, drive, focused attention etc.
I think this is very possible. I don't know how true this is anatomically, but functionally it does seem to be true. I think this may be why SSRIs can work for GAD too. Reduces the "vigilance" associated with anxiety.
IMO if you experience apathy/anhedonia on SSRIs but have achieved symptomatic relief, the first thing to try is a dose reduction. We know from TCAs that subtherapeutic doses are often just as good, especially if you've been on the medication for some time. My totally unscientific suspicion on SSRI 'poop-out' is that it can - sometimes - be alleviated by *reducing* the medication, not increasing it or augmenting it.
Posted by SLS on March 23, 2006, at 21:06:31
In reply to Re: A very interesting article re: SSRI long term » linkadge, posted by Caedmon on March 23, 2006, at 19:28:29
> My totally unscientific suspicion on SSRI 'poop-out' is that it can - sometimes - be alleviated by *reducing* the medication, not increasing it or augmenting it.
That's a good thought. It would be analogous to taking the antidepressant, tianeptine, a drug that accelerates 5-HT reuptake. I've seen this improvement occur upon dosage reductions with TCAs and Effexor. However, this improvement last for a very short time.
- Scott
Posted by linkadge on March 24, 2006, at 15:16:33
In reply to Re: A very interesting article re: SSRI long term, posted by SLS on March 23, 2006, at 21:06:31
On the surface it would seem that they'd cancel. It would be interesting. Combine the two so that you have a net change of 0 in SERT. IF there is still an antidepressant effect, then maybe the molecule has other intrinsic effects.
Linkadge
This is the end of the thread.
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