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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 budgie on April 13, 2004, at 14:30:49
I know this flies in the face of everything the pdocs and AD paraphanalia say, but let me know what you all think/know:
I've had tremendous initial responses to several ADs, including Zoloft, Effexor, and now Celexa (and Parnate, too, but that turned out to be a different beast all together). I feel really positive for a week or 2 (could be placebo, I don't know, but it's happened every time) and then I descend into worse and worse anxiety as it builds up in my system until it's intolerable. This has happened every time, too.
With Celexa, I took it for 2 weeks and started getting REALLY tense. NOT my imagination. I stopped and felt better after about 2 days or so. A few days later (last night) I started noticing the depression again. This morning I took a 1/2 dose and am feeling better.
What gives? Are ADs, particularly SSRIs, really something that you need to take in a constant dose every day? What about for people who are super med-sensative?
BTW, I'm also on Lamictal and a bit of Klonopin (not what I was on during previous ADs).
Thanks...
Posted by Racer on April 13, 2004, at 17:57:15
In reply to Anti-depressants on an as-needed basis?, posted by budgie on April 13, 2004, at 14:30:49
Has your doctor tried lowering your dose? The initial response sounds like placebo, and the worsening anxiety sounds like it might be related to starting at too high a dose. It's possible that titrating up is all you need to do.
As for the side effects, those are a whole nother matter. Some side effects do wear off over time, but others are here to stay. Some ADs cause more stimulation than others, and sometimes an AD can highlight an otherwise undiagnosed anxiety disorder. Talk to your pdoc about this, and make sure you're both on the same page. If your pdoc is working WITH you, rather than ON you -- if you get what I mean -- you may be able to tolerate the effects until they wear off.
As for the as-needed basis, no. It's not a myth that ADs take time to work. What it sounds like to me is that you still have the drug in your system, so the half dose is just bringing it back to work again. Or, it's placebo again.
I know, this is the news that I hate myself, and is the reason that I'm sitting in front of my computer hating my life and hating myself. The drugs need time to work. The drugs have side effects that can have a significant impact on your life. The adverse effects of the drugs may mitigate the effectiveness of the treatment.
On the other hand, I think that I, personally, could handle that if someone, anyone, involved in my treatment would say, "Hush, I know it's hard, and I wish I could do better for you. I can't, but I will listen to you, and I will hold your hand." That's true for me, but it might be true for others as well. See if it feels right to you, and if it does, talk to your pdoc about it.
Good luck.
Posted by linkadge on April 13, 2004, at 18:22:02
In reply to Re: Anti-depressants on an as-needed basis?, posted by Racer on April 13, 2004, at 17:57:15
There is some research to suggest that sudden increase of serotonin can effect your mood.
Why do large meals with loads of carbs make you feel better, because they acutely increase serotonin.
As well it has been shown that tryptophan depleation very rapidly causes relapse back into depression. Especially if your mood problems seem to be cyclical or hormonally based.
I know of a few people just need antidepressants to get them through their time of the month.
People think that I am crazy but I felt emmediate antianxiety effects from taking SSRI's.
Linkadge
Posted by Mike Lynch on April 13, 2004, at 19:12:56
In reply to I disagree, posted by linkadge on April 13, 2004, at 18:22:02
Say I were to "pulse" my medication , im not saying I am , but if I did , are there any dangers to adhereing to this type of method , which would result in more trouble then the already present side effects?
Posted by zero on April 13, 2004, at 23:53:27
In reply to Re: Anti-depressants on an as-needed basis?, posted by Racer on April 13, 2004, at 17:57:15
My experience with AD's (Trazodone, MAOI's, SRI's, a couple of TCA's, Wellbutrin, and more) is an almost immediate mood elevation (even w. low dose, i.e. 1/10th normal dose). With me, this continues into hypomania and further if I keep taking a "normal" dose regularly.
I doubt it's placebo, as the 1st one, Trazodone, caught me off-guard and made me feel "on top of the world" in 2 hrs. (rx'd to help me go to sleep, and "in a few weeks or so", help w. my depression).
My reaction is the same with every AD I've taken.
My 2nd psychopharm. (and 1st insightful one) said, after my 1st week on Nardil @15mg./day, "you're feeling too good, too soon, on too low a dose - I think you're bipolar".
This psychopharm. also told me that most of his patients "like me" (bipolar spectrum w. lots of anxiety features) did best on very low-dose SRI + mood stabilizer ("pediatric doses" he called them).
I know people who use Effexor "as needed", and break open a time release capsule to count out the # of sphere's to take (one person ranges from 6-20 spheres per day, 1-3 days per week, might skip a week, depending).
The mode of action of AD's is not fully understood and is, at best, a work in progress.
Individuals respond quite differently to psych. meds. - for more reasons than are understood.
My experience (and I know there are others like me) w. low-dose AD use, is that they can work, work almost immediately (not placebo), and can be used PRN.
Everyone is different.
Posted by SLS on April 14, 2004, at 7:14:58
In reply to I get immediate mood lift from low dose AD's » Racer, posted by zero on April 13, 2004, at 23:53:27
A great many doctors think that pulsing antidepressants can lead to treatment resistance.
- Scott
Posted by linkadge on April 14, 2004, at 9:50:44
In reply to Re: I get immediate mood lift from low dose AD's, posted by SLS on April 14, 2004, at 7:14:58
I would think that pulsing AD's would lead to better results. Long term SSRI's can cause a general downregulation of the dopamine system.
FOr some, the longer they take SSRI's the more apathetic they become. I knew of a few people who avoided the apathy of SSRI's by not taking them on weekends.
Linkadge
Posted by Questionmark on April 14, 2004, at 10:40:39
In reply to I disagree, posted by linkadge on April 13, 2004, at 18:22:02
> There is some research to suggest that sudden increase of serotonin can effect your mood.
>
> Why do large meals with loads of carbs make you feel better, because they acutely increase serotonin.
>
> As well it has been shown that tryptophan depleation very rapidly causes relapse back into depression. Especially if your mood problems seem to be cyclical or hormonally based.
>
> I know of a few people just need antidepressants to get them through their time of the month.
>
> People think that I am crazy but I felt emmediate antianxiety effects from taking SSRI's.
>
> Linkadgei totally believe and understand that. i did as well. i felt about a few days of antianxiety and antidepressant effects when first starting, then about a week of deep depression, and then a gradual progression and then sustainance of antianxiety and, to some extent, antidepressant response. This all makes perfect sense when you look at the proposed serotonin receptor adaptations that occur after starting and staying on an SSRI: first, increased 5-HT in synapse due to 5-HT reuptake inhibition; then, decreased 5-HT in synapse due to continued activation of autoreceptors and the consequent inhibition of release; then finally, increased 5-HT levels in synapse again due to down-regulation of autoreceptors (and then eventually tolerance effects due to down-regulation of transporters and postsynaptic receptors, and inhibition of dopamine release [?] ).
Also, regarding as-needed use of antidepressants, i also think it can work tremendously. After being on high dose Paxil for about 2 years, and then being off drugs for several months (and still feeling like i was experiencing Paxil withdrawal effects-- horrible despair, anxiety, restlessness, and fragmented thoughts), i started taking about 5 to 10 mg Paxil every few days or so, and each day i did that i felt *tremendously* better (although this may have been due at least in part to alleviation of Paxil withdrawal, if indeed i was still under some withdrawal). But yeah, 5 to 10 mg Paxil every few days and i seriously feel great when i took it. However, i imagine tolerance would develop fast if taken every day, and on days i did not take it i would feel terrible again (maybe even worse than normal i think?). Fortunately Nardil has given me every-day relief from that horrible despair and extreme anxiety.
Intersting thoughts/ideas and topic though.
Posted by Budgie on April 14, 2004, at 14:42:22
In reply to I get immediate mood lift from low dose AD's » Racer, posted by zero on April 13, 2004, at 23:53:27
> My experience with AD's (Trazodone, MAOI's, SRI's, a couple of TCA's, Wellbutrin, and more) is an almost immediate mood elevation (even w. low dose, i.e. 1/10th normal dose). With me, this continues into hypomania and further if I keep taking a "normal" dose regularly.
This is really interesting. This is the same response I get. The hypomania thing (experienced consistently with every AD) was what got my pdoc and me thinking about BP and hence Lamictal, which has been a Godsend, I must say.
> I doubt it's placebo, as the 1st one, Trazodone, caught me off-guard and made me feel "on top of the world" in 2 hrs. (rx'd to help me go to sleep, and "in a few weeks or so", help w. my depression).
Yeah, a very quick, intense response for me, too. I know I'm ultra med-sensitive to everything I've tried (which is a lot), not just ADs.
> My reaction is the same with every AD I've taken.
>
> My 2nd psychopharm. (and 1st insightful one) said, after my 1st week on Nardil @15mg./day, "you're feeling too good, too soon, on too low a dose - I think you're bipolar".
>
> This psychopharm. also told me that most of his patients "like me" (bipolar spectrum w. lots of anxiety features) did best on very low-dose SRI + mood stabilizer ("pediatric doses" he called them).What exactly is the pediatric dose for, say, Celexa? Do pdocs ever pulse ADs for kids??
> I know people who use Effexor "as needed", and break open a time release capsule to count out the # of sphere's to take (one person ranges from 6-20 spheres per day, 1-3 days per week, might skip a week, depending).
>
> The mode of action of AD's is not fully understood and is, at best, a work in progress.
>
> Individuals respond quite differently to psych. meds. - for more reasons than are understood.Yeah, all I can really go by is my own personal experience. I think I'm pretty (extremely) aware of the most minute feelings I experience (who on this board isn't?). I don't really know what to think when scientific studies and conventional experience don't match my own.
> My experience (and I know there are others like me) w. low-dose AD use, is that they can work, work almost immediately (not placebo), and can be used PRN.
>
> Everyone is different.
>
>Thanks for the input, everyone.
Budgie
Posted by SLS on April 14, 2004, at 16:04:45
In reply to really ?, posted by linkadge on April 14, 2004, at 9:50:44
> I would think that pulsing AD's would lead to better results.
I don't know what to think.
"Depression" encompasses a wide array of presentations and, perhaps, physiological etiologies as well. Many people posting on PB have described experiencing an improvement within a few days or even hours of their first dose of medication. But it seems to me like the majority do not benefit from taking a traditional antidepressant until they have taken it continuously for at least two weeks. As far as "pulsing" is concerned, I think doctors speak in terms of being on and off drugs for weeks or months at a time, not days. As people justifiably point out, everyone is different. I have certainly read plenty of accounts of people remaining well on an antidepressant for a period of time who decided to discontinue treatment. After relapsing, usually within four months, the same drug proves useless. They have become treatment resistant to the drug due to their prior exposure it. This is not really pulsing, though, but it is worth noting. It is my impression that the vast majority of people suffering from a classic unequivocal moderate to severe endogenous clinical depression persisting for a month or more will not respond to the kind of episodic administration of antidepressants described here.
There is much to be said for homeostasis.
- Scott
Posted by SLS on April 14, 2004, at 16:14:44
In reply to Re: As-needed AD use » linkadge, posted by Questionmark on April 14, 2004, at 10:40:39
Hi.
> i felt about a few days of antianxiety and antidepressant effects when first starting,
I think this is the "blip" response that Martin Jensen looks for when treating people using his drug screening method.
> then about a week of deep depression, and then a gradual progression and then sustainance of antianxiety and, to some extent, antidepressant response.
I don't think that this is such an uncommon scenario.
> This all makes perfect sense when you look at the proposed serotonin receptor adaptations that occur after starting and staying on an SSRI:
Sounds good to me!
- Scott
Posted by Racer on April 14, 2004, at 16:16:19
In reply to Re: I get immediate mood lift from low dose AD's » zero, posted by Budgie on April 14, 2004, at 14:42:22
This is totally off-topic, but are you THE budgie, whom I met years ago in San Francisco? If so, you made me weak in the knees. If not, never mind...
Posted by zero on April 14, 2004, at 18:55:36
In reply to Re: really ?, posted by SLS on April 14, 2004, at 16:04:45
Very true - there are lots of different types of depression (in both presentation, and cause).
Different types (i.e. "typical", "atypical", "bipolar", "psychotic" et. al.) and causes of depression, require different treatment modalities.
I believe most people w. endogenous, typical unipolar depression do respond to AD's in "normal" doses, and in several weeks.
I don't "pulse" - can't comment 1st hand, but know intermittent use of AD's is helpful for some.
I have, however, taken Paxil (my SRI of choice) in low-dose (1/10 "normal" dose), for several different periods (usually lasting over a yr.), with breaks of not taking it (lasting up to a yr.), and every time I've gone back to taking it, it still works as before.
I've read that stopping an AD may make that particular AD not effective in the future. I'm sure this is sometimes true.
My own responses to psych. meds. are not always "typical" - I seem to be ultra-sensitive to them.
This is an interesting thread.
Posted by Budgie on April 15, 2004, at 12:37:33
In reply to Re: really ?, posted by SLS on April 14, 2004, at 16:04:45
So does treatment resistance with the same med occur only when one stops after continual, sustained use? This is actually another reason why I'm wondering about the low-dose, as-needed thing- so that huge amounts of the drug never build up in my system in the first place.
I'm guessing, though, that there haven't been many studies on this phenomenon in relation to pulsing.
Posted by Budgie on April 15, 2004, at 12:42:11
In reply to Re: I get immediate mood lift from low dose AD's » Budgie, posted by Racer on April 14, 2004, at 16:16:19
There are many budgies in the world. I have two of them myself. The last time I was in San Francisco I was 12, so I hope I didn't make you weak in the knees! I'm also a guy, if that helps sort things out for you. Good luck finding your Budgie, though. :)
Posted by SLS on April 15, 2004, at 22:33:33
In reply to Re: really ? » SLS, posted by Budgie on April 15, 2004, at 12:37:33
> So does treatment resistance with the same med occur only when one stops after continual, sustained use?
It happens. But so too does resistance to a drug develop without stopping it - "poop-out".
> This is actually another reason why I'm wondering about the low-dose, as-needed thing- so that huge amounts of the drug never build up in my system in the first place.
I wish I knew enough to be able to encourage you or discourage you. I don't. It's a pretty weighty issue, though. You are the one who knows best how you feel. If you respond predictably and reliably to antidepressants when they are administered episodically "as needed", perhaps that's what's best for you. I guess it depends on how long is the interval between depressive episodes. But it does sound kind of funny for someone to say that they use antidepressants only when they need it as they get depressed every few days. Duh.
> I'm guessing, though, that there haven't been many studies on this phenomenon in relation to pulsing.
That's the thing. Sometimes there is nothing else to work with but anecdotes and a clinician's personal experience.
Posted by SLS on April 15, 2004, at 23:11:47
In reply to Re: really ?, posted by SLS on April 15, 2004, at 22:33:33
> But it does sound kind of funny for someone to say that they use antidepressants only when they need it as they get depressed every few days.
> Duh.
Sorry. That wasn't directed toward anyone in particular. Probably could have left out the "Duh".
- Scott
This is the end of the thread.
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