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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Tepiaca on December 13, 2004, at 22:28:43
I don´t know what is wrong with me , but I feel incredibly better when I stop taking my medicine
(NARDIL). I lost the fear to people , I can talk to them , look everybody and give my points of view in something I am not agree with. This start after the third day of supending the medicine , then it last about 2 or 3 days more and the fear and depression return. That is when I restart the Nardil and again I start feeling very confident about myself but this time the effect last about 7 days and then I enter into a constantly zone of middle and high fear a social avoidanceWhat is happening here???
I have seriously thought to do this often in order to feel good at least some days in the month.I just don´t know if this is safe
Do you have any idea of what dangers are involved in doing this??
any thoughts??
Posted by mike13 on December 13, 2004, at 23:04:07
In reply to starting,suspending,starting,suspending MEDICINES, posted by Tepiaca on December 13, 2004, at 22:28:43
> I don´t know what is wrong with me , but I feel incredibly better when I stop taking my medicine
> (NARDIL). I lost the fear to people , I can talk to them , look everybody and give my points of view in something I am not agree with. This start after the third day of supending the medicine , then it last about 2 or 3 days more and the fear and depression return. That is when I restart the Nardil and again I start feeling very confident about myself but this time the effect last about 7 days and then I enter into a constantly zone of middle and high fear a social avoidance
>
> What is happening here???
>
> I have seriously thought to do this often in order to feel good at least some days in the month.I just don´t know if this is safe
>
> Do you have any idea of what dangers are involved in doing this??
>
> any thoughts??
I am unsure of the dangers involved in doing this but I experience the exact samething, everytime I begin a medicine or ween myself off it I experience a significant period of well being.. It's happened to me with pretty much every SSRI i've tried.. I wish I had more information on this as well..
Posted by francesco on December 14, 2004, at 17:10:16
In reply to Re: starting,suspending,starting,suspending MEDICINES, posted by mike13 on December 13, 2004, at 23:04:07
Yes, I have been there. I also considered like you'are doing the "start and suspend" strategy but I think it's quite unsane. I experienced this well being every time I quit Anafranil and I got to the following conclusions.
Quitting Ananafranil makes me hypomaniac. Since it's a sedating med my brain reacts in the opposite direction when I quit it. Moreover when you withdraw your med the med doesn't stop to work immediately. For example I have trouble in concentrating and this is the reason why I take Anafranil. But I can concentrate very well for a month or so after the withdrawal. I think it's the same if you suffer from depression. Therefore for a short period you have the *good* of the med without the *bad* (the side-effects). Just my two cents.
Posted by Le Grande Fromage on December 16, 2004, at 6:27:49
In reply to Re: starting,suspending,starting,suspending MEDICINES, posted by francesco on December 14, 2004, at 17:10:16
Same here. I have always felt better once stopping my pills, but only for a few days to maybe a couple of weeks. This was most pronounced when stopping Effexor.
This is clearly because the beneficial effects of SSRIs take at least two weeks to kick in, whereas the negative side-effects are immediate. (The reason why it takes 2 weeks for pills to help is the subject of some controversy, but a convincing argument is that antidepressants trigger a kind of neural regeneration in certain brain structures). As a result, when you stop the pills, the beneficial effects do not stop right away, rather they linger for about two weeks. But (most of) the negative side effects stop right away. So you find yourself in a post-antidepressant glow, with the benefits of medication without its myriad miserable side-effects.
It is trite that long-term serotonin elevation decreases the dopamine levels in the brain. This is theorized to be the cause of "Prozac poop-out", and perhaps that flat zombie-like apathy some of us feel when taking our meds like we're supposed to. Anyway, the corollary would be that when you stop your pills, and your serotonin normalizes, so does your dopamine. In other words, your dopamine levels will increase when you stop your pills. The longer you have been taking the pills, and the higher your dose, the more pronounced the dopamine effect, in part because your brain, in it's dopamine-deprived state, has become more sensitive to its effects.
So, not only do you enjoy the long-term serotonin benefits without the concomitant side-effects, you also get a dopamine boost to boot!
However, this seems to go against the weight of experience of people reporting negative withdrawl effects. Perhaps there is something unique in my own physiology, or a certain subset of patients that causes this apparent contradiction. I have withdrawn from several medications expecting a hellish withdrawl period, only to be greeted by a fortnight's mood-elevation. The only negative effect I've had from discontinuation has been a feeling akin to dizziness, which seems to pass after several weeks.
Interestingly, I found that when on Effexor (150mg), which increased both my serotonin and nor-epinephrine levels, and arguably depressed my dopamine system, I suddenly found nicotine to be very reinforcing. Perhaps this is because of the increase in dopamine associated with nicotine, combined with an increased sensitivity to dopamine as a result of it's decrease by serotonin. On the other hand, when on the MAOI Parnate, smoking made me feel nauseous, perhaps because my dopamine was already high before lighting up. This is presumably how Wellbutrin/Zyban works.
Anyway, sorry for the length of this post, best of Luck
Posted by Tepiaca on December 16, 2004, at 21:03:34
In reply to Re: antidepressant afterglow, posted by Le Grande Fromage on December 16, 2004, at 6:27:49
Very interesting answer. I enjoyed reading it
.
>
> It is trite that long-term serotonin elevation decreases the dopamine levels in the brain. This is theorized to be the cause of "Prozac poop-out", and perhaps that flat zombie-like apathy some of us feel when taking our meds like we're supposed to. Anyway, the corollary would be that when you stop your pills, and your serotonin normalizes, so does your dopamine. In other words, your dopamine levels will increase when you stop your pills. The longer you have been taking the pills, and the higher your dose, the more pronounced the dopamine effect, in part because your brain, in it's dopamine-deprived state, has become more sensitive to its effects.
>
> So, not only do you enjoy the long-term serotonin benefits without the concomitant side-effects, you also get a dopamine boost to boot!
>
So it would be like taking an stimulant ???> However, this seems to go against the weight of experience of people reporting negative withdrawl effects. Perhaps there is something unique in my own physiology, or a certain subset of patients that causes this apparent contradiction. I have withdrawn from several medications expecting a hellish withdrawl period, only to be greeted by a fortnight's mood-elevation. The only negative effect I've had from discontinuation has been a feeling akin to dizziness, which seems to pass after several weeks.
I don´t experience any side effects when stopping the medicines cold turkey.Thi is rare , I have stopped all my medicines during my 8 years on them , cold turkey , and I only remember a little uncomfort on klonopin , but it passed very quickly.
I´m currently on Nardil , I also have vivid nigthmares but only in the second week without it. In the first 7 seven days I feel very good.Can you think in something that could happen to my brain if I continue starting and suspending the medicine ??? Brain damage... Hypertensive Crisis.... Tardive Diskinesia ???
I would like to hear your opinion on this =)
thank you very much
Tep
Posted by Le Grande Fromage on December 17, 2004, at 16:06:00
In reply to Re: antidepressant afterglow » Le Grande Fromage, posted by Tepiaca on December 16, 2004, at 21:03:34
> So it would be like taking an stimulant ???
>Not necessarily, I suppose it depends on the effect the drug has on you. My theory about increased dopamine doesn't work so well with a MAOI like Nardil, because it would have boosted dopamine, so presumably on discontinuation, your dopamine may actually drop. (Interestingly, MAOIs have been less commonly implicated in SSRI-apathy, perhaps because they don't neglect the dopamine while boosting the serotonin.) Keep in mind that when you stop your pills, the level of the drug in your body does not drop immediately. Depending on its half-life, the drug may remain in your system for days or weeks.
A possible explanation for your experience of feeling good for a couple of days, and then crashing, is that the drug level has stayed fairly high for those days, and only thereafter dropped significantly. Since the therapeutic effect of your pills are merely one of their many side-effects, it is arguable that some of their side effects persist for longer than others, upon cessation of the drug. In other words, when you take a pill, it will have effect A for a time, effect B for another length of time and so forth. So it's possible that some of the negative side-effects fade faster than the therapeutic effect. Of course, this is all speculation as no one really knows how antidepressants "work".
> I´m currently on Nardil , I also have vivid nigthmares but only in the second week without it. In the first 7 seven days I feel very good.
>
>
> Can you think in something that could happen to my brain if I continue starting and suspending the medicine ??? Brain damage... Hypertensive Crisis.... Tardive Diskinesia ???
>The main danger is probably that your brain chemistry will be constantly shifting, so you will be less likely to make an intelligent decision about whether to continue your meds. One is tempted to stop after a couple of weeks when all one experiences is the side-effects. But if the medical experts are to be believed, your pills should be given at least 6 weeks to kick in properly. Likewise, if you decide to go without them, you should stay off them for at least 6 weeks. They take a while to reach therapeutic dosage, and likewise to be worked out of your system.
I have experienced the same concerns about repeatedly starting and stopping my meds. Any attempt to answer your question about whether you may cause some kind of permanent damage would be absolute speculation. I'm inclined to think that it is not healthy for your neurochemical levels to be in a constant state of flux. However, ceasing medication which is not working may be akin to giving your brain a break from the stimulation of meds, allowing what goes up to come down.
My main concern with starting and stopping is not permanent damage but rather a delay in finding a tenable situation. You have to wonder whether such a neurochemical rollercoaster delays the attainment of some kind of neurochemical equilibrium, which your brain may have been able to achieve minus all the repeated changes.
I once asked my psychiatrist about whether it was a problem that I kept stopping pills and opting for different brands. He felt it was risky, because whatever benefit accrued the first time may be lost by your system's newfound familiarity with such drugs. Indeed, I found my first few days on my first few drugs much more intense in terms of side effects. As I worked my way through the SSRIs I found their side-effects less bothersome (and impliedly their positive effects less significant), so it does seem that my body was less effected by each subsequent drug. However, it is equally arguable that my body would have adapted as rapidly, if not more so, had I remained on one drug for the entire period. But it's all conjecture and not even my psych really knew what was going on. He just wanted to add more pills to the mix to see what would happen.
Did you take Nardil for SA? Did it work? Did you stop because of side-effects? I have tried Effexor, Lexapro, Celexa, Parnate, beta blockers, Buspar, and Remeron. All of them failed on the side-effect : benefit ratio.
Good luck!
Posted by francesco on December 18, 2004, at 20:33:33
In reply to Re: antidepressant afterglow, posted by Le Grande Fromage on December 17, 2004, at 16:06:00
Your posts were very interesting for me and I have a couple of questions for you if you don't mind. You said that the "more serotonin - less dopamine" theory is a fact and this seems to fit with my personal experience. I can 'feel' my dopamine drop when I take antidepressants, and, curious to say, I started smoking immediately after my first trial of an antidepressant.
But how does this theory fit with the people who DON'T experience apathy on SSRI ? I find that antidepressants usually make me depressed so I have no problems in accepting your theory but what about people who find them useful ?
Second question. Do you think that TCA elevate dopamine ? I have not read many reports about TCA and apathy and I have read somewhere that TCA elevate also dopamine even if, more often, I read that they affect only NE and SE.
Moreover I drink more often and more heavily when I'm on antidepressants, could it be maybe a way to boost dopamine ? If your statements are true it seem to me that the only genuine antidepressants are MAOIs. And this sucks considered how many people take other stuff.
Posted by Le Grande Fromage on December 19, 2004, at 12:34:01
In reply to Re: antidepressant afterglow » Le Grande Fromage, posted by francesco on December 18, 2004, at 20:33:33
> You said that the "more serotonin - less dopamine" theory is a fact and this seems to fit with my personal experience. I can 'feel' my dopamine drop when I take antidepressants, and, curious to say, I started smoking immediately after my first trial of an antidepressant.
> But how does this theory fit with the people who DON'T experience apathy on SSRI ? I find that antidepressants usually make me depressed so I have no problems in accepting your theory but what about people who find them useful ?
>Placebo response rate is 75% as high as medication response. This implies that some, if not most, of the benefit one gains from taking medication is itself placebo-related. Perhaps those who escape antidepressant apathy are not biologically affected by their dosage, but are enjoying a placebo response. An alternative explanation is that people have different responses to drugs depending on the efficiency or presence of various enzymes (not sure of the temrinology here). Some people cannot metabolize alcohol as efficiently as others (for instance, women, in general, cannot metabolize alcohol as quickly as men and get correspondingly more drunk on the same dose per mass). Similarly, some people feel more anxious on caffeine, and others simply feel more alert. Likewise, some people may not experience a dopamine-reduction apathy, because of their unique reactions to the drugs. Or else they may simply be enjoying a placebo effect. Or a combination of both.
> Second question. Do you think that TCA elevate dopamine ? I have not read many reports about TCA and apathy and I have read somewhere that TCA elevate also dopamine even if, more often, I read that they affect only NE and SE.Each drug has a unique profile for how much it effects each neurotransmitter. Each neurotransmitter has several sub-types, which the drugs also affect at differing amounts. As far as I know, tryciclics do not affect dopamine. However, it's possible that at different dosages, some of them may have an effect. Effexor, which in my opinion is more of a tryciclic than an SNRI (or, dare I say, a "rebranded" tricyclic vying for 21st century patent profits) also affects dopamine at higher doses. But for some people, an average dose is a high dose, so I'm certain that many people out there on "standard doses" of effexor are also having their dopamine tweaked. If effexor, which is similar to tricyclics can do it, then I'm sure the tricyclics can too.
It seems strangely anomylous that antidepressants are prescribed in standard doses, when each person has a unique physiology and will have an optimum response to a different dose. It would make more sense for the drugs to be sold as powders or liquids to be measured out according to, at the very least, the patients' mass. It's almost as if mere convenience of distribution has overcome the patients' best interest.
>
> Moreover I drink more often and more heavily when I'm on antidepressants, could it be maybe a way to boost dopamine ? If your statements are true it seem to me that the only genuine antidepressants are MAOIs. And this sucks considered how many people take other stuff.This could be caused by increased impulsiveness. When you take a drug which purports to reduce your inhibitions and make you worry less, then it stands to reason that you'll also take more risks.
Alternatively, you may enjoy alcohol more because it temporarily reduces the amounts of serotonin and perhaps NE (not sure about dopamine). In a brain flooded with these neurochemicals this may come as a welcome relief. I find alcohol sedating and stupefying whilst on SSRIs. I also like to drink when on pills simply because of the relief it brings to side-effects like nausea and restlessness.Your comment about MAOIs being the only true antidepressants may hold some truth. SSRIs did not rise to prominence because they are more effective, but because they have less, and less serious, side-effects. Their popularity is more a result of marketing and perception than neuroscience. Medical practitioners are more willing to prescribe them because they're avoiding the risk of fatal side-effects. Same as with benzos. If you spend months on an SSRI which doesn't work, your doc is less responsible because he's just current medical practice. If he prescribes you a MAOI and you suffer a hypertensive crisis, suddenly he's implicated.
Add to this predisposition to prescribe modern, safe medicines, the role of pharmaceutical companies and it becomes clear why most of us are on SSRIs. There are not many studies of, for instance, the effect of Nardil on Social Anxiety, because the patent has run out and no one stands to gain by increasing its salesm and no one is going to pay the vast sums required for a clinical trial. The only reason Paxil is so commonly prescribed for Social Anxiety is because GlaxoSmithKline saw the gap and knew that SSRIs were already prescribed off-label for the disorder. Millions of consumers on a less-than-suitable drug is the logical endpoint of the meeting between capitalism and medicine. So even if, as you suggest, MAOIs are better, they will remain underprescribed because of vested financial interests. The same cycle has already occured with benzos like Xanax, which used to be the most commonly prescribed medication, and it will undoubtedly be repeated with SSRIs (but not before the patent runs out).Sorry about the lenghth of this response.
Posted by ed_uk on December 19, 2004, at 13:38:05
In reply to Re: antidepressant afterglow, posted by Le Grande Fromage on December 19, 2004, at 12:34:01
>It seems strangely anomylous that antidepressants are prescribed in standard doses, when each person has a unique physiology and will have an optimum response to a different dose.
>It's almost as if mere convenience of distribution has overcome the patients' best interest.You are so right. SSRIs were advertised as being easier to use than TCAs because treatment could be initiated with the 'standard dose' eg. 20mg, however unsuitable this dose may be for an individual patient.
>Their popularity is more a result of marketing and perception than neuroscience.
Among the general public in the UK (where prescription drugs cannot be advertised to the public) a lot of people seem to think that Prozac was the first antidepressant.
>If you spend months on an SSRI which doesn't work, your doc is less responsible because he's just current medical practice. If he prescribes you a MAOI and you suffer a hypertensive crisis, suddenly he's implicated.
Avoiding legal action has become a major factor when making prescribing decisions.
Ed.
Posted by dove on December 20, 2004, at 12:04:11
In reply to Re: antidepressant afterglow, posted by ed_uk on December 19, 2004, at 13:38:05
>Avoiding legal action has become a major factor when making prescribing decisions.
>Which is why I have a hard time with everyone suing as soon as a med has some ugly side-effects. Some of the meds that really work do have some serious side-effects. We should be aware of this potentially life-threatening consequences while still allowing doc's and consumers to make informed decisions to utilize those meds. My humble opinion on a very gray monday morning :-)
dove
Posted by ed_uk on December 20, 2004, at 12:23:39
In reply to Re: antidepressant afterglow, posted by dove on December 20, 2004, at 12:04:11
Posted by Optimist on December 20, 2004, at 15:55:10
In reply to Re: antidepressant afterglow, posted by dove on December 20, 2004, at 12:04:11
Posted by pablo1 on December 20, 2004, at 20:52:38
In reply to Re: antidepressant afterglow, posted by Le Grande Fromage on December 16, 2004, at 6:27:49
I felt a real obvious dopamine rebound coming off effexor. The closest to manic I've ever been. The effexor was sedating, then began to keep me awake at night so I quit. I've just stopped zolof which comes with a significant pro-dopamine effect and found it plenty stimulating, not sedating at all but I've also not felt any improvement from zoloft, in fact as it has taken effect over a month, I'm getting more depresed & beginning to have sleep troubles so have given up on that too.
Posted by theo on December 22, 2004, at 10:00:52
In reply to Re: antidepressant afterglow, posted by Le Grande Fromage on December 19, 2004, at 12:34:01
Something sparked when you talked about starting smoking because of lowering of dopamine. I experimented back 20 years ago at college with cocaine. I am not a smoker but would smoke a pack when using cocaine and other stimulants.
I know many people that are not every day smokers but smoke when using cocaine or even drinking.
This has always confused me.
Posted by Dave001 on December 23, 2004, at 20:49:49
In reply to Re: antidepressant afterglow, posted by dove on December 20, 2004, at 12:04:11
> >Avoiding legal action has become a major factor when making prescribing decisions.
> >
>
> Which is why I have a hard time with everyone suing as soon as a med has some ugly side-effects. Some of the meds that really work do have some serious side-effects. We should be aware of this potentially life-threatening consequences while still allowing doc's and consumers to make informed decisions to utilize those meds. My humble opinion on a very gray monday morning :-)
>
> doveYou'll find nothing but agreement from me.
http://www.dr-bob.org/babble/20040921/msgs/393514.html
Dave
Posted by Tepiaca on December 23, 2004, at 22:22:23
In reply to Re: antidepressant afterglow, posted by Le Grande Fromage on December 17, 2004, at 16:06:00
thank you very much for all your posts , they are very interesting . I enjoyed reading all of them
> Did you take Nardil for SA? Did it work? Did you stop because of side-effects? I have tried Effexor, Lexapro, Celexa, Parnate, beta blockers, Buspar, and Remeron. All of them failed on the side-effect : benefit ratio.
>
> Good luck!I have Social Phobia , mixed wit depression and some years ago I had little psychotic symptopms that were fixed with Zyprexa and Seroquel.
Nardil has been the medicine that has help me more in terms of Social Phobia. I haven been on it for 1 year 4 months. I tried both the old and the new brand, and in my particular experience I found the old brand to be enourmosly better than the new one.It is a shame they changed the formula.
The Max dose of Nardil I have been is 75 mg (new Nardil) , I experience terrible insomnia and I did not noticed anyimprovement from 60 to 75.
My big problem is the lack of Nardil at the pharmacy . So there are times in which I have to stop taking the Nardil for weeks and that is why I start this thread. In this weeks off an on of NArdil I have felt so great that I want to continue doing this.
90 mgs is my next step , but first I have to wait to receive my shipment of Seroquel, which I am sure will control the imsomnia problems.
Thank you very much again.
I hope more people can give their opinion on this thread
Posted by ed_uk on December 24, 2004, at 8:08:26
In reply to Re: antidepressant afterglow » Le Grande Fromage, posted by Tepiaca on December 23, 2004, at 22:22:23
Hi Tep,
I hope you are feeling a bit better lately.
Best Regards,
Ed.
Posted by Tepiaca on December 25, 2004, at 13:17:13
In reply to Re: antidepressant afterglow » Tepiaca, posted by ed_uk on December 24, 2004, at 8:08:26
This is the end of the thread.
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