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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 Alexanderfromdenmark on April 1, 2009, at 7:41:54
What effects do SSRI's like Lexapro fx have on Acetylcholine release?
Posted by g_g_g_unit on April 2, 2009, at 1:43:28
In reply to SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 1, 2009, at 7:41:54
as far as i know, they downregulate ACH
Posted by Alexanderfromdenmark on April 2, 2009, at 10:55:26
In reply to Re: SSRI's and acetylcholine, posted by g_g_g_unit on April 2, 2009, at 1:43:28
> as far as i know, they downregulate ACH
And they downregulate dopamine too! What's the point of an ad the downregualtes all the neurotransmitters that make us smart, creative and energetic?
Posted by g_g_g_unit on April 4, 2009, at 1:40:23
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 2, 2009, at 10:55:26
SLS (I think?) mentioned that ADs' anti-cholinergic effects might be a necessary part of their mechanism. Same goes for dopamine, I guess, insofar as, in my case at least, the downregulation has helped to curb my more impulsive behaviour. But yeah - I'm definitely sick of the associated side-effects (poor memory, lack of creativity, general dopiness, etc.)
Posted by Alexanderfromdenmark on April 7, 2009, at 8:43:57
In reply to Re: SSRI's and acetylcholine, posted by g_g_g_unit on April 4, 2009, at 1:40:23
In that case I'd rather say that very selective SSRI's are more akin to mood stabiliseres than anti-depressants.
Posted by Garnet71 on April 7, 2009, at 9:46:16
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 7, 2009, at 8:43:57
Hey Alexander -
Do you have a specific link to a resource that explains this concept? I'm very interested in this topic. Yeah, I can google..and search and search...but do you know of a simple summary type webpage or paper offhand that I can start with?
Thanks ~
Posted by Alexanderfromdenmark on April 7, 2009, at 11:47:02
In reply to Re: SSRI's and acetylcholine » Alexanderfromdenmark, posted by Garnet71 on April 7, 2009, at 9:46:16
> Hey Alexander -
>
> Do you have a specific link to a resource that explains this concept? I'm very interested in this topic. Yeah, I can google..and search and search...but do you know of a simple summary type webpage or paper offhand that I can start with?
>
> Thanks ~What I meant is that SSRI's that do not signicantly inhibit the reuptake of NA and DA cause emotional blunting instead of the Antidepressant effect we really need. Which is the ability to experience positive emotions, joy, excitement, pleasure and etc. Life feels meaningless without emotions and SSRI's are often responsible for anhedonia, which is just that, the inability to feel positive emotions.
Here is a long artice shedding light on ssri's, anhedonia and what to do about it.
http://www.freepatentsonline.com/y2006/0217394.htmlAlso, you can google, SSRI's may tharwt the quest for love. Or something like that anyway. I was only on lexapro for approx 1 year, and I'm now 9 months off and I still have anhedonia, constant fatigue, low free testosterone levels and lowered levels of t3. So this so called antidepressant as permantly killed my ability to experiencé emotions, killed off my manly hormone which has made me more or less impotent and i've lost muscle mass and gained fat, and lowered my thyroid function.
My Pdoc assured me that all side effects would go away when I stopped, and that I shouldn't have been so worried about the side effects. I now bear a permanent grudge against that pdoc and the pharma producing SSRI's for f*ck*ng up my neurochemistry and endoctrine system.
The inital problem for which I tried the drug is uncomparible compared to the misery I've aquired because of that stupid drug.
You can go through Marianco's post in this thread, he's extremely knowledgable and I believe he is a psychiatrist.
http://forum.mesomorphosis.com/mens-health-forum/antidepressants-134239845-2.html
Posted by Alexanderfromdenmark on April 7, 2009, at 12:00:27
In reply to Re: SSRI's and acetylcholine » Alexanderfromdenmark, posted by Garnet71 on April 7, 2009, at 9:46:16
> Hey Alexander -
>
> Do you have a specific link to a resource that explains this concept? I'm very interested in this topic. Yeah, I can google..and search and search...but do you know of a simple summary type webpage or paper offhand that I can start with?
>
> Thanks ~
"Once a patient is diagnosed with a form of anhedonia, in certain embodiments the treatment regimen of the present invention includes the administration of one or more agents capable of directly and/or indirectly increasing the availability of dopamine and/or directly or indirectly increasing the efficiency of dopaminergic activity. In one embodiment, the agent or agents used to treat anhedonia are administered while a patient is undergoing treatment for a major depressive disorder.Specifically, patients diagnosed as exhibiting anhedonia are treated with an effective amount of a pharmaceutically active agent, where the amount of agent and type of agent is sufficient to induce, facilitate, or improve dopaminergic availability and/or neurotransmission efficiency. Compounds that facilitate dopaminergic transmission include dopamine analogues, direct dopamine agonists, indirect dopamine agonists, compounds that induce transcription of genes encoding dopamine receptors, any agent or agents that increase the synthesis and/or release of dopamine, compounds that inhibit transcription of genes encoding DAT, compounds that inhibit dopamine binding by DAT, and/or agents that act through dopamine receptors by either direct and/or indirect action to enhance the efficiency of dopaminergic transmission. For patients diagnosed and treated using the present methods, one practiced in the art can thereby facilitate the return to a state in which positive affect can be triggered by stimuli generally considered to be ordinary and normal by one practiced in the art, and such affect mobilized over its normal range.
Accordingly, the present invention addresses (1) patients exposed to the chronic use of SSRI or SNRI medications who do now and/or will in the future suffer degradation of treatment response as a direct consequence of alterations in dopaminergic transmission efficiency induced by whatever root cause, as well as (2) the significant fraction of patients who spontaneously (e.g., without chronic or significant prior exposure to an SSRI or SNRI) exhibit or develop anhedonic symptoms.
As described above, in certain embodiments, the present invention defines a symptom pattern as treatment emergent anhedonia, or iatrogenic anhedonia, resulting from pharmacological treatment of a patient with an agent or agents that increase serotonin transmission efficiency with or without similar increases in the efficiency and availability of norepinephrine. "
Posted by g_g_g_unit on April 7, 2009, at 17:28:24
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 7, 2009, at 11:47:02
Hey, how long have you been off Lexapro for? I've been experiencing something similar to you after being on SSRI's for the past year. If it's any help, I posted on a Nootropics forum I frequent about trying to upregulate the systems affected by SSRI's and this is what someone advised:
"If you don't presently take 2-6g of Omega 3's daily, start. It will probably help over the course of a few months, and it's just good stuff for just about anyone (just get molecularly distilled fish sources, as mercury sucks).
Nardil's effects take a while to dissipate, so keep that in mind when beginning new stuff (I think it's a month, but ask your Doc).
If it were me, I'd try Piracetam, Acetyl-L-Carnitine, N-Acetyl-Tyrosine, Bacopa and/or Rhodiola probably starting with Piracetam or ALCAR. Maybe a vasodilator such as Vinpocetine or Gingko. Start small and take each agent for 2 weeks gradually upscaling until a desirable effect is reached (more is not always better). If you experience negative effects that outweigh any beneficial effects, drop that stuff like a cheating girlfriend. When a stable beneficial effect is reached with the first agent, evaluate whether or not it's enough or if you think another agent is necessary. Evaluate what symptoms you still experience and need to relieve. Choose the agent that relieves the many or all of those symptoms. Rinse, repeat. It's slower, but it saves money and cross-reactions. You'll always know you're taking the right stuff, and how beneficial it actually is, and if you ever start experiencing negative side effects, you're more likely to know what's causing them and so what to drop."Hope it helps. I plan to begin experimenting once I'm fully cleared of Nardil.
Posted by Alexanderfromdenmark on April 8, 2009, at 5:43:07
In reply to Re: SSRI's and acetylcholine, posted by g_g_g_unit on April 7, 2009, at 17:28:24
> Hey, how long have you been off Lexapro for? I've been experiencing something similar to you after being on SSRI's for the past year. If it's any help, I posted on a Nootropics forum I frequent about trying to upregulate the systems affected by SSRI's and this is what someone advised:
>
> "If you don't presently take 2-6g of Omega 3's daily, start. It will probably help over the course of a few months, and it's just good stuff for just about anyone (just get molecularly distilled fish sources, as mercury sucks).
>
> Nardil's effects take a while to dissipate, so keep that in mind when beginning new stuff (I think it's a month, but ask your Doc).
> If it were me, I'd try Piracetam, Acetyl-L-Carnitine, N-Acetyl-Tyrosine, Bacopa and/or Rhodiola probably starting with Piracetam or ALCAR. Maybe a vasodilator such as Vinpocetine or Gingko. Start small and take each agent for 2 weeks gradually upscaling until a desirable effect is reached (more is not always better). If you experience negative effects that outweigh any beneficial effects, drop that stuff like a cheating girlfriend. When a stable beneficial effect is reached with the first agent, evaluate whether or not it's enough or if you think another agent is necessary. Evaluate what symptoms you still experience and need to relieve. Choose the agent that relieves the many or all of those symptoms. Rinse, repeat. It's slower, but it saves money and cross-reactions. You'll always know you're taking the right stuff, and how beneficial it actually is, and if you ever start experiencing negative side effects, you're more likely to know what's causing them and so what to drop."
>
> Hope it helps. I plan to begin experimenting once I'm fully cleared of Nardil.I've already tried that. I'm completely insensitive to almost all supplemnts and meds right now. Havn't tried Piracetam. But I think I need something stronger like wellbutrin, parnate or Emsam. Problem is I don't have a psychiatrist right now, I left him behind because he was so incompetent. he said that Wellbutrin wasn't an antidepressant, when I asked him to add to my lexapro because I was getting so sluggish and apathetic.
Posted by desolationrower on April 8, 2009, at 8:15:37
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 7, 2009, at 11:47:02
> Also, you can google, SSRI's may tharwt the quest for love. Or something like that anyway. I was only on lexapro for approx 1 year, and I'm now 9 months off and I still have anhedonia, constant fatigue, low free testosterone levels and lowered levels of t3. So this so called antidepressant as permantly killed my ability to experiencé emotions, killed off my manly hormone which has made me more or less impotent and i've lost muscle mass and gained fat, and lowered my thyroid function.
>i'm hardly a fan of ssris, but depression and fat gain can also cause anhedonia (not fat gain on this one), fatigue, low T, and low t3, and theres more evidence of this connection than there is for post-use ssri effect. of course wellbutrin would help with that in any case.
-d/r
Posted by Alexanderfromdenmark on April 8, 2009, at 8:59:08
In reply to Re: SSRI's and acetylcholine, posted by desolationrower on April 8, 2009, at 8:15:37
> > Also, you can google, SSRI's may tharwt the quest for love. Or something like that anyway. I was only on lexapro for approx 1 year, and I'm now 9 months off and I still have anhedonia, constant fatigue, low free testosterone levels and lowered levels of t3. So this so called antidepressant as permantly killed my ability to experiencé emotions, killed off my manly hormone which has made me more or less impotent and i've lost muscle mass and gained fat, and lowered my thyroid function.
> >
>
> i'm hardly a fan of ssris, but depression and fat gain can also cause anhedonia (not fat gain on this one), fatigue, low T, and low t3, and theres more evidence of this connection than there is for post-use ssri effect. of course wellbutrin would help with that in any case.
>
> -d/r"Baseline TSH correlated strongly with response to treatment as measured by change in Ham-D scores (r = 0.64, p = 0.003). Low TSH values correlated with greater improvement in depressive symptoms. Thyroid hormone levels decreased with treatment, but these decreases did not correlate with clinical improvement.
Conclusion""With antidepressant treatment, the most common change in thyroid hormones is a decrease in T4 and free T4 without a significant reduction in TSH."
http://www.mhsanctuary.com/rx/testos.htm
"Twelve men and eight women were evaluated. Eight men had subnormal free testosterone levels, two additional men had borderline low levels. Six women had subnormal levels of free testosterone. The average age of male subjects was 50.5 years. The male ASEX mean score was 20 with a mean free Testosterone of 13.5 pg/ml. The laboratory range of free Testosterone was 16-33 pg/ml. The average age of female subjects 39.6 years; female ASEX score was 20, and the mean free Testosterone level was 0.8 pg/ml. (normal range 0.8 - 3.0 pg/ml). (Laboratory ranges were modified according to standardized norms for age; average free testosterone levels decline slightly with increasing age.) Table #1 summarizes the data on all of the subjects in the study. Prolactin levels were above normal in only two subjects (one male, one female), both of whom were also found to have sub-normal levels of free testosterone. All of the other subjects had normal Prolactin levels. Thyroid stimulating hormone was found to be normal in all subjects."
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=518867
"Chronic treatment with fluoxetine (Prozac) has been shown to cause persistent desensitization of 5HT1A receptors even after removal of the SSRI in rats.[25] These long-term adaptive changes in 5-HT receptors, as well as more complex, global changes, are likely to be mediated through alterations of gene expression.[26][27][28][29][30] Some of these gene expression changes are a result of altered DNA structure caused by chromatin remodeling,[31][32] specifically epigenetic modification of histones[33] and gene silencing by DNA methylation due to increased expression of the methyl binding proteins MeCP2 and MBD1.[34] Altered gene expression and chromatin remodeling are also involved in the mechanism of action of electroconvulsive therapy (ECT).[35][36]Because described gene expression changes are complex, and can involve persistent modifications of chromatin structure, it has been suggested that SSRI use can result in persistently altered cerebral gene expression leading to compromised catecholaminergic neurotransmission and neuroendocrine disturbances,[11] such as decreased testosterone levels[37], reduced sperm counts[38], and reduced semen quality with damaged sperm DNA[39]. However, without detailed neuropsychopharmacological, pharmacogenomic and toxicogenomic[40] research, the definitive cause remains unknown."
That last quote is from wikipedia, which may seem a little untrustworthy, but the sources from this statement are primarily from pubmed and thus not wholly untrustworthy.
I have no definitve evidence that the SSRI's caused me this misery, but I think the fact that my current problems only started on the SSRI's and have persisted after the ssri's and that I have blood tests revealing low free free t3, high tsh and low free testosterone is more than adequate evidence in my case. There's also thousands of people with the PSSD syndrome and I'm pretty sure that adequate blood tests would only yield similar evidence.
Before SSRI's I could run 10 km almost every day and was an active sportsmen(mainly to fight depression), yet know I feel like i am dying if I run only 3 km and i'm left iwth a fatigued and aching body for days, which I suppose is because of the low free testosterone wihch is an anabolic steroid.
Also don't forget that they give SSRI's to sexual offenders. As such the SSRI's decrease vigilance, motivation and libido. I couldn't think worse long term solution to treat depression. As such a decrease in thyroid hormones and testosterone in young males like me can only be described as rapid aging.
I don't dispute that some people are helped the SSRI's but I find psychiatry a dangerous profession and starting psychiatric treatment seems wholly a gamble. A gamble which I have lost and must now pay dearly for in a look time to come.
Posted by garnet71 on April 8, 2009, at 9:06:43
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 7, 2009, at 11:47:02
Hey Alexander,
Thanks for posting all that. :) I've never had anhedonia, but it sounds like it sux. Yeah, I heard weight gain can really screw up your hormones like d/r said. I keep thinking that as I go back to my normal weight, some of my problems will just vanish. I really think that.
But still-trying to talk myself out of going on a SSRI again...for anxiety.
When I read your post the first time, I kept thinking - would you have initially taken the SSRI if you thought that it would have eventually messed up your system the way you suspect it has?
If someone told me it might do this to me, I think when I had severe depression, I would have taken it anyway. You know how you read the inserts on the script sometimes - that say - can cause seizures and all kind of other scary side effects......don't we just think that's not going to happen to us and take the medications anyway?
Looking back, would you have taken it, ignoring, say-if you were told your current condition was a potential side effect...would you have taken an SSRI anyway?
Posted by Alexanderfromdenmark on April 8, 2009, at 17:10:28
In reply to Re: SSRI's and acetylcholine » Alexanderfromdenmark, posted by garnet71 on April 8, 2009, at 9:06:43
> Hey Alexander,
>
> Thanks for posting all that. :) I've never had anhedonia, but it sounds like it sux. Yeah, I heard weight gain can really screw up your hormones like d/r said. I keep thinking that as I go back to my normal weight, some of my problems will just vanish. I really think that.
>
> But still-trying to talk myself out of going on a SSRI again...for anxiety.
>
> When I read your post the first time, I kept thinking - would you have initially taken the SSRI if you thought that it would have eventually messed up your system the way you suspect it has?
>
> If someone told me it might do this to me, I think when I had severe depression, I would have taken it anyway. You know how you read the inserts on the script sometimes - that say - can cause seizures and all kind of other scary side effects......don't we just think that's not going to happen to us and take the medications anyway?
>
> Looking back, would you have taken it, ignoring, say-if you were told your current condition was a potential side effect...would you have taken an SSRI anyway?
>
>
>
>I would never ever have taken lexapro if I knew it would have done this. Granted I was desperate, but no I wouldnt, why would I?
I got all cons and no pros. Becoming an anhedonic eneuch is not my idea of a succesful treatment. On top of that, I may never have children, since I doubt the state of my poor tests can be very healthy for my fertility. Low thyroid and low testosterone are serious conditions, not just minor side effects and I DO feel the effects from these conditions, but hopefully that will be treated sucessfully in the coming months if my internist would spend less time asking me whether I hear voices and more time treating my actual problems(I had a very bad consultation with an internist last thursday).
With regards to hormones and weight gain, despite the fact I've gained almost 40 pounds, I'm not actually overweight. I have more belly fat, that is true, but before meds, I was actually underweight weighing 54 kilos at 173 cm.
Back in the day when I was mildly depressed I told a girlfriend of mine that having negative emotions was better than no emotions. Now that I've experienced that, I completely agree. I miss passion, energy, anger, fear, joy, sadness compared to this emotional dulling called anhedonia or apathy, or whatever we may call it.
with regards to whether or not you should go an SSRI for anxiety, I really cannot give you any help. My own experience have been a complete catastrophy, but there are other succes stories. I find solaray magnesium citrate to be has good for tension as any SSRI and that GABA enhancing meds create an emotional stability far more likeable compared to the mental dulling of the SSRI's. Is the anxiety because of meds, reactional or part of your psych problems right now?
Posted by desolationrower on April 9, 2009, at 6:59:14
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 8, 2009, at 17:10:28
have you thought about a trial of tianeptine
-d/r
Posted by garnet71 on April 9, 2009, at 11:33:30
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 8, 2009, at 17:10:28
Well, I decided to not be angry about it anymore and focus on moving forward. it did piss me off for a while that doctors kept prescribing me ssris for anxiety that made me feel miserable. I mean, when I told the last PDoc I couldn't function on them, he said "what do you want me to do?". Prior to that, my care was managed by a nurse, not sure if that had something to do with it, but i kept feeling worse on SSRIs, but no alternatives were ever brought up, except switching to another, so I'd quit taking them, eventualy get reoccurring anxiety attaacks, start on them again, merry go round. So really, a lot of misery from the past 3 years or so could have been avoided. It wasn't till I came here to this forum, that I saw all the alternatives and realized what was going on. yeah, cost me years of life quality, but I've gotten over it.
What does continue to bother me, only because it still effects my life in terms of my personal resources, is always having to be your own expert. It's so time consuming and a waste of mental energy. I remember this happening at a very young age, well when I was stiill a teenager, and was screwed out of school financial aid I was entitled to because the financial aid guy at the school did not know his job. Cost me $10,000, which took me 10 plus years to pay back. I realized this only 2 years later, and tried to recoup it, but there really was no legal remedey I could see, but I couldn't afford an attorney anyway. At the time, I argued with the guy, stating I think he was wrong-but he swore he knew for sure. There was no itnernet back then to search, and I guess being so young and inexperienced, I didn't pursue it further.
I mean, just the other day medical assistance lady told me my VA educational benefits count as income. WEll, I had already checked state regs, and knew it did not. I told her this. she argued with me. wEll, she calls me back and says you're right, it doesn't count as income. Everything is back and forth with her. I still can't get medical assistance, but I think their might be a way, and as soon as I have more time, I'm going to try to figure it out.
So that's the only thing that still bothers me. It's time consuming to read regulations and do all the legwork yourself when their are people paid to do a job. Like psychiatrists.
So, I wonder how many people are screwed because an expert doesn't know their job. I understand no one is perfect and I make employment mistakes as well, but as you can see-costing a person $10,000, especailly when I argued about it on several occaisons-I rmember this distinctly--is an example that led me to always researching everything I have to do. I mean, if someone doesn't bring up the possibility, that's one thing, but when the client or whoever brings something to your attention, woudln't you check into it? I honestly am sick of it. I never knew I had to do it for psychiatric care until recently.
So that's a non-answer answer i guess. lol
I think anxiety for me is 50% genetic, 50% enviornmental-childhood issues, lifestyle, chronic stress reaction. I always think someday I will be able to manage it w/o meds. I have been med free for as much as 6 months at a time since it started, and had long stretches where I had no anxiety.
Posted by garnet71 on April 11, 2009, at 2:49:03
In reply to Re: SSRI's and acetylcholine, posted by Alexanderfromdenmark on April 8, 2009, at 17:10:28
"Low thyroid and low testosterone are serious conditions, not just minor side effects and I DO feel the effects from these conditions, but hopefully that will be treated sucessfully in the coming months if my internist would spend less time asking me whether I hear voices and more time treating my actual problems(I had a very bad consultation with an internist last thursday)."
Can't you go to an endocronologist instead???
Posted by Alexanderfromdenmark on April 13, 2009, at 9:56:56
In reply to Re: SSRI's and acetylcholine » Alexanderfromdenmark, posted by garnet71 on April 11, 2009, at 2:49:03
> "Low thyroid and low testosterone are serious conditions, not just minor side effects and I DO feel the effects from these conditions, but hopefully that will be treated sucessfully in the coming months if my internist would spend less time asking me whether I hear voices and more time treating my actual problems(I had a very bad consultation with an internist last thursday)."
>
> Can't you go to an endocronologist instead???
>The internist I am seeing is an endocronologist. I hate waiting 2 months to see an endocronologist, only to have my sanity questioned. I might not feel well, but I'm not insane. Being sick dosn't equal=insane. When we go to Pdocs, doctors, specialists, or whatever, we don't come in a position of strength. The extra burden of being considered insane or an hypochondriac is really probably the most depressing thing in world, it makes you feel so hopeless, because I NEED their help, I can't solve hormonal problems on my own.
I know what you mean Garnet about having to be your own expert. Going on an SSRI and deciding to trust my Pdoc is probably the biggest mistake I have ever made, the only time I decided to give up control an have faith in my Pdoc. From now on, when it comes to Psych meds, I will be my own expert and the pdoc will only be the person that prescribes them. If I ever see a pdoc again. I think I'll have to though, to get something that boosts DA.
This is the end of the thread.
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