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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Phillipa on July 25, 2011, at 19:19:00
Just googled this and didn't realize that a name was given for those who have used ad's and might not regain their previous level of functioning. Rather scarey. Phillipa
Tardive Dysphoria Is A Potential Long-Term Side-Effect Of Antidepressant Medication
On March 7, 2011, in Depression, Medication, submitted by Christopher Fisher, PhD ....In the current issue of Psychotherapy and Psychosomatics, a new important side effect of antidepressant drugs is described: tardive dysphoria. Treatment-resistant depression (TRD) may be related to inadequate dosing of antidepressants or antidepressant tolerance. Alternatively, there are reasons to believe that antidepressant treatment itself may contribute to a chronic depressive syndrome.This study reports on a case of antidepressant discontinuation in a patient with TRD a 67-year-old white man with onset of major depressive illness at the age of 45. He was homozygous for the short form of the serotonin transporter. He was treated off and on until the age of 59 and had been on an antidepressant continuously until the age of 67. Over the previous 2 years, he had been depressed without any relief by medication or 2 electroconvulsive treatments. His medications at the time of evaluation included paroxetine (10 mg daily), venlafaxine (75 mg daily), and clonazepam (3 mg daily). His 17-item Hamilton depression score was 22.
Over the subsequent 6 months, he was started on bupropion and then tapered off all antidepressants, including the bupropion. His Hamilton depression score dropped to 18. The patient was not satisfied with his progress and sought another opinion to restart antidepressants. One year later, on duloxetine (60 mg daily), he continued to complain of unremitting depression.
A possible prodepressant effect of antidepressants has been previously proposed. Fava was the first to suggest that an antidepressant-related neurobiochemical mechanism of increasing vulnerability to depression might play a role in worsening the long-term outcome of the illness. Understanding of potential mechanisms of this phenomenon can be gleaned from observations regarding the short form of the serotonin transporter (5HTTR). Patients with the short form of the 5HTTR and prolonged antidepressant exposure, may be particularly vulnerable to antidepressant-related worsening.
In other words, prolonged exposure to antidepressants can induce neuroplastic changes that result in the genesis of antidepressant-induced dysphoric symptoms. The investigators propose the term tardive dysphoria to describe such a phenomenon and describe diagnostic criteria for it. Tapering or discontinuing the antidepressant might reverse the dysphoric state.
Antidepressant discontinuation may not provide immediate relief. In fact, it is likely that transient symptoms of withdrawal will occur in the initial 24 weeks following antidepressant discontinuation or tapering. However, after a prolonged period of antidepressant abstinence, one may see a gradual return to the patients baseline.
Material adapted from Journal of Psychotherapy and Psychosomatics.
Reference / Abstract
Rif S. El-Mallakh, Yonglin Gao, Brian T. Briscoe, & R. Jeannie Roberts. Antidepressant-Induced Tardive Dysphoria. Psychother Psychosom 2011; 80:5759.
Posted by Christ_empowered on July 25, 2011, at 20:02:02
In reply to Tardive Dysphoria Meaning of, posted by Phillipa on July 25, 2011, at 19:19:00
Reminds me of tardive psychosis--a condition in which long term antipsychotic use worsens (or creates) psychosis. Antidepressants should not be as popular as they have been since Prozac hit the scene.
Posted by jono_in_adelaide on July 25, 2011, at 20:03:12
In reply to Tardive Dysphoria Meaning of, posted by Phillipa on July 25, 2011, at 19:19:00
Jesus, what a can of worms..... you're damned if you take them and damend if you dont..... realy, what is one to do?
Posted by Phillipa on July 25, 2011, at 21:18:28
In reply to Re: Tardive Dysphoria Meaning of, posted by jono_in_adelaide on July 25, 2011, at 20:03:12
Well for me only benzos really worked the times the paxil and luvox did I also was drinking beer at night and that gave me relief from the side effects of paxil. With luvox had the choral hydrate and it's like alchohol. Phillipa what if we go off them now and never really took a high dose or had remittance. Doesn't that give a clue that I didn't need them. Doctors
Posted by Christ_empowered on July 25, 2011, at 21:33:02
In reply to Re: Tardive Dysphoria Meaning of » jono_in_adelaide, posted by Phillipa on July 25, 2011, at 21:18:28
I'm hoping that tardive dysphoria is relatively rare. I mean, I have to personally accept the risks of tardive psychosis because I have to take a relatively high dose (30mgs/day) of Abilify to stay OK. For me, staying out of the hospital is worth the risk, and I know about it. With all these millions of people on ADs, I'm not sure you can make the argument that benefits outweigh the risks. I also sometimes need antidepressants for psychotic depression.
I think maybe the solution would be to emphasize therapy and other forms of non-medical treatment, along with maybe using other kinds of drugs (stimulants, benzos...hell, medical marijuana. Whatever works, right?) besides or in addition to antidepressants. If you go back to when the MAOIs and the TCAs were first introduced, docs didn't have this idea that depression=antidepressant treatment. It might mean ECT, neuroleptics, meprobamate, stimulants, uppers and downers together. Of course, back then, it could also mean a lobotomy was in order, but you get the idea--they targeted symptoms.
These days, you hear about people going from AD to AD or mixing and matching them. If the ADs don't work they're told they have "treatment-resistant depression," or that its a personality disorder (gotta love axis II). Honestly, I think a lot of "depressed" people these days could benefit from talking to somebody (maybe not even a therapist--just somebody who's reasonably empathetic) and taking some Valium.
Anyway, that's my rant on the subject.
Posted by jono_in_adelaide on July 25, 2011, at 22:19:16
In reply to Re: Tardive Dysphoria Meaning of, posted by Christ_empowered on July 25, 2011, at 21:33:02
I think christ makes a valid oint about AD's being overused, but I think it might be not that they are overused for MDD, but that doctors hand them out for basicly every type of unhappiness and dissatisfaction with life.
I had a co-worker whos wife left him, and a couple of days later, he started madly itching all over. Instead of reasurance, or an anthhistamine, or a few Valium, he came away with a script for paroxetine, 30 tabs and 5 repeats...... a six months supply of SSRI because he was itching for a day or two
Posted by sleepygirl2 on July 25, 2011, at 22:50:48
In reply to Tardive Dysphoria Meaning of, posted by Phillipa on July 25, 2011, at 19:19:00
to get off meds
Posted by Phillipa on July 25, 2011, at 23:26:52
In reply to Re: Tardive Dysphoria Meaning of, posted by Christ_empowered on July 25, 2011, at 21:33:02
CE how do you rate meprobamate as took it years ago and didn't have a problem withdrawing just stopped it. Before I knew a thing about meds was combined with valium 5mg three time a day and some beer at night. Had so much energy was when taught Aerobic Dance and raising three kids. Want to talk you can be my therapist? Phillipa
Posted by Phillipa on July 26, 2011, at 0:01:50
In reply to greeeaaaattt....so f*ck*d, another reason, posted by sleepygirl2 on July 25, 2011, at 22:50:48
That's the way I feel also you said it for me. But I'm betting soon things will be different. Do what cha gotta do now and that's all we can do. If I'd know about benzos 41 years ago would have gone on them anyway as had to take care of three little ones and they have worked for years. So I can't complain. Love Phillipa
Posted by floatingbridge on July 26, 2011, at 5:49:43
In reply to Tardive Dysphoria Meaning of, posted by Phillipa on July 25, 2011, at 19:19:00
Tardive Dysphoria is a working theory, not a dx. I would try not to frighten myself or others. Some folks are looking at the possible ramifications of chronic AD use. Most importantly, in my book, it can suggest a possible reason for an increase in the bpii and bpnos categories.
It's interesting to read. I admit to poorly editing and converting the document. (there are some repetitions.). It's theory and no reason to throw meds out the window unless you were already planning too. The authors offer no answers but ask only the same questions we have asked collectively
for some time. Don't use the article against yourselves, please in a reactive manner. SLS has already sagely commented.Besides, even within the theory it does not occur for
everyone.
Posted by kizzie2 on July 26, 2011, at 6:02:46
In reply to Fuller article at top of board' for Kizzie, posted by floatingbridge on July 26, 2011, at 5:49:43
Thank you very much for finding this for me. Much appreciated
This is the end of the thread.
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