Psycho-Babble Medication Thread 1093684

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What you think of research on long term SSRI use

Posted by Prefect on December 26, 2016, at 19:29:57

Some research has shown long term SSRI use perturbs receptors and causes untreatable major depressive disorder. Any opinions on this research?

https://www.ncbi.nlm.nih.gov/pubmed/21459521

 

Re: What you think of research on long term SSRI use

Posted by rjlockhart37 on December 26, 2016, at 22:19:05

In reply to What you think of research on long term SSRI use, posted by Prefect on December 26, 2016, at 19:29:57

i've been Prozac since i was 18, so basically all my early adult life, i've been on Prozac. It worked when i first started taking it but it mainly was at 40mg when it started becoming effective, i notice now if i don't take prozac for a few days i get back into serious depression....it did help with depression. If i don't take it, it's everything get's low, and dark.....prozac made things more content, and able to function. Still yes i do get depressed thinking about things that bother me, htere's no anything that would make you not depressed unless your taking serious hard core drugs like exctasy, or high power opiates, but it doenst stay stable.....because it wears off and depression come on......i've been on prozac since 2005, it has worked....mood is more baseline and content, but if it's removed it causes major depression withdrawl

 

Re: What you think of research on long term SSRI use

Posted by Larry Hoover on December 26, 2016, at 23:30:09

In reply to What you think of research on long term SSRI use, posted by Prefect on December 26, 2016, at 19:29:57

> Some research has shown long term SSRI use perturbs receptors and causes untreatable major depressive disorder. Any opinions on this research?
>
> https://www.ncbi.nlm.nih.gov/pubmed/21459521
>

The abstract to this paper included the following: "Depressed patients who ultimately become treatment resistant FREQUENTLY have had a positive initial response to antidepressants and INVARIABLY have received these agents for prolonged time periods at high doses."

I bolded two words to emphasize them. The latter clause may stand on its own, but it has no relevance to the former statement whatsoever. What are the statistics that validate these rhetorical statements?

Can anyone supply me with the full-text of this paper? I call POLITICS not SCIENCE here.

Lar

 

Re: What you think of research on long term SSRI use

Posted by PeterMartin on December 27, 2016, at 1:23:46

In reply to Re: What you think of research on long term SSRI use, posted by rjlockhart37 on December 26, 2016, at 22:19:05

This is just my own dumb theory that is not based on any real study but they say rates of dementia have actually been decreasing since the 90s and they're not sure why. I had a thought that since SSRIs became popular in the 90s they may have some preventative effect against dementia. Many of psych med metabolites are not filtered out by water treatment plants before going back into the drinking water so even people not prescribed medicine get trace doses of popular medications (prozac for ex).

Personally I'm not too concerned about SSRIs causing harder to treat depression as I know I'll most likely be on medicine for the rest of life. I feel they're safe though. Haven't read too many anecdotes over the years of people claiming to have long term side effects after ceasing any SSRI.....

 

Re: What you think of research on long term SSRI use Larry Hoover

Posted by SLS on December 27, 2016, at 6:58:33

In reply to Re: What you think of research on long term SSRI use, posted by Larry Hoover on December 26, 2016, at 23:30:09

Hi, Larry.

It's nice to see your smiling face again. :-)


> > Some research has shown long term SSRI use perturbs receptors and causes untreatable major depressive disorder. Any opinions on this research?
> >
> > https://www.ncbi.nlm.nih.gov/pubmed/21459521
> >
>
> The abstract to this paper included the following: "Depressed patients who ultimately become treatment resistant FREQUENTLY have had a positive initial response to antidepressants and INVARIABLY have received these agents for prolonged time periods at high doses."
>
> I bolded two words to emphasize them. The latter clause may stand on its own, but it has no relevance to the former statement whatsoever. What are the statistics that validate these rhetorical statements?

I agree with you on this one.

Maybe:

Even if this drug-induced "tardive dysphoria" exists as a phenomenon, this study does not provide adequate evidence of it. If it does not exist, it may be that upon discontinuation of an antidepressant, someone experiences a severe depressive withdrawal rebound followed by a return of (treatment-resistant) depression. During the period of rebound, someone will feel worse than their untreated baseline depression, leading them to believe that they are to feel this exacerbation indefinitely. Eventually, however, the withdrawal symptoms gradually ease, leaving them "stuck" back in their original baseline depression that they now interpret as tardive dysphoria. Of course, it is likely that they will not respond robustly to the same agent they discontinued due to an accommodation for neural function. This could also be mistakenly interpreted as tardive dysphoria.

Thank you for your comments here.


- Scott

 

Re: What you think of research on long term SSRI use

Posted by Prefect on December 27, 2016, at 7:58:34

In reply to Re: What you think of research on long term SSRI use Larry Hoover, posted by SLS on December 27, 2016, at 6:58:33

It's comforting to know how many people on this site have been on SSRIs long term.

I've been on Fluvoxamine for 20 YEARS, and I can't say it's done much for my anxiety (or whatever it is I have), but I did get a lot worse the one time I tapered down and then did not respond to the same dosage.

One of these days I need to find the courage to taper it down fully, deal with the consequences, and try a new drug that will actually improve me. WIth courage I mean, I'm a working single father and can't afford to be "offline".

 

Re: What you think of research on long term SSRI use

Posted by SLS on December 27, 2016, at 8:27:29

In reply to Re: What you think of research on long term SSRI use, posted by Prefect on December 27, 2016, at 7:58:34

> It's comforting to know how many people on this site have been on SSRIs long term.
>
> I've been on Fluvoxamine for 20 YEARS, and I can't say it's done much for my anxiety (or whatever it is I have), but I did get a lot worse the one time I tapered down and then did not respond to the same dosage.
>
> One of these days I need to find the courage to taper it down fully, deal with the consequences, and try a new drug that will actually improve me. WIth courage I mean, I'm a working single father and can't afford to be "offline".

You might consider adding the new drug before tapering the fluvoxamine. With a little finesse, you can cross-titrate , wherein you bring the dosage of the old drug down as you bring the new one up.

What drug are you thinking of switching too? With Wellbutrin, Remeron, desipramine, or nortriptyline, you can simply add the new drug.


- Scott

 

Re: What you think of research on long term SSRI use SLS

Posted by Prefect on December 27, 2016, at 14:40:36

In reply to Re: What you think of research on long term SSRI use, posted by SLS on December 27, 2016, at 8:27:29

I'm thinking about a dopamine norepinephrine reuptake inhibitor or something.

My anxiety is the passive somatization/derealization/can't focus/dear in headlight type rather than the cardiac freakout type and I have long sweaty REM sleep late in the morning from which I wake up and can't get mentally alert till like noon. During that time my decision making ability is very low. This is why for years I was misdiagnosed with Chronic Fatigue Syndrome. The kicker is I don't have body fatigue, can exercise like people half my age, and drink alcohol with no consequence, all of which pretty much exclude chronic fatigue syndrome.

I've almost started getting curious about narcolepsy meds or even just over the counter nicotine gum.

 

Re: What you think of research on long term SSRI use SLS

Posted by Prefect on December 27, 2016, at 14:57:12

In reply to Re: What you think of research on long term SSRI use, posted by SLS on December 27, 2016, at 8:27:29

In facts I will go as far as saying I'm slowly getting convinced the last 20 years I've been suffering from some type of severe brain endorphin dysfunction/deficiency and my anxiety is secondary to this condition. I suspect norepinepherin/dopamine deficiency but I could be wrong. Just shooting in the dark.

I'm entering a moment in my life where I'm pretty much willing to try everything. I think the Luvox was a bad choice by doc 20 years ago.

 

Re: What you think of research on long term SSRI use Prefect

Posted by SLS on December 27, 2016, at 16:31:43

In reply to Re: What you think of research on long term SSRI use SLS, posted by Prefect on December 27, 2016, at 14:57:12

Which other antidepressants have you tried?

Do you think that you are treatment-resistant?

Any bipolarity involved with you or your family?

I was very much stricken by low energy, anxiety, depression, and derealization/depersonalization at a time previous to my beginning drug treatment. Because it was 1982, SSRIs and SNRIs were not available. Both TCA and MAOI were helpful, but only for short periods of time. Later, I found that SNRIs were more effective for me than SSRIs. Wellbutrin makes me feel worse. So, I used nortriptyline in combination with Effexor. I found this moderately effective.

Your hunch regarding NE and DA might be right. With a little luck, we will see the approval of the so-called "triple reuptake inhibitors" or "serotoninnorepinephrinedopamine reuptake inhibitors" (SNDRI). In the meantime, I would consider establishing a core antidepressant regime around which to experiment with augmenters if necessary. You could explore using a SNRI (Effexor, Pristiq, Cymbalta) as one core. I would first add Wellbutrin to that. Using a MAOI would be an alternative core. With each core, you could try adding Lamictal and Abilify.

I am currently taking:

Parnate 80 mg/day
Nortriptyline 150 mg/day
Lamictal 300 mg/day
Lithium 300 mg/day
Abilify 10 mg/day
Prazosin 30 mg/day

I am feeling better since bringing up the dosage of nortriptyline and giving this regime time to work (2 months).


- Scott

 

Re: What you think of research on long term SSRI use SLS

Posted by Prefect on December 27, 2016, at 17:19:04

In reply to Re: What you think of research on long term SSRI use Prefect, posted by SLS on December 27, 2016, at 16:31:43

Other drugs? None.

My entire mother's side have mental illness-OCD, GAD, and panic disorder. No bipolarity.

This started in 1997 right after what appeared to be a hepatitis of unknown origin (tested negative for all pathogens) and no jaundice.

From 1997 to 2004 I was convinced I had chronic fatigue syndrome (main symptom was brainfog and inability to concentrate), so I just took 25mg of Luvox (doc who put me on it assumed CFS is a sleep disorder and said low dose SSRI increases restorative deep sleep). The drug didn't do much, I sort of learned to live with the symptoms.

2004 I developed agoraphobia so bumped up Luvox to 50 mg

2013 I tapered down to 40 mg over a 2 month period to see what happens and agoraphobia came back with a vengeance. 50 mg no longer worked so I bumped it up to 100 mg

Last April got divorced (my condition unfortunately makes me challenging partner) and got 50% custody of my 2 year old. Disruption to my sleep on days I have him is likely the reason my derealization/brain fog/anxiety is getting worse again.

So I wouldn't say I'm treatment resistant. I'm not sure what I have, or I would take the drug. Where Luvox falls in with quagmire is just by chance and an original false diagnosis.

So far I've only tried augmentation supplements these last couple of months because I've promised myself to try something new every week, because the stakes are getting higher.

Since 3-4 weeks ago Magnesium L-Threonine - No significant improvement
Since 2 weeks ago 1000 mg Vit D - No significant improvement
About a week ago - Ginger root tea for anti-inflammatory properties (not bad actually, but wearing off again)
Today I started Tyrosine - Didn't make a difference (wouldn't it right away if I'm dopamine deficient?)
Today I also started Zinc supplementation.

In a couple of days I may try nicotine gum.

I'm desperate.

BTW I was a heavy smoker in 1997 and quit smoking the week I came down with this thing that year.

That's funny my latest family doctor;s been talking about putting me on Pristique.

 

Re: What you think of research on long term SSRI use

Posted by SLS on December 27, 2016, at 18:16:46

In reply to Re: What you think of research on long term SSRI use SLS, posted by Prefect on December 27, 2016, at 17:19:04

> Other drugs? None.
>
> My entire mother's side have mental illness-OCD, GAD, and panic disorder. No bipolarity.
>
> This started in 1997 right after what appeared to be a hepatitis of unknown origin (tested negative for all pathogens) and no jaundice.
>
> From 1997 to 2004 I was convinced I had chronic fatigue syndrome (main symptom was brainfog and inability to concentrate), so I just took 25mg of Luvox (doc who put me on it assumed CFS is a sleep disorder and said low dose SSRI increases restorative deep sleep). The drug didn't do much, I sort of learned to live with the symptoms.
>
> 2004 I developed agoraphobia

Do you also have panic attacks?

You might respond to Effexor (venlafaxine).

If you find yourself being resistant to treatment with SSRIs or SNRIs, you might then consider trying:

1. Anafranil (clomipramine): tricyclic

2. Nardil (phenelzine): MAOI

Both drugs are effective in treating depression, GAD, OCD, and panic disorder (with or without agoraphobia).

I would still look into trying Effexor or some other SNRI first. Effexor has been well studied for panic disorder and agoraphobia.


- Scott

 

Re: What you think of research on long term SSRI use SLS

Posted by Prefect on December 28, 2016, at 9:02:32

In reply to Re: What you think of research on long term SSRI use, posted by SLS on December 27, 2016, at 18:16:46

Thanks Scott.

 

Re: What you think of research on long term SSRI use Larry Hoover

Posted by linkadge on December 28, 2016, at 15:26:56

In reply to Re: What you think of research on long term SSRI use, posted by Larry Hoover on December 26, 2016, at 23:30:09

>INVARIABLY have received these agents for
>prolonged time periods at high doses

Do high doses of antidepressants lead to treatment resistance, or does treatment resistance lead to high doses of antidepressants?

Linkadge

 

Re: What you think of research on long term SSRI use linkadge

Posted by SLS on December 28, 2016, at 17:28:10

In reply to Re: What you think of research on long term SSRI use Larry Hoover, posted by linkadge on December 28, 2016, at 15:26:56

> >INVARIABLY have received these agents for
> >prolonged time periods at high doses
>
> Do high doses of antidepressants lead to treatment resistance, or does treatment resistance lead to high doses of antidepressants?

Perfect question.

Probably both.


- Scott

 

Re: What you think of research on long term SSRI use

Posted by linkadge on December 28, 2016, at 18:22:10

In reply to Re: What you think of research on long term SSRI use linkadge, posted by SLS on December 28, 2016, at 17:28:10

To me, the use of high doses is a sign that either:

a) the individual metabolizes the drug too quickly
b) depression is severe and biochemical alternations are significant requiring a higher dose
c) the individual is responding to an active metabolite (or secondary neurotransmitter target) which requires a higher dose
d) the drug isn't working and so higher doses are tried
e) the individual is developing tolerance

It is possible that higher doses lead to (or are associated with) increased resistance. I don't know the exact reasons for this but they could include:

a) the drug is toxic in higher doses and is damaging the brain in some way as to lead to further worsening
b) the individual is over a therapeutic window and hence responds less to higher doses (i.e. excessive levels of adverse metabolites or the suppression of other neurotransmitter function)
c) side effects of higher doses are interfering with clinical effects)
d) the drug (despite maximal doses) is not able to correct the particular biochemical alterations caused by genetic or situational factors

Or just, as the old saying goes...

"You can never gen enough of the things that you don't need" (i.e the drug just ain't fixing the right problem)


Sorry,

Rambling here.

Linakdge

 

Re: What you think of research on long term SSRI use

Posted by SLS on December 29, 2016, at 8:16:46

In reply to Re: What you think of research on long term SSRI use, posted by linkadge on December 28, 2016, at 18:22:10

Excellent.

I could not have put the words together as well. I agree with you completely.

Thanks. I'm going to copy this to my archives.


- Scott

__________________________________________________________________

> To me, the use of high doses is a sign that either:
>
> a) the individual metabolizes the drug too quickly
> b) depression is severe and biochemical alternations are significant requiring a higher dose
> c) the individual is responding to an active metabolite (or secondary neurotransmitter target) which requires a higher dose
> d) the drug isn't working and so higher doses are tried
> e) the individual is developing tolerance
>
> It is possible that higher doses lead to (or are associated with) increased resistance. I don't know the exact reasons for this but they could include:
>
> a) the drug is toxic in higher doses and is damaging the brain in some way as to lead to further worsening
> b) the individual is over a therapeutic window and hence responds less to higher doses (i.e. excessive levels of adverse metabolites or the suppression of other neurotransmitter function)
> c) side effects of higher doses are interfering with clinical effects)
> d) the drug (despite maximal doses) is not able to correct the particular biochemical alterations caused by genetic or situational factors
>
> Or just, as the old saying goes...
>
> "You can never gen enough of the things that you don't need" (i.e the drug just ain't fixing the right problem)
>
>
>
>
> Sorry,
>
> Rambling here.
>
> Linakdge

 

Re: What you think of research on long term SSRI use Prefect

Posted by Tony P on January 5, 2017, at 0:49:49

In reply to Re: What you think of research on long term SSRI use SLS, posted by Prefect on December 27, 2016, at 14:40:36

>I've almost started getting curious about narcolepsy meds or even just over the counter nicotine gum.

Ritalin I find has a positive effect on motivation, alertnes and well-being, but there is some addiction potential. Late-in-the-day dosing can produce insomnia.

Modafinil (Alertec, Provigil etc.) and its prodrug Adrafinil is a unique cognitive and wakefulness enhancer, promoted mainly for narcolepsy and other sleep disorders but used off-label as an AD and mood-enhancer. It works by a completely different mechanism (not completely understood) from Ritalin and the amphetamine derivatives. Notably, it does not prevent normal sleep. I highly recommend it - I think it should be used much more for depression. I am highly addiction-prone but have never had a problem with modafinil.

For a discussion of nicotine (NRT) as an AD see the thread "Why isn't nicotine gum used for mood disorders?".

 

Re: What you think of research on long term SSRI use

Posted by Tony P on January 6, 2017, at 16:28:48

In reply to What you think of research on long term SSRI use, posted by Prefect on December 26, 2016, at 19:29:57

I notice one of the common complaints here is "My A-D has pooped out, what do I do now". I haven't investigated all the research, but my hunch is that it's true. We know our bodies tend to maintain homeostasis - rebalance physiology to stay the same - e.g. developing tolerance to certain drugs. Why wouldn't that also be true of A-Ds? I've personally experienced poop-out a couple of times.

The issue of whether A-D's cause long-term or permanent damage to receptors is a bigee, and I would certainly like to know more.

 

Re: What you think of research on long term SSRI use

Posted by linkadge on January 8, 2017, at 16:39:16

In reply to Re: What you think of research on long term SSRI use, posted by Tony P on January 6, 2017, at 16:28:48

Some people develop tolerance to antidepressants. We don't know the exact reasons. However, not everybody does develop a tolerance.

In terms of homeostasis, you are right. However, think of it this way. 'Homeostasis' is not depressed. The body wants to maintain a slightly positive mood as this is beneficial for the entire system.

My hunch, is that, if an antidepressant is making you feel better than normal, or if it is only masking the depressogenic effect of certain unresolved environmental stressors, than yes it can poop out, as your body will look to fight it off.

I know, in my life, if I haven't dealt with stressors (or toxic relationships) in my life, then eventually the depression comes back.

I have found the addition of lithium very beneficial in keeping me well for longer periods of time without relapse.

Keep in mind too, that this is a disease. Relapse can happen whether you're taking meds or not.

I try to think of SSRIs as just one of dozens of tools that need to be in the tool box for combating depression.

Linkadge

 

Re: What you think of research on long term SSRI use

Posted by phidippus on October 7, 2017, at 14:28:41

In reply to What you think of research on long term SSRI use, posted by Prefect on December 26, 2016, at 19:29:57

A very limited meta study...


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