![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by NewQuestions on April 3, 2009, at 10:11:01
It seems like poop out is a SSRI phenomenon only. It does not seem like long time users of MAOIs and TCAs poop out. Why?
Posted by myco on April 3, 2009, at 10:33:49
In reply to How come no MAOI/TCA poop out? Only SSRI poop out, posted by NewQuestions on April 3, 2009, at 10:11:01
> It seems like poop out is a SSRI phenomenon only. It does not seem like long time users of MAOIs and TCAs poop out. Why?
************************
Maois do "poop out" but not how you may think. It's not that stop working really...well studies suggest they do in a way. For me im over 4 months now on nardil and the physical aspect of it is gone...it has incorporated itself into my behaviours now only...no other indication im on the med. but im noticing over time that my concentration and energy levels, that it once was awesome for, are going down (still good on anxiety though)...this is attributable to Dopamine downregulation or inhibition/dulling of dopamine "firing"...this happens for most AD's after awhile. they begin to lose that DA and NE effect from downregulation of dopamine but normally retain the SE effect, if you have a need for it. those that experience "poop out" may simply neeed more DA and NE perhaps not as much SE. I dont like ssri's....depression and anxiety are so much more than just seratonin.
2 relevent studies (i have full text if needed):
------------------------
"Association of Changes in Norepinephrine and Serotonin Transporter Expression with the Long-Term Behavioral Effects of Antidepressant Drugs"Zhao et al. Neuropsychopharmacology (2008), 115
Previous work has shown that repeated desipramine treatment causes downregulation of the norepinephrine transporter (NET) and persistent antidepressant-like effects on behavior, ie effects observed 2 days after discontinuation of drug treatment when acute effects are minimized. The present study examined whether this mechanism generalizes to other antidepressants and also is evident for the serotonin transporter (SERT). Treatment of rats for 14 days with 20 mg/kg per day protriptyline or 7.5 mg/kg per day sertraline reduced NET and SERT expression, respectively, in cerebral cortex and hippocampus; these treatments also induced a persistent antidepressantlike
effect on forced-swim behavior. Increased serotonergic neurotransmission likely mediated the behavioral effect of sertraline, as it was
blocked by inhibition of serotonin synthesis with p-chlorophenylalanine; a parallel effect was observed previously for desipramine and
noradrenergic neurotransmission. Treatment with 20 mg/kg per day reboxetine for 42, but not 14, days reduced NET expression; antidepressant-like effects on behavior were observed for both treatment durations. Treatment for 14 days with 70 mg/kg per day venlafaxine, which inhibits both the NET and SERT, or 10 mg/kg per day phenelzine, a monoamine oxidase inhibitor, produced
antidepressant-like effects on behavior without altering NET or SERT expression. For all drugs tested, reductions of NET and SERT
protein were not accompanied by reduced NET or SERT mRNA in locus coeruleus or dorsal raphe nucleus, respectively. Overall, the
present results suggest an important, though not universal, role for NET and SERT regulation in the long-term behavioral effects of
antidepressants. Understanding the mechanisms underlying transporter regulation in vivo may suggest novel targets for the development
of antidepressant drugs
------------------------------------------
"Long-term administration of monoamine
oxidase inhibitors alters the firing rate and
pattern of dopamine neurons in the ventral
tegmental area"Chenu et al. International Journal of Neuropsychopharmacology, Page 1 of 11.
Monoamine oxidase inhibitors (MAOIs) exert their antidepressant action by increasing the function of the serotonin (5-HT), norepinephrine and dopamine (DA) systems. There is, however, limited electrophysiological data on the effects of MAOIs on DA neurons. The effects of 2-d and 21-d administration of three MAOIs were investigated (clorgyline, selective MAOI-A; deprenyl, selective MAOI-B; phenelzine, non-selective MAOI) on the firing activity of DA neurons in the ventral tegmental area using in-vivo
electrophysiology in rats. Short-term clorgyline (1 mg/kg) and phenelzine (2.5 mg/kg) was devoid of
effect on DA neurons, whereas prolonged administration significantly decreased their firing rate (by 30% and 20%, respectively), number of bursts (by 80% and 45%, respectively), and percentage of spikes occurring in bursts only in clorgyline-treated rats (70 %). Deprenyl (0.25 mg/kg) was without effects. DA firing was restored in clorgyline-treated rats by inhibiting 5-HT synthesis using para-chlorophenylalanine
(p-CPA; 300 mg/kg . d for three consecutive days). The 5-HT3 antagonist ondansetron (0.5 mg/kg) was devoid of effect in control rats, but completely reversed the alterations of DA neuronal activity in clorgyline-treated rats. An attenuation of DA neuronal activity was thus produced by prolonged blockade of MAOA activity. The absence of effect of MAOA inhibition after subacute administration suggested an indirect mechanism. This was confirmed by the observation that p-CPA antagonized the effects of clorgyline.
Since ondansetron completely reversed the effects of clorgyline on DA neuronal activity, the effects
of MAOA inhibition appeared to be mediated by 5-HT3 receptors.
------------------------
Posted by NewQuestions on April 3, 2009, at 10:49:57
In reply to Re: How come no MAOI/TCA poop out? Only SSRI poop out » NewQuestions, posted by myco on April 3, 2009, at 10:33:49
But it seems like the problems I am experiencing (i.e., long term use of SSRI leads to tolerance and adaptation leads to inability to take SSRI's or other antidepressants leads to long term protracted withdrawal) and that others seem to experience in various forms and degrees, does not occur with MAOIs and TCAs...?
Posted by myco on April 3, 2009, at 11:12:28
In reply to Re: How come no MAOI/TCA poop out? Only SSRI poop, posted by NewQuestions on April 3, 2009, at 10:49:57
I dont have alot of experience with TCA's and this is my MAOI...I cant yet give you much in the way of long term effects here as of yet...never having withdrawed from a maoi.
I dont think its tolerance, well, it's more adaptation to the effects of the SSRI. Im not sure but I think those meds actually alter something in your head that persists for along time...perhaps imprinting itself on the cns the way benzos do after long term use. Im not a psychopharmacologist. can only give you my ideas/opinions here.
Its possible that the ssri's have altered something, like i said, that persists for ages...have you waited a long time between ssri use? I havent myself noticed any long term sides "hanging out" from my ssri use. longest med i was on was effexor.
I think once people hit maois they are on and have been on meds for ages and dont tend to go off for very long so dont really get the full effect of being med free and seeing how they feel. not sure this answers anything youve asked lol. somewhat above my head here....d/r?
-----------
> But it seems like the problems I am experiencing (i.e., long term use of SSRI leads to tolerance and adaptation leads to inability to take SSRI's or other antidepressants leads to long term protracted withdrawal) and that others seem to experience in various forms and degrees, does not occur with MAOIs and TCAs...?
Posted by Zana on April 3, 2009, at 12:03:38
In reply to Re: How come no MAOI/TCA poop out? Only SSRI poop » NewQuestions, posted by myco on April 3, 2009, at 11:12:28
I think I understand your question tho I definitely don't understand the implication of the articles Myco added. I have been through every SSRI known to man and they have all either pooped out or been agitating. I don't know why they are agitating and I don't know why they poop out. But I have a vague idea that the brain adapts to the med and returns to a pre med homeostasis - which is depression. I would be interested to know if this is different with MAOI's. I had good luck with selegiline (Emsam) but developed a rash in my mouth after several months so had to discontinue it. My therapist is eager for me to try Pristiq but I don't know why I would have any more success with it than I had with Effexor or any of the other SSRI's. I'm on Seroquel now and it's really not much help.
Zana
Posted by Phillipa on April 3, 2009, at 12:17:47
In reply to Re: How come no MAOI/TCA poop out? Only SSRI poop, posted by Zana on April 3, 2009, at 12:03:38
Anyone know why SSRI's never made me tired? Always agitated as anxiety and panic were the main problems. Now doing a left turn and seems I just feel nothing on SSRI's and the benzos that gave me energy just make me tired. So in essecence does this mean that no meds work? Or that since trials were for a few months only that they are meant for short term use? Love Phillipa see how late it is EST and just finished dressing?
Posted by desolationrower on April 4, 2009, at 1:50:08
In reply to Re: How come no MAOI/TCA poop out? Only SSRI poop, posted by Phillipa on April 3, 2009, at 12:17:47
i haven't heard any good ideas for why ssris are worse about poop-out. (and myco, always calling me in for the impossible questions...)
but, lets says that NA has a more central regulatory role? NA drugs tend to do more normalizing on it, whereas 5ht tends to be merely raised?
-d/r
Posted by myco on April 4, 2009, at 11:23:26
In reply to Re: How come no MAOI/TCA poop out? Only SSRI poop, posted by desolationrower on April 4, 2009, at 1:50:08
Another idea I have about ssri's, and this is logical if you think about it, is the rate at which they come out.
You start on some med, under guidance of a dr who is inistant on ssri's and ignorant to the fact that dep is more than SE, and its working ok but not enough to "cover" everything you need it to do...then one day you have an issue or a problem that is "stronger" than the AD and it doesnt work aswell...then you change ssris because you complain to dr and they have heard of some new ssri that is supposed to do blah blah blah...and you enter the world of what i call "the ssri merry-go-round" switching all the time and getting no profound benefit from anything....because your issue is more than just SE...DA, NE, etc (i dont know everything involved in modern theory here) play roles to...hense maois being a good option as they hit all kinds of things. people on maois tend to stay or come back to maois...plus there are less to choose so if you have good experience on maois, better than ssris, you tend to stay in that area....and from someone looking inside from the outside...an ssri patient seeing a maoi patient doing "better for longer" you may get the wrong impression....ugh i think i just lost my argument there. blasted nardil lol
> i haven't heard any good ideas for why ssris are worse about poop-out. (and myco, always calling me in for the impossible questions...)
>
> but, lets says that NA has a more central regulatory role? NA drugs tend to do more normalizing on it, whereas 5ht tends to be merely raised?
>
> -d/r
Posted by myco on April 4, 2009, at 11:25:04
In reply to Re: How come no MAOI/TCA poop out? Only SSRI poop » desolationrower, posted by myco on April 4, 2009, at 11:23:26
Posted by rose45 on August 12, 2019, at 17:20:22
In reply to oops (above for NewQuestions)..cuz u rock d/r lol (nm) » myco, posted by myco on April 4, 2009, at 11:25:04
both nardil and parnate which are maois have pooped out on me...... I cant be the only one. And all I can say is that the psychic pain and anxiety is excruciating.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.