Posted by ItsHowdyDudyTime on November 27, 2002, at 20:52:52
In reply to Is there a medical term for AD poop-out?, posted by Jackster on November 27, 2002, at 12:28:22
There is no formal medical term for antidepressant poop out to my knowledge. This just exemplifies the lack of interest within psychiatry to help the chronic TRD patient. They dont even have terms to accurately describe this common occurence known as antidepressant poop out.
However I can tell you that the term "tolerance" as one poster described, is not an accurate description of what is happening here. Tolerance is a term used with drugs of addiction...alcohol, cocaine, heroin, amphetamines, etc. With drugs of physical addiction, you need more and more drug to maintain the effect, this is due to "tolerance" and is well established in medical literature.
However, antidepressants are not controlled substances and are not physically addictive. Therefore "tolerance" is a very poor term to use to describe what you are describing. The most common theory concerning why ADs poop out revolves around subtle dopamine depletion over the longterm. Many ADs, particularly the newer SSRIs, slowly deplete dopamine over time. As dopamine levels deplete, activation of the antidepressant tends to decrease. This leads to AD poop out. Some claim that adding a dopaminergic agent to the SSRI such as Ritalin or a small dose of Amantadine or Wellbutrin can restore activation.
Other cases of AD poop out are supposedly due to misdiagnosis. In other words the patient was dxed purely as depressed but in actuality has other comorbid Axis 1 disorders such as bipolar disorder, a psychotic component to the depression, severe anxiety disorders such as OCD, etc. In these cases, coadministration of a mood stabilizer usually lithium can reactivate the antidepressant. Or addition of an atypical anti-psychotic can reactivate the AD.
However these strategies are still iffy and its rare that a person who clinically presents as a depressive really has bipolar disorder or is psychotic. Most of the time, the real problem is a simple lack of technological knowledge on the part of psychiatry to understand the true nature of the brain. To put it bluntly, psychiatrists really dontknow much about the brain and brain diseases. Many cases of TRD eventually turn out to be things like Parkinsons disease, MS and other Neurological conditions. Just sometimes the depression shows up first.
High technology added to psychiatry would go a long long way towards helping to solve problems like you are inquiring about. However psychiatry has little interest in high technology or in improving itself. This is why 30% of all depressives are not able to get out of depression no matter what they do. Its a simple lack of understanding in a hard science, neurological kind of way as to whats really going on in the brains of these individuals.
Its not a good thing
Howdy Doody
poster:ItsHowdyDudyTime
thread:129589
URL: http://www.dr-bob.org/babble/20021127/msgs/129656.html