Posted by Viridis on August 31, 2003, at 18:13:06
In reply to Questions about SSRI's, any feedback?, posted by krybrahaha on August 31, 2003, at 0:14:40
Re: trying two SSRIs and then changing to a different class of meds: I think this just comes from a general observation that if you don't do well on two, then you're unlikely to do well on others. That doesn't make it an absolute rule, and in your case, you got lucky.
Although all the SSRIs are supposed to increase levels of serotonin in synapses (spaces between brain cells through which chemical signals are transferred), they do so differently, and besides, nobody really knows how these meds work. There are effects on other brain neurotransmitters as well, they may stimulate growth of new brain cells, and so on. So, it's not surprising that some people might benefit from one but not another. I certainly reacted differently to Zoloft than Prozac (although very negatively in each case). I suppose I could try all of the SSRIs for 6-8 weeks or so and see if any actually work for me, but I really don't want to go through that, so I found alternatives that work.
I think the time-lag issue has a lot to do with it -- given the long period it takes to establish whether a given SSRI is effective, most doctors don't want you to have to go through a couple of months on one, then a couple on another, and so on, until you get relief. They do want you to get better, and you could easily spend a year or more trying all of them.
Re: criticism of SSRIs: I seriously doubt that SSRIs are likely to make many people violent, suicidal etc. But they're prescribed so widely that there are bound to be weird reactions in a few people. Almost any med out there can cause problems for a small minority. For example, the antibiotic Cipro (which was used during the anthrax scare) can occasionally induce psychosis.
I do suspect that for someone who's been severely depressed and unable to do much of anything, a sudden change that allows them to function could trigger dangerous behavior if there's latent hostility, suicidal tendencies, etc. But I doubt this applies to more than a tiny proportion of SSRI users.
Another reason to bash SSRIs is that they have major side effects for many people, and many of these haven't been acknowledged until recently. When Prozac etc. came out, they got tremendous hype. Now it turns out that they're not just benign, feel-good drugs, and I think this has caused something of a backlash among those who were led to believe that they were essentially side effect-free. This doesn't mean that they shouldn't be used, just that people have to weigh the pros and cons. I did very badly with the SSRIs I've tried, but know others whose lives have been changed by them.
Overall, I suspect that the early publicity, combined with the wide prescribing, has led to emphasis on the really serious reactions. And, given the extensive use of these meds, it's also inevitable that people with dangerous personality disorders are going to get them too, even if other drugs are more appropriate. So, if a paranoid schizophrenic who's misdiagnosed by their GP is given Prozac and kills someone, was it the Prozac, or a bad diagnosis, or some combination?
I think this is a lot like the endless discussions here about the safety of benzodiazepines -- there's lots of evidence that they're excellent meds for many people with anxiety disorders, but given the way that Valium, Xanax etc. were handed out so freely, a few people were bound to have problems, and those get emphasized. So, suddenly, these are labelled "dangerous", "addictive" drugs. They're not for everyone, and neither are SSRIs, but each class of meds has its place.
poster:Viridis
thread:255825
URL: http://www.dr-bob.org/babble/20030828/msgs/255969.html