Posted by mattdds on January 9, 2004, at 16:16:58
In reply to A question/concern about 5-HT reuptake inhibition, posted by Ame Sans Vie on January 9, 2004, at 10:05:23
ASV,
Or should I say Mike? Michael?
You bring up some interesting issues that I have thought about as well.
First, though, what exactly do you mean by "undue stress"? Define "stress" in this context. And what potential problems might arise from it? I'm not asking sarcastically, but it would help if you clarified what you meant by that.
First off, let me start by saying that I think we really have *no* idea how antidepressants are working, but that they seem to certainly work in some people.
As I'm sure you're well aware, the brain is amazingly plastic. When there is too much serotonin, for example, in the synapses, compensatory mechanisms like receptor down regulation or desensitization will kick in to ensure that the serotonergic (or DA-ergic, or NE-ergic, etc.) "tone" is not too high.
So you have all this excess serotonin floating around in the synapse, and initially, this creates strain on the system, but after downregulation of postsynaptic receptors, the net serotonergic transmission should be similar to what it was originally.
This is what has always perplexed me. If the net serotonergic transmission returns to equilibrium after a sufficient amount of exposure to say, fluoxetine, how is it even working? Why doesn't it just poop out for everybody? It doesn't, though.
This is not to say it *isn't* working, it's just always puzzled me, and up to this point I haven't seen a convincing explanation.
Same goes with benzodiazepines. Excess stimulation of the GABA-ergic system --> downregulation or desensitization of benzodiazepine receptors (not sure which one it is) --> GABA-ergic transmission similar to baseline after sustained treatment. But what perplexes me (again!), is that the benzos continue to work for me - long after the "stress" has been relieved.
So perhaps, they are somehow normalizing the equilibrium by placing this initial stress, with the subsequent compensatory efforts.
This is just my idea of how it might work, but it seems logical / possible.
So, by "stress", what exactly do you mean, and what potential problems worry you (e.g. Nerve damage? Neoplasia?).
I ask these questions not cynically, but just to perhaps probe a bit more into what exactly you're concerned about.
But I wouldn't worry about "sress" as long as you are feeling better, because we really don't have a clue what these drugs are doing (well, ok, we have *some* clue). That's why I am a big advocate of focusing on *symptoms*, and real life day-to-day functioning...things that we can measure (at least at this point).
Sorry for the rambly, blabbering form this post took. Haha.
Best,
Matt
poster:mattdds
thread:298512
URL: http://www.dr-bob.org/babble/20040109/msgs/298747.html