Posted by humanPDR on June 9, 2010, at 9:15:42
In reply to Re: Drug Holiday?, posted by morganator on June 1, 2010, at 1:51:37
> > Ask to add Nortriptyline to your ongoing Lex.
> >
> > I have no scientific proof, but I am convinced that when a treatment targets both norepinephrine and serotonin simultaneously in fairly equal potencies, the likelihood of a more complete response is enhanced and the likelihood of avoiding poopout is enhanced. While SSRIs are so popular because of their supposed lighter side effects (not true) and because of the political atmosphere of the medical community, I am convinced that focusing treatment predominantly on serotonin at the expense of the other neurotransmitters is destined for disappointment down the road. I say that based on hundreds of posts I've seen here over the years from longtime SSRI users. The longest I ever saw someone go on prozac was 10 years, zoloft 8 years, lexapro 4 years, and all of those were very rare happenings in the big picture. Nearly everyone following longterm pure SSRI treatment develops some kind of weird problems they never had before, in addition to their original symptoms.
> >
> > But that is just what my eyes have seen. Take it or leave it at your discretion.
> >
> Are you sure cases of being successfully treated with SSRIs for a long time is all that rare? Don't you think this may just what you have seen, as you already mentioned? I know several people that have had success on one SSRI for a very long time. I think we just hear about the cases of "poop out" and other bad experiences on the internet. I was on Zoloft for 8 years and the only reason it stopped working was because I stopped taking it. I crashed 5 months later after the perfect storm sent me into a horrible mixed state. After this I tried Zoloft and it just didn't work for me the same way. I had a lot more going on then also. If I had not stopped taking Zoloft and had avoided physical and emotional trauma, there is a very good chance I would still be successfully treated by it today. I just think we hear more about the bad experiences people have on the net and the people having good experiences are simply out there living their lives and not bothering to come on the internet to tell everyone how great their medication has been working for them for so many years.
>
>As a student of neuroscience and biochem, I totally agree with you. Having taken a couple of SSRIs with absolutely no reduction in depression/anxiety, IMO serotonin isn't the whole picture. All the SSRIs did was turn me into a lobotomized individual with ZERO motivation, flat affect etc...terrible. The only thing that has ever worked is that MAO Selegiline in the EMSAM patch (at min dose of 6mg to maintain MAO-B selectivity). In my case, my depression was dopaminergic, not serotonergic.
That being said, many people do respond well to them, although statistically they aren't much better than placebos. Placebos in treatment of depression are surprisingly effective however, which may lead to a statistical "under-estimation" of SSRI efficacy.
The truth is, the scientific community still doesn't know **** about the complex pathophysiology of depression. Theories range from NT/receptor ratios/lvls to endogenous endorphin abnormalities to abnormal HPA-axis (hypothalmic-pituitary-adrenal axis) which has alot to do with elevated stress hormones exerting negative feedback and various brain regions. This theory is supported by the observed atrophy (monitored by CREB mRNA via in situ hybridizations) of brain regions such as the hippocampus in chronic depressives.
IMHO, I think depression has its roots in all three of those theories, but in different "ratios" from patient to patient, which is why some respond to SSRI, and some only to MAOIs. But I still feel that to focus solely on the 5-HT system is a vastly oversimplified pharmacological target.
poster:humanPDR
thread:948597
URL: http://www.dr-bob.org/babble/20100604/msgs/950450.html