Posted by Tarasaur on June 25, 2010, at 3:18:47
In reply to Re: zoloft , apathy/anhedonia, pregnancy, nursing, posted by Laurie Beth on April 5, 2006, at 14:15:15
"> I'm a nursing mom with post-partum depression. I felt great during this pregnancy. True, I was on ~50 mg. of Zoloft throughout (I had continued on Zoloft after a prior PPD episode). But it seemed to me that the pregnancy hormones themselves were a big factor in my feeling very good. (After several years of secondary infertility treatment, I was thrilled to beat the odds and get pregnant at age 41, so that might have something to do with it too, but I also felt better in the second and third trimesters than in the first, so I tend to think that the high levels of estrogen and progesterone, perhaps in combination with the Zoloft, were making me feel good and think clearly.) At birth, we raised my Zoloft dose to 100 mg. prophylactically, in one day. Possibly that had something to do with what happened next, but note that I had been on 200 - 300 mg. of Zoloft between pregnancies, with some blunting of affect and some decrease in motivation, but not so much that I chose to go off at the time (even after I finally figured out that Zoloft was implicated in thesse reactions; no one told me that; like many here, I had to figure it out on my own before I saw it confirmed here). I nursed this baby, as I did my first baby, and continued to feel good for the first 2 months after she was born, and thought that Zoloft and many other precautions had saved me from a second episode of PPD. Then, when she started sleeping through the night at 2 months, I started to feel more anxious, perfectionistic, irritable, and apathetic, started having some insomnia, started having trouble making decisions, and started having problems with cognitive slowing, memory, and even clumsiness. We raised the dose to 200 mg., and the anxiety went away, replaced by increased cognitive slowing, incredible sleepiness and, when I wasn't so sleepy, incredible apathy and anhedonia. I was still nursing.
>
> So why did I now feel SOOOO bad on 100 - 200 mg. of Zoloft, when I had felt only some apathy and emotional blunting on 200 mg. - 300 mg. before? Maybe it was just Zoloft poop-out, but I wonder about the role of of the hormones involved, or of the sudden change in hormones - from estrogen and progesterone in pregnancy, to prolactin and oxytocin after birth, and then, at 2 months, presumably to less, but still significant levels prolactin and oxytocin, as I continued to nurse the baby, but no longer during the night.
>
> I often try to puzzle out these connections. But I can't figure it out in any satisfying way.
>
> I have since gone off Zoloft completely (very slow taper), and started being able to cry again (thank goodness), but I still had significant apathy, anhedonia, and irritability. Two months after taking my last Zoloft pill, I started on Wellbutrin, and am now at 600 mg. and doing better on all fronts - not great, but better. I am still nursing, but my baby is now 15 months, and the birth is 15 months past, so I'm not sure how much of the change is attributable to the Wellbutrin, and how much is attributable to just time, or to being the mother of a toddler instead of a baby now.
>
> My pdoc said that I'd probably be fine again if we could induce a "false pregnancy" hormone state in me. I speculated to him that my brain just doesn't seem to like prolactin (because I had PPD both times, while nursing my daughters), but he said if that, if anything, the emotional and mental difficulties probably had more to do with oxytocin (but he didn't elaborate).
>
> So, for me, it doesn't seem as simple as oxytocin good / serotonin bad. Though I do think that rapid CHANGES in hormones (due to nursing, and due to probable perimenopause) might be a big part of the problems.
>
> Speculation welcome....
>
> -Laurie"Hi, Laurie. I wonder if you have looked into acetalcholine. I have only recently been made aware of it when I read somewhere that introverts burn through way more acetalcholine than most people, and then they start to get childish and wonky (I know I do). The main source I have been looking at is from an article called "A Heads-Up Look at Brain Health," which can be found at
http://spwb.com/articles/brainarticle.html
Here is some of what it says about acetalcholine"
"AcetylcholineReview: A normal brain takes about 300 msec (milliseconds) plus a persons age in years to think. This is the measurement of the time delay, or latency, between a stimulus given and the recognition of that stimulus in the brain. As the latency increases (speed decreases), a person moves from mild cognition deficits to severe dementia.
Acetylcholine-associated disease states
A diagnostic evaluation of a persons brain speed can give objective evidence of disturbances in cognition, memory, attention, and behavior. After subtracting the patients age, the baseline latency measurement indicates the following: 300 msec is normal; 350 msec indicates mild to moderate disturbances in cognitive function (muddled thinking); 360 to 370 msec indicates ADD or variability of attention, errors of omission or commission, and delayed reaction time; 380 msec is typically found in Parkinson patients; 420 msec is the threshold for Alzheimer disease, with increasing latency as the dementia progresses. Early detection of deficiencies in the speed at which the brain operates can allow early intervention to slow or reverse the decline, possibly delaying or preventing the onset of Alzheimer and other dementias.
Beyond detecting a frank disease state associated with severe acetylcholine deficiency, physicians can analyze the balance of the four neurotransmitters to determine a patients personality type.
The acetylcholine-dominant personality
Acetylcholine is produced in the parietal lobes, which are responsible for thinking functions such as language processing, intelligence, and attention. People with an excess of acetylcholine (about 17% of the worlds population) are adept at working with their senses and view the world in sensory terms. They are quick thinkers, highly creative, and open to new ideas. Flexibility, creativity, and impulsivity open them up to trying almost anything, as long as it offers the promise of excitement and something new; they are not afraid of failure. They love to travel and have a quest for lifelong learning. These people also tend to be extremely sociable, even charismatic. They love making new friends and put a lot of energy into all of their relationships, whether at work, at home, or in the community. They are eternally optimistic, romantic with their significant other, and attentive to the needs of their children. They are quite popular with a broad range of people. People with extremely high levels of acetylcholine, however, risk giving too much of themselves to others, even to the point of being masochistic. They may feel that the world is taking advantage of them, or they may become paranoid. Too much acetylcholine can drive a person into isolation.
The acetylcholine-deficient personality
Low levels of acetylcholine result when either the brain burns too much or produces too little. Shifts in personality occur at a much milder deficiency than the dementia- producing deficiencies mentioned earlier. These personality traits can, in fact, manifest when the acetylcholine level is only slightly lower than the levels of the other three neurotransmitters. And remember, were looking at the relative balance of neurotransmitters. A deficiency in one neurotransmitter is usually offset by an excess of another, which typically produces the personality traits associated with a dominance of that other neurotransmitter.
The eccentric. The absence of thought connections to other people and the world makes this persons behavior seem odd. The eccentric usually steers away from human interaction and keeps himself isolated. Outwardly, he appears bland and inexpressive. When even mildly stressed, however, he can become a danger to himself and others.
The perfectionist. This person is usually hard working, detail oriented, devoted, and exacting. Self-discipline is a hallmark of this personality type, which can be either a plus or a minus, depending on the severity of the imbalance and which other neurotransmitter is dominant. This person can be an excellent worker, or he can be rigid and obsessive to the point that nothing is actually accomplished. The perfectionists life is usually lacking in enjoyment, relaxation, and warmth, which can make that person unapproachable."
Just throwing it out there. Good luck to all of us.
poster:Tarasaur
thread:628113
URL: http://www.dr-bob.org/babble/20100615/msgs/952112.html