![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 38. This is the beginning of the thread.
Posted by CatSparkle on November 24, 2000, at 19:35:36
Hello. I wonder if anyone has any advice/experience they can share with me? Please bear with me through what may be a bit of a long story.
I started taking Serzone four days ago for double depression. I have had a number of major depressions in my life, becoming suicidal during those times. The last time (about 5 years ago) Zoloft helped remarkably, quickly, almost miraculously (at first). I had some side effects which I chose to tolerate, given the alternative. I had some sexual problems (still wanted and enjoyed sex, but had difficulty having an orgasm, and when I did, it was not as "good" as it had been prior to the Zoloft, if that makes sense), and a reduced ability to have strong feelings or write creatively (my hobby). I could not write a word on Zoloft. Still, I took it for three years with pretty good results, although I had to increase from 50 to 150 mg over time, but in the fourth year or so, it seemed to be not as effective; while I was not severely depressed, I was sliding back into the day-to-day depression that is the norm for me. I was mostly functional, though (I handle my normal depression pretty well).
I decided to stop taking the Zoloft about a year ago, as my husband and I were considering trying to have a baby sometime in the following year (this is now out of the question, btw.) Other than a rough withdrawal even though I tapered off of it (severe dizziness, nausea, rageful feelings which were quite uncharacteristic for me), I stuck to it and was my normal (semi-depressed but not unbearably so) self for about 8 months. Then, all hell broke loose and I was in the pit again, and not long after I was once again planning suicide. This time around, I have had major sleep problems (early awakening), and feelings of anxiety (panic, actually) which were not as severe in prior episodes. I really didn't want to go back on ADs, so initially I went to my MD only for the sleeplessness, refusing ADs, and he prescribed ambien, which was only helpful about half of the time. At the follow-up visit, he suggested Serzone because of the sleep issues, the decreased effectiveness of the Zoloft, plus the sexual and other difficulties and the problem with withdrawal that I had with it. (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much discomfort and then restart only when I need to. My MD supports this.)
So now, I am heading into my fourth day of divided 50mg doses of the Serzone, and frankly, I feel like hell. I don't look for side effects of drugs (in fact, did not anticipate any because my doctor emphasized how few side effects it has). I'm experiencing nausea, diarrhea (with constant lower abdominal pain), blurry vision, confusion in the afternoon/early evening hours, sleepiness, and a pretty serious lack of coordination (more than usual, that is). I also feel very weak, and have this strange prickly-burning sensation in my hands and arms (and a little in my face also). I attribute it to the Serzone because it started after two doses (one night and one morning), and I have never before felt this way.
My question is, will this pass??? I could deal with the burning, the lack of coordination since my job isn't physical (although I did crash into and knock over one of my bookcases on Wednesday afternoon), maybe even the nausea and weakness. I might even be able to manage the diarrhea with something else, like lomotil or something. But if the confusion doesn't go away, I won't be able to take the drug, as my job is mentally/intellectually demanding. And I can't change my hours to avoid the time of day when I'm most confused (about 1pm - 7pm). The depression had slowed me down somewhat intellectually, but this is ten times worse. I get VERY confused - can't focus on anything - couldn't even find the office key Wednesday night (on my keyring, where it always is), can't follow well during conversations with clients (forget what they said a sentence ago or don't understand what they are saying to me at that moment), spent an hour looking for papers I know I had (somewhere) the day before (still can't find them), forget how to give the right change when I buy something at the convenience store. And I have a big conference coming up next week, which will require me to be very focused, sharp, and detail oriented. The blurry vision isn't awful, but I do worry about driving (I drive a half hour each way to work, and a couple times a month I travel to other cities for meetings, which are 2-3 hours away.) On the plus side, I can see a big difference already in my anxiety/panic levels. Not much change with the depression, although I know it is too soon for that anyway. I do want to give the drug a chance, as this last episode has been the worst ever, particularly the suicidal feelings (don't worry, I'm not in any imminent danger.)
I am afraid to increase the dosage next week (supposed to do 100mg in divided doses starting Tuesday). My (trusted) pharmacist says that I could take the meds only in the evening, and I could increase slower than the starter kit indicates. In addition to the meds, I see a psychologist once a week who I am comfortable with and have seen in the past. He helps, but I have been in this place before and am now past denying that I can get through it without meds.
Please pardon this long post. If this is just temporary, I'll muddle through, but if not…. Any advice?
Posted by R.Anne on November 24, 2000, at 20:26:45
In reply to Serzone side effects - just temporary?, posted by CatSparkle on November 24, 2000, at 19:35:36
> Hello. I wonder if anyone has any advice/experience they can share with me? Please bear with me through what may be a bit of a long story.
>
> I started taking Serzone four days ago for double depression. I have had a number of major depressions in my life, becoming suicidal during those times. The last time (about 5 years ago) Zoloft helped remarkably, quickly, almost miraculously (at first). I had some side effects which I chose to tolerate, given the alternative. I had some sexual problems (still wanted and enjoyed sex, but had difficulty having an orgasm, and when I did, it was not as "good" as it had been prior to the Zoloft, if that makes sense), and a reduced ability to have strong feelings or write creatively (my hobby). I could not write a word on Zoloft. Still, I took it for three years with pretty good results, although I had to increase from 50 to 150 mg over time, but in the fourth year or so, it seemed to be not as effective; while I was not severely depressed, I was sliding back into the day-to-day depression that is the norm for me. I was mostly functional, though (I handle my normal depression pretty well).
>
> I decided to stop taking the Zoloft about a year ago, as my husband and I were considering trying to have a baby sometime in the following year (this is now out of the question, btw.) Other than a rough withdrawal even though I tapered off of it (severe dizziness, nausea, rageful feelings which were quite uncharacteristic for me), I stuck to it and was my normal (semi-depressed but not unbearably so) self for about 8 months. Then, all hell broke loose and I was in the pit again, and not long after I was once again planning suicide. This time around, I have had major sleep problems (early awakening), and feelings of anxiety (panic, actually) which were not as severe in prior episodes. I really didn't want to go back on ADs, so initially I went to my MD only for the sleeplessness, refusing ADs, and he prescribed ambien, which was only helpful about half of the time. At the follow-up visit, he suggested Serzone because of the sleep issues, the decreased effectiveness of the Zoloft, plus the sexual and other difficulties and the problem with withdrawal that I had with it. (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much discomfort and then restart only when I need to. My MD supports this.)
>
> So now, I am heading into my fourth day of divided 50mg doses of the Serzone, and frankly, I feel like hell. I don't look for side effects of drugs (in fact, did not anticipate any because my doctor emphasized how few side effects it has). I'm experiencing nausea, diarrhea (with constant lower abdominal pain), blurry vision, confusion in the afternoon/early evening hours, sleepiness, and a pretty serious lack of coordination (more than usual, that is). I also feel very weak, and have this strange prickly-burning sensation in my hands and arms (and a little in my face also). I attribute it to the Serzone because it started after two doses (one night and one morning), and I have never before felt this way.
>
> My question is, will this pass??? I could deal with the burning, the lack of coordination since my job isn't physical (although I did crash into and knock over one of my bookcases on Wednesday afternoon), maybe even the nausea and weakness. I might even be able to manage the diarrhea with something else, like lomotil or something. But if the confusion doesn't go away, I won't be able to take the drug, as my job is mentally/intellectually demanding. And I can't change my hours to avoid the time of day when I'm most confused (about 1pm - 7pm). The depression had slowed me down somewhat intellectually, but this is ten times worse. I get VERY confused - can't focus on anything - couldn't even find the office key Wednesday night (on my keyring, where it always is), can't follow well during conversations with clients (forget what they said a sentence ago or don't understand what they are saying to me at that moment), spent an hour looking for papers I know I had (somewhere) the day before (still can't find them), forget how to give the right change when I buy something at the convenience store. And I have a big conference coming up next week, which will require me to be very focused, sharp, and detail oriented. The blurry vision isn't awful, but I do worry about driving (I drive a half hour each way to work, and a couple times a month I travel to other cities for meetings, which are 2-3 hours away.) On the plus side, I can see a big difference already in my anxiety/panic levels. Not much change with the depression, although I know it is too soon for that anyway. I do want to give the drug a chance, as this last episode has been the worst ever, particularly the suicidal feelings (don't worry, I'm not in any imminent danger.)
>
> I am afraid to increase the dosage next week (supposed to do 100mg in divided doses starting Tuesday). My (trusted) pharmacist says that I could take the meds only in the evening, and I could increase slower than the starter kit indicates. In addition to the meds, I see a psychologist once a week who I am comfortable with and have seen in the past. He helps, but I have been in this place before and am now past denying that I can get through it without meds.
>
> Please pardon this long post. If this is just temporary, I'll muddle through, but if not…. Any advice?*****
In the end it is totally up to you what you want to do as you know, I'm sure. When I was in the position of having to perform duties and trying to adjust to antidepressants I would go off ones that gave me terrible unbearable side effects pretty soon. I would usually feel that I could not tolerate the drug within a few days. At other times I have tolerated less bothersome side effects until they went away within 2-4 weeks. At times I would need to take another medicine along with it for side effects, like anxiety that some of them produced for me. Several times I put up with some awful side effects and they did not go away even after a month. I did not want to try something else at that time and just tried to stick it out. Ultimately, though, I ended up having to go on another when the side effects were horrible in my estimation. It's up to you. Good luck!
Posted by stjames on November 24, 2000, at 21:07:57
In reply to Re: Serzone side effects - just temporary?, posted by R.Anne on November 24, 2000, at 20:26:45
If this is just temporary, I'll muddle through, but if not…. Any advice?
>James here....
Could be, all you can do is wait and see.
james
Posted by stjames on November 25, 2000, at 1:42:32
In reply to Serzone side effects - just temporary?, posted by CatSparkle on November 24, 2000, at 19:35:36
(I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much
discomfort and then restart only when I need to. My MD supports this.)James here....
This statement conserns me. I hope you are seeing a real Pdoc. The danger of treating cronic
depression (and you have gone well past meeting the requirements of cronic depression) is that
depression is a progressive process. If not treated throughly, with the goal of never having
relapses, one depressive relapse kindles another, they happen more often and are more significant.
Treating only during relapse has the end result of the meds being less and less
effective. A day may come when nothing works. Because you have been "penny wise and pound
foolish" you now have treatment resistant depression, which may only respond to lots of meds or
not respond at all to any med(s). Anyone who has had multiple depressions to the point of becoming suicidal
should be on meds all the time. It seems foolish to "play with fire" here. If you had diabeties you would not
be foolish to for go insulin, would you ? Regular medication can be free of side effects and give you
a depression free life.James
Posted by Sigolene on November 25, 2000, at 2:40:07
In reply to Serzone side effects - just temporary?, posted by CatSparkle on November 24, 2000, at 19:35:36
Bonjour,
Je ne peux malheureusement pas vous aider, mais vous avez toute ma sympathie car j'ai déjà vécu ces moments difficiles que vous vivez. Il vous faudra beaucoup de patience et de courage, le corps finit toujours par s'habituer à un nouveau médicament.
Sigolène.
> Hello. I wonder if anyone has any advice/experience they can share with me? Please bear with me through what may be a bit of a long story.
>
> I started taking Serzone four days ago for double depression. I have had a number of major depressions in my life, becoming suicidal during those times. The last time (about 5 years ago) Zoloft helped remarkably, quickly, almost miraculously (at first). I had some side effects which I chose to tolerate, given the alternative. I had some sexual problems (still wanted and enjoyed sex, but had difficulty having an orgasm, and when I did, it was not as "good" as it had been prior to the Zoloft, if that makes sense), and a reduced ability to have strong feelings or write creatively (my hobby). I could not write a word on Zoloft. Still, I took it for three years with pretty good results, although I had to increase from 50 to 150 mg over time, but in the fourth year or so, it seemed to be not as effective; while I was not severely depressed, I was sliding back into the day-to-day depression that is the norm for me. I was mostly functional, though (I handle my normal depression pretty well).
>
> I decided to stop taking the Zoloft about a year ago, as my husband and I were considering trying to have a baby sometime in the following year (this is now out of the question, btw.) Other than a rough withdrawal even though I tapered off of it (severe dizziness, nausea, rageful feelings which were quite uncharacteristic for me), I stuck to it and was my normal (semi-depressed but not unbearably so) self for about 8 months. Then, all hell broke loose and I was in the pit again, and not long after I was once again planning suicide. This time around, I have had major sleep problems (early awakening), and feelings of anxiety (panic, actually) which were not as severe in prior episodes. I really didn't want to go back on ADs, so initially I went to my MD only for the sleeplessness, refusing ADs, and he prescribed ambien, which was only helpful about half of the time. At the follow-up visit, he suggested Serzone because of the sleep issues, the decreased effectiveness of the Zoloft, plus the sexual and other difficulties and the problem with withdrawal that I had with it. (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much discomfort and then restart only when I need to. My MD supports this.)
>
> So now, I am heading into my fourth day of divided 50mg doses of the Serzone, and frankly, I feel like hell. I don't look for side effects of drugs (in fact, did not anticipate any because my doctor emphasized how few side effects it has). I'm experiencing nausea, diarrhea (with constant lower abdominal pain), blurry vision, confusion in the afternoon/early evening hours, sleepiness, and a pretty serious lack of coordination (more than usual, that is). I also feel very weak, and have this strange prickly-burning sensation in my hands and arms (and a little in my face also). I attribute it to the Serzone because it started after two doses (one night and one morning), and I have never before felt this way.
>
> My question is, will this pass??? I could deal with the burning, the lack of coordination since my job isn't physical (although I did crash into and knock over one of my bookcases on Wednesday afternoon), maybe even the nausea and weakness. I might even be able to manage the diarrhea with something else, like lomotil or something. But if the confusion doesn't go away, I won't be able to take the drug, as my job is mentally/intellectually demanding. And I can't change my hours to avoid the time of day when I'm most confused (about 1pm - 7pm). The depression had slowed me down somewhat intellectually, but this is ten times worse. I get VERY confused - can't focus on anything - couldn't even find the office key Wednesday night (on my keyring, where it always is), can't follow well during conversations with clients (forget what they said a sentence ago or don't understand what they are saying to me at that moment), spent an hour looking for papers I know I had (somewhere) the day before (still can't find them), forget how to give the right change when I buy something at the convenience store. And I have a big conference coming up next week, which will require me to be very focused, sharp, and detail oriented. The blurry vision isn't awful, but I do worry about driving (I drive a half hour each way to work, and a couple times a month I travel to other cities for meetings, which are 2-3 hours away.) On the plus side, I can see a big difference already in my anxiety/panic levels. Not much change with the depression, although I know it is too soon for that anyway. I do want to give the drug a chance, as this last episode has been the worst ever, particularly the suicidal feelings (don't worry, I'm not in any imminent danger.)
>
> I am afraid to increase the dosage next week (supposed to do 100mg in divided doses starting Tuesday). My (trusted) pharmacist says that I could take the meds only in the evening, and I could increase slower than the starter kit indicates. In addition to the meds, I see a psychologist once a week who I am comfortable with and have seen in the past. He helps, but I have been in this place before and am now past denying that I can get through it without meds.
>
> Please pardon this long post. If this is just temporary, I'll muddle through, but if not…. Any advice?
Posted by JohnL on November 25, 2000, at 18:32:12
In reply to Serzone side effects - just temporary?, posted by CatSparkle on November 24, 2000, at 19:35:36
Serzone is a weird one. It's a finnicky one. It can work great, it can work horrible, and everything inbetween. Clinical trials look very impressive. But at this board I think we get more mixed reviews.
When I tried it I definitely had good sleep and good sex. Sadly it just made me more depressed as time went on. Weird.
One doctor I know has had good success with Serzone. He credits that success to his dosing techniques. He starts patients at 25mg per day, and then increases it by 25mg every four days. (taken in later afternoon or early evening, bedtime is too late) If the patient needs longer time at a particular dose to become more accustomed to it, then they can go at their own pace. But no faster than 25mg every four days. This slower titration in small steps is for several reasons: 1) It is easier to get adjusted to the side effects; 2)For some unknown reason Serzone just seems to work better that way; 3)There is often a therapeutic window with Serzone. Too much is just as bad as not enough. Gotta find that window. Don't want to fly right past it.
Anyway, you might do well to follow your pharmicist's advice. I think that was good advice. Go at a pace that is comfortable to you. Or as the doctor I mentioned said, go only 25mg more every four days (or longer), but no faster than that pace. Just an idea that has worked for others. You really won't know for at least 6 to 12 weeks whether the side effects will diminish or disappear, but at least until then you can make the ride a lot smoother.
If by chance you find yourself get more depressed instead of staying the same or getting better, then you should consider stopping or at least slowing way down. It took me six weeks on Serzone to finally realize I was actually a whole lot worse than I was before I started. Geez. But I've also heard of other people who stuck with it, the side effects went away, and they felt great. We're all different.
John
Posted by CatSparkle on November 25, 2000, at 18:53:31
In reply to Serzone side effects - just temporary?, posted by CatSparkle on November 24, 2000, at 19:35:36
Thanks all for your advice. Yesterday, I started taking the Serzone just in the evenings. Some of the side effects are better today. I still feel weak and tired, but that could be from the last few days of being sick. But I wasn't confused at all today, stomach is better, vision is less blurry, and my hands and face are not as burn-y.
I feel a bit more depressed than yesterday, but I think I'm just weak from being sick (several days of diarrhea and confusion and assorted other things.) Still, much less anxiety and panic than usual.
Again, I appreciate the time all of you took to give me advice.
Cat
Posted by SLS on November 25, 2000, at 21:15:56
In reply to Re: Serzone side effects - just temporary?, posted by Sigolene on November 25, 2000, at 2:40:07
> Bonjour,
>
> Je ne peux malheureusement pas vous aider, mais vous avez toute ma sympathie car j'ai déjà vécu ces moments difficiles que vous vivez. Il vous faudra beaucoup de patience et de courage, le corps finit toujours par s'habituer à un nouveau médicament.
> Sigolène.
Hey Sigolène, I didn't know you could speak Spanish!Je voudrais parler français bien comme vous parlez Anglais. J'ai oublié presque tout. (Most of what I have forgotten, I never knew). Vous le parlez magnifique! C'est bon qu'il y a quelqu'un ici qui peut communiquer avec les autres sur les choses importantes. Vous nous aidez beaucoup.
Vous êtes très gentil. You're real nice too. :-)
Sincerely,
Scott
Posted by Dr. Bob on November 25, 2000, at 22:35:42
In reply to Re: Serzone side effects - just temporary? » Sigolene, posted by SLS on November 25, 2000, at 21:15:56
Bonsoir,
Rappelez-vous s'il vous plaît, quand vous soumettez un message, d'indiquer, sous votre " sujet ", le langage dans dans lequel il est. De cette façon, le traducteur automatique peut offrir les options appropriées. Merci!
Bob
(?)
Posted by SLS on November 26, 2000, at 6:49:23
In reply to Re: language indicator, posted by Dr. Bob on November 25, 2000, at 22:35:42
> Bonsoir,
>
> Rappelez-vous s'il vous plaît, quand vous soumettez un message, d'indiquer, sous votre " sujet ", le langage dans dans lequel il est. De cette façon, le traducteur automatique peut offrir les options appropriées. Merci!
>
> Bob
>De nada.
:-)
- Scott
> (?)
Posted by Buffalo1 on November 26, 2000, at 15:06:39
In reply to Re: Serzone side effects - just temporary?, posted by JohnL on November 25, 2000, at 18:32:12
Boy it would be nice if Serzone came in an extended release version so one wouldn't have to do the b.i.d or t.i.d. dosing. Anyone know if this is in the works?
Posted by R.Anne on November 26, 2000, at 23:05:16
In reply to Re: Serzone side effects - just temporary?, posted by stjames on November 25, 2000, at 1:42:32
James,
My concern is written below where I have indicated it is to you.r.anne> (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much
> discomfort and then restart only when I need to. My MD supports this.)
>
> James here....
>
> This statement conserns me. I hope you are seeing a real Pdoc. The danger of treating cronic
> depression (and you have gone well past meeting the requirements of cronic depression) is that
> depression is a progressive process. If not treated throughly, with the goal of never having
> relapses, one depressive relapse kindles another, they happen more often and are more significant.
*****
This is to
James from r.anne,
I don't think it is being wise to predict this outcome as it is very negative and it tends to blame, too. A person who is severely depressed does not need this reproach. I felt bad reading it and it wasn't for me but I relate to her as I've been through this and, for me, it did not come out as you are predicting. I needed to voice this and I hope I did not offend. r.anne
> Treating only during relapse has the end result of the meds being less and less
> effective. A day may come when nothing works. Because you have been "penny wise and pound
> foolish" you now have treatment resistant depression, which may only respond to lots of meds or
> not respond at all to any med(s).
&&&&&&&&&&&&
Anyone who has had multiple depressions to the point of becoming suicidal
> should be on meds all the time. It seems foolish to "play with fire" here. If you had diabeties you would not
> be foolish to for go insulin, would you ? Regular medication can be free of side effects and give you
> a depression free life.
>
> James
Posted by R.Anne on November 26, 2000, at 23:20:12
In reply to Re: Serzone side effects - just temporary?James, posted by R.Anne on November 26, 2000, at 23:05:16
I didn't mean to offend anyone as I said and I want to stress that. I know I did not start this thread but felt a strong reaction to it. I felt I needed to voice my feelings and reaction and hope I was civil enough in doing so.r.anne
Posted by stjames on November 27, 2000, at 3:00:42
In reply to Re: Serzone side effects - just temporary?James, posted by R.Anne on November 26, 2000, at 23:05:16
> This is to
> James from r.anne,
> I don't think it is being wise to predict this outcome as it is very negative and it tends to blame, too. A person who is severely depressed does not need this reproach. I felt bad reading it and it wasn't for me but I relate to her as I've been through this and, for me, it did not come out as you are predicting. I needed to voice this and I hope I did not offend. r.anne
>James here....
Not predicting, just using statictics and facts. True there is always the exception
but there is no question to the chronic nature and progression of depression.j
Posted by stjames on November 27, 2000, at 3:32:22
In reply to Strong Reaction, posted by R.Anne on November 26, 2000, at 23:20:12
> I didn't mean to offend anyone as I said and I want to stress that. I know I did not start this thread but felt a strong reaction to it.
James here....
15 yrs of dperession and alot of reading have brought me to some truths. I tend to state them blunty because mental illness
is a very significant so I don't pussy foot around.
As long as you keep it in terms of "this is wnat I think" and not attack you are fine with
me.As such, I don't think there is any question that with most mental illness, if there are several relapses, the condition
is chronic. At least 50 yrs of case history supports this. I don't see this is a negetive, but a fact to be delt with.
It's treatable, with a high rate of sucess. Treating it also means it does not get worse. If going off the meds means a relapse and sucidial thoughts, why stop.
Esp. if the staticits support this. I never, ever, never, ever
want to think about killing myself again. I have had a 100% cure of this happening, for 15 yrs, on meds. This is good news, not negative.j
Posted by JohnL on November 27, 2000, at 5:07:31
In reply to Re: Serzone, any chance of an XR version?, posted by Buffalo1 on November 26, 2000, at 15:06:39
> Boy it would be nice if Serzone came in an extended release version so one wouldn't have to do the b.i.d or t.i.d. dosing. Anyone know if this is in the works?
Just an interesting tidbit. Clinical studies have been done to compare b.i.d. dosing with once-a-day dosing. There was no significant difference. Serzone can be taken just once a day if desired, despite its relatively short halflife. I've also heard anecdotal reports here at this board of people who take it just once a day and do fine.
The best time to take it might be late afternoon or early evening. This way the sedation will kick in at bedtime and not carryover so much into the next day. And XR version would be cool. But even without it Serzone can be dosed just once a day if desired.
John
Posted by shellie on November 27, 2000, at 9:10:40
In reply to Re: Serzone side effects - just temporary?, posted by stjames on November 25, 2000, at 1:42:32
> (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much
> discomfort and then restart only when I need to. My MD supports this.)
>
> James here....
>
>
> Treating only during relapse has the end result of the meds being less and less
> effective. A day may come when nothing works. Because you have been "penny wise and pound
> foolish" you now have treatment resistant depression, which may only respond to lots of meds or
> not respond at all to any med(s). Anyone who has had multiple depressions to the point of becoming suicidal
> should be on meds all the time.James, the part that I would disagree with here is that going on and off of meds is responsible for treatment resistent depression. So it seems as if you are blaming catsparkle. Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them. There are certainly a lot of examples of that on the board, including myself. You cannot predict if catsparkle never went off her medication whether she would become treatment resistent or not. Perhaps she is more likely to become treatment resistent if she goes on and off meds, you say the stats support this and I am not familiar enough with the stats to assume that you are not correct. shellie
Posted by SLS on November 27, 2000, at 18:04:57
In reply to Re: Serzone side effects - just temporary? » stjames, posted by shellie on November 27, 2000, at 9:10:40
> > > (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much discomfort and then restart only when I need to. My MD supports this.)
> > James here....> > Treating only during relapse has the end result of the meds being less and less effective. A day may come when nothing works. Because you have been "penny wise and pound foolish" you now have treatment resistant depression, which may only respond to lots of meds or not respond at all to any med(s). Anyone who has had multiple depressions to the point of becoming suicidal should be on meds all the time.
> James, the part that I would disagree with here is that going on and off of meds is responsible for treatment resistent depression. So it seems as if you are blaming catsparkle. Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them. There are certainly a lot of examples of that on the board, including myself. You cannot predict if catsparkle never went off her medication whether she would become treatment resistent or not. Perhaps she is more likely to become treatment resistent if she goes on and off meds, you say the stats support this and I am not familiar enough with the stats to assume that you are not correct. shellie
I agree with both of you.The jargon used for going on and off medication rapidly is "pulsing". Pulsing antidepressants is discouraged and can indeed foster treatment resistance (obviously, not always) as well as precipitate mania in vulnerable individuals. However, I think pulsing refers more to going on and off an effective medication frequently during a single depressive episode. Treating infrequent recurrent episodes periodically does not qualify as pulsing. The problem is, treatment is often truncated at six months, frequently resulting in relapse. I'm too lazy to verify these numbers, but one of my doctors used a treatment range of 12-14 months to "solidify" things and greatly reduce the risk of relapse. If a case history displays frequent recurrent episodes (I believe DSM IV gives guidelines for the word "recurrent"), indefinite treatment is indicated.
> Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them.
Shellie, this is a fascinating notion. Well, actually, it is a notion of critical importance. I'm going to keep it in mind from now on. It is a new idea for me. Thanks. As you come across corroborative observations and information regarding this topic, please don't hesitate to post them.
Bye...
- Scott
Posted by CatSparkle on November 28, 2000, at 7:22:43
In reply to Serzone side effects - just temporary?, posted by CatSparkle on November 24, 2000, at 19:35:36
stjames said: "Because you have been "penny wise and pound foolish" you now have treatment resistant depression, which may only respond to lots of meds or not respond at all to any med(s)."
Well, I haven't commented on this, but I suppose I will now.
I wanted to clarify: I have not become "treatment-resisitant" because I went off Zoloft. I don't know whether I even warrant that label yet or not, and if I do, nothing I've done has caused it. I discontinued Zoloft (after four years of taking it continuously) because in the final year it had begun to lose effectiveness and I was having side effects which, after so many years, I felt were unacceptable (the sexual difficulties, the inability to write (or even think!) creatively, the inability to feel anything deeply (either sadness or joy). Therefore, a dose increase was not an option. So if my depression has become "resistant," so far it is only to the Zoloft. And it became "resistant" to Zoloft before I stopped, not because I stopped.
I have just begun taking the Serzone, so I can't say yet whether or not I am "resistant" to it. Currently, it is helping the anxiety and panic, just not the depression (but it has only been a week).
My doctor and I decided that I would try to go drug-free for awhile, because my husband and I were thinking about becoming pregnant. They (MD and psychologist) felt that as long as I was vigilant about return of symptoms (which I admit wasn't, and (believe me) I've learned my lesson), I might not have to take meds continuously. Once I'm better, if I want to try again, they might let me taper off. But if I get bad again (particularly if I can't last more than a year off drug), then I know that I may need to be on them for life. I admit I wasn't as good as I should have been about watching for symptoms of the depression's return. I won't make that mistake again.
Try to understand, it's difficult when a person has to make a decision about having children. I am pretty far into my childbearing years, so it's an important issue for me. I won't become pregnant with these drugs in my system. No matter what anyone says, there's no drug that can be guaranteed not to have an adverse effect on a baby. So having to be on meds forever (to me) means not having children. And that's a difficult thing for me. I would want my child to have the best start possible, and I worry as it is about passing on (genetically) a predisposition for depression and about my ability (due to a strange childhood) about my ability to even be a parent.
Well, I've rambled enough. But I did want to comment on your opinion that stopping Zoloft making me "resistant." That isn't what happened.
Anyway, I appreciate everyone's thoughtful responses to my post (even though I can't read French J).
Thanks for listening,
Cat
Posted by shellie on November 28, 2000, at 8:11:13
In reply to Re: Serzone side effects - just temporary?, posted by SLS on November 27, 2000, at 18:04:57
.
>
> > Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them.
>
> Shellie, this is a fascinating notion. Well, actually, it is a notion of critical importance. I'm going to keep it in mind from now on. It is a new idea for me. Thanks. As you come across corroborative observations and information regarding this topic, please don't hesitate to post them.
>
> Bye...
>
>
> - ScottScott, are you teasing me here? later, Shellie
Posted by Crystal on November 28, 2000, at 10:12:55
In reply to clarification (oops - also posted below), posted by CatSparkle on November 28, 2000, at 7:22:43
I just wanted to wish you luck. I have been on Serzone for a little over a week now and I am hoping for good results. I switched from Paxil for personnal reasons, like you did Serzone has only gotten better since the first couple of days for me. I couldn't work for the first 4 days on serzone because of the dizziness and concentration problems. They are much better now, it has been 10 days.
> stjames said: "Because you have been "penny wise and pound foolish" you now have treatment resistant depression, which may only respond to lots of meds or not respond at all to any med(s)."
>
> Well, I haven't commented on this, but I suppose I will now.
>
> I wanted to clarify: I have not become "treatment-resisitant" because I went off Zoloft. I don't know whether I even warrant that label yet or not, and if I do, nothing I've done has caused it. I discontinued Zoloft (after four years of taking it continuously) because in the final year it had begun to lose effectiveness and I was having side effects which, after so many years, I felt were unacceptable (the sexual difficulties, the inability to write (or even think!) creatively, the inability to feel anything deeply (either sadness or joy). Therefore, a dose increase was not an option. So if my depression has become "resistant," so far it is only to the Zoloft. And it became "resistant" to Zoloft before I stopped, not because I stopped.
>
> I have just begun taking the Serzone, so I can't say yet whether or not I am "resistant" to it. Currently, it is helping the anxiety and panic, just not the depression (but it has only been a week).
>
> My doctor and I decided that I would try to go drug-free for awhile, because my husband and I were thinking about becoming pregnant. They (MD and psychologist) felt that as long as I was vigilant about return of symptoms (which I admit wasn't, and (believe me) I've learned my lesson), I might not have to take meds continuously. Once I'm better, if I want to try again, they might let me taper off. But if I get bad again (particularly if I can't last more than a year off drug), then I know that I may need to be on them for life. I admit I wasn't as good as I should have been about watching for symptoms of the depression's return. I won't make that mistake again.
>
> Try to understand, it's difficult when a person has to make a decision about having children. I am pretty far into my childbearing years, so it's an important issue for me. I won't become pregnant with these drugs in my system. No matter what anyone says, there's no drug that can be guaranteed not to have an adverse effect on a baby. So having to be on meds forever (to me) means not having children. And that's a difficult thing for me. I would want my child to have the best start possible, and I worry as it is about passing on (genetically) a predisposition for depression and about my ability (due to a strange childhood) about my ability to even be a parent.
>
> Well, I've rambled enough. But I did want to comment on your opinion that stopping Zoloft making me "resistant." That isn't what happened.
>
> Anyway, I appreciate everyone's thoughtful responses to my post (even though I can't read French J).
>
> Thanks for listening,
> Cat
Posted by SLS on November 28, 2000, at 10:56:45
In reply to Re: Serzone side effects - just temporary? » SLS, posted by shellie on November 28, 2000, at 8:11:13
> > > Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them.
> > Shellie, this is a fascinating notion. Well, actually, it is a notion of critical importance. I'm going to keep it in mind from now on. It is a new idea for me. Thanks. As you come across corroborative observations and information regarding this topic, please don't hesitate to post them.
> >
> > Bye...
> >
> >
> > - Scott
> Scott, are you teasing me here? later, Shellie
No, Shellie, I am not teasing you. If I were, it would be with affection and unambiguous.I was very serious about being intrigued by your idea. I was even contemplating it in the shower this morning. It might truly be counterproductive to continue taking an antidepressant beyond what may be necessary to attain a full remission along with resistance of relapse within the context of the presenting episode.
Have you seen anything written about this subject? I would want to look at it right away.
I remain very admiring of you.
- Scott
Posted by catsparkle on November 28, 2000, at 17:31:46
In reply to Re: clarification (oops - also posted below), posted by Crystal on November 28, 2000, at 10:12:55
Crystal,
Thanks for sharing that with me - it's good to know that someone else experienced what I did (that awful confusion/concentration problem was scary), and that it actually did get better.
It gives me some hope.
Thanks again,
Cat> I just wanted to wish you luck. I have been on Serzone for a little over a week now and I am hoping for good results. I switched from Paxil for personnal reasons, like you did Serzone has only gotten better since the first couple of days for me. I couldn't work for the first 4 days on serzone because of the dizziness and concentration problems. They are much better now, it has been 10 days
Posted by dove on November 29, 2000, at 11:18:23
In reply to Re: Serzone side effects - just temporary? » shellie, posted by SLS on November 28, 2000, at 10:56:45
> > Scott, are you teasing me here? later, Shellie
>
>
> No, Shellie, I am not teasing you. If I were, it would be with affection and unambiguous.
>
> I was very serious about being intrigued by your idea. I was even contemplating it in the shower this morning. It might truly be counterproductive to continue taking an antidepressant beyond what may be necessary to attain a full remission along with resistance of relapse within the context of the presenting episode.
>
> Have you seen anything written about this subject? I would want to look at it right away.
>
>
> I remain very admiring of you.
>
>
> - ScottI just want to second Scott's admiration of your intriguing statement. I will be searching abstract archives this weekend for any similar findings. Thank you Shellie!
dove
Posted by shellie on November 29, 2000, at 13:11:53
In reply to Re: Serzone side effects - just temporary?, posted by dove on November 29, 2000, at 11:18:23
Scott and Dove.
What I was talking about here was the effect of what has been called "poop-out". I was on nardil for about eight years, then it was no longer effective. After being off for several months I went back on with renewed effectiveness; then about five years later nardil lost its effectiveness again and this time a break does not reproduce it's original effectiveness. I go for a consultation with a psychopharmacolgist and he says this is quite common--the tendency for anti-depressants, to lose effectiveness over time.
I have not had a lot of time to look on the internet; it does not seem to be a very researched topic, or else I am putting in the wrong key words.
I guess I thought this was popular knowledge because of the many many people on the board who have used a specific antidepressant successfully, only to have it die on them. So maybe you guys are reading something it to my statement that I had not intended.
And I've thought of the concept of perhaps if I had not stayed on the nardil for so long originally, I could have bought myself more time later for success on it. (I think, perhaps that was what you were thinking about in the shower, Scott).
My sister had to double her dose of prozac after about six years to get the same effect--there might be some info on increasing same medication to maintain the same effect, which may be related to the idea of an antidepressant losing effectiveness. Perhaps if I was able to double nardil, that would have done the trick, but side effects eliminated that possibility. I didn't start out as treatment resistent; my life didn't take an unexpected bad turn. I've always assumed it had to do with the development of tolerance toward a medication. This has also made me a skeptic when it comes to finding the right cocktail for me--if found, how do I know how long will it remain effective for me.
Anyway, are these the ideas you are talking about, or are you extrapolating something else from what I said?
later, and later, Shellie
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