![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by NewQuestions on October 15, 2008, at 14:26:24
I was on 200 mg of zoloft for 8 years, with the typical (mild) side effects. Then, after 8 years, I started to notice a change in the SEs. I became lethargic, had less muscle energy, mentally foggy and lazy, heaviness, had non-restful sleep, more withdrawn, and my physical appearance/grooming grew worse. It was still "working" but the side effects became overwhelming.
So, I tried other SSRI's and they also had devastating side effects. Lexapro gave me SE's similar to zoloft. Prozac (very small dose) was great for the first 4 weeks (smarter, more cognitive energy), but then made me incredibly depressed.
The other anti-depressants also had bad SEs. Remeron made me feel better, smarter, more cognitive energy, relieved inner-tension but it made me incredibly tired during the day (I tried it again later and it gave me a numbing depression.) Cymbalta, Wellbutrin and Buspar made me too anxious.
I tried a very small dose of Effexor and it helped with the depression, but increased anxiety (jitteriness) and internal restlessness. All the benzos give me a numbing depression, except Ativan.
SAM-e helped with the depression, but affected my concentration and made me jittery. Stablon did not do anything. Lamictal, which helped a little, had serious memory/cognitive effects (which is not atypical).
My theory is that the drugs changed my brain to the point where I have become hypersensitive to them. While little is known about the long-term effects of these drugs, it is known that the pre-synaptic receptors become de-sensitized and there is a reduction in the number of post-synaptic receptors. Perhaps these changes in my brain have increased the SE's, and reduced their effectiveness.
Of course, I tried to go off the drugs for 6 months but it was very difficult. I hoped I would snap back to be pre-drug self (which wasn't really that bad) but I didn't. I became really depressed, desperate, obsessive, nervous, anxious, more ruminating and figidity. (Perhaps I should have given it more time for my body to "heal"?)
Can any long-term users of SSRI's relate to this? What did you do? Why is this happening to me and not other people?
(FYI, right now I am on a medium dose of the MAOI Parnate. It am experiencing the usual side effects (insomnia, irritability, fatigue) but it is also making me feel sedated and apathetic. This may sound weird but I think it is helping with my depression but also making me depressed in a different way?)
Posted by linkadge on October 15, 2008, at 14:38:03
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
Hey. Yes I have noticed may of these things. I am especially sensitive to the drug induced apathy.
I havn't found a medication that works consistently.
I end up creating more problems, trying to fixing the side effects of one drug with another.
I just end up feeling sicker over time. Why not just tell me outright that their drugs are no good?Linkadge
Posted by Phillipa on October 15, 2008, at 16:54:41
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by linkadge on October 15, 2008, at 14:38:03
Same here. Love Phillipa
Posted by Bob on October 15, 2008, at 22:05:45
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
I can very much relate to just about everything you've lamented in your post. I have EXTREME problems with just about all meds now, problems that were not evident years and years ago when I first started the meds. The meds were never fun, but the real, real nasty problems started after about 4 or 5 years of exposure to SSRI's. It has been unbelievably brutal for the last 10 years.
Posted by jedi on October 16, 2008, at 1:53:08
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
> Can any long-term users of SSRI's relate to this? What did you do? Why is this happening to me and not other people?
Hi,
Seems to me the SSRI amotivational syndrome is fairly common. I know it hit me when using SSRIs and SNRIs, not as much with the MAOIs. My depression is atypical with increased sleep, eating, etc. Ironic that some of the major MAOI side effects, at least with Nardil, are the same as the major symptoms of the disease. But Nardil with clonazepam is the only combination that worked for my major atypical depression; it kept me alive.
Be Well,
JediReference:
J Psychiatr Pract. 2004 May;10(3):196-9.
SSRI-induced apathy syndrome: a clinical review.
Barnhart WJ, Makela EH, Latocha MJ.Department of Behavioral Health and Psychiatry, North Colorado Medical Center, Greeley 80631, USA.
The authors review the literature pertaining to selective serotonin reuptake inhibitor (SSRI)-induced apathy syndrome. A literature search of Medline and International Pharmaceutical Abstracts from 1970 to the present was performed for relevant articles. Twelve relevant case reports and one open-label treatment trial were identified. An amotivational, or apathy, syndrome has been reported in a number of patients receiving SSRI treatment over the last decade. This adverse effect has been noted to be dose-dependent and reversible, but is often unrecognized. This phenomenon has caused significant negative consequences for adults as well as social and academic difficulties in adolescents.
Posted by seldomseen on October 16, 2008, at 5:40:53
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
I've been on Prozac for nine years now (I think).
Of course, I have the awful habit of stopping it when I feel good. Then restarting it when the depression comes back (and it always does for me). So I'll be on it for about a year, stop for a month or two, restart, suffer the start-up side effects (anxiety, emotional numbness etc) for about two weeks or so, then level off again. All of this is against doctors orders of course.
While the re-start up sucks, I think getting the prozac out of my system for a while has helped me avoid the "poop-out" syndrome that a lot of people get. I also don't have the cumulative side effect build up that a lot of people have reported here.
I hope the nardil levels out for you, but if you decide to try the SSRI's again this regimen has worked for me.
Seldom.
Posted by NewQuestions on October 16, 2008, at 9:04:37
In reply to Re: Long-Term Users of SSRI's--Need Your Help » NewQuestions, posted by Bob on October 15, 2008, at 22:05:45
Bob--Can you give me more details? What was your response to each medication? What do you think happen? Did you ever bounce back? I feel like my only choice is to go off all medications that affect the major neurotransmitters and try either hormones or surgery or maybe opiates.
Posted by bleauberry on October 16, 2008, at 16:30:32
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
I can relate very well to what you have described. I think it happens more often than anyone has looked at. Maybe someday they'll have a name for it.
In any case, post-meds and post-ECT, the only med on the planet that has actually been able to help me feel better, kind of like meds used to back in the early days, is Milnacipran. Since you've already tried Tianeptine, I see you are not shy about ordering your own meds, so maybe Milnacipran is something to consider. Don't know if it would work or not. But all I can say is that while I am in a very similar condition as you are, it is somehow a unique different drug unlike any of the others.
Other than that, you just gotta keep trying things. You might need a combination, and maybe meds from categories you have not tried, such as the zyprexa family or the nortriptyline family.
Posted by NewQuestions on October 16, 2008, at 16:52:03
In reply to Re: Long-Term Users of SSRI's--Need Your Help » NewQuestions, posted by bleauberry on October 16, 2008, at 16:30:32
2 of 3 of those meds appear to be re-uptake inhibitors. I feel like re-uptake inhibitors don't work anymore, or otherwise the side effects are too severe. Do you know if they work on different pre-synaptic receptors than the other SSRI's?
Posted by 49er on October 16, 2008, at 20:13:17
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
New Questions,
I started taking psych meds in 1995 including SSRIS. To make a long story short, I decided to taper completely off of my psych med cocktail of Remeron, Adderall, Doxepin, and Wellbutrin SL, after being diagnosed with a hearing loss that I am convinced was due to Remeron. I also suffered severe apathy and many other cognitive issues.
Currently, I am down to a low dose of Remeron and Doxepin.
The key for my success in tapering has been to taper slowly. Right now, I am tapering Remeron at 5% of the current dose every 3 weeks.
It still isn't easy but I am able to maintain a somewhat decently quality of life. I can at least hold a job. Whatever else I accomplish depends on where I am in the withdrawal cycle.
You might have tapered your meds too quickly. And yes, perhaps, you should given your body more time. But you did the best you could as you didn't know any better.
What your describing sounds like poop out which is very common.
Anyway, I definitely feel it is possible to live med free. But it takes alot of work and I have to reframe negative thoughts that I know in the past would have been my downfall.
I simply have no choice as the side effects are simply not acceptable to me. I am very optimistic I will be successful.
In summary, if you decide to quit your meds, the key is to taper very slowly.
Good luck.
49er
PS - I am not implying that people who chose to stay on meds don't work hard on their lives either
Posted by bleauberry on October 17, 2008, at 21:44:06
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 16, 2008, at 16:52:03
> 2 of 3 of those meds appear to be re-uptake inhibitors. I feel like re-uptake inhibitors don't work anymore, or otherwise the side effects are too severe. Do you know if they work on different pre-synaptic receptors than the other SSRI's?
Yes, Milnacipran is a reuptake inhibitor. I'm telling you though, it is different. I have no clue how. Must be in the way it manipulates various receptors or how it integrates various neurotransmitter systems or whatever. I just know, that after every ssri and snri on the market, mood stabilizers, benzos, all the mood stabilizers, a couple tcas, everything except maois, milnacipran is different enough from them all to be in a class all its own with no other peers in that class. It has some slight similarities to other reuptake inhibitors, but by slight I mean whatever else it does is a lot stronger. Whether it actually works for someone or not is the same odds as any other med, but I just wanted to say it is "different" than anything you've tried.
Posted by NewQuestions on October 20, 2008, at 10:20:11
In reply to Re: Long-Term Users of SSRI's--Need Your Help » NewQuestions, posted by bleauberry on October 17, 2008, at 21:44:06
> > 2 of 3 of those meds appear to be re-uptake inhibitors. I feel like re-uptake inhibitors don't work anymore, or otherwise the side effects are too severe. Do you know if they work on different pre-synaptic receptors than the other SSRI's?
>
> Yes, Milnacipran is a reuptake inhibitor. I'm telling you though, it is different. I have no clue how. Must be in the way it manipulates various receptors or how it integrates various neurotransmitter systems or whatever. I just know, that after every ssri and snri on the market, mood stabilizers, benzos, all the mood stabilizers, a couple tcas, everything except maois, milnacipran is different enough from them all to be in a class all its own with no other peers in that class. It has some slight similarities to other reuptake inhibitors, but by slight I mean whatever else it does is a lot stronger. Whether it actually works for someone or not is the same odds as any other med, but I just wanted to say it is "different" than anything you've tried.
>
>Do you experience the muscle ache, joint pain and lethary that many other drugs can cause? What about cognitive effects?
Posted by Abby Cunningham on October 20, 2008, at 19:14:40
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by linkadge on October 15, 2008, at 14:38:03
Link,
Agree with you. I think most if not all psych drugs are not worth it for people with mild to moderate anxiety and even severe depression as I have. The benzos have ruined my life after 25+ years - anyone - who takes benzos - be warned you WILL reach tolerance/withdrawal eventually, early or later, and it is HELL.The "only way out is through" as Winston Churchill said--which is true for these brain drugs. Not saying they don't have a place for the very mentally ill, but on the whole, they all poop out or reach "TOLERANCE" people, where they stop working (?helping). I have seen people diagnosed with borderline personality disorder who are doing so much better OFF drugs than on them.
Sorry for the rant; been burned and iatrogenically addicted to benzodiazepines and will not let another mind destroying drug pass my lips unless it is absolutely proven to not be detrimental to my health ( notice I don't say proven to be helpful, since there is no drug YET that is proven to workfor years. EVERY PSYCH DRUG IS ADDICTIVE/CAUSES PHYSICAL DEPENDENCE to some degree or another. Today's medicine just does not have working psychiatric drugs for the vast majority of people; maybe in the next century. Look at the 50's and 60's when valium, barbiturates, ritalin and amphetamines were the panacea for all neurotic ills, and antipsychotics were thorazine that wonderful drug that chemically lobotomized so many patients, and today we have such things as Zyprexa which causes diabetes and HEART BLOCK which my father died from ---- all because a stupid doctor put him on it for his dementia from strokes.
No more drugs for me. I pray that everyone uses discernment before taking these experiments.
Abby
Posted by Phillipa on October 20, 2008, at 19:58:13
In reply to Re: Long-Term Users of SSRI's--Need Your Help » linkadge, posted by Abby Cunningham on October 20, 2008, at 19:14:40
Abby really no more meds for you? Love Phillipa
Posted by crittercuddler on December 16, 2008, at 3:12:52
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
Stephen Stahl recommends adding or switching to agents that act to increase NE or DA in order to combat the apathy syndrome or "apathetic recovery". I see that you said that your depression did indeed lift when you took Cymbalta, Effexor, Remeron, and Wellbutrin, which all work on NE, DA, or both... so that supports that theory. I am making that statement based on what I have read (and can see) from the book Essential Psychopharmacology by Stephen Stahl. (which is partly viewable online). You are having a problem with anxiety, insomnia, and jitteriness... Knowing that I would recommend you try augmenting an SSRI or an SNRI or Remeron as follows below....
SARIs play an important role as well. What is an SARI? This could be nefazodone or trazodone. This class of drugs is a potent antagonist of 5HT2A receptors. (The stimulation of these receptors is linked with the insomnia, anxiety, agitation, and akthasia (restlessness) that SSRIs can cause. So, by antagonizing these receptors SARIs can help with sleep and anxiety. Antagonism is also linked to helping depression. At the same time SARIs less potently inhibit serotonin and NE reuptake and thus work as an anti-depressant that way as well. And by inhibiting NE reuptake they can increase dopamine. Atypical antipsychotics and the TCA nortriptyline have 5HT2-A antagonism as well.
With that being said I am going to try and suggest some combinations....
a. SSRI at regular dose plus a SARI at a low to moderate dose (like trazadone)
b. SSRI at regular dose plus the TCA nortriptyline at a lower dose
c. SSRI at regular dose plus buspirone at regular dose (Buspirone is postulated to help reverse anti-depressant poop out)
d. Remeron plus Modafinil- (Remeron has 5HT2A antagonism) and you could take the Modafinil for the sleepiness
e. Effexor plus an atypical anti-psychotic that is a 5HT2A antagonist (like Risperdal, Seroquel, or Zyprexa)
f.Effexor with an SARI
g.Effexor with Nortriptyline
h.Buproprion and an SSRI?
This stuff is so hard for me to wrap my brain around tonight.
PLEASE by all means take these as suggestions to investigate further and ask your doctor about. From what I have read today I believe the combinations I suggested make sense... but I would clarify on your own and with your doctor and others on this forum to be doubly sure.
Posted by crittercuddler on December 16, 2008, at 3:14:02
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 16, 2008, at 3:12:52
I found this too...
Here are some tidbits I have found while researching. Perhaps they can be helpful.
1.Inositol may reverse desensitization in serotonin receptors. If I understand correctly that is the mechanism behind poop out, right?
Fux M, Levine J, Aviv A, Belmaker RH: Inositol treatment of obsessive
compulsive disorder. Am J Psychiatry 153:1219-1221, 1996."Inositol
As noted above, there is now considerable evidence that
pharmacologic manipulation of the serotonergic system may help with OCD
symptoms. Myo-inositol is a ubiquitous carbohydrate that is present in large
amounts in brain tissue and is involved in neuronal signaling and
osmoregulation (Vadnal et al, 1997) and, the phosphatidylinositol cycle is
the second messenger system for several neurotransmitters, including several
subtypes of serotonin receptors (Hoyter et al, 1994). In addition,
desensitization of serotonin receptors is reversed by the addition of
exogenous inositol (Rahman & Neuman, 1993). There are reports that exogenous
inositol was effective in controlled trials for patients with depression and
panic, and recently a research group performed a double-blind, controlled
crossover trial of 18 grams/day of inositol versus placebo for 6 weeks each
(Fux et al, 1996). The subjects had significantly lower scores on the YBOCS
when taking inositol than when taking placebo."Help anyone?????????????
Posted by desolationrower on December 16, 2008, at 10:46:42
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 16, 2008, at 3:14:02
> I found this too...
>
> Here are some tidbits I have found while researching. Perhaps they can be helpful.
>
> 1.Inositol may reverse desensitization in serotonin receptors. If I understand correctly that is the mechanism behind poop out, right?
>
> Fux M, Levine J, Aviv A, Belmaker RH: Inositol treatment of obsessive
> compulsive disorder. Am J Psychiatry 153:1219-1221, 1996.
>
> "Inositol
> As noted above, there is now considerable evidence that
> pharmacologic manipulation of the serotonergic system may help with OCD
> symptoms. Myo-inositol is a ubiquitous carbohydrate that is present in large
> amounts in brain tissue and is involved in neuronal signaling and
> osmoregulation (Vadnal et al, 1997) and, the phosphatidylinositol cycle is
> the second messenger system for several neurotransmitters, including several
> subtypes of serotonin receptors (Hoyter et al, 1994). In addition,
> desensitization of serotonin receptors is reversed by the addition of
> exogenous inositol (Rahman & Neuman, 1993). There are reports that exogenous
> inositol was effective in controlled trials for patients with depression and
> panic, and recently a research group performed a double-blind, controlled
> crossover trial of 18 grams/day of inositol versus placebo for 6 weeks each
> (Fux et al, 1996). The subjects had significantly lower scores on the YBOCS
> when taking inositol than when taking placebo."
>
> Help anyone?????????????
>
>Its hard to know how inositol is working...its involved in several cell processes, dowstream from several receptors being activated...There was research done into mood stabilizers Lithium, valproate, carbazapine on if they work by depleting inositol...its still an open question.
-d/r
Posted by JPHR on December 30, 2008, at 14:30:02
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
Others have posted some useful advice. I simply wanted to state that, yes, a so-called "apathy syndrome" does occur in some people (children, adolescents, & adults) after long-term use of an SSRI and that this syndrome can be quite disabling.
For me, the problem began about two years ago, after being on various SSRIs for (approximately) six years. The onset was so insidious that I did not realize what was happening until the fatigue and apathy/avolition had become quite severe. Around two years ago, I began to complain to various doctors of extreme lethargy, without getting any help from them (fatigue can be caused by so many things, including depression, that I can't blame them for not taking the time to figure out what was going on.)
About one year ago, I began to realize that I had almost no volition to complete even important tasks, and also felt very apathetic about this. I explained these major changes in my personality (I have always been a hard-worker and am used to taking on many responsibilities) as the result of "burn out": and it seems that I had convinced my psychiatrist of this, too. I had many work-related responsibilities and had been working at a fairly hectic pace for several years. As a result, last spring, I resigned from my most-challenging position and replaced it with some less-demanding duties .
Nonetheless, over the summer my apathy and fatigue became even worse. As a college-level psychology instructor, I was able to "get by" during this time because I wasn't required to work. But I still had a number of uncompleted projects hanging over my head--tasks that I had put off because of my lack of volition and my lethargy--yet I felt unable to work on them.
It was only at the end of the summer that my psychiatrist decided that I must be suffering from "apathy syndrome," which I had never heard of!! I put exclamation marks at the end of that sentence because I have taught a number of psychology courses (including psychopathology) and was trained in biological psychology--yet, I was completely unaware of this syndrome. It turns out that it is not well publicized and that little is known about its causes. The (too-brief) 2004 review article to which one respondent already referred emphasized these points.
My doctors' (and my own) ignorance of the SSRI-induced "apathy syndrome" led to two very frustrating--and even frightening--years in which I became increasingly unable to effectively perform my job responsibilities. The syndrome also had negative effects on my person life. What makes this all even worse is that it is very difficult to explain to others why I was having so much difficulty over this time, even to those whom I feel secure revealing my antidepressant use to. Apathy and avolition are negative attributes in our work-obsessed culture and, among the professionals with whom I work, they are reviled.
It is essential that those prescribing these medications be more aware of the symptoms of this syndrome; and, most important, that they be proactive in detecting these symptoms in any of their patients who have been taking SSRIs for at least several years.
Posted by Bob on December 30, 2008, at 15:50:18
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 14:30:02
> Others have posted some useful advice. I simply wanted to state that, yes, a so-called "apathy syndrome" does occur in some people (children, adolescents, & adults) after long-term use of an SSRI and that this syndrome can be quite disabling.
>
> For me, the problem began about two years ago, after being on various SSRIs for (approximately) six years. The onset was so insidious that I did not realize what was happening until the fatigue and apathy/avolition had become quite severe. Around two years ago, I began to complain to various doctors of extreme lethargy, without getting any help from them (fatigue can be caused by so many things, including depression, that I can't blame them for not taking the time to figure out what was going on.)
>
> About one year ago, I began to realize that I had almost no volition to complete even important tasks, and also felt very apathetic about this. I explained these major changes in my personality (I have always been a hard-worker and am used to taking on many responsibilities) as the result of "burn out": and it seems that I had convinced my psychiatrist of this, too. I had many work-related responsibilities and had been working at a fairly hectic pace for several years. As a result, last spring, I resigned from my most-challenging position and replaced it with some less-demanding duties .
>
> Nonetheless, over the summer my apathy and fatigue became even worse. As a college-level psychology instructor, I was able to "get by" during this time because I wasn't required to work. But I still had a number of uncompleted projects hanging over my head--tasks that I had put off because of my lack of volition and my lethargy--yet I felt unable to work on them.
>
> It was only at the end of the summer that my psychiatrist decided that I must be suffering from "apathy syndrome," which I had never heard of!! I put exclamation marks at the end of that sentence because I have taught a number of psychology courses (including psychopathology) and was trained in biological psychology--yet, I was completely unaware of this syndrome. It turns out that it is not well publicized and that little is known about its causes. The (too-brief) 2004 review article to which one respondent already referred emphasized these points.
>
> My doctors' (and my own) ignorance of the SSRI-induced "apathy syndrome" led to two very frustrating--and even frightening--years in which I became increasingly unable to effectively perform my job responsibilities. The syndrome also had negative effects on my person life. What makes this all even worse is that it is very difficult to explain to others why I was having so much difficulty over this time, even to those whom I feel secure revealing my antidepressant use to. Apathy and avolition are negative attributes in our work-obsessed culture and, among the professionals with whom I work, they are reviled.
>
> It is essential that those prescribing these medications be more aware of the symptoms of this syndrome; and, most important, that they be proactive in detecting these symptoms in any of their patients who have been taking SSRIs for at least several years.
- Uhhh... so what was done to alleviate the apathy?
Posted by JPHR on December 30, 2008, at 16:22:24
In reply to Re: Long-Term Users of SSRI's--Need Your Help » JPHR, posted by Bob on December 30, 2008, at 15:50:18
> Uhhh... so what was done to alleviate the apathy?
As I stated, other respondents already provided some useful advice, so I wasn't focusing on that issue in my post, especially since any actions taken to reduce/eliminate the symptoms successfully will vary over individuals (as the previous posts demonstrate).
But since you asked so politely, this is what I did: First, after speaking with my psychiatrist, I gradually reduced the dose of paroxetine (Paxil), which was at 60 mg; and he added 200 mg of buproprion (Welbutrin), which some studies (open-label and case studies, unfortunately) suggest may help. Because paroxetine has such a long half-life, it tskes several weeks (at least) to determine if dosage changes help.
In my case, even 10 mg caused too much fatigue: I still had an extremely difficult time getting up in the morning and was tired throughout the day. As for the apathy/avolition, I think there was some improvement, but it was difficult to be sure because I was so tired.
Thus, I stopped taking even the 10 mg dose a few weeks ago. I'm still withdrawing from the paroxetine, but I'm feeling well enough to contribute to this thread!! In other words, I'm less fatigued and apathetic, and feel much more motivated to tackle work-related and everyday chores (even with the fragmented sleep I'm getting, which probably is a result of the withdrawal).
However, I would not necessarily recommend this to anyone else: each person's physiology and psychological issues differ. I decided to go this route because my ability to function on paroxetine was so minimal. In other words, even if I develop problems because I'm no longer taking paroxetine (especially anxiety & depression), my functioning probably can't get any worse than if I had stayed on it.
If I'm wrong about this, then I'll try one of the non-SSRI medications that some research suggests do not lead to the apathy syndrome. Again, however, I know of no research on this issue that is well-controlled; and there also is a lot of variation among individuals. Thus, in the end, a trial-&-error approach (informed by whatever research is out there) must be used for each person.
Posted by crittercuddler on December 30, 2008, at 17:02:42
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 16:22:24
Which drug therapies are shown to not cause an apathy syndrome?
Posted by JPHR on December 30, 2008, at 17:31:23
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 30, 2008, at 17:02:42
> Which drug therapies are shown to not cause an apathy syndrome?
I'm definitely not an expert on any of this--just like you, I'm only at the beginning of trying to understand this problem--but some references I've looked listed several possibilities. For example, Barnart, Makela, & Latocha (2004) mentioned the following medications:
"It has been noted that patients who experienced apathy while taking an SSRI have not experienced such a result when treated with monoamine oxidase inhibitors or tricyclic antidepressants, or even clomipramine, despite the fact that clomipramine is a strong serotonin reuptake inhibitor. Garland and Baerg ... noted that they had not observed medication-induced apathy as a result of venlafaxine [Effexor] treatment"
And an online report by Lee and Keltner (2005) stated that, "It is important to note that AAS [Antidepressant Apathy Syndrome] has been observed with all SSRIs but not with monoamine oxidase inhibitors or tricyclic antidepressants."
Again, a good psychiatrist should know the relevant literature and be able to suggest possible alternatives to SSRIs.
REFERENCES
Barnhart, W.J., Makela, E.H., & Latocha, J. (2004). Selective serotonin reuptake inhibitor induced apathy syndrome: A clinical review. Journal of Psychiatric Practice, 10(3), 196-199.
Lee, S. I., & Keltner, N. L. (2005). Antidepressant apathy syndrome. RedOrbit News. Retrieved at: http://www.redorbit.com/news/display/?id=333128
Posted by JPHR on December 30, 2008, at 18:43:59
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 17:31:23
By the way, I read something written by "Dr. Bob" recommedning that newcomers might want to introduce themselves. Today is the first day that I've posted here. I came across the site when a Google search led me to the initial post in this thread. I read through the other posts and decided to share my experiences with "SSRI-induced apathy syndrome."
A few minutes ago, I read an old thread about the same issue ( started in 2002: http://www.dr-bob.org/babble/20020930/msgs/121851.html ) and was gratified to know that others have found these symptoms to be as frightening as I have and decided to share their experiences (along with helpful advice about how one might deal with these symptoms). It was difficult for me to realize that the beneficial effects of a medication--one that had helped me so much for so many years--could change so dramatically to mostly negative ones.
As some others in this thread have mentioned, psychotropic medications change the ways in which our brains work, and some of these changes may develop only after months or years. When medication effects change from being more-on-the-positive side to being more-on-the-negative side (as they did with me), even discontinuing the medication MAY not reverse some of these changes, or at least not completely. This is very difficult (scary) for those of us who have suffered from incapacitating depression, anxiety, and/or other problems.
It is a good thing to share these concerns with those who have or are going through similar experiences. I'm grateful that forums such as this one exist.
Thanks to you all.
Posted by elanor roosevelt on January 2, 2009, at 22:09:11
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
this does not seem to be something the medical community understandsthe apathy and lethargy sneak up on you
for me it's like being a captive until i figure it out
Posted by Neal on January 4, 2009, at 1:02:17
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 16, 2008, at 3:12:52
Newbies should know that depression itself is a leading cause of apathy, so that being over or under medicated can cause problems.
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