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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 33 to 57 of 89. Go back in thread:
Posted by Garnet71 on January 22, 2009, at 10:49:09
In reply to Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on January 16, 2009, at 10:28:30
NewQuestions
I forgot to tell you - check into central sleep apnea - get a sleep study. I developed this autonomous nervous system problem (and this is one reason I am going to a neurologist), and found out it is very serious. Many people do not know they have it.
When you 'forget to breath' while you are sleeping, the brain lacks oxygen and it can cause cognitive problems (not to mention feeling like sh*t every day).
I had a sleep study done several years ago - was diagnosed with central sleep apnea - and my doctor - pdoc - thought nothing of it. I just found out it is very serious.
One does not usually know that have this - there is no snoring involved in this type of sleep apnea. This is where you wake up 100s or 1000s of times during the night without knowing it (as opposed to obstructive sleep apnea).
Could SSRIs cause autonomous nervous system damage? I wouldn't be surprised - no one knows for sure.
Check into this!!
Good luck
Posted by Garnet71 on January 24, 2009, at 9:28:42
In reply to Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on January 16, 2009, at 10:28:30
I'm just throwing this out here...started a new thread:
Several of us have been complaining about cognitive and other symptoms. Doctors often call it treatment resistant depression or Bipolar II (which, btw, seem to be catch all diagnoses for when doctors can't figure out what is wrong with you). Maybe we have a mild version of seratonin syndrome? How does a doctor know we are deficient in seratonin when they prescribe SSRIs? Since they do not possibly know, maybe we have too much seratonin in our brains.
I haven't taken anti depressants for over a week, and my mind feels much more clear.
Just thinking out of the box...take a look into this for yourself.
From WIKI:
The symptoms are often described as a clinical triad of abnormalities:[3][4]
Cognitive effects: mental confusion, hypomania, hallucinations, agitation, headache, coma.
Autonomic effects: shivering, sweating, hyperthermia, hypertension, tachycardia, nausea, diarrhea.
Somatic effects: myoclonus (muscle twitching), hyperreflexia (manifested by clonus), tremor.
Posted by desolationrower on January 25, 2009, at 2:14:37
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by Garnet71 on January 24, 2009, at 9:28:42
serotonin syndrome is an acute syndrome, not a chronic one.
-d/r
Posted by Garnet71 on January 25, 2009, at 7:13:44
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by desolationrower on January 25, 2009, at 2:14:37
> serotonin syndrome is an acute syndrome, not a chronic one.
>
> -d/r----------------
I realize that the technical description is for an acute condition...I'm not thinking in terms of norms, that's why I said some sort of "mild version of seratonin syndrome"
Whose to say whether or not you have too much seratonin in your brain for extended periods of time? Could it be that if one does not lack serotinin to begin with, one can have too much in their brain from taking SSRIs?
Posted by desolationrower on January 25, 2009, at 11:55:58
In reply to Re: Long Term SSRI Use Has Destabilzed Me » desolationrower, posted by Garnet71 on January 25, 2009, at 7:13:44
Sure, sris aren't universally helpful. I just don't think its useful to think of it in terms of serotonin syndrome. ITs like calling obesity 'i got heartburn from eating too much last few years.'
-d/r
Posted by Connor on January 27, 2009, at 22:54:26
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by MChain on January 22, 2009, at 4:06:32
I'm thankful that there are others who are going through what I am going through. There was a time when all I did was search the internet for people experiencing the symptoms I did post-ssri. I found a few reports but they were very few.
What I hate more then anything is the professionals telling me it's a result of being depressed (the reason I originally went on the drugs). That is such b*llsh*t, I mean I just came off a 3 week break from school and I actually had some of the best weeks of my life. But even still, everything was much duller then it should have been. My sex drive, motivation, mental ability are consistently low no matter what mood I am in. Life has become unbearably uninteresting and I'm not sure how much longer I can take this. Every moment I'm just waiting for time to pass because I just don't know what to do, my soul has been sucked out of me
Posted by MChain on January 28, 2009, at 3:07:10
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by Connor on January 27, 2009, at 22:54:26
> I'm thankful that there are others who are going through what I am going through. There was a time when all I did was search the internet for people experiencing the symptoms I did post-ssri. I found a few reports but they were very few.
>
> What I hate more then anything is the professionals telling me it's a result of being depressed (the reason I originally went on the drugs). That is such b*llsh*t, I mean I just came off a 3 week break from school and I actually had some of the best weeks of my life. But even still, everything was much duller then it should have been. My sex drive, motivation, mental ability are consistently low no matter what mood I am in. Life has become unbearably uninteresting and I'm not sure how much longer I can take this. Every moment I'm just waiting for time to pass because I just don't know what to do, my soul has been sucked out of meConnor, it seems like we're in exactly the same situation, which is incredible to me because until now it seemed like ex-ssri users experienced everything under the sun except for my symptoms, and people even seemed to ignore my posts on message boards because of a lack of interest/experience or whatever. I too spend HOURS at a time just googling "SSRI+name a symptom" to see what popped up, and it was usually the same 5 websites and I never got any useful information.
When did you use the ssris (what age range?) and how long have you been off? I kind of feel like things are getting better (its been almost 11 months) but at the same time the cognitive fog is driving me nuts, its like my knowledge of the English language/working memory are both destroyed. I'll read newspaper articles, and though I understand the premise I'm constantly confused by words and phrases, like i'm 5 years old and learning how to read.
I know the frustration of being told your depressed every time you try to reach out to a psychiatrist, its exactly what my current pdoc is telling me, that there is no evidence to support my claim that my brain has been damaged by SSRIs. I am however starting to feel that all psych-meds may not be bad, since my current rate of recovery is incredibly slow, and I also had some kind of weird pain thing (fibromyalgia) at the same time i got depressed originally (age 12). I may give Wellbutrin a try on thursday after I see the psych but I don't know really how I should be going about my recovery, and I don't want to screw things up more.
I did find this study though that lends a little credibility to what we are saying http://www.informaworld.com/smpp/content~db=all?content=10.1080/10401230490281618 but the fact that we've been off the medications for awhile already seems to perplex all the doctors. I agree with the people on paxil progress etc. in that this could be a "protracted withdrawal" but I dont feel any physical symptoms, just these psychological things like apathy, low sex-drive, and cognitive dysfunction.
In any case, just hang in there because I think we're gonna both get through this, and if you feel comfortable sharing your e-mail with me please do so. I'm m.chain@yahoo.com
Posted by Connor on January 28, 2009, at 10:13:10
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by MChain on January 28, 2009, at 3:07:10
> Connor, it seems like we're in exactly the same situation, which is incredible to me because until now it seemed like ex-ssri users experienced everything under the sun except for my symptoms, and people even seemed to ignore my posts on message boards because of a lack of interest/experience or whatever. I too spend HOURS at a time just googling "SSRI+name a symptom" to see what popped up, and it was usually the same 5 websites and I never got any useful information.
>
> When did you use the ssris (what age range?) and how long have you been off? I kind of feel like things are getting better (its been almost 11 months) but at the same time the cognitive fog is driving me nuts, its like my knowledge of the English language/working memory are both destroyed. I'll read newspaper articles, and though I understand the premise I'm constantly confused by words and phrases, like i'm 5 years old and learning how to read.
>
> I know the frustration of being told your depressed every time you try to reach out to a psychiatrist, its exactly what my current pdoc is telling me, that there is no evidence to support my claim that my brain has been damaged by SSRIs. I am however starting to feel that all psych-meds may not be bad, since my current rate of recovery is incredibly slow, and I also had some kind of weird pain thing (fibromyalgia) at the same time i got depressed originally (age 12). I may give Wellbutrin a try on thursday after I see the psych but I don't know really how I should be going about my recovery, and I don't want to screw things up more.
>
> I did find this study though that lends a little credibility to what we are saying http://www.informaworld.com/smpp/content~db=all?content=10.1080/10401230490281618 but the fact that we've been off the medications for awhile already seems to perplex all the doctors. I agree with the people on paxil progress etc. in that this could be a "protracted withdrawal" but I dont feel any physical symptoms, just these psychological things like apathy, low sex-drive, and cognitive dysfunction.
>
> In any case, just hang in there because I think we're gonna both get through this, and if you feel comfortable sharing your e-mail with me please do so. I'm m.chain@yahoo.comI first started taking antidepressants when I was 15-16 years old. I was on Paxil, and what an experience that was. At first it did nothing, but eventually it like super charged my brain and I felt more intelligent, quicker, wittier. I was talking more. Then after a while the effects went away, and I started to feel dead inside, like my personality was burnt out. So I went off the drug but things just got worse. This is when I was terrified. What the hell is happening to me I wondered? I couldn't figure exactly what it was, I just knew something wasn't right. The way people would talk to me and joke around with me, and I just kind of sat there, not knowing how to respond to anyone anymore. And when I did it came out a jumbled mess because apparently i lost the ability to phrase things properly
Oh your just depressed, said the "experts" well I bought that. Four antidepressants later and two more years of sleeping all day, being anti-social, zombie like, emotionless, slow mentally, etc,etc. I finally just said screw it and stopped taking my prozac. That was in 2005.
When I started withdrawing I thought things were getting better. My emotions were more intense then before, and I felt I was coming back, but it was just the rollercoaster ride from the withdrawal which was just sending my mind and body for a ride. I remember breaking out into tears because of nothing. I remember not being able to give speeches because my anxiety was so high I would nearly like cry (this was never a problem before, and it's not a problem now either)
I'm not sure if I feel any better. With the aid of certain supplements I have been able to speed up my mind and maintain a certain amount of normalcy their. But their effectiveness is limited. I only take them when I go out and I can have a decent time. But without them I'm pretty much a drone. My main symptoms now are lack of libido, and lack of emotion/desire/enjoyment.
I am also thinking about trying wellbutrin, but I am so fearful that it could make things worse. I mean this is the situation I am in. I got depressed over a temporary situation that made me go on these drugs. Now I'm off these drugs and I'm depressed because of what these drugs have done to me. What do i do? Go back on more psycho-tropic drugs?? Ya right. I just fight through it. Convince myself that I can get better, but it seems like I'll be dealing with these problems for life. The question is how long I can take this before I explode. It's a problem hardly anyone understands or even acknowledges exists. I've been on many medications and I never had these long term problems the way I did with ssri's
Posted by Cseagraves on January 28, 2009, at 12:59:03
In reply to Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on January 16, 2009, at 10:28:30
Dear New Question,
OMG - I can't believe I found this post. I just posted a new thread below under "Marplan users update" I stated below that I was beginning to wonder about the same thing you posted.
I have GAD, agoraphobia and panic. The difference is that I have only been this way for a couple of years. (I'm 41) This just started a couple of years ago, but was still able to function outside of the house (grocery shopping, traveling, etc.) up until a year ago, then things got worse. Started on Zoloft about 9 years ago, took it for a couple of years, but then pooped out at 50mgs. When pdoc tried to raise the dose to 100mgs, anxieties got worse.
When I came off of it, things got better, so I didn't take anything for a while. Anxieties came back a couple of years ago so I started going through the other ssri's, but had awful side effects on each one and am worn out going on and off each one.
My last ssri was lexapro (have been off it now for over a month. Tried trazodone and remeron for sleep and had bad effects from both of those also. So I haven't taken anything since Jan. 12th. Pdoc is thinking about starting me on Marplan on Feb. 5th as he thinks I have become sensitive to ssri's.
Had all of the physical effects that you described with your meds and am still having numbness of arms and legs, but is getting better. Also having what feels like electric shocks going down my arms to my hands.
I mentioned in my post that I was thinking that instead of starting on the Marplan just yet, maybe giving my body and brain a break and see what happens. I still have my zanax as back-up.
I already have a good diet, start back exercising regularly and just try to cleanse myself of all this awful stuff to see what happens. Had all blood work done recently and everything came back fine.
Along with my aminos, I am taking extra doses of Gaba, L-theanine, L-taurine, Choline and Phosphatidyl Serine.
Although I haven't been off of meds long, I can tell physically I am not as sore and my arms and legs aren't going numb as much. I can also tell that my memory is getting better.
Have been reading up on some studies now that ssri's have been out for a while and they are saying the same things about there effectiveness and long-term side effects.
Interesting that others are starting to feel the same way. Please note that i am not encouraging anyone else to come off their meds, but for me I might try and see what happens if I take a break and see if my brain can heal itself.
Want to see if I can do this myself. If it doesn't work then I guess I will try the Marplan.
Thank you for your post and know that I think that what you are feeling and thinking might be true.
Please keep us informed on what you plan to do and how you are feeling.
Courtney
Posted by Connor on January 28, 2009, at 13:04:22
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by MChain on January 28, 2009, at 3:07:10
Also m.chain I noticed you posted on that one board for pssd. Funny because I did the exact same thing asking about the exact same problems. This was before I had any sexual problems. The sexual problems suddenly occured when I stopped the medication.
Posted by MChain on January 28, 2009, at 22:47:40
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by Connor on January 28, 2009, at 10:13:10
Wow, so you're saying its been 3.5-4 years since you've touched a psychotropic and you still feel this way? That is discouraging, and makes me lean even more toward trying that Wellbutrin tomorrow if things just remain the same.
I know exactly what you mean about the constant boredom, inability to get excited etc., I can't even manage to get myself excited about the superbowl this week and I used to be the hugest of football fans. And basically that indifference extends to all areas of my life. I went through that period of hyper-emotionality too around 6 months after my last dose, but things just kind of stabilized although I think im doing better than while on the medication (except for terrible anxiety). Sometimes it seems like i feel sadness the way I did before I ever started the medications but never the same unbridled joy and enthusiasm for things.
Since its not one of your major complaints I assume that the cognitive problems cleared up for you a bit? That's reassuring because for me at the moment every time I say or write something I question whether it makes sense and often forget common words. When did that stuff go away?
Also, what are the supplements that allow you to function (leave the house i think you said)? The only thing i take is fish oil and I really don't notice a difference whether I take it or not, although I tried several things like ginkgo a few months ago but couldn't really gage if they were having an effect. And bottom line we shouldnt have to depend on supplements to function. I'm trying to find something that assists with brain repair like nootropics, I don't know if you have any experience with those or not.
haha yeah, except the people in the ssrisex group are so absorbed seemingly by their sexual problems that they don't even notice these other symptoms or don't think much of them. I feel like my post was more or less ignored.
Posted by Connor on January 28, 2009, at 23:10:40
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by MChain on January 28, 2009, at 22:47:40
> Wow, so you're saying its been 3.5-4 years since you've touched a psychotropic and you still feel this way? That is discouraging, and makes me lean even more toward trying that Wellbutrin tomorrow if things just remain the same.
>
> I know exactly what you mean about the constant boredom, inability to get excited etc., I can't even manage to get myself excited about the superbowl this week and I used to be the hugest of football fans. And basically that indifference extends to all areas of my life. I went through that period of hyper-emotionality too around 6 months after my last dose, but things just kind of stabilized although I think im doing better than while on the medication (except for terrible anxiety). Sometimes it seems like i feel sadness the way I did before I ever started the medications but never the same unbridled joy and enthusiasm for things.
>
> Since its not one of your major complaints I assume that the cognitive problems cleared up for you a bit? That's reassuring because for me at the moment every time I say or write something I question whether it makes sense and often forget common words. When did that stuff go away?
>
> Also, what are the supplements that allow you to function (leave the house i think you said)? The only thing i take is fish oil and I really don't notice a difference whether I take it or not, although I tried several things like ginkgo a few months ago but couldn't really gage if they were having an effect. And bottom line we shouldnt have to depend on supplements to function. I'm trying to find something that assists with brain repair like nootropics, I don't know if you have any experience with those or not.
>
> haha yeah, except the people in the ssrisex group are so absorbed seemingly by their sexual problems that they don't even notice these other symptoms or don't think much of them. I feel like my post was more or less ignored.1. Yes it's been that long and I can't say I've really improved. Even whilst going on exercise sprees, the only benefits I get are short lived.
2. About getting excited, ya I don't get excited about anything anymore really, I use to get super hyped for a lot of things and that just doesn't happen anymore.
3. My cognitive problems have cleared up with the aid of nootropics. Without them they would still be present I believe. They are honestly the only reason I am able to tolerate life. I take them anytime I want to feel somewhat normal, mostly in social situations. The most effective supplement I have tried is Piracetam. It helps bring back my personality, it seems to make me smarter, helps with the flowing of my ideas, makes me wittier, etc, etc. Others that have helped include gingko, ginseng, 5-htp and taking multi-vitamins. While these supplements help my cognitively, emotionally I still feel pretty dull, so I'm looking for something to correct that. I've been abusing certain drugs to help compensate for my emotional emptiness.
4. Ya I know what you mean. The thing is if you search that group there are several posts about what you posted about, but honestly I think it's sad to say that that group, while it has many members it seems to only have a handful of active users.
Posted by MChain on January 28, 2009, at 23:44:39
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by Connor on January 28, 2009, at 23:10:40
Yeah after that long it just seems like things aren't going to improve on their own after what drugs have done to you and I, so maybe this whole "natural approach" thing isn't going to cut it.
The only other way I look at it without feeling extremely hopeless is that perhaps instead of some kind of damage our brains have just shut off the regions responsible for feeling pleasure and it won't be turned on without the aid of a different type of drug. I've been trying to avoid this kind of thinking but I really can't live like this and I know you can't either. I think there are people who never took SSRIs who feel like us, so it seems like our minds have been made to mimic theirs' and we need to follow a similar type of treatment etc.
I hate to be dependent on a drug and worry about poop out, long term brain damage but as I wait to get better on my own the meaningless days continue to pass by.
BTW have you trade any of the other racetams, hup-A, choline, Lecithin (sp?) or just Piracetam? Some of those supps seem promising but I'm pretty sure 5-htp is going to screw us up more though.
Posted by Connor on January 29, 2009, at 10:35:51
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by MChain on January 28, 2009, at 23:44:39
>
>BTW have you trade any of the other racetams, hup-A, choline, Lecithin (sp?) or just Piracetam? >Some of those supps seem promising but I'm pretty >sure 5-htp is going to screw us up more though.It is my opinion that 5-htp is pretty safe. It works differently then ssri's, in that it just naturally creates more serotonin, it's not intrusive like ssri's are. I don't take it too much though.
You're actually suppose to combine choline with the racetams. Choline doesen't do much anyway for me, but supposedly that's how you make the racetams effective. I have tried Piracetam for a while, but I am about to try Pramiracetam which I suppose to be a super charged verson of Piracetam. And I hear it's the most effective.
Posted by Deputy Dinah on January 29, 2009, at 22:15:09
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by Garnet71 on January 17, 2009, at 21:19:12
My sincere apologies on interrupting.
Dr. Bob has a policy requesting that posters not post more than three posts in a row without interruptions, except for a few specific exceptions included in the FAQ.
http://www.dr-bob.org/babble/faq.html#civil
I'm afraid that as his deputy, I'm going to have to ask you to please follow his guidelines. If you wait until someone replies, or fit your posts into one of the exceptions in the rules, or perhaps combine a few studies into one post?
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration. They, as well as replies to the above posts, should of course themselves be civil.
Dr. Bob is always free to override deputy decisions. His email is on the bottom of each page. Please feel free to email him if you believe this decision was made in error.
Dinah, acting as deputy to Dr. Bob
Posted by MChain on January 30, 2009, at 3:44:14
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by Connor on January 29, 2009, at 10:35:51
I just read somewhere that Dopamine system recovery can take about 4 years to fully occur...so maybe you're right around the corner from getting better.
Also, do you ever wonder if after a prolonged period of time in this state you've healed but are so discouraged that you develop a depression similar to the original symptoms? By no means does this mean go back to pharmacology, but have you tried other counter-depression measures besides the supplements? I'm sure you have, but in the off chance you've given up hope in traditional methods for combating stress/anxiety like CBT.
I don't doubt that our nervous systems/brains have been compromised, and someone gave me a recommendation for a neuropsych that acknowledges drug induced neurological problems so I may give him a try though it'll be expensive.
Anyway, keep me posted on your developments, feel free to e-mail (m.chain@yahoo.com) so we don't have to go through this message board for a more or less two way correspondence.
Posted by TimeLord on January 31, 2009, at 13:31:57
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by MChain on January 30, 2009, at 3:44:14
The mind/CNS is resilient and has fantastic regenerative properties, but it's slower than a snail at the DMV.
I've been off my meds for eight months now. Eight. I feel somewhat better and can tell I am healing, but it's an uphill battle. I eat well, I exercise (for a living (I'm a martial artist/instructor)), so I am sure that lifestyle plays a part in how we heal, but rest assured that we do eventually heal.
SSRI use sucks, but your CNS is raw and compromised. Give it a chance to catch up! :)
Posted by NewQuestions on February 2, 2009, at 9:08:27
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by TimeLord on January 31, 2009, at 13:31:57
Clearly, the long term use of SSRI's have change my system. Is there any reason to thing ECT will "reset" my system? Or does ECT only work for a specific sub-set of people, perhaps people that never found any relief from drugs?
Posted by MChain on February 3, 2009, at 8:27:11
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on February 2, 2009, at 9:08:27
Yeah a miracle could happen but you also run the risk that it makes you irreparably worse.
Posted by SLS on February 3, 2009, at 17:40:42
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on February 2, 2009, at 9:08:27
> Clearly, the long term use of SSRI's have change my system. Is there any reason to thing ECT will "reset" my system? Or does ECT only work for a specific sub-set of people, perhaps people that never found any relief from drugs?
The irony is that people who don't respond to a bunch of different drugs don't usually respond to ECT either. Still, there are some people who report responding to drugs after ECT that had not worked for them before ECT. I would be reluctant to subscribe to the intuitive notion that ECT somehow resets a system. Often, one much go for maintenance treatments every month or so.
I am not certain how I feel about ECT. I don't think it is a black-and-white issue, as there are obvious examples of its utility. I went for 15 treatments. They didn't help. I am unclear what role ECT should have in the treatment of mental illness. I know some people who consider ECT to be a godsend. I can't imagine wanting to be responsible for taking it away from them.
- Scott
Posted by NewQuestions on February 4, 2009, at 14:25:08
In reply to Re: Long Term SSRI Use Has Destabilzed Me » NewQuestions, posted by SLS on February 3, 2009, at 17:40:42
I just read this on another site. It may explain some of the problems I am having:
In my humble opinion, discontinuation syndrome is a form of hypothalamic-pituitary-adrenal (HPA) axis dysregulation. One way to look at it is as induced hypercortisolemia or even pseudo-Cushings Syndrome. See Gillespie, et al, Hypercortisolemia and Depression, Psychosomatic Medicine 67:S26-S28 (2005), full text available at http://www.psychosomaticmedicine.org...plement_1/S26:
"...More than 40 years ago, a significant number of patients with depression were noted to exhibit both hypersecretion of cortisol (1,2) and its metabolites (3). The observation that patients with Cushings disease or syndrome often experienced severe depression and anxiety, and the increased production and secretion of glucocorticoids such as cortisol in healthy people exposed to stress, in part contributed to the modern stress-diathesis hypothesis of depression in which excess secretion of cortisol is thought to play a significant pathophysiologic role in the etiology of depression....
... Currently, several novel approaches to the treatment of depression are being evaluated based on the present understanding of HPA axis dysregulation in mood disorders. The CRF-1 receptor antagonist R121919 has shown promise in the treatment of depression (43) but was subsequently withdrawn from clinical trials due to hepatotoxicity. More recently, the glucocorticoid receptor antagonist, mifepristone (RU486), has been reported to be effective in the treatment of psychotic depression (44). These compounds may be effective in treating depression through the interruption of reverberating neuroendocrine loops involving the HPA axis and several areas of the brain (prefrontal cortex, amygdala, hippocampus, and hypothalamus) that become excessively activated in response to stress driven perhaps by hypersecretion of CRF. Such interruption of a positive feedback loop may allow the system to return to a more adaptive set point associated with remission of depression (45)...."
One of the researchers looking at glucocorticoid receptor antagonists as described above is Dr. Owen Wolkowitz at the University of California San Francisco (See Wolkowitz and Reus, Treatment of Depression With Antiglucocorticoid Drugs, Psychosomatic Medicine 61:698-711 (1999), see full text at http://www.psychosomaticmedicine.org...full/61/5/698).
Aside from antiglucorticoids, including RU486 aka the abortion pill, Drs. W. and Reus discussed high doses of the glucocorticoid dexamethasone:
"...If short-term, high-dose dexamethasone treatment proves to have antidepressant effects, how might this be reconciled with antiglucocorticoids having similar effects? Antiglucocorticoids and dexamethasone administration could both have antidepressant effects via 1) their common effect of lowering cortisol levels (with resultant upregulation of brain corticosteroid receptors); 2) altering levels of other adrenal steroid hormones; or 3) increasing ACTH levels (with short-term, high-dose dexamethasone treatment, this might occur after dexamethasones acute inhibitory effects are terminated and the suppressed adrenal axis signals increased ACTH output). Additionally, recent evidence suggests that dexamethasone is actively excluded from brain and does not replace endogenous corticosteroids at hippocampal mineralocorticoid and glucocorticoid receptor sites (144). Its behavioral effects, therefore, may result from indirect effects of dexamethasone-induced ACTH suppression on the balance between the two corticosteroid receptor types in the hippocampus (144). Long-term dexamethasone treatment has also been shown to result in an increase in glucocorticoid receptor mRNA levels in hippocampus, an effect that parallels changes observed over the course of antidepressant treatment (33, 145)...."
Steroids are used to treat many illnesses, including autoimmune diseases, and people do take them for quite a while. Doctors do know how to use them, but they usually prescribe them in very high doses that have serious side effects. Note that I have been emphasizing a LOW DOSE approach.
I believe the HPA axis dysregulation resulting from discontinuation syndrome makes us hypersensitive -- we don't need much of anything to tip into HPA overdrive. A physiological dose rather than a therapeutic dose of anything can go a long way with us. The large doses of steroids that doctors usually prescribe are way, way too strong. Taking the hyperreactivity of the HPA axis into account, a tiny bit of something could help break the cortisol feedback loop -- "the self-propagating response" -- and help the HPA axis stabilize.
Posted by Garnet71 on February 4, 2009, at 15:18:55
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on February 4, 2009, at 14:25:08
Hey New Questions,
I keep coming back to this thread too. I have to admit that I cannot read that whole thing right now. Do you think this is worth bringing to my endochronologist next week, or would she just roll her eyes if I presented it?
Is the pituitary gland that one at the base of your neck? I was going to start a new thread about a symptom I've had for a few months now-lots of fluid sounds and sensations coming from the back of my neck/base of my head. Or does everyone have that?
Maybe someone will come along and interpret the article you posted. I hope you are closer to finding a solution to your health issues!!
Thanks,
Garnet
Posted by SLS on February 4, 2009, at 15:55:00
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on February 4, 2009, at 14:25:08
> In my humble opinion, discontinuation syndrome is a form of hypothalamic-pituitary-adrenal (HPA) axis dysregulation.
Maybe we can put our humble heads together and come up with a more comprehensive theory. I feel that something must precede the HPA dysregulation. I suggest that the withdrawal syndrome is the result of neural hyperactivity in several areas of the brain, including the amygdala, the fear center of the brain, thus producing anxiety as one of the symptoms. I think it might be the kindling of glutamatergic pathways that leads to the persistence of withdrawal syndrome after discontinuation seen in some people.
It is my suggestion that it is a kindling effect that a rapid discontinuation of a SRI drug induces that makes one more sensitive to drugs subsequently.
Somewhere in here is, of course, serotonin. It is probably the loss of serotoninergic inhibition of glutamatergic pathways that allows for the withdrawal syndrome to manifest.
- Scott
Posted by NewQuestions on February 4, 2009, at 16:04:15
In reply to Re: Long Term SSRI Use Has Destabilzed Me » NewQuestions, posted by Garnet71 on February 4, 2009, at 15:18:55
Thanks Garnet. My sense is that you are not experiencing what I am experiencing. My body has adapted to the drugs, I have become hypersensitive to them, I am now off of them and my body is stressed because of the withdrawal, and the HPA axis is not in balance. My sense with you is that you are still struggling to find the right drug to begin with. Therefore, the information might not be of much value to you.
Posted by SLS on February 4, 2009, at 16:32:45
In reply to Re: Long Term SSRI Use Has Destabilzed Me, posted by NewQuestions on February 4, 2009, at 16:04:15
> Thanks Garnet. My sense is that you are not experiencing what I am experiencing. My body has adapted to the drugs, I have become hypersensitive to them, I am now off of them and my body is stressed because of the withdrawal, and the HPA axis is not in balance. My sense with you is that you are still struggling to find the right drug to begin with. Therefore, the information might not be of much value to you.
There is always the "spit test". It is a quick way to get a cortisol level. In depression, cortisol is often elevated. This test used to be used routinely in the 1980s in some clinics.
There is also the dexamethasone-suppression test (DST) to evaluate the state of the HPA axis. The subject takes a single dose of dexamethasone, a corticosteroid. In a healthy person, this will produce a negative feedback loop that reduces (suppresses) the amount of ACTH released by the pituitary gland. This can be assayed in the blood. In many depressed people, ACTH secretion is not inhibited. So, dexamethasone non-suppression is an indication of major depressive disorder.
- Scott
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