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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 32. This is the beginning of the thread.
Posted by J Kelly on March 15, 2016, at 13:26:01
I do not do well on SSRI's. I'm sure I'm not alone.
My question: Can too much serotonin actually cause depression and/or anxiety? Naturally occurring or med induced?
Prozac not only did not help my depression but caused such anxiety that I could not look people in the eye.
Does this mean I simply have enough naturally occurring serotonin? Or could it be that my natural serotonin level is too high? Following this line of thinking could a serotonin reducing med help my depression/anxiety?
Thanks, Jade
PS-A family member told me Prozac changed his world from black and white to color. So I accept we're all different in our responses.
Posted by Lamdage22 on March 15, 2016, at 14:15:22
In reply to Too much Serotonin?, posted by J Kelly on March 15, 2016, at 13:26:01
> Prozac not only did not help my depression but caused such anxiety that I could not look people in the eye.
Psychosis or anxiety? A mixture?
I have no idea what that means. Probably you should look for something else. But there is no guarantee that everybody will find "the right" med for them. Its worth looking though.
Posted by Lamdage22 on March 15, 2016, at 14:18:37
In reply to Re: Too much Serotonin?, posted by Lamdage22 on March 15, 2016, at 14:15:22
Have you ever had psychoeducation?
It is important that you understand your mind and what happened.
Posted by J Kelly on March 15, 2016, at 15:15:40
In reply to Re: Too much Serotonin?, posted by Lamdage22 on March 15, 2016, at 14:15:22
> > Prozac not only did not help my depression but caused such anxiety that I could not look people in the eye.
>
> Psychosis or anxiety? A mixture?No psychosis at all. Simple anxiety. This was prior to my Parnate trial.
>
> I have no idea what that means. Probably you should look for something else. But there is no guarantee that everybody will find "the right" med for them. Its worth looking though.
>
Posted by J Kelly on March 15, 2016, at 15:24:49
In reply to Re: Too much Serotonin?, posted by Lamdage22 on March 15, 2016, at 14:18:37
> Have you ever had psychoeducation?
Psychoeducation? No. Who provides that? I'm ashamed to say I've only just now started therapy. My T seems shocked at the level of psychosis I suffered but frankly, its not something I want to examine at length at this point. I want to learn how to complement my other treatment(s) ie meds.
I want to learn how to cope with feelings and behaviors that are not healthy for me.
>
> It is important that you understand your mind and what happened.In regards to future med trials I agree.
Jade
Posted by linkadge on March 15, 2016, at 16:11:58
In reply to Re: Too much Serotonin? » Lamdage22, posted by J Kelly on March 15, 2016, at 15:24:49
For sure, SSRI's can (for some individuals) increase depression and anxiety.
I can identify with SSRI's increasing social anxiety to the point of not being able to look people in the eye.
I have noticed the same thing, that SSRI's can increase the intensity of social interaction. I would notice myself looking down or to the side because it was just too intense.
There are some theories as to why this happens. It is likely that for some indivudals SSRI's offset the balance of serotonin to other neurotransmitters such as dopamine.
It could be high serotonin, low dopamine or a high serotonin to dopamine ratio, or something else.
Linkadge
Posted by J Kelly on March 15, 2016, at 20:03:45
In reply to Re: Too much Serotonin?, posted by linkadge on March 15, 2016, at 16:11:58
> For sure, SSRI's can (for some individuals) increase depression and anxiety.
>
> I can identify with SSRI's increasing social anxiety to the point of not being able to look people in the eye.
>
> I have noticed the same thing, that SSRI's can increase the intensity of social interaction. I would notice myself looking down or to the side because it was just too intense.
>
> There are some theories as to why this happens. It is likely that for some indivudals SSRI's offset the balance of serotonin to other neurotransmitters such as dopamine.
>
> It could be high serotonin, low dopamine or a high serotonin to dopamine ratio, or something else.
>
> Linkadge"In general, whenever norepinephrine and dopamine are depleted (I.e., as occurs with continual use of stimulants) the potential for serotonin to become too high increases."
I hope my stimulant use (Ritalin) has not increased my serotonin to levels that are adding to my depression and/or anxiety.
Is anyone familiar with a med that actually lowers serotonin?
Jade
Posted by Tomatheus on March 15, 2016, at 20:51:58
In reply to Re: Too much Serotonin? » linkadge, posted by J Kelly on March 15, 2016, at 20:03:45
> Is anyone familiar with a med that actually lowers serotonin?
Jade,
There's some reason to think that tianeptine, which is sold under the trade name of Stablon in some countries, might enhance the reuptake of serotonin instead of inhibiting it like many first-line antidepressants do. According to McEwen et al. (2010), tianeptine has been found to reduce the extracellular levels of serotonin in older rat studies, and the medication has also been found to reduce the number of serotonin transporter sites and the mRNA levels of these sites in the dorsal raphe nuclei of rat brains. However, more recent studies have shown that acute and long-term administration of tianeptine to conscious rats does not produce either a marked increase or a marked decrease in extracellular serotonin levels in corticolimbic brain structures (McEwen et al., 2010). The authors explained further: "From an electrophysiological point of view, sustained administration of tianeptine did not modify the spontaneous firing rate of serotonergic neurons in the dorsal raphe, nor did it modify the activity of postsynaptic 5-HT1A receptors nor the effectiveness of the terminal 5-HT autoreceptor antagonist in increasing the efficacy of the stimulation of the 5-HT pathway, despite prolonged treatment."
So, even though some earlier rat studies have suggested that tianeptine might act as a serotonin reuptake enhancer, more recent studies have called the initial findings into question. Tianeptine is also being discussed in another thread here on Psycho-Babble, which can be found here:
http://www.dr-bob.org/babble/20160306/msgs/1087150.html
Tomatheus
==
REFERENCE
McEwen, B.S., Chattarji, S., Diamond, D.M., Jay, T.M., Reagan, L.P., Svenningsson, P., et al. (2010). The neurobiological properties of tianeptine (Stablon): From monoamine hypothesis to glutamatergic modulation. Molecular Psychiatry, 15, 237-249. Article: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2902200/
Posted by linkadge on March 17, 2016, at 7:18:30
In reply to Re: Too much Serotonin? » J Kelly, posted by Tomatheus on March 15, 2016, at 20:51:58
Tianeptine was recently discovered to be active at certain opioid receptors.
Linkadge
Posted by J Kelly on March 17, 2016, at 10:46:09
In reply to Re: Too much Serotonin? » J Kelly, posted by Tomatheus on March 15, 2016, at 20:51:58
> > Is anyone familiar with a med that actually lowers serotonin?
>>
> There's some reason to think that tianeptine, which is sold under the trade name of Stablon in some countries, might enhance the reuptake of serotonin instead of inhibiting it like many first-line antidepressants do.> Tianeptine is also being discussed in another thread here on Psycho-Babble, which can be found here:
>
> http://www.dr-bob.org/babble/20160306/msgs/1087150.html
>
> Tomatheus
>
Hi Tomatheus :)I actually posted on the above thread. Interestingly, I tried Stablon many years ago and it made me quite "high". It was a very nice feeling but I would not have been able to function or be around people in that condition. I never tried it again.
Maybe its worth revisiting. I could try a very small dose.
Thanks,
Jade
Posted by J Kelly on March 17, 2016, at 10:59:38
In reply to Re: Too much Serotonin?, posted by linkadge on March 17, 2016, at 7:18:30
> Tianeptine was recently discovered to be active at certain opioid receptors.
>
> LinkadgeAnd as a result of this, Stablon may cause euphoria in some people, right?
And how, if at all, does this relate to Stablon's ability to reduce serotonin?
Thanks,
Jade
Posted by linkadge on March 17, 2016, at 11:17:42
In reply to Re: Too much Serotonin? » linkadge, posted by J Kelly on March 17, 2016, at 10:59:38
>And how, if at all, does this relate to Stablon's >ability to reduce serotonin?
It doesn't. It was a link to the idea that serotonin reuptake enhancement is likely not the underlying mechanism of stablon.
Have you tried serotonin antagonists such as mirtazapine, cyproheptadine, amitritptyline etc?
Linkadge
Posted by J Kelly on March 17, 2016, at 11:31:00
In reply to Re: Too much Serotonin?, posted by linkadge on March 17, 2016, at 11:17:42
>
> Have you tried serotonin antagonists such as mirtazapine, cyproheptadine, amitritptyline etc?
>
> LinkadgeI haven't but I'm gonna look those up now and add them to my list of meds to review with my pdoc. I'm really curious about this serotonin surplus angle. If nothing else, it may save me from ill-advised med trials that increase serotonin.
Thanks,
jade
Posted by SLS on March 17, 2016, at 12:30:12
In reply to Re: Too much Serotonin?, posted by linkadge on March 17, 2016, at 11:17:42
I read a recent article that reported that tianeptine does not do what we thought it did with regard to serotonin reuptake acceleration. I doubt that I would be able to find the article again. Of course, the article could have been wrong.
Tianeptine might get some people high because it is a mu-opioid receptor agonist.
- Scott
Posted by SLS on March 17, 2016, at 12:37:13
In reply to Re: Too much Serotonin?, posted by SLS on March 17, 2016, at 12:30:12
For whatever a Wiki article may be worth:
https://en.wikipedia.org/wiki/Reuptake_enhancer
"The antidepressant tianeptine was once claimed to be a (selective) serotonin reuptake enhancer (SRE or SSRE), but the role of serotonin reuptake in its mechanism is doubtful. Tianeptine has no affinity to the serotonin transporter, neither increases nor decreases extracellular levels of serotonin in cortico-limbic structures of conscious rats, and it didn't show any other long-term effect on the serotonin pathway.[1] Thus, tianeptine's role as an SSRE may have been the coincidence of a yet unknown mechanism of action."
- Scott
Posted by J Kelly on March 17, 2016, at 13:23:44
In reply to Re: Too much Serotonin?, posted by linkadge on March 17, 2016, at 11:17:42
>
> Have you tried serotonin antagonists such as mirtazapine, cyproheptadine, amitritptyline etc?
>
> Linkadge
Wikipedia:"Serotonin antagonist and reuptake inhibitors (SARIs) are a class of drugs used mainly as antidepressants, but also as anxiolytics and hypnotics. They act by antagonizing serotonin receptors such as 5-HT2A and inhibiting the reuptake of serotonin, norepinephrine, and/or dopamine."
I'm confused (easily as of late) don't serotonin antagonists, like the meds you mentioned, increase levels of serotonin? I'm suggesting my serotonin levels may be too high, leading to the anxiety and social phobia that I feel. Especially when taking SSRI's.
Any thoughts?
Thanks,
Jade
Posted by Tomatheus on March 17, 2016, at 13:25:36
In reply to Re: Too much Serotonin? » Tomatheus, posted by J Kelly on March 17, 2016, at 10:46:09
> Hi Tomatheus :)
>
> I actually posted on the above thread.Whoops! Not recognizing that you posted to the Stablon thread that RJ started was quite a BIG oversight on my part, and I apologize for making it. I do recall feeling rushed as I was finishing up my response to you earlier in this thread, as I wanted to finish writing my post quickly to tend to something else that I needed to do, and I suspect that that might have played a role in leading me to not even think about the fact that you posted to the Stablon thread before I even did. And I did read your posts to the thread, so it's not like I didn't know that you posted there, but it completely slipped my mind. So again, I apologize. You deserve better than to have your contributions to this board overlooked.
Regarding tianeptine (Stablon) itself, I don't know how likely it is that trying the medication again might produce the kind of results that you're probably looking for, although as you mentioned, giving tianeptine another try with just a very small dose might be something to consider. Looking into the serotonin receptor antagonists that Linkadge just mentioned (and I know that you already wrote that you'd be looking into them) seems like it would be more likely to help you achieve what you want to achieve as far dampening down the serotonin system is concerned than taking tianeptine.
Tomatheus
Posted by J Kelly on March 17, 2016, at 13:37:35
In reply to Re: Too much Serotonin? » J Kelly, posted by Tomatheus on March 17, 2016, at 13:25:36
> > Hi Tomatheus :)
> >
> > I actually posted on the above thread.
>
> Whoops! Not recognizing that you posted to the Stablon thread that RJ started was quite a BIG oversight on my part, and I apologize for making it. I do recall feeling rushed as I was finishing up my response to you earlier in this thread, as I wanted to finish writing my post quickly to tend to something else that I needed to do, and I suspect that that might have played a role in leading me to not even think about the fact that you posted to the Stablon thread before I even did. And I did read your posts to the thread, so it's not like I didn't know that you posted there, but it completely slipped my mind. So again, I apologize. You deserve better than to have your contributions to this board overlooked.Oh my gosh you hold yourself to such a high standard!! Absolutely no apology necessary.
I really appreciate the time and effort that obviously goes into your posts. You are a very generous contributor here from what I've seen :)
>
> Regarding tianeptine (Stablon) itself, I don't know how likely it is that trying the medication again might produce the kind of results that you're probably looking for, although as you mentioned, giving tianeptine another try with just a very small dose might be something to consider.> Looking into the serotonin receptor antagonists that Linkadge just mentioned (and I know that you already wrote that you'd be looking into them) seems like it would be more likely to help you achieve what you want to achieve as far dampening down the serotonin system is concerned than taking tianeptine.
I posted to Linkadge that I'm confused by the suggestion to try serotonin antagonists. Don't they increase serotonin? Please pardon my ignorance. I just don't understand.
Jade
>
> Tomatheus
Posted by linkadge on March 17, 2016, at 15:23:18
In reply to Re: Too much Serotonin? » linkadge, posted by J Kelly on March 17, 2016, at 13:23:44
Serotonin antagonists block the action of serotonin at one or more serotonin receptors.
Some of these drugs also act as serotonin reuptake inhibitors (meaning they will increase serotonin and block its action at certain receptors).
Cyproheptadine would generally only block the action of serotonin since it is a receptor blocker but not a reuptake inhibitor. Cyproheptadine can be used to block serotonin syndrome - which can occur when certain serotonin boosters are combined.
Something like theanine (in green tea) has been shown to normalize serotonin function in cases where it can become elevated because of anxiety.
Also, gingko biloba might be worth looking into. It enhances serotonin reuptake, block certain serotonin receptors, and can enhance dopamine function.
Another herb would be feverfew. It is traditionally used in migraines, but has an anti serotonin action.
Linkadge
Posted by Lamdage22 on March 17, 2016, at 15:38:02
In reply to Re: Too much Serotonin?, posted by linkadge on March 17, 2016, at 15:23:18
Hey, J Kelly,
If you take Zyprexa anyway, you dont take it for psychosis and you dont want to stop i dont know why you couldnt take a shot with Nardil.
Chances are that the 10mg Zyprexa will block psychosis and mania.
Scott?
Posted by Lamdage22 on March 17, 2016, at 15:45:48
In reply to Re: Too much Serotonin?, posted by Lamdage22 on March 17, 2016, at 15:38:02
I dont know if i would choose that myself but i guess other people would.
APs are not my favorites.
Posted by Tomatheus on March 17, 2016, at 16:59:44
In reply to Re: Too much Serotonin? » Tomatheus, posted by J Kelly on March 17, 2016, at 13:37:35
> Oh my gosh you hold yourself to such a high standard!! Absolutely no apology necessary.
>
> I really appreciate the time and effort that obviously goes into your posts. You are a very generous contributor here from what I've seen :)Thank you for writing this, Jade. It's helpful to know that you value the contributions that I make to this board, but given that I think that you've contributed to this board quite positively yourself (especially as of late), I still think that you deserve better than to have what you wrote on the Stablon thread that RJ started overlooked. As I said, my oversight was a big one, and even though I didn't intend to overlook what you had written, I don't like that what I wrote might have inadvertently led to you have felt overlooked.
Regarding serotonin antagonists, my understanding of the effects that these medications have on serotonergic neurotransmission is limited, but I'll try to explain what I know. Essentially, serotonin is a neurotransmitter that some neurons use to communicate with one another, and this process is accomplished when presynaptic neurons release the neurotransmitter from their axon terminals into the gaps between two neurons that are referred to as synapses. After passing through the synapse between two neurons, serotonin then activates receptors on the dendrites of postsynaptic neurons. This receptor activation opens ion channels that produce either an excitatory response or an inhibitory response in the postsynaptic neuron. Now, some medications can bind to the same receptors that serotonin activates with different types of effects. Like the serotonin molecules themselves, serotonin receptor agonists (otherwise known as "full agonists") serve to activate the receptors, basically mimicking the effects of the neurotransmitter. Partial agonists of serotonin receptors also activate the receptors, but with less intensity than full agonists do. Serotonin receptor antagonists essentially bind to the receptors that they have an affinity for without activating them. In other words, antagonists essentially block the activation of the receptors that both serotonin and the receptor agonists would produce.
In all likelihood, though serotonin receptor antagonists do block the receptor activation that serotonin would produce, blocking serotonin receptors may have other effects on the serotonin system, most of which I would suspect are beyond my current level of understanding of how neurotransmission operates. For instance, activating one type of serotonin receptor (the 5HT2A receptor) actually leads to a reduction in the stimulation of another type of serotonin receptor, the 5HT1A receptor (Stahl, 2000). Antagonizing, or blocking, 5HT2A receptors might then indirectly boost the effects of stimulating 5HT1A receptors, at least according to Stahl (2000). So, obviously, the effects that serotonin antagonists might have are rather complicated, at least to me, but I think that one of the more apparent effects that serotonin receptor antagonists have is to block the receptor activation that serotonin would produce.
Tomatheus
==
REFERENCE
Stahl, S.M. (2000). Essential psychopharmacology of depression and bipolar disorder. Cambridge, U.K.: Cambridge University Press.
Posted by J Kelly on March 17, 2016, at 19:22:04
In reply to Re: Too much Serotonin? » J Kelly, posted by Tomatheus on March 17, 2016, at 16:59:44
> So, obviously, the effects that serotonin antagonists might have are rather complicated, at least to me, but I think that one of the more apparent effects that serotonin receptor antagonists have is to block the receptor activation that serotonin would produce.
>
> Tomatheus
>Hi again,
Its complicated enough that I better leave this one up to my pdoc. I'm gonna bring to his attention my concerns regarding serotonin levels, remind him of my responses to SSRI's, and ask him to look at the meds that Linkadge mentioned.
Thanks for your help :)
Jade
Posted by J Kelly on March 17, 2016, at 19:42:49
In reply to Re: Too much Serotonin? » J Kelly, posted by Tomatheus on March 17, 2016, at 16:59:44
Btw Tomatheus,
Please don't give up on trying to educate me. Its just my brain has endured some insults that I'm trying to recover from. As Scott says, repetition. And in my case repetition, repetition, repetition :)
Jade
Posted by Tomatheus on March 17, 2016, at 21:19:45
In reply to Re: Too much Serotonin? » Tomatheus, posted by J Kelly on March 17, 2016, at 19:42:49
Jade,
Thank you for your replies. Sharing your concerns as they pertain to serotonin levels with your pdoc, while also reminding your pdoc about your past responses to SSRIs and asking your pdoc about the medications that Linkadge mentioned, would definitely make a lot of sense. As much as I think that this forum is a good place for those of us with mental health conditions to share information with one another and to suggest some ideas as far as treatment possibilities are concerned, I definitely think that your choice to ultimately leave any medication-related decisions that might be made regarding your case to your pdoc is a wise one. It's my belief that playing an active part in the treatment process as many of us here on Psycho-Babble do can be a good thing for a few different reasons. Among other things, being active in our treatment helps us to foster knowledge and ideas that can lead to better treatment decisions. But most of us, with the possible exception of a select few on this site (and I don't consider myself to be one of these individuals), don't have anywhere close to as much expertise on medications and mental health-related research as those who treat us do, and so I think it's definitely sensible to leave the decisions to be made regarding medications up to our treatment professionals as you're planning on doing.
Tomatheus
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