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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Bonnie on May 16, 2000, at 18:24:45
my pdoc prescribed me liquid paxil...has anyone ever taken Paxil? and good news or bad news about it?
Posted by Cam W. on May 16, 2000, at 19:44:52
In reply to am now taking Paxil..., posted by Bonnie on May 16, 2000, at 18:24:45
> my pdoc prescribed me liquid paxil...has anyone ever taken Paxil? and good news or bad news about it?
Bonnie - Paxil is an antidepressant/anti-anxiety/antiobsessional medication in the SSRI family of mood modifiers (or more commonly - SSRI antidepressants). Paxil blocks the reuptake of the neurotransmitter serotonin (a chemical in the body that carries an electrical signal from one nerve cell to another). In many depressions, your level of serotonin is low and by blocking it's reuptake into the nerve cell that it was released from, you are, in essence, increasing the amount of serotonin available from transmitting the electrical signal.
You may notice some side effects (nausea, drowsiness, headache) when starting the Paxil, but these usually dissipate within the first couple of weeks, as your body adjusts to the drug. A couple of side effects that do persist in some people are decreased libido (&/or harder to reach orgasm) and delayed weight gain. The weight gain can occur about a month or two into therapy. I believe part of the reason why there is weight gain is that your depression is resolving and you feel like eating again. Weight gain may be minimized by watching your diet closely.
You may notice the Paxil to start to resolve your depressive symptoms as early as two weeks, but it may take eight weeks (sometimes more) to see it's full effects. I generally tell people that in two or three weeks other people begin to notice a change in you and in four to six weeks you begin to notice a change.
It is important to tell yourself to keep taking the Paxil through the side effects and through the seemingly lack of antidepressant effect, as it does take time to work.
Hope this helps - Cam
Posted by tina on May 16, 2000, at 21:36:06
In reply to Re: am now taking Paxil..., posted by Cam W. on May 16, 2000, at 19:44:52
I know I might sound stupid asking this but--Why does serotonin effect mood? I've read some articles and other websites but I still don't get it. It's always couched in such techy language. I was wondering if you could explain it in everyday terms. How does loss of serotonin or mao or dopamine or norepinephrine really effect mood? Please don't think I'm too dumb for asking, in my state I easily get confused.
Thanks bud
> >
my pdoc prescribed me liquid paxil...has anyone ever taken Paxil? and good news or bad news about it?
>
> Bonnie - Paxil is an antidepressant/anti-anxiety/antiobsessional medication in the SSRI family of mood modifiers (or more commonly - SSRI antidepressants). Paxil blocks the reuptake of the neurotransmitter serotonin (a chemical in the body that carries an electrical signal from one nerve cell to another). In many depressions, your level of serotonin is low and by blocking it's reuptake into the nerve cell that it was released from, you are, in essence, increasing the amount of serotonin available from transmitting the electrical signal.
>
> You may notice some side effects (nausea, drowsiness, headache) when starting the Paxil, but these usually dissipate within the first couple of weeks, as your body adjusts to the drug. A couple of side effects that do persist in some people are decreased libido (&/or harder to reach orgasm) and delayed weight gain. The weight gain can occur about a month or two into therapy. I believe part of the reason why there is weight gain is that your depression is resolving and you feel like eating again. Weight gain may be minimized by watching your diet closely.
>
> You may notice the Paxil to start to resolve your depressive symptoms as early as two weeks, but it may take eight weeks (sometimes more) to see it's full effects. I generally tell people that in two or three weeks other people begin to notice a change in you and in four to six weeks you begin to notice a change.
>
> It is important to tell yourself to keep taking the Paxil through the side effects and through the seemingly lack of antidepressant effect, as it does take time to work.
>
> Hope this helps - Cam
Posted by Cam W. on May 17, 2000, at 0:05:28
In reply to Cam--Need explanation??, posted by tina on May 16, 2000, at 21:36:06
Tina - I dunno.
As you know from this board, serotonin is just one of the neurotransmitters. They seem to find more everyday. All are different, but do or don't work differently. They all work as a unit, kinda like a sports team on a roll, or when the defence falters, we get depression. Lack of serotonin doesn't "cause" a depression anymore than a goaltender "causes" a loss (his team just didn't score enough goals). We can deplete serotonin from the body and it doesn't cause depression, but adding serotonin (or in other cases, norepinephrine) can resolve the"symptoms of depression". Like adding a good goaltender to the team and the team starts working as a unit again.
Serotonin is one of the neurotransmitters involved in the body's stress response system (HPA axis). Serotonin receptors and neurons are located throughout the body and brain (even in platelets), but are concentrated in a midbrain structure called the raphe nuclei. Serotonin nerves mainly start from this structure and extend out to various other nerve cells and brain structures. This widespread distribution of serotonin "innervation" affects a variety of bodily functions, including: the sleep-wake cycle, sexual behavior, feeding behavior, control of body temperature, pain control, etc. as well as mood control.
Serotonin system "dysfunction" (or breakdown) is implicated in (but probably not a direct cause of) a number of "neuropathological processes" (disorders) such as: sleep disorders, anxiety disorders, aggression, bulemia, anorexia, as well as depression. Also, serotonin problems are seen in Alzheimer's, Parkinson's and Huntington's diseases.
There are many types of serotonin receptors in the body (at least 15 that I have read about) that all do something slightly (or majorly) different. For example, stimilating one type of serotonin receptor can increase dopamine release, while stimulating another serotonin receptor can decrease dopamine release.
By interacting in different ways at these different receptors and acting on and being acted upon by other chemicals (eg in combination with other neurotransmitters, neuropeptides, amino acids, etc., each with their own complement of different receptors) serotonin is a major player in the control of mood. Change the amount of serotonin and mood changes (but not to the point of major depression - different, mostly unknown breakdowns, have to also occur to induce depressive symptoms).
Serotonin and these other chemicals bind to receptors, which alters the shape of the cell membrane that they attach to, causing a chain reaction of chemical signals inside the cell that basically tells the DNA in the cell nucleus to produce an enzyme, protein, etc. from specific genes. These products are released into the blood stream and interact with other receptors, causing further interactions with other cells and signaling more DNA to produce different chemicals, ad nauseum.
All this produces what we call a human being, including all of our body functions, thoughts, movements, etc.
Somewhere in all this, serotonin is helping to maintain the HPA axis, so that the body can respond appropriately to stress. Prolonged stress can cause a breakdown of the HPA axis and manifest as the symptoms we call depression. Serotonin, in conjunction with a bunch of other neuropeptides (chemicals) regulates what we call mood. In this system, it seems that serotonin is a major player (Gretzky), but it takes the whole team working together to win.
See, I dunno. I hope this muddles you as much as it does me. The further you look into these processes, the more lost you get (until you absolutely do not know what is going on and then they call you an expert).
I really hope this helps - Thanks for listening - Cam
Posted by Cam W. on May 17, 2000, at 6:49:55
In reply to Re: Cam--Need explanation?? - Tina, posted by Cam W. on May 17, 2000, at 0:05:28
Tina - BTW, as you can see from the post below, you questions were anything but dumb.
Actually, if you have a university (college) medical library near you, a very, very interesting article that I found the other day, gives an incredible history of human thought on stress and depression from Plato to the existentialists to the present day. Do not let the title scare you, it is actually very easy to read:
Dubrovsky,B. The specificity of stress responses to different nocuous stimuli: Neurosteroids and depression, Brain Reasearch Bulletin, 2000, vol 51, no.6: p443-445.
It is available on-line by subscription at www.neuroscion.com. The first 6 months are free, but this really is a neurochmistry "geek" site. Although, I think it's cool. Hmmm, what does that say about me? - Cam
>Tina - I dunno.
>
> As you know from this board, serotonin is just one of the neurotransmitters. They seem to find more everyday. All are different, but do or don't work differently. They all work as a unit, kinda like a sports team on a roll, or when the defence falters, we get depression. Lack of serotonin doesn't "cause" a depression anymore than a goaltender "causes" a loss (his team just didn't score enough goals). We can deplete serotonin from the body and it doesn't cause depression, but adding serotonin (or in other cases, norepinephrine) can resolve the"symptoms of depression". Like adding a good goaltender to the team and the team starts working as a unit again.
>
> Serotonin is one of the neurotransmitters involved in the body's stress response system (HPA axis). Serotonin receptors and neurons are located throughout the body and brain (even in platelets), but are concentrated in a midbrain structure called the raphe nuclei. Serotonin nerves mainly start from this structure and extend out to various other nerve cells and brain structures. This widespread distribution of serotonin "innervation" affects a variety of bodily functions, including: the sleep-wake cycle, sexual behavior, feeding behavior, control of body temperature, pain control, etc. as well as mood control.
>
> Serotonin system "dysfunction" (or breakdown) is implicated in (but probably not a direct cause of) a number of "neuropathological processes" (disorders) such as: sleep disorders, anxiety disorders, aggression, bulemia, anorexia, as well as depression. Also, serotonin problems are seen in Alzheimer's, Parkinson's and Huntington's diseases.
>
> There are many types of serotonin receptors in the body (at least 15 that I have read about) that all do something slightly (or majorly) different. For example, stimilating one type of serotonin receptor can increase dopamine release, while stimulating another serotonin receptor can decrease dopamine release.
>
> By interacting in different ways at these different receptors and acting on and being acted upon by other chemicals (eg in combination with other neurotransmitters, neuropeptides, amino acids, etc., each with their own complement of different receptors) serotonin is a major player in the control of mood. Change the amount of serotonin and mood changes (but not to the point of major depression - different, mostly unknown breakdowns, have to also occur to induce depressive symptoms).
>
> Serotonin and these other chemicals bind to receptors, which alters the shape of the cell membrane that they attach to, causing a chain reaction of chemical signals inside the cell that basically tells the DNA in the cell nucleus to produce an enzyme, protein, etc. from specific genes. These products are released into the blood stream and interact with other receptors, causing further interactions with other cells and signaling more DNA to produce different chemicals, ad nauseum.
>
> All this produces what we call a human being, including all of our body functions, thoughts, movements, etc.
>
> Somewhere in all this, serotonin is helping to maintain the HPA axis, so that the body can respond appropriately to stress. Prolonged stress can cause a breakdown of the HPA axis and manifest as the symptoms we call depression. Serotonin, in conjunction with a bunch of other neuropeptides (chemicals) regulates what we call mood. In this system, it seems that serotonin is a major player (Gretzky), but it takes the whole team working together to win.
> See, I dunno. I hope this muddles you as much as it does me. The further you look into these processes, the more lost you get (until you absolutely do not know what is going on and then they call you an expert).
>
> I really hope this helps - Thanks for listening - Cam
Posted by tina on May 17, 2000, at 8:01:33
In reply to Re: Cam--Need explanation?? - Tina, posted by Cam W. on May 17, 2000, at 6:49:55
So, Panic attacks are caused by this same HPA axis breakdown or more likely the seratonin response or lack there of? What is the difference in chemical reaction in the neurotransmitters between panic disorder and depression? Same or what? If seratonin is only "implicated" in panic disorder, how do you know which neurochemical to work on? Is there a test or is it just trial and error. Sorry, I'm into this now. Gotta know everything.
> Tina - BTW, as you can see from the post below, you questions were anything but dumb.
>
> Actually, if you have a university (college) medical library near you, a very, very interesting article that I found the other day, gives an incredible history of human thought on stress and depression from Plato to the existentialists to the present day. Do not let the title scare you, it is actually very easy to read:
>
> Dubrovsky,B. The specificity of stress responses to different nocuous stimuli: Neurosteroids and depression, Brain Reasearch Bulletin, 2000, vol 51, no.6: p443-445.
>
> It is available on-line by subscription at www.neuroscion.com. The first 6 months are free, but this really is a neurochmistry "geek" site. Although, I think it's cool. Hmmm, what does that say about me? - Cam
>
> >Tina - I dunno.
> >
> > As you know from this board, serotonin is just one of the neurotransmitters. They seem to find more everyday. All are different, but do or don't work differently. They all work as a unit, kinda like a sports team on a roll, or when the defence falters, we get depression. Lack of serotonin doesn't "cause" a depression anymore than a goaltender "causes" a loss (his team just didn't score enough goals). We can deplete serotonin from the body and it doesn't cause depression, but adding serotonin (or in other cases, norepinephrine) can resolve the"symptoms of depression". Like adding a good goaltender to the team and the team starts working as a unit again.
> >
> > Serotonin is one of the neurotransmitters involved in the body's stress response system (HPA axis). Serotonin receptors and neurons are located throughout the body and brain (even in platelets), but are concentrated in a midbrain structure called the raphe nuclei. Serotonin nerves mainly start from this structure and extend out to various other nerve cells and brain structures. This widespread distribution of serotonin "innervation" affects a variety of bodily functions, including: the sleep-wake cycle, sexual behavior, feeding behavior, control of body temperature, pain control, etc. as well as mood control.
> >
> > Serotonin system "dysfunction" (or breakdown) is implicated in (but probably not a direct cause of) a number of "neuropathological processes" (disorders) such as: sleep disorders, anxiety disorders, aggression, bulemia, anorexia, as well as depression. Also, serotonin problems are seen in Alzheimer's, Parkinson's and Huntington's diseases.
> >
> > There are many types of serotonin receptors in the body (at least 15 that I have read about) that all do something slightly (or majorly) different. For example, stimilating one type of serotonin receptor can increase dopamine release, while stimulating another serotonin receptor can decrease dopamine release.
> >
> > By interacting in different ways at these different receptors and acting on and being acted upon by other chemicals (eg in combination with other neurotransmitters, neuropeptides, amino acids, etc., each with their own complement of different receptors) serotonin is a major player in the control of mood. Change the amount of serotonin and mood changes (but not to the point of major depression - different, mostly unknown breakdowns, have to also occur to induce depressive symptoms).
> >
> > Serotonin and these other chemicals bind to receptors, which alters the shape of the cell membrane that they attach to, causing a chain reaction of chemical signals inside the cell that basically tells the DNA in the cell nucleus to produce an enzyme, protein, etc. from specific genes. These products are released into the blood stream and interact with other receptors, causing further interactions with other cells and signaling more DNA to produce different chemicals, ad nauseum.
> >
> > All this produces what we call a human being, including all of our body functions, thoughts, movements, etc.
> >
> > Somewhere in all this, serotonin is helping to maintain the HPA axis, so that the body can respond appropriately to stress. Prolonged stress can cause a breakdown of the HPA axis and manifest as the symptoms we call depression. Serotonin, in conjunction with a bunch of other neuropeptides (chemicals) regulates what we call mood. In this system, it seems that serotonin is a major player (Gretzky), but it takes the whole team working together to win.
>
> > See, I dunno. I hope this muddles you as much as it does me. The further you look into these processes, the more lost you get (until you absolutely do not know what is going on and then they call you an expert).
> >
> > I really hope this helps - Thanks for listening - Cam
Posted by Cam W. on May 17, 2000, at 18:47:06
In reply to Re: Cam--Need explanation??-CAM, posted by tina on May 17, 2000, at 8:01:33
Tina - Actually, scientists think that it is different serotonin pathways ending at different sites affect differnet types of emotions or moods. Most serotonin nerves start in the raphe nuclei and project (or go to) different structures in the brain. A breakdown of one of these pathways may lead (in a round about way) to panic disorder and a breakdown of another pathway to a different site may lead to depression and the breakdown of still another pathway may lead to depression. It is the endpoint or where the serotonin nerve attaches to that determines what system serotonin is modulating (or affecting). Sorry, off hand I cannot remember which pathway breakdowns lead to which disorders, but I have that information at work.Hope this helps - Cam
Posted by medlib on May 17, 2000, at 21:02:28
In reply to Re: Cam--Need explanation??-Tina, posted by Cam W. on May 17, 2000, at 18:47:06
>
> Tina - Actually, scientists think that it is different serotonin pathways ending at different sites affect differnet types of emotions or moods. Most serotonin nerves start in the raphe nuclei and project (or go to) different structures in the brain. A breakdown of one of these pathways may lead (in a round about way) to panic disorder and a breakdown of another pathway to a different site may lead to depression and the breakdown of still another pathway may lead to depression. It is the endpoint or where the serotonin nerve attaches to that determines what system serotonin is modulating (or affecting). Sorry, off hand I cannot remember which pathway breakdowns lead to which disorders, but I have that information at work.
>
> Hope this helps - Cam
---------------------------------Cam--
If it's not too much trouble to access the information you mentioned above on serotonin-modulated pathways, I would find it very helpful. (I think several others on this board would appreciate it as well.)
BTW, how goes the "To Do" list? When you listed it in an earlier post, I thought it sounded like a job for Superman.
Well wishes--medlib
Posted by medlib on May 18, 2000, at 3:26:28
In reply to Re: Cam--Serotonin-modulated pathways?, posted by medlib on May 17, 2000, at 21:02:28
Cam--
Re that "To Do" list:
You've probably crossed the gero-psychopharm lit review off your list, but I stumbled across a pretty new, comprehensive article on a recent search. You might find it applicable if you haven't seen it already.
"Cognitive and psychomotor effects of antidepressants with emphasis on serotonin reuptake inhibitors and the depressed elderly."
Pub. 9-7-99 in German J. of Psychiatry, available full-text online at:
www.gwdg.de/~bbandel/gjp-article-lane.htmHaving fun yet?
Well wishes--medlib
Posted by Cam W. on May 18, 2000, at 13:01:31
In reply to Re: Cam--Serotonin-modulated pathways?, posted by medlib on May 17, 2000, at 21:02:28
medlib & all - The serotonin pathways that are broken down (or disinhibited) are as follows:
Serotonin neurons from the midbrain raphe nuclei to:
Prefrontal Cortex (higher mental activities) - Depression.
Limbic System (incl.limbic cortex and hippocampus) (arousal & motivation) - Panic Disorder.
Basal Ganglia (movement, motor circuitry) - OCD.
Hypothalamus (sugar & fat metabolism) - Bulemia.
These serotonin pathways (between the midbrain raphe nuclei and above structures) are thought to be involved in the above disorders. It is more complicated than this, involving other neurotransmitters and hormones, but this does show serotonin's involvemnet in these disorders.
Thanks for the article medlib - Cam
Posted by SLS on May 19, 2000, at 13:25:10
In reply to Re: Cam--Serotonin-modulated pathways?, posted by Cam W. on May 18, 2000, at 13:01:31
> medlib & all - The serotonin pathways that are broken down (or disinhibited) are as follows:
>
> Serotonin neurons from the midbrain raphe nuclei to:
>
> Prefrontal Cortex (higher mental activities) - Depression.
>
> Limbic System (incl.limbic cortex and hippocampus) (arousal & motivation) - Panic Disorder.
>
> Basal Ganglia (movement, motor circuitry) - OCD.
>
> Hypothalamus (sugar & fat metabolism) - Bulemia.
>
> These serotonin pathways (between the midbrain raphe nuclei and above structures) are thought to be involved in the above disorders. It is more complicated than this, involving other neurotransmitters and hormones, but this does show serotonin's involvemnet in these disorders.
This is a great summary. All but the prefrontal cortex association surprised me. Thank-you.Question: Do you think that the prefrontal cortex is involved in SSRI-induced apathy through the stimulation of 5-HT2 receptors located there?
Do you think it is feasible to use small doses of a 5-HT2 antagonist to deal with this? (Remeron, Serzone, Periactin...)? Has anyone described such an effect?
The more of the posts I read between you, PeterJ and medlib, the more of a dummy I feel like. I think this is a good thing. It helps me to remember how educated I am not.
Thanks again.
Sincerely,
Scott
Posted by Cam W. on May 19, 2000, at 20:05:32
In reply to Re: Cam--Serotonin-modulated pathways?, posted by SLS on May 19, 2000, at 13:25:10
Scott - I think that the prefrontal cortex stuff is the inattention, difficulty concentrating and thinking that occurs with depression. A 5-HT2 antagonist may help. We see how well Zyprexa works in bipolar disorder. They should certainly help with the sexual dysfunction. Do you think that the apathy could be more of a euthymia, as you come out of a depressive state?It's not that you are a dummy, it's that we just know the words. This is our job, so we talk in our own lingo (really no different than "Down a Mac" at MacDonalds). This is no different than in any profession. I still do not know as much as I would like and I still can't visualize the neural circuitry as I would like to. It's a learning process and as long as we keep learning, our brains should not wilt. I know much more than I did a year ago and infinitely more than two years ago, as I immerse myself in my current position at mental health.
I have to know more about the meds than the docs to be effective in my job. I still do not think I am there, yet, but I am trying. This site helps, as clinical information surpasses book knowledge. The info I get from this site (and from much of what you have contributed) is a Godsend. The stuff I have learned here has put me ahead of the docs in many areas.
Keep teaching me and I will keep teaching you, Scott. I consider you a colleague. I find it hard to believe that you are not "in the biz". I guess you are self-taught, like DaVinci.
Sincerely - Cam
Posted by PeterJ on May 19, 2000, at 20:37:35
In reply to Re: Cam--Serotonin-modulated pathways?, posted by SLS on May 19, 2000, at 13:25:10
> Question: Do you think that the prefrontal cortex is involved in SSRI-induced apathy through the stimulation of 5-HT2 receptors located there?
>
> Do you think it is feasible to use small doses of a 5-HT2 antagonist to deal with this? (Remeron, Serzone, Periactin...)? Has anyone described such an effect?That's an excellent idea. The usual explanation for SSRI induced apathy is that SSRI stimulation of 5-HT2 receptors on DA cell bodies inhibits firing of DA cells which project to (voila!) the frontal cortex. So bromocriptine has been used to treat the apathy with anecdotal success. The apathy is often compared to ADHD. SSRIs sometimes worsen ADHD.
A direct opposition of the effects of DA and 5-HT projections has also been hypothesized, but I don't know if it's been proven.
In either case, using a 5-HT2 antagonist makes perfect sense, and I don't know why it hasn't been tried. 5-HT2 antagonism helps the apathy of schizophrenia ("negative symptoms") and has anecdotally helped SSRI sexual dysfunction (sexual apathy) in a few cases, but I haven't heard of its use for SSRI apathy per se.
BTW, a great drug that unfortunately never got approved was the 5-HT2 blocker ritanserin. It was a pure 5-HT2 antagonist unlike the current 5-HT antagonists which all do something else (DA blockade with Risperidone and other antipsychotics, and several receptor effects with Nefazodone and Mirtazepine...). Ritanserin didn't quite make the FDA cutoff point in antidepressant studies. Too bad for those who might respond to it. It's also great for sleep. It increases deep slow wave sleep. I talked to the drug company that made it and they told me they tried but couldn't get it approved for sleep disorders because, according to the FDA. "there is no such disorder as lack of slow wave sleep."
> The more of the posts I read between you, PeterJ and medlib, the more of a dummy I feel like. I think this is a good thing. It helps me to remember how educated I am not.
"The sense of worthlessness or guilt associated with Major Depressive Disorder may include unrealistic negative evaluations of one's worth...(Criterion A7)"---DSM IV, Mood Disorders, p. 321.
Peter
This is the end of the thread.
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