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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by colin wallace on March 1, 2002, at 12:27:29
It was insinuated by my psych. that my adverse reaction to ssri's, which did not usually reveal itself until three or four weeks into treatment, was a figment of my imagination.Restlessness/agitation/aggression usually present immidiately, if they are to present at all, he said.Some of the posts here have made mention of the fact that increased seratonin can lead to a corresponding decrease in dopamine.I'm wondering whether perhaps this interplay may account for a delayed adverse reaction, suggesting maybe a dopamine deficiency?After all, it would take a few weeks to deplete the dopamine, surely?I'm about to give an ssri a final shot at redeeming itself (in a low dose sam-e combo.)
If I start to slide, I'm figuring wellbutrin may be the answer.******* me off though, to have to figure these things out for myself, the hard way.Anyone else had a similar ssri experience ,presenting only after some time, without dose increments to account for the reaction?? Any thoughts appreciated.
Posted by JohnX2 on March 1, 2002, at 22:03:37
In reply to SSRI Dopamine depletion...., posted by colin wallace on March 1, 2002, at 12:27:29
Colin,Which medicines made you feel agressive/agitated?
-John
> It was insinuated by my psych. that my adverse reaction to ssri's, which did not usually reveal itself until three or four weeks into treatment, was a figment of my imagination.Restlessness/agitation/aggression usually present immidiately, if they are to present at all, he said.Some of the posts here have made mention of the fact that increased seratonin can lead to a corresponding decrease in dopamine.I'm wondering whether perhaps this interplay may account for a delayed adverse reaction, suggesting maybe a dopamine deficiency?After all, it would take a few weeks to deplete the dopamine, surely?I'm about to give an ssri a final shot at redeeming itself (in a low dose sam-e combo.)
> If I start to slide, I'm figuring wellbutrin may be the answer.******* me off though, to have to figure these things out for myself, the hard way.Anyone else had a similar ssri experience ,presenting only after some time, without dose increments to account for the reaction?? Any thoughts appreciated.
Posted by colin wallace on March 2, 2002, at 4:25:58
In reply to SSRI Dopamine depletion...., posted by colin wallace on March 1, 2002, at 12:27:29
Prozac (generic!), Celexa (Cipramil)and Effexor.....but not Prozac (original).
Strange eh?!
Posted by Ron Hill on March 2, 2002, at 8:53:36
In reply to SSRI Dopamine depletion...., posted by colin wallace on March 1, 2002, at 12:27:29
Colin,
Based on personal experience, I subscribe to the theory that SSRIs may reduce dopamine levels. However, for me the decrease in dopamine (if that's what it is) causes me to become lethargic, unmotivated, void of energy, blunted emotions, etc. In contrast, your symptoms (restlessness/agitation/aggression) I have always attributed to elevated norepinephine levels. These symptoms present when I take Wellbutrin.
Like you, I also have found great success using SAM-e. Please allow me to use this as an opportunity to post my SAM-e testimonial again. As you know, SAM-e is a naturally occurring compound and is manufactured by the human body. However, some people do not produce enough of it and supplementation may be beneficial.
SAM-e is involved in a plethora of various biochemical reactions in the human body. It functions as a very important methyl group donor. With regard to mood and related brain chemistry, SAM-e serves as the methylating agent in the biochemical reaction mechanism whereby various neurotransmitters (serotonin and dopamine in particular) are synthesized from amino acids in dietary protein.
For me personally, SAM-e has turned out to be a lifesaver! I have waited to post on this topic until I gave it some time to make sure it did not poop out right away. I do not want to post a proSAM-e testimonial only to find out later that it did not last. However, I have experienced positive results for four consecutive months and, therefore, I am ready to post.
I'm BPII. Lithium adequately controls my hypomania but does nothing for my depression. Any of the SSRI's will take away my "I want to die" mood but leaves me with side effects (loss of ambition, loss of energy, lack of motivation, blunted emotions, etc). I have tried a ton of other ADs over the years, but I will not bore you with the details.
Four months ago I went to my regular visit with my pdoc. At the time, I was only taking Li because of the AD side effects. Depression was a problem for me at the time. My pdoc had recently reviewed several studies showing success in treating depression using SAM-e in conjunction with an AD and success using SAM-e alone. He suggested that I take two 200 mg SAM-e tablets daily in conjunction with 25 mg of Zoloft. I am hypersensitive to most medication so I take small doses.
Initially I could only take one 200 mg tablet of SAM-e every other day. If I took more, I would experience side effects (flush, nausea, confused thinking, general ill feeling, "skin crawling"). Currently, I take one 200 mg tablet daily without any adverse side effects. I currently take 600 mg Lithobid, 12.5 mg Zoloft, and 200 mg SAM-e. Eventually, I plan to discontinue the small amount of Zoloft.
Bottom line: 200 mg SAM-e daily has helped me more than any of the many ADs I've tried over the years. It is very important to take plenty of B-6, B-12 (sublingual form) and folate with the SAM-e. Also take SAM-e on an empty stomach.
Here are some links to articles on the topic. Do some research (use "SAM-e" in search engine). Buy a good name brand to ensure product quality.
http://www.biopsychiatry.com/sameart.html
http://more.abcnews.go.com/sections/living/inyourhead/allinyourhead_36.html
http://www.psycom.net/depression.central.same.html
http://www.mhsource.com/expert/exp1041299b.html
http://www.arthritissupport.com/track/goto/rtgoto30l.cfm
-- Ron
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> It was insinuated by my psych. that my adverse reaction to ssri's, which did not usually reveal itself until three or four weeks into treatment, was a figment of my imagination.Restlessness/agitation/aggression usually present immidiately, if they are to present at all, he said.Some of the posts here have made mention of the fact that increased seratonin can lead to a corresponding decrease in dopamine.I'm wondering whether perhaps this interplay may account for a delayed adverse reaction, suggesting maybe a dopamine deficiency?After all, it would take a few weeks to deplete the dopamine, surely?I'm about to give an ssri a final shot at redeeming itself (in a low dose sam-e combo.)
> If I start to slide, I'm figuring wellbutrin may be the answer.******* me off though, to have to figure these things out for myself, the hard way.Anyone else had a similar ssri experience ,presenting only after some time, without dose increments to account for the reaction?? Any thoughts appreciated.
Posted by Simcha on March 2, 2002, at 16:02:05
In reply to SSRI Dopamine depletion...., posted by colin wallace on March 1, 2002, at 12:27:29
Yes, this can happen. It happened to me. I was originally on Wellbutrin and Celexa. My pdoc said that the excess seratonin was causing me to grind my teeth at night. He said I needed the blockage removed. Benzos do the trick. I'm on Clonazepam/Klonopin at 1mg/night. It seems to do the trick. It works great for my anxiety too.
Your mileage may vary,
Simcha
Posted by anna345 on May 1, 2003, at 22:37:58
In reply to Re: SSRI Dopamine depletion.... » colin wallace, posted by JohnX2 on March 1, 2002, at 22:03:37
My brother had a severe reaction to Lexapro. Three weeks later, after no problems whatsoever (he stopped taking Lexapro) he is experiencing tremors, extreme anxiety and paranoia. I have been combing these articles looking for any answers, and the below one grabbed my attention. Could my brother be experiencing a depletion of dopamine, that took three weeks to manifest?
>
> > It was insinuated by my psych. that my adverse reaction to ssri's, which did not usually reveal itself until three or four weeks into treatment, was a figment of my imagination.Restlessness/agitation/aggression usually present immidiately, if they are to present at all, he said.Some of the posts here have made mention of the fact that increased seratonin can lead to a corresponding decrease in dopamine.I'm wondering whether perhaps this interplay may account for a delayed adverse reaction, suggesting maybe a dopamine deficiency?After all, it would take a few weeks to deplete the dopamine, surely?I'm about to give an ssri a final shot at redeeming itself (in a low dose sam-e combo.)
> > If I start to slide, I'm figuring wellbutrin may be the answer.******* me off though, to have to figure these things out for myself, the hard way.Anyone else had a similar ssri experience ,presenting only after some time, without dose increments to account for the reaction?? Any thoughts appreciated.
>
>
Posted by worrier on May 2, 2003, at 20:11:14
In reply to Re: SSRI Dopamine depletion...., posted by anna345 on May 1, 2003, at 22:37:58
> My brother had a severe reaction to Lexapro. Three weeks later, after no problems whatsoever (he stopped taking Lexapro) he is experiencing tremors, extreme anxiety and paranoia. I have been combing these articles looking for any answers, and the below one grabbed my attention. Could my brother be experiencing a depletion of dopamine, that took three weeks to manifest?
> >
> > > It was insinuated by my psych. that my adverse reaction to ssri's, which did not usually reveal itself until three or four weeks into treatment, was a figment of my imagination.Restlessness/agitation/aggression usually present immidiately, if they are to present at all, he said.Some of the posts here have made mention of the fact that increased seratonin can lead to a corresponding decrease in dopamine.I'm wondering whether perhaps this interplay may account for a delayed adverse reaction, suggesting maybe a dopamine deficiency?After all, it would take a few weeks to deplete the dopamine, surely?I'm about to give an ssri a final shot at redeeming itself (in a low dose sam-e combo.)
> > > If I start to slide, I'm figuring wellbutrin may be the answer.******* me off though, to have to figure these things out for myself, the hard way.Anyone else had a similar ssri experience ,presenting only after some time, without dose increments to account for the reaction?? Any thoughts appreciated.
> >
> >
>
>
> Just wanted to add the comment that you might want to consider the possibility that the agitation,etc. is caused by excessive levels of serotonin rather that dopamine depletion. I can't tolerate any of the SSRIs...paxil sent me to the ER with what my pdoc called a serotonin storm...a year later I'm still not back to my pre-SSRI state. These drugs are great for alot of people, but should be used with caution in people whose primary problem is anxiety/panic. Luck to you, Worrier.
Posted by ace on May 16, 2003, at 0:32:56
In reply to Re: SSRI Dopamine depletion...., posted by worrier on May 2, 2003, at 20:11:14
For info on this see Dr. Shipko's website. He presents a cogent argument.
He thinks it's very possible we are gonna see a lot of ex-SSRI users with Parkinsons.
For my part, I stay clear of SSRIs for many reasons, including lack of efficacy and possible long-term effects as described above.
Ace.
Posted by Jack Smith on May 16, 2003, at 12:59:51
In reply to Re: SSRI Dopamine depletion...., posted by ace on May 16, 2003, at 0:32:56
> For info on this see Dr. Shipko's website. He presents a cogent argument.
>
> He thinks it's very possible we are gonna see a lot of ex-SSRI users with Parkinsons.
>
> For my part, I stay clear of SSRIs for many reasons, including lack of efficacy and possible long-term effects as described above.
>
> Ace.I am just curious why, if this is true about Parkinsons, we don't see Parkinsons in people that have been using TCA's for years. Anafrinil is just as potent a seratonin reuptake inhibitor as any ssri???? SSRI's may not work for everyone but they are safe drugs.
JACK
Posted by ace on May 19, 2003, at 3:13:19
In reply to SSRI's and Parkinsons, posted by Jack Smith on May 16, 2003, at 12:59:51
> > For info on this see Dr. Shipko's website. He presents a cogent argument.
> >
> > He thinks it's very possible we are gonna see a lot of ex-SSRI users with Parkinsons.
> >
> > For my part, I stay clear of SSRIs for many reasons, including lack of efficacy and possible long-term effects as described above.
> >
> > Ace.
>
> I am just curious why, if this is true about Parkinsons, we don't see Parkinsons in people that have been using TCA's for years. Anafrinil is just as potent a seratonin reuptake inhibitor as any ssri????Parkinsons results in dopamine depletion, not serotonin probs.
SSRI's may not work for everyone but they are safe drugs.
>
> JACK
>
>
>
Posted by Jack Smith on May 19, 2003, at 14:23:30
In reply to Re: SSRI's and Parkinsons » Jack Smith, posted by ace on May 19, 2003, at 3:13:19
> > I am just curious why, if this is true about Parkinsons, we don't see Parkinsons in people that have been using TCA's for years. Anafrinil is just as potent a seratonin reuptake inhibitor as any ssri????
>
> Parkinsons results in dopamine depletion, not serotonin probs.
>I know that but the theory is that SSRI's by their seratonin reuptake mechanism somehow depletes dopamine. I do not think that Parkinsons is going to be a long-term effect of the SSRI's. The only psychiatric drugs with proven long-term side effects are anti-psychotics (of course, I could be wrong, and also MAOI's can have the long term side effect of death if you mix them with the wrong drugs).
Ace, I think you feel as strongly as I do that drug therapy is a good thing and that there are a lot of anti-drug nuts out there crying about how these medications are so horrible. I think the criticisms of SSRI's are by the same people. SSRI's did not work well for you and they don't seem to do it for me either anymore. BUT they are great for some people, they generally have less side effects than other drugs and, I think most importantly, their wide popularity has caused drug companies to invest billions in newer better medications and revolutionary treatments for depression. Older drugs are often more powerful but I think you cannot disagree that the more drugs that are available for people like us the better.
Just my two cents,
JACK
This is the end of the thread.
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