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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by automatedlady on June 3, 2002, at 19:40:11
I've been on Effexor, Prozac and Celexa (although I'm now told Effexor isn't an SSRI- I have a stupid doctor..) On each I had the same reaction - a few weeks of feeling more awake and able to socialise and get things done, followed by a crash into a total lack of feelings or interest in anything. After a few months of this I'm in a worse state than i am off ADs. It's been suggested that a tricyclic called desipramine might be more effective for me. Does anyone else have these problems with SSRIs and what works?
AL
Posted by bookgurl99 on June 3, 2002, at 20:02:51
In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11
Hey, I've experienced the same problem on 50 mgs of Zoloft after moving up from 25 mgs. Because I'm experiencing symptom relief at 25 mgs, my pdoc's nurse told me to bump down to 25 mgs until I see him again.
Some of us respond to low doses quite well; you could see if that would work.
Also, I took Serzone for two years. It's an SNRI antidepressant (like Effexor), but didn't cause these feelings of apathy. (I'd still be on it, but developed an allergic reaction to it.)
I'm also trying out a sample pack of Viagra for the sexual side effects. .. I'll post after my little experiment with it tonight. (heh heh)
bookgurl99
Posted by XaosSurfer on June 3, 2002, at 22:08:30
In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11
Al,
Yes. I had terrible problems with apathy when I was taking 60mg of Celexa. My pdoc and I decided to switch to Effexor XR. As I lowered my dose of Celexa the apathy lifted. At 30 mg it became much less a problem. It is still around by more managable. I will eventually do the switch to Effexor but not until the depression has been lifted for 6 months at least.
I also take dexedrine for ADD. This helps with motivation and tiredness. At 60 mg of Celexa I would sleep through every possible dose of dexedrine. Wierd.
BRW, my wife says the apathy was just a bad a the depression. It is nasty.
Paul
Posted by JohnX2 on June 4, 2002, at 1:13:51
In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11
> I've been on Effexor, Prozac and Celexa (although I'm now told Effexor isn't an SSRI- I have a stupid doctor..) On each I had the same reaction - a few weeks of feeling more awake and able to socialise and get things done, followed by a crash into a total lack of feelings or interest in anything. After a few months of this I'm in a worse state than i am off ADs. It's been suggested that a tricyclic called desipramine might be more effective for me. Does anyone else have these problems with SSRIs and what works?
>
> ALThis problem is not likely to occur
on Remeron and Wellbutrin. (of the standard ADs).Serzone may be a good choice to, but it can be
a bit sedating.If fact, Wellbutrin may make you much more
motivated. It has no sexual side effects either.
Its not a great AD for people who are very anxious
however.Desipramine of the tricyclics may be a helpful
medicine too. It doesn't work on serotonin like
those other SSRIs, and it does help with anxiety
and depression and probably motivation.Good Luck,
John
Posted by turalizz on June 4, 2002, at 5:29:54
In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11
It's been suggested that a tricyclic called desipramine might be more effective for me. Does anyone else have these problems with SSRIs and what works?
>
> ALYes, noradrenergic AD's may be the solution to apathy. Try something like desipramine, reboxetine, wellbutrin or remeron.
cem
Posted by 3 Beer Effect on June 4, 2002, at 14:15:26
In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11
People get an Apathetic effect to SSRIs in the long term because Serotonin & Dopamine act basically like a "see-saw" to keep each other in balance. When Serotonin is raised for a couple of months, eventually Dopamine is either (downregulated?) or depleted. If this see-saw affect did not happen, then the person would have too much serotonin and dopamine & would probably have a manic switch/episode.
The only SSRI that has some Dopamine reuputake inhibition is Zoloft, & while this degree of dopamine potentiation is not that high, it is much higher than the other SSRIs & even higher than Wellbutrin SR (but the "hydroxybuproprion" metabolite of Wellbutrin SR is the "real drug" of Wellbutrin SR & is probably much more powerful than Zoloft and inhibiting the reuputake of Dopamine). So if you must take an SSRI Zoloft would be the least likely of the SSRIs to induce apathy, but if it did, it would take longer than the other SSRIs to do so. (As posted before, the starting dose of Zoloft 50 mg/day is generally ineffective- 75 or 100 mg are more effective & roughly comparable to the starting dose of Prozac (20 mg=80 mg of Zoloft).
I believe that norepinephrine is not affected by this serotonin/dopamine see-saw effect.
The two best anti-depressants that would prevent this effect would be Wellbutrin SR & Desipramine.
The metabolite of Wellbutrin SR, hydroxybuproprion is basically a powerful Norepinephrine/Dopamine reuputake inhibitor with little effect on Serotonin, which would eliminate both depression & apathy but can in some cases cause anxiety.
Desipramine is the most potent Tricyclic in potentiating norepinephrine, & also according to the charts has the least amount of tricyclic/anticholinergic side effects. Compared to Dexedrine which had a potency on norepinephrine of 2, Desipramine had a potency of 110, more than even Vivactil/Protriptyline (100)! Norepinephrine is associated with ambition, drive, getting things done etc.
I've never tried Desipramine, but atleast on paper it looks like a great medicine- It has less affinity for the antimuscarinic/anti-cholinergic receptor than Paxil! It also has the lowest incidence of anti-histamine & other traditional tricyclic negative side effects of all the tricyclics, BUT it does have a higher affinity/more side effects on all these measures than Wellbutrin SR or any of the SSRIs. So it probably will have more side effects than Wellbutrin SR. One suggestion i've heard is to buy the brand name Norpramin if you can afford it because it supposedly is less toxic (be sure your doctor writes Norpramin & not Desipramine or the pharmacy won't give you the brand name).3 Beers......
Posted by Anyuser on June 4, 2002, at 19:51:14
In reply to Serotonin Dopamine are a see-saw » automatedlady, posted by 3 Beer Effect on June 4, 2002, at 14:15:26
Does augmentation of a therapeutic dose of SSRI with a small dose of Wellbutrin solve the problem? Does anybody ever augment a therapeutic dose of Wellbutrin with a small dose of SSRI?
Posted by fachad on June 5, 2002, at 10:07:44
In reply to Apathy on SSRIs, posted by automatedlady on June 3, 2002, at 19:40:11
There has been a lot of info on the SSRI induced apathy problem here on this board as well as other places.
I'll put in a few links to posts I have done on this topic, and some to other sources of info.
Ritalin for SSRI Induced Apathy
http://www.dr-bob.org/babble/20020307/msgs/97130.html
Here is a link to an article in The Journal of Clinical Psychiatry on Antidepressant Apathy Syndrome
http://www.dr-bob.org/babble/20020425/msgs/104624.html
Just search this board using the keywords "apathy" and "SSRI". For better results, use the advanced options so you can pick all years and only hits with both words.
> I've been on Effexor, Prozac and Celexa (although I'm now told Effexor isn't an SSRI- I have a stupid doctor..) On each I had the same reaction - a few weeks of feeling more awake and able to socialise and get things done, followed by a crash into a total lack of feelings or interest in anything. After a few months of this I'm in a worse state than i am off ADs. It's been suggested that a tricyclic called desipramine might be more effective for me. Does anyone else have these problems with SSRIs and what works?
>
> AL
Posted by automatedlady on June 7, 2002, at 15:05:39
In reply to Re: Apathy on SSRIs - Lots of Info on this problem » automatedlady, posted by fachad on June 5, 2002, at 10:07:44
Posted by automatedlady on June 7, 2002, at 15:16:41
In reply to Re: Apathy on SSRIs - Lots of Info on this problem » automatedlady, posted by fachad on June 5, 2002, at 10:07:44
Does anyone know? I think it might be prescribed to help quit smoking, but I'm not sure they give it out as an ordinary AD (and for smoking cessation I think it's only supposed to be a short term thing).
I think this has to be my next step. Will go to my doctor next week and hope I don't get treated like a hypchondriac/druggy/fool (often happens when I suggest treatments...)
Posted by Sleepy Lizard on June 7, 2002, at 21:02:20
In reply to Is bupropion available as an AD in the UK?, posted by automatedlady on June 7, 2002, at 15:16:41
You can get Zyban in the UK but not Wellbutrin SR. They are the same drug. Zyban is marketed for cessation of smoking. Wellbutrin SR as an anti-depressant in the US. In the U.K. bupropion is usually prescribed initially at 150 mg three times a day, followed by a reduction to 150 mg twice a day. I have read that it is also prescribed for low female libido, neurogenic pain, and weight loss.
Good Luck
Posted by NikkiT2 on June 8, 2002, at 8:00:41
In reply to Re: Is bupropion available as an AD in the UK? » automatedlady, posted by Sleepy Lizard on June 7, 2002, at 21:02:20
I'vre desperately been trying to get prescribed this, but my psychiatrist, my GP, and consultant all say it will only be prescribed for smoking cessation - I've even tried offering to give up smoking but that track didn't work.
It seems awfully stupid that they can presc\ribe it for giving up smoking, but not as an AD... *sighs*
Nikki x
Posted by automatedlady on June 8, 2002, at 16:48:32
In reply to Re: Is bupropion available as an AD in the UK?, posted by NikkiT2 on June 8, 2002, at 8:00:41
I'd been anticipating that might happen, so I was thinking I might just go to my GP and say I'm desperate to give up smoking... but when they prescribe it for smoking, do they expect you to take it long term or is it just a matter of weeks?
Btw, was the doc NHS? i was also thinking of going private. I NEED AN AD THAT WORKS!
AL x
Posted by NikkiT2 on June 9, 2002, at 13:16:17
In reply to Re: Is bupropion available as an AD in the UK?, posted by NikkiT2 on June 8, 2002, at 8:00:41
I think they'll only prescribe for like, 6 weeks.. thats what the only person I know who used it for giving up smoking.
I do know someone here who manages to get Zyban for depression from a private pdoc... Its an option i wish was on me, but after being out of work for a year I am severely hard up!!!
Let me know how you get on...
nikki
Posted by omega man on June 9, 2002, at 14:47:38
In reply to Re: Is bupropion available as an AD in the UK?, posted by NikkiT2 on June 8, 2002, at 8:00:41
Clozaril just got made availible for Schizophrenia in the UK..even though everybody knew it was needed for years...
our health system just waits and waits and waits..and until people die and cause problems..it just keeps....
waiting.
Posted by Denise528 on November 13, 2002, at 8:03:05
In reply to Re: Is bupropion available as an AD in the UK?, posted by NikkiT2 on June 8, 2002, at 8:00:41
Hi,
Anybody out there who has had agitation on SSRIs but gone on to find relief with Wellbutrin. All of the SSRIs so far have increased my agitation/anxiety so was wondering if anyone of the same ilk had found relief with Wellbutrin. I've heard that Wellbutrin can increase agitation so am a bit leery about taking it.
Denise
Posted by homewood on November 14, 2002, at 12:30:36
In reply to Re: Wellbutrin vs SSRIs, posted by Denise528 on November 13, 2002, at 8:03:05
I've been on Wellbutrin SR (150mg 2x) for 2 months now and it has helped tremendously with the agitiation/anxiety symptoms of vitamin Z.
Posted by Denise528 on November 15, 2002, at 11:52:19
In reply to Re: Wellbutrin vs SSRIs, posted by homewood on November 14, 2002, at 12:30:36
Had you tried the SSRIs first, if so, how did they affect you?
Denise
Posted by homewood on November 15, 2002, at 12:44:52
In reply to Re: Wellbutrin vs SSRIs, posted by Denise528 on November 15, 2002, at 11:52:19
I started on Zoloft first....
This is the end of the thread.
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