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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 14 to 38 of 38. Go back in thread:
Posted by stjames on November 27, 2000, at 3:00:42
In reply to Re: Serzone side effects - just temporary?James, posted by R.Anne on November 26, 2000, at 23:05:16
> This is to
> James from r.anne,
> I don't think it is being wise to predict this outcome as it is very negative and it tends to blame, too. A person who is severely depressed does not need this reproach. I felt bad reading it and it wasn't for me but I relate to her as I've been through this and, for me, it did not come out as you are predicting. I needed to voice this and I hope I did not offend. r.anne
>James here....
Not predicting, just using statictics and facts. True there is always the exception
but there is no question to the chronic nature and progression of depression.j
Posted by stjames on November 27, 2000, at 3:32:22
In reply to Strong Reaction, posted by R.Anne on November 26, 2000, at 23:20:12
> I didn't mean to offend anyone as I said and I want to stress that. I know I did not start this thread but felt a strong reaction to it.
James here....
15 yrs of dperession and alot of reading have brought me to some truths. I tend to state them blunty because mental illness
is a very significant so I don't pussy foot around.
As long as you keep it in terms of "this is wnat I think" and not attack you are fine with
me.As such, I don't think there is any question that with most mental illness, if there are several relapses, the condition
is chronic. At least 50 yrs of case history supports this. I don't see this is a negetive, but a fact to be delt with.
It's treatable, with a high rate of sucess. Treating it also means it does not get worse. If going off the meds means a relapse and sucidial thoughts, why stop.
Esp. if the staticits support this. I never, ever, never, ever
want to think about killing myself again. I have had a 100% cure of this happening, for 15 yrs, on meds. This is good news, not negative.j
Posted by JohnL on November 27, 2000, at 5:07:31
In reply to Re: Serzone, any chance of an XR version?, posted by Buffalo1 on November 26, 2000, at 15:06:39
> Boy it would be nice if Serzone came in an extended release version so one wouldn't have to do the b.i.d or t.i.d. dosing. Anyone know if this is in the works?
Just an interesting tidbit. Clinical studies have been done to compare b.i.d. dosing with once-a-day dosing. There was no significant difference. Serzone can be taken just once a day if desired, despite its relatively short halflife. I've also heard anecdotal reports here at this board of people who take it just once a day and do fine.
The best time to take it might be late afternoon or early evening. This way the sedation will kick in at bedtime and not carryover so much into the next day. And XR version would be cool. But even without it Serzone can be dosed just once a day if desired.
John
Posted by shellie on November 27, 2000, at 9:10:40
In reply to Re: Serzone side effects - just temporary?, posted by stjames on November 25, 2000, at 1:42:32
> (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much
> discomfort and then restart only when I need to. My MD supports this.)
>
> James here....
>
>
> Treating only during relapse has the end result of the meds being less and less
> effective. A day may come when nothing works. Because you have been "penny wise and pound
> foolish" you now have treatment resistant depression, which may only respond to lots of meds or
> not respond at all to any med(s). Anyone who has had multiple depressions to the point of becoming suicidal
> should be on meds all the time.James, the part that I would disagree with here is that going on and off of meds is responsible for treatment resistent depression. So it seems as if you are blaming catsparkle. Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them. There are certainly a lot of examples of that on the board, including myself. You cannot predict if catsparkle never went off her medication whether she would become treatment resistent or not. Perhaps she is more likely to become treatment resistent if she goes on and off meds, you say the stats support this and I am not familiar enough with the stats to assume that you are not correct. shellie
Posted by SLS on November 27, 2000, at 18:04:57
In reply to Re: Serzone side effects - just temporary? » stjames, posted by shellie on November 27, 2000, at 9:10:40
> > > (I am committed to not being on medication continuously for the rest of my life, and would like to be able to stop without too much discomfort and then restart only when I need to. My MD supports this.)
> > James here....> > Treating only during relapse has the end result of the meds being less and less effective. A day may come when nothing works. Because you have been "penny wise and pound foolish" you now have treatment resistant depression, which may only respond to lots of meds or not respond at all to any med(s). Anyone who has had multiple depressions to the point of becoming suicidal should be on meds all the time.
> James, the part that I would disagree with here is that going on and off of meds is responsible for treatment resistent depression. So it seems as if you are blaming catsparkle. Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them. There are certainly a lot of examples of that on the board, including myself. You cannot predict if catsparkle never went off her medication whether she would become treatment resistent or not. Perhaps she is more likely to become treatment resistent if she goes on and off meds, you say the stats support this and I am not familiar enough with the stats to assume that you are not correct. shellie
I agree with both of you.The jargon used for going on and off medication rapidly is "pulsing". Pulsing antidepressants is discouraged and can indeed foster treatment resistance (obviously, not always) as well as precipitate mania in vulnerable individuals. However, I think pulsing refers more to going on and off an effective medication frequently during a single depressive episode. Treating infrequent recurrent episodes periodically does not qualify as pulsing. The problem is, treatment is often truncated at six months, frequently resulting in relapse. I'm too lazy to verify these numbers, but one of my doctors used a treatment range of 12-14 months to "solidify" things and greatly reduce the risk of relapse. If a case history displays frequent recurrent episodes (I believe DSM IV gives guidelines for the word "recurrent"), indefinite treatment is indicated.
> Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them.
Shellie, this is a fascinating notion. Well, actually, it is a notion of critical importance. I'm going to keep it in mind from now on. It is a new idea for me. Thanks. As you come across corroborative observations and information regarding this topic, please don't hesitate to post them.
Bye...
- Scott
Posted by CatSparkle on November 28, 2000, at 7:22:43
In reply to Serzone side effects - just temporary?, posted by CatSparkle on November 24, 2000, at 19:35:36
stjames said: "Because you have been "penny wise and pound foolish" you now have treatment resistant depression, which may only respond to lots of meds or not respond at all to any med(s)."
Well, I haven't commented on this, but I suppose I will now.
I wanted to clarify: I have not become "treatment-resisitant" because I went off Zoloft. I don't know whether I even warrant that label yet or not, and if I do, nothing I've done has caused it. I discontinued Zoloft (after four years of taking it continuously) because in the final year it had begun to lose effectiveness and I was having side effects which, after so many years, I felt were unacceptable (the sexual difficulties, the inability to write (or even think!) creatively, the inability to feel anything deeply (either sadness or joy). Therefore, a dose increase was not an option. So if my depression has become "resistant," so far it is only to the Zoloft. And it became "resistant" to Zoloft before I stopped, not because I stopped.
I have just begun taking the Serzone, so I can't say yet whether or not I am "resistant" to it. Currently, it is helping the anxiety and panic, just not the depression (but it has only been a week).
My doctor and I decided that I would try to go drug-free for awhile, because my husband and I were thinking about becoming pregnant. They (MD and psychologist) felt that as long as I was vigilant about return of symptoms (which I admit wasn't, and (believe me) I've learned my lesson), I might not have to take meds continuously. Once I'm better, if I want to try again, they might let me taper off. But if I get bad again (particularly if I can't last more than a year off drug), then I know that I may need to be on them for life. I admit I wasn't as good as I should have been about watching for symptoms of the depression's return. I won't make that mistake again.
Try to understand, it's difficult when a person has to make a decision about having children. I am pretty far into my childbearing years, so it's an important issue for me. I won't become pregnant with these drugs in my system. No matter what anyone says, there's no drug that can be guaranteed not to have an adverse effect on a baby. So having to be on meds forever (to me) means not having children. And that's a difficult thing for me. I would want my child to have the best start possible, and I worry as it is about passing on (genetically) a predisposition for depression and about my ability (due to a strange childhood) about my ability to even be a parent.
Well, I've rambled enough. But I did want to comment on your opinion that stopping Zoloft making me "resistant." That isn't what happened.
Anyway, I appreciate everyone's thoughtful responses to my post (even though I can't read French J).
Thanks for listening,
Cat
Posted by shellie on November 28, 2000, at 8:11:13
In reply to Re: Serzone side effects - just temporary?, posted by SLS on November 27, 2000, at 18:04:57
.
>
> > Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them.
>
> Shellie, this is a fascinating notion. Well, actually, it is a notion of critical importance. I'm going to keep it in mind from now on. It is a new idea for me. Thanks. As you come across corroborative observations and information regarding this topic, please don't hesitate to post them.
>
> Bye...
>
>
> - ScottScott, are you teasing me here? later, Shellie
Posted by Crystal on November 28, 2000, at 10:12:55
In reply to clarification (oops - also posted below), posted by CatSparkle on November 28, 2000, at 7:22:43
I just wanted to wish you luck. I have been on Serzone for a little over a week now and I am hoping for good results. I switched from Paxil for personnal reasons, like you did Serzone has only gotten better since the first couple of days for me. I couldn't work for the first 4 days on serzone because of the dizziness and concentration problems. They are much better now, it has been 10 days.
> stjames said: "Because you have been "penny wise and pound foolish" you now have treatment resistant depression, which may only respond to lots of meds or not respond at all to any med(s)."
>
> Well, I haven't commented on this, but I suppose I will now.
>
> I wanted to clarify: I have not become "treatment-resisitant" because I went off Zoloft. I don't know whether I even warrant that label yet or not, and if I do, nothing I've done has caused it. I discontinued Zoloft (after four years of taking it continuously) because in the final year it had begun to lose effectiveness and I was having side effects which, after so many years, I felt were unacceptable (the sexual difficulties, the inability to write (or even think!) creatively, the inability to feel anything deeply (either sadness or joy). Therefore, a dose increase was not an option. So if my depression has become "resistant," so far it is only to the Zoloft. And it became "resistant" to Zoloft before I stopped, not because I stopped.
>
> I have just begun taking the Serzone, so I can't say yet whether or not I am "resistant" to it. Currently, it is helping the anxiety and panic, just not the depression (but it has only been a week).
>
> My doctor and I decided that I would try to go drug-free for awhile, because my husband and I were thinking about becoming pregnant. They (MD and psychologist) felt that as long as I was vigilant about return of symptoms (which I admit wasn't, and (believe me) I've learned my lesson), I might not have to take meds continuously. Once I'm better, if I want to try again, they might let me taper off. But if I get bad again (particularly if I can't last more than a year off drug), then I know that I may need to be on them for life. I admit I wasn't as good as I should have been about watching for symptoms of the depression's return. I won't make that mistake again.
>
> Try to understand, it's difficult when a person has to make a decision about having children. I am pretty far into my childbearing years, so it's an important issue for me. I won't become pregnant with these drugs in my system. No matter what anyone says, there's no drug that can be guaranteed not to have an adverse effect on a baby. So having to be on meds forever (to me) means not having children. And that's a difficult thing for me. I would want my child to have the best start possible, and I worry as it is about passing on (genetically) a predisposition for depression and about my ability (due to a strange childhood) about my ability to even be a parent.
>
> Well, I've rambled enough. But I did want to comment on your opinion that stopping Zoloft making me "resistant." That isn't what happened.
>
> Anyway, I appreciate everyone's thoughtful responses to my post (even though I can't read French J).
>
> Thanks for listening,
> Cat
Posted by SLS on November 28, 2000, at 10:56:45
In reply to Re: Serzone side effects - just temporary? » SLS, posted by shellie on November 28, 2000, at 8:11:13
> > > Treatment resistent depression can also occur through continuous anti-depression treatment for many, with drugs becoming less effective the longer you take them.
> > Shellie, this is a fascinating notion. Well, actually, it is a notion of critical importance. I'm going to keep it in mind from now on. It is a new idea for me. Thanks. As you come across corroborative observations and information regarding this topic, please don't hesitate to post them.
> >
> > Bye...
> >
> >
> > - Scott
> Scott, are you teasing me here? later, Shellie
No, Shellie, I am not teasing you. If I were, it would be with affection and unambiguous.I was very serious about being intrigued by your idea. I was even contemplating it in the shower this morning. It might truly be counterproductive to continue taking an antidepressant beyond what may be necessary to attain a full remission along with resistance of relapse within the context of the presenting episode.
Have you seen anything written about this subject? I would want to look at it right away.
I remain very admiring of you.
- Scott
Posted by catsparkle on November 28, 2000, at 17:31:46
In reply to Re: clarification (oops - also posted below), posted by Crystal on November 28, 2000, at 10:12:55
Crystal,
Thanks for sharing that with me - it's good to know that someone else experienced what I did (that awful confusion/concentration problem was scary), and that it actually did get better.
It gives me some hope.
Thanks again,
Cat> I just wanted to wish you luck. I have been on Serzone for a little over a week now and I am hoping for good results. I switched from Paxil for personnal reasons, like you did Serzone has only gotten better since the first couple of days for me. I couldn't work for the first 4 days on serzone because of the dizziness and concentration problems. They are much better now, it has been 10 days
Posted by dove on November 29, 2000, at 11:18:23
In reply to Re: Serzone side effects - just temporary? » shellie, posted by SLS on November 28, 2000, at 10:56:45
> > Scott, are you teasing me here? later, Shellie
>
>
> No, Shellie, I am not teasing you. If I were, it would be with affection and unambiguous.
>
> I was very serious about being intrigued by your idea. I was even contemplating it in the shower this morning. It might truly be counterproductive to continue taking an antidepressant beyond what may be necessary to attain a full remission along with resistance of relapse within the context of the presenting episode.
>
> Have you seen anything written about this subject? I would want to look at it right away.
>
>
> I remain very admiring of you.
>
>
> - ScottI just want to second Scott's admiration of your intriguing statement. I will be searching abstract archives this weekend for any similar findings. Thank you Shellie!
dove
Posted by shellie on November 29, 2000, at 13:11:53
In reply to Re: Serzone side effects - just temporary?, posted by dove on November 29, 2000, at 11:18:23
Scott and Dove.
What I was talking about here was the effect of what has been called "poop-out". I was on nardil for about eight years, then it was no longer effective. After being off for several months I went back on with renewed effectiveness; then about five years later nardil lost its effectiveness again and this time a break does not reproduce it's original effectiveness. I go for a consultation with a psychopharmacolgist and he says this is quite common--the tendency for anti-depressants, to lose effectiveness over time.
I have not had a lot of time to look on the internet; it does not seem to be a very researched topic, or else I am putting in the wrong key words.
I guess I thought this was popular knowledge because of the many many people on the board who have used a specific antidepressant successfully, only to have it die on them. So maybe you guys are reading something it to my statement that I had not intended.
And I've thought of the concept of perhaps if I had not stayed on the nardil for so long originally, I could have bought myself more time later for success on it. (I think, perhaps that was what you were thinking about in the shower, Scott).
My sister had to double her dose of prozac after about six years to get the same effect--there might be some info on increasing same medication to maintain the same effect, which may be related to the idea of an antidepressant losing effectiveness. Perhaps if I was able to double nardil, that would have done the trick, but side effects eliminated that possibility. I didn't start out as treatment resistent; my life didn't take an unexpected bad turn. I've always assumed it had to do with the development of tolerance toward a medication. This has also made me a skeptic when it comes to finding the right cocktail for me--if found, how do I know how long will it remain effective for me.
Anyway, are these the ideas you are talking about, or are you extrapolating something else from what I said?
later, and later, Shellie
Posted by SLS on November 29, 2000, at 23:04:43
In reply to Re: long-term ad ineffectiveness: scott and dove, posted by shellie on November 29, 2000, at 13:11:53
Hi Shellie.
How are you?
> And I've thought of the concept of perhaps if I had not stayed on the nardil for so long originally, I could have bought myself more time later for success on it.
This is the critical question.
> (I think, perhaps that was what you were thinking about in the shower, Scott).
Among other things...
:-)
> This has also made me a skeptic when it comes to finding the right cocktail for me--if found, how do I know how long will it remain effective for me.
Tell me about it. Work twenty years to find one thing that will work for only two? Should I commit to a new career? Should I matriculate? Well, maybe only in the shower for now.
> Anyway, are these the ideas you are talking about, or are you extrapolating something else from what I said?
Both. Good work.
Smiles,
Scott
Posted by stjames on November 30, 2000, at 2:16:08
In reply to Re: long-term ad ineffectiveness: scott and dove, posted by shellie on November 29, 2000, at 13:11:53
I pooped out on TCA's in 1994-95, but Effexor saved the day.
My concept of poop out is that after several years
the body readjusts itself, compensating for the med.
The body reassurts it's desired state. Switching class
of AD helps; we are lucky to have a few classes to chose from.
The future holds AD's that work thru different pathways than we have
now. Some are in trial now. These will give more options.
Posted by R.Anne on December 1, 2000, at 19:17:45
In reply to Re: Strong Reaction, posted by stjames on November 27, 2000, at 3:32:22
> > I didn't mean to offend anyone as I said and I want to stress that. I know I did not start this thread but felt a strong reaction to it.
>
> James here....
>
> 15 yrs of dperession and alot of reading have brought me to some truths. I tend to state them blunty because mental illness
> is a very significant so I don't pussy foot around.
> As long as you keep it in terms of "this is wnat I think" and not attack you are fine with
> me.
>
> As such, I don't think there is any question that with most mental illness, if there are several relapses, the condition
> is chronic. At least 50 yrs of case history supports this. I don't see this is a negetive, but a fact to be delt with.
> It's treatable, with a high rate of sucess. Treating it also means it does not get worse. If going off the meds means a relapse and sucidial thoughts, why stop.
> Esp. if the staticits support this. I never, ever, never, ever
> want to think about killing myself again. I have had a 100% cure of this happening, for 15 yrs, on meds. This is good news, not negative.
>
> jJames:
I have a strong background in psychology for one thing, have had depression a long time, too, and know what I am talking about. You did seem to make a prediction and I have no idea what your stats are or how it qualifies you to make that sort of statement. That sort of statement can set up a person who believes what you said and I simply don't believe what you said. I am entitled to my opinion. There are many more exceptions than the rule and then it depends on what research material you are looking at. To be supportive is the goal of this board and that blunt, thoughtless statement was not supportive.r.
Posted by R.Anne on December 1, 2000, at 19:23:53
In reply to Re: Serzone side effects - just temporary?James, posted by stjames on November 27, 2000, at 3:00:42
>
> > This is to
> > James from r.anne,
> > I don't think it is being wise to predict this outcome as it is very negative and it tends to blame, too. A person who is severely depressed does not need this reproach. I felt bad reading it and it wasn't for me but I relate to her as I've been through this and, for me, it did not come out as you are predicting. I needed to voice this and I hope I did not offend. r.anne
> >
>
> James here....
>
> Not predicting, just using statictics and facts. True there is always the exception
> but there is no question to the chronic nature and progression of depression.
>
> j*************
You told her the outcome of her depression. You are not correct with whatever stats you are using. Of course depression can be chronic and I've had it on and off for 33 years +. There are questions about the progression of depression for sure. All of them have not been answered and I suggest you search for more information and then you will see that the so-called facts are only hypotheses to be tested by many and debated, too. You need to learn more, yet, as we all do-please remember that.
Posted by stjames on December 1, 2000, at 19:58:23
In reply to Re: Serzone side effects - just temporary?James, posted by R.Anne on December 1, 2000, at 19:23:53
Actually this is the post you need to read:
http://www.dr-bob.org/babble/20001115/msgs/49588.html
I'm not really happy about having my nose rubbed in it again, esp after I said I was clearly wrong.
Why bring this up again after, thankfully, it had rolled over to last month ?james
Posted by JohnB on December 2, 2000, at 1:38:13
In reply to Re: Serzone side effects - just temporary?James, posted by stjames on December 1, 2000, at 19:58:23
"The risk of recurrance is significant: 50% after one episode, 70% after two episodes, 90% after three episodes."
Stephen M. Stahl, "Essential Psychopharmacology of Depression and Bipolar Disorder", page 6.
Posted by R.Anne on December 5, 2000, at 14:57:50
In reply to Re: Serzone side effects - just temporary?James, posted by stjames on December 1, 2000, at 19:58:23
From where I was standing, you never said you were clearly wrong. Unless I missed something. Seems like you like to reproach me and the lady who started the thread, too. Practice what you preach. You are trying to rub my nose in it, aren't you? Why don't you allow me to be human?
I have my own sources that I follow and apparantly you never got the real gist of what I was saying.***
> Actually this is the post you need to read:
>
> http://www.dr-bob.org/babble/20001115/msgs/49588.html
>
> I'm not really happy about having my nose rubbed in it again, esp after I said I was clearly wrong.
> Why bring this up again after, thankfully, it had rolled over to last month ?
>
> james
Posted by stjames on December 5, 2000, at 15:10:24
In reply to Re: Serzone side effects - just temporary?James, posted by R.Anne on December 5, 2000, at 14:57:50
> From where I was standing, you never said you were clearly wrong.
James here....
Then what does this mean ?
"It is clearly not true nor was it my
intent. I'm sorry, CatSparkle."I even used the word clearly !
james
Posted by tricksaturnsc2 on March 6, 2003, at 1:10:20
In reply to Re: Serzone side effects - just temporary?, posted by stjames on November 25, 2000, at 1:42:32
Yes they do go away. I have started off with 100 mg to begin with (i've kept on coming back to serzone) & for the first 3 days I feel totally stoned & manic. But after that there's minimal depression. Tried wellbutrin, doesn't do a damn thing. Other ADs have sexual side effects. The only other thing that looks promising is remeron. Never tried that.
But stay with the serzone.
SSRI's only increase serotonin which can blunt emotion and cognitive ability. But serzone increases noradrenaline also. It is a SNRI. It has an energizing effect (initially it is both sedating but energizing).
You're not bipolar so it won't make you manic like me but intoxicating at first? Definately. Effective without being intoxicating later? Definately.
Posted by noa on March 6, 2003, at 17:31:22
In reply to Serzone is the bomb!, posted by tricksaturnsc2 on March 6, 2003, at 1:10:20
When I first started Serzone, I had some start-up effects like crying a lot, balance problems, fogginess. It went away after a few weeks.
Serzone has helped me a lot. I take it at night, becuase it is quite sedating. But I have no sedation lingering into the morning or daytime.
Posted by beardedlady on March 7, 2003, at 6:48:19
In reply to Re: Serzone is the bomb!, posted by noa on March 6, 2003, at 17:31:22
It's great. It does nothing to make me happy, but it keeps me from being falsely anxious so I can sleep.
beardy : )>
Posted by noa on March 7, 2003, at 17:31:54
In reply to ditto everything you said. » noa, posted by beardedlady on March 7, 2003, at 6:48:19
though wouldn't ya know...press release yesterday by an advocacy group (I forget which one) about those darn liver problems from Serzone. Does make me worry.
Posted by beardedlady on March 8, 2003, at 14:55:07
In reply to Re: serzone, posted by noa on March 7, 2003, at 17:31:54
My doc says it's more of a reaction than a problem that happens after years of use. He said if it's going to happen to you, it'll happen in the first months of use, not after a year, meaning it doesn't "damage" your liver; it's simply how some livers respond to this substance.
He also said it's happened to very few people. I woudn't worry about it. Just be sure to have your liver levels tested once or twice a year.
beardy : )>
This is the end of the thread.
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