![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 27 to 51 of 51. Go back in thread:
Posted by chemist on April 9, 2004, at 23:33:21
In reply to Re: ssri's effect on cognitive functioning???, posted by SpaceFairy on April 9, 2004, at 3:05:27
> > Ho do you know if you are unable to metabolize SSRIs ? Is it just SSRIs or any antidepressants ?
> > Thanks
>
> Hi!
>
> Thanks for posting such interesting questions. I had to look in to this a bit further, and I think I have got the answer (but please consult a medical expert, as this is not my area). Basically, if you lack the P450 2D6 liver enzyme this will lead to an inability to metabolise serotongeric and tricyclic antidepressants. MAOI's are implicated with the enzyme, but the only info that I can find is surrounding the long established risk of mixing them with other drugs. New methods have been developed to detect the ability through something called cytochrome P450 2D6 (CYP2D6) genotyping. That's the science bit (just in case you wanted to look the key words up through a search engine). One link is
> http://www.preskorn.com/books/ssri_s7.html?print=1
>
> Now - what it means for us! As far as I am aware, this can be done through analysis of our blood. If I'm right this could have massive implications - a simple blood test before prescribing antidepressants could predict the probability of experiencing a negative reaction. As I say, this is not really my field so I'm not 100% sure - & also, it seems so simplistic that I would imagine that it would have been in place already what with all the controversy & everything.
>
> I'll post a couple of message around the experts & see what response I get back & let you know.
>
> Take care,
>
> Space Fairy
>
chemist here...there is a bit of misinformation above: monoamine oxidase inhibitors are antagonists for the enzyme monoamine oxidase. the mechinism my which this enzyme works is by deaminating drugs with a secondary or tertiary amine, as found in phenethylamine derivatives such as parnate and nardil. monoamine oxidase is prevalent throughout our bodies, and if you are taking an MAOI, you risk hypertension/stroke due to excessive buildup of the ``unmetabolized'' parent compund, which is most pronounced for CNS agents such as Nardil and Parnate. as for metabolism of SSRIs and others: it is most common that the parent compund is not the psychoactive agent - e.g., diazepam (valium) is metabolized to nordiazepam which does the work - and SSRIs are not autoinducers of CYP450A (i generalize) and you need not worry about cognitive impairment, as this is *strongly* tied to agonism of neuronal nicotine receptors, which are implicated in alzheimer's, parkinson's, and schizophrenia. now, i have to say that most SSRIs are metabolized via the CYP 450 2D6 enzyme, although this is of import if you are taking tricyclics, which you are not. if you have liver disfunction, it is prudent to play it safe, but in general, the SSRIs of yesteryear and today are very safe....best, chemist
Posted by SpaceFairy on April 10, 2004, at 2:11:50
In reply to Re: ssri's effect on cognitive functioning???, posted by chemist on April 9, 2004, at 23:33:21
Hi Chemist,
Thanks for the reply. As I said yesterday this really isn't my field of expertise (well the nerurobiology isn't!), so I've been doing a bit of digging & managed to find out the following:
"Some drugs are metabolized by the cytochrome P450 2D6 enzymes, individuals having a deficiency of this enzyme will have a higher toxicity of drugs metabolized by them. It is not possible to generalize which drugs are metabolized by the enzyme system, since different drugs undergo different pathways of metabolism. Yes, Pharmacogenetics can be used to select individual for particular therapy, though it still is a very expensive way of deciding.You are right in assuming that the test can bve carried out using a blood sample, this could be done by studying what is known as an ex-vivo system. That is you give the drug to the whole individual and then test for metabolites in the blood."
and also:
"This type of determination is still very much at the research stage but as you are probably aware has become a prime target to explain certain drug interactions. There are so many isoenzymes in the cytochrome P450 group that it is becoming increasingly difficult to keep up-to-date with them. Different types are involved with different drugs and just because one SSRI affects one subtype it does not follow that a similar SSRI will affect the same subtype, never mind the MAOIs et al. As far as I know the technology is available do the appropriate genotyping on a blood sample but it is not yet a routine test and is unlikely to be so for several years yet."
As of for the risk of cognitive impairment, there have been short-term risks identified by many studies & case files (in individauls who are unable to metabolist these drugs), and also the PANES report (Lathe) outlines the possibility for longer term damage. As for the trycyclics, whilst I did not suffer any long-term cognitive problems with them I have been left with tardive tremor. Whilst there are a significant amount of people that find these drugs beneficial, we must also address the possibility that they can cause damage with others. After all, is that not why more & more research is looking at gli cells as being instrumental in mental health problems, with the aim of developing safer medications?
Best wishes, SpaceFairy
Posted by SpaceFairy on April 10, 2004, at 3:03:22
In reply to Re: ssri's effect on cognitive functioning???, posted by chemist on April 9, 2004, at 23:33:21
Hi Chemist,
Sorry - it just occurred to me at breakfast that the correct reference for the PANES report is indeed Green - Laithe actually reported specifically on the long-term effects of Venlafaxine.
Best wishes,
SpaceFairy
Posted by chemist on April 10, 2004, at 19:05:43
In reply to Re: ssri's effect on cognitive functioning??? » chemist, posted by SpaceFairy on April 10, 2004, at 2:11:50
spacefairy, you are right-on in re: the miasma of isoenzymes involved in metabolizing any drug. as you note - and i certainly agree - the goal is the pinpoint effective therapies and, sadly, this is currently done using the shotgun approach by most mental healthcare practitioners (``don't like prozac? try some remeron...how about paxil?'' etc.). the cognitive impairment by SSRIs or TCSa baffles me, and i am wont to attribute these effects to (very) particular genetic variations in subpopulations, as the receptors targeted by SSRIs/TCAs are not those implicated in neurodegenerative diseases (neuronal nicotine receptors, for one). in any event, all the white-papers by every manufacturer of an SSRI/TCA does in fact reflect what you correctly note in re: the hepatic pathway for metabolism. i stand corrected and wish you well...best, chemist
> Hi Chemist,
>
> Thanks for the reply. As I said yesterday this really isn't my field of expertise (well the nerurobiology isn't!), so I've been doing a bit of digging & managed to find out the following:
>
> "Some drugs are metabolized by the cytochrome P450 2D6 enzymes, individuals having a deficiency of this enzyme will have a higher toxicity of drugs metabolized by them. It is not possible to generalize which drugs are metabolized by the enzyme system, since different drugs undergo different pathways of metabolism. Yes, Pharmacogenetics can be used to select individual for particular therapy, though it still is a very expensive way of deciding.You are right in assuming that the test can bve carried out using a blood sample, this could be done by studying what is known as an ex-vivo system. That is you give the drug to the whole individual and then test for metabolites in the blood."
>
> and also:
>
> "This type of determination is still very much at the research stage but as you are probably aware has become a prime target to explain certain drug interactions. There are so many isoenzymes in the cytochrome P450 group that it is becoming increasingly difficult to keep up-to-date with them. Different types are involved with different drugs and just because one SSRI affects one subtype it does not follow that a similar SSRI will affect the same subtype, never mind the MAOIs et al. As far as I know the technology is available do the appropriate genotyping on a blood sample but it is not yet a routine test and is unlikely to be so for several years yet."
>
> As of for the risk of cognitive impairment, there have been short-term risks identified by many studies & case files (in individauls who are unable to metabolist these drugs), and also the PANES report (Lathe) outlines the possibility for longer term damage. As for the trycyclics, whilst I did not suffer any long-term cognitive problems with them I have been left with tardive tremor. Whilst there are a significant amount of people that find these drugs beneficial, we must also address the possibility that they can cause damage with others. After all, is that not why more & more research is looking at gli cells as being instrumental in mental health problems, with the aim of developing safer medications?
>
> Best wishes, SpaceFairy
>
Posted by terrics on April 11, 2004, at 11:14:26
In reply to Re: ssri's effect on cognitive functioning???, posted by SpaceFairy on April 8, 2004, at 3:47:10
Love your screen name. I looked at the link you posted and really did not find anything about cognitive function. I have alot of trouble remembering the names of things. I am on effexor xr, lithium, klonopin, wellbutrin and inderal. If you find anything else about cognitive functiong and meds I hope you will share. terrics
Posted by allie1962 on April 21, 2004, at 16:32:27
In reply to Re: ssri's effect on cognitive functioning???, posted by Mike Lynch on April 1, 2004, at 17:12:53
hi, my daughter was put on lexapro about 3 weeks ago and is currently in the process of being taken off. she cannot function on it at all, it took all the life out of her she cannot even hold a conversation. she is being treated for depression and this made her worse. is she ever going to come back to a person who has thoughts and ideas. she says she cannot even concentrate on anything. she just startes blanky into space I am so concerned that this is irreversible
Posted by bookgurl99 on April 21, 2004, at 19:20:43
In reply to Re: ssri's effect on cognitive functioning???, posted by allie1962 on April 21, 2004, at 16:32:27
Hey Allie --
It sounds like your daughter just had a strong reaction to Lexapro. But she will likely start to be better within the month. This may have been the wrong stimulus, or too much.
Those of us who complain of the long-term negative cognitive effects of meds have, for the most part, been taking these medications for a VERY long time -- years at a time, if not longer. Three weeks of use should wear off fairly quickly.
It's interesting that the SSRI's 'took all the life' out of her -- a lot of people complain about feeling zombiefied on meds. Maybe anxiety was helping her to function in some ways, by motivating her.
Anyways, I think that she will be fine from the med if she has enough time. And then should not be scared to find another method -- therapy, another medication, etc. -- to combat the depression.
Good luck,
books
Posted by Kelle on April 26, 2004, at 18:55:22
In reply to Re: ssri's effect on cognitive functioning??? » Mike Lynch, posted by francesco on April 2, 2004, at 14:00:03
I've been on Zoloft for almost 3 months now. I am experiencing what I think is pretty troubling cognitive impairment. I have a high-stress job at a PR agency and find myself unable to concentrate. My short-term memory is completely shot, I will get up to do something and completely forget what it was a second later. Or, I'll start to say something and then...pooof...it's just gone! I don't seem to be able to put together complex thoughts...or I start to but can't finish any idea to the end. My thoughts are scattered. And, sometimes thoughts just pop into my head for no apparent reason. I'll have a completely random memory just "pop in" - it's really bizarre and kind of scary. It's also embarassing - I have been talking to colleagues and clients and all of a sudden don't know what I was going to say next. I almost feel retarded sometimes. What's so bizarre is that I have always been the complete opposite - I generally have a memory like a "steel trap" and everyone I know has told me that I should have been a lawyer (not necessarily a good thing ;> ) because of my reasoning, analytical, argument skills. BUT this is all gone now!! I feel like a complete idiot. Also, early this morning, I woke up after having really bizarre nightmares and dreams and it seemed I was having some type of lingering hallucination. When I opened my eyes, I saw an image of small balls spinning. I kept blinking my eyes and after a few minutes, it did pass. But, that totally freaked me out. Something like that has NEVER EVER happened to me. I'm relating it to the Zoloft and I think I'll be calling my dr. to start getting off of this stuff.
Posted by LyndaK on April 27, 2004, at 1:32:01
In reply to Re: ssri's effect on cognitive functioning???, posted by Kelle on April 26, 2004, at 18:55:22
I haven't read all the posts before yours, but I just had to respond to yours. I took Zoloft off and on for 5 or 6 years and the cognitive side-effects were what finally made me decide that I could not stay with it. Since I went off and on (having my babies) I knew for CERTAIN that the Zoloft was causing these effects. It was much like what you describe only with time and increased dose it contintued to get worse and worse. Eventually it impaired my long-term memory as well -- couldn't remember the alarm code to my house; couldn't remember phone numbers that had been in my head 10 or more years. I felt like a stroke patient. The bad news is, if you're having these symptoms, they WON'T get better. The good news is, all of my memory came back to normal once the Zoloft was completely out of my system. Make sure you work with your doctor to taper off the Zoloft. Not only does it feel awful if you go cold-turkey, it can also throw you into a re-bound depression that's more severe (one time I went cold-turkey and became suicidal). Just my experience, but I wouldn't want you to risk experiencing the same. Do a nice SLOW taper off and you'll be fine.
Good luck.
Lynda
> I've been on Zoloft for almost 3 months now. I am experiencing what I think is pretty troubling cognitive impairment. I have a high-stress job at a PR agency and find myself unable to concentrate. My short-term memory is completely shot, I will get up to do something and completely forget what it was a second later. Or, I'll start to say something and then...pooof...it's just gone! I don't seem to be able to put together complex thoughts...or I start to but can't finish any idea to the end. My thoughts are scattered. And, sometimes thoughts just pop into my head for no apparent reason. I'll have a completely random memory just "pop in" - it's really bizarre and kind of scary. It's also embarassing - I have been talking to colleagues and clients and all of a sudden don't know what I was going to say next. I almost feel retarded sometimes. What's so bizarre is that I have always been the complete opposite - I generally have a memory like a "steel trap" and everyone I know has told me that I should have been a lawyer (not necessarily a good thing ;> ) because of my reasoning, analytical, argument skills. BUT this is all gone now!! I feel like a complete idiot. Also, early this morning, I woke up after having really bizarre nightmares and dreams and it seemed I was having some type of lingering hallucination. When I opened my eyes, I saw an image of small balls spinning. I kept blinking my eyes and after a few minutes, it did pass. But, that totally freaked me out. Something like that has NEVER EVER happened to me. I'm relating it to the Zoloft and I think I'll be calling my dr. to start getting off of this stuff.
Posted by SpaceFairy on April 27, 2004, at 2:41:56
In reply to Re: ssri's effect on cognitive functioning???, posted by Kelle on April 26, 2004, at 18:55:22
Hi there!
Sorry to hear you have been going through problems. However, it is good that you are at a level where you are able to identify a problem (unfortunately I was on such a high dose of venlafaxine for a prolonged period of time I was too confused to know what was happening). I am not trained medically, but all the symptoms that you describe are well reported adverse effects of SSRI & SNRI medications. If you truly feel that you would be better off on balance without the medication then I would strongly advise you to go to your doctor. However, even with all the information that has come to light I have found a great deal of ignorance amongst the medical profession, so I would advise looking at sites such as antidepressantsfacts.com first - this will enable you to approach your doctor with all the latest information & also has some great tips for helping you recover. I literally had to educate my doctor! The good news is that I have been medication free now for 6 months and my cognitive ability is almost back to normal (this will probably be shorter for you since you have not been on the medication for as long).
Good luck!
SpaceFairy
> I've been on Zoloft for almost 3 months now. I am experiencing what I think is pretty troubling cognitive impairment. I have a high-stress job at a PR agency and find myself unable to concentrate. My short-term memory is completely shot, I will get up to do something and completely forget what it was a second later. Or, I'll start to say something and then...pooof...it's just gone! I don't seem to be able to put together complex thoughts...or I start to but can't finish any idea to the end. My thoughts are scattered. And, sometimes thoughts just pop into my head for no apparent reason. I'll have a completely random memory just "pop in" - it's really bizarre and kind of scary. It's also embarassing - I have been talking to colleagues and clients and all of a sudden don't know what I was going to say next. I almost feel retarded sometimes. What's so bizarre is that I have always been the complete opposite - I generally have a memory like a "steel trap" and everyone I know has told me that I should have been a lawyer (not necessarily a good thing ;> ) because of my reasoning, analytical, argument skills. BUT this is all gone now!! I feel like a complete idiot. Also, early this morning, I woke up after having really bizarre nightmares and dreams and it seemed I was having some type of lingering hallucination. When I opened my eyes, I saw an image of small balls spinning. I kept blinking my eyes and after a few minutes, it did pass. But, that totally freaked me out. Something like that has NEVER EVER happened to me. I'm relating it to the Zoloft and I think I'll be calling my dr. to start getting off of this stuff.
Posted by SLS on April 27, 2004, at 10:15:07
In reply to Re: ssri's effect on cognitive functioning???, posted by SpaceFairy on April 27, 2004, at 2:41:56
I took a peak at the website you mentioned: antidepressantsfacts.com
I would not recommend it. It seems to be dedicated to demonizing psychotropic drugs. It is a matter of perspective. With an obviously biased agenda, someone over there seems to have made it his life's work to remove a set of valuable medical tools and selfishly deny millions of people a modern miracle. Someone is on a mission to convince people that antidepressants are universally destructive and, perhaps, a product of some sort of covert collusion. That's silly. :-)
Most of what this website contains is factually true. It makes for a pursuasive argument that antidepressants possess undesirable attributes. Of course they do. This is not such a unique circumstance. To read the PDR is to voyage through the plethora of adverse and sometimes fatal side effects that so many of these valuable drugs produce. Without the benefit of numbers and statistics, however; that is to say, without the benefit of a perspective that is provided only by knowing ALL of the facts, one cannot evaluate properly the risks versus the benefits of these treatments. Yes, there is such a thing as a magic pill, and, fortunately, they already exist. It is the life's work of thousands of men and women around the world to develop even more magic pills that are more effective, safer, and have fewer side effects.
- Scott
Posted by SpaceFairy on April 27, 2004, at 11:36:38
In reply to Re: ssri's effect on cognitive functioning???, posted by SLS on April 27, 2004, at 10:15:07
Dear Scott,
I fully appreciate your comments, as these types of psychopharmaceuticals have been found by many to be beneficial - which is great. However, one must not ignore basic scientific findings such as that 10% of caucasion people are unable to metabolise them leading to excess levels of 5-HT and dangerous side effects (APA). It is also now generally agreed that the SSRI's & SNRI's may be targeting the wrong function (one of the main arguements for this is the recognition that they do have such adverse side effects) & research has now turned to alternate neurological function in the hope of developing a more efficicous and safe class of antidepressants. There is much scientific data that supports all that is said. Also, 87% of the total amount of studies carried out in to the efficacy of these drugs is in some way funded by or linked to the pharmaceutical companies (APA) - who are not in it for the love of humankind I assure you.
Also, on a more personal note I am sure that individuals who have experienced a negative reaction to these drugs would in no way perceive them as wonder drugs - just because they work for some people does not mean we should ignore the hell they put others through. For me the site antidepressantsfacts.com was an absolute relief - by the time that I had it pointed out to me I was literally at the end of my teather - having life threatening seizures etc. It contains valuable information on how to taper off successfully and how to survive a negative reaction - resources that have been invaluable in my recovery. The site also lists highly reliable empirical findings and case studies from leading experts such as Breggin & Healey. If you can discredit these experts & their research findings, or discount the experiences of millions of people who have been affected by these drugs then we may as well go back almost half a century to the time that Valium was marketed as being 'Mother's Little Helper'.
SpaceFairy
Posted by SLS on April 27, 2004, at 12:25:31
In reply to Re: ssri's effect on cognitive functioning???, posted by SpaceFairy on April 27, 2004, at 11:36:38
> The site also lists highly reliable empirical findings and case studies from leading experts such as Breggin & Healey. If you can discredit these experts & their research findings...
I think I'll leave that to someone else.
- Scott
Posted by SpaceFairy on April 27, 2004, at 15:09:36
In reply to Re: ssri's effect on cognitive functioning???, posted by SLS on April 27, 2004, at 12:25:31
I rest my case
Posted by SLS on April 27, 2004, at 16:11:17
In reply to Re: ssri's effect on cognitive functioning???, posted by SLS on April 27, 2004, at 10:15:07
Hi All.
> To read the PDR is to voyage through the plethora of adverse and sometimes fatal side effects that so many of these valuable drugs produce.
My wording here is inprecise and too easily misunderstood.
Edit:
"To read the PDR is to voyage through a plethora of adverse and sometimes fatal side effects that so many of our valuable drugs can sometimes produce."
Thanks.
- Scott
Posted by bobbiedobbs on May 2, 2004, at 23:47:37
In reply to Re: ssri's effect on cognitive functioning???, posted by zefdie on April 1, 2004, at 13:26:37
To Zeftie, particularly, but also to some of the other posters - The articulateness that you've "lost" isn't evident from your post, which was quite articulate and compelling - I can relate because I am a writer myself and am struggling with balancing relief from social anxiety brought on by SSRIs with mental numbness and can't find-the-word syndrome.
That's the encouragement.
My question: for folks who've tried various anti-anxiety meds, is there one that stands out as helping anxiety yet not causing dehabiligating fatigue and loss of sexual prowess (sorry, but that's not only imprecise but kind of obnoxious).
Tried: Luvox, Proxzac, Lexapro - all caused sleepies (less so Lex; Nardil (the bomb) but problem with sides; Parnate (tolerable but eh)
Considering: Effexor (different chemical profile), Zoloft (probably no as I don't dig stupor) and Marplan (another MAOI).Suggestions?
> This problem is driving me crazy. I had it before I went on Wellbutrin and it has only worsened since then. Reading up about Wellbutrin scared me--there seemed to be a high incidence, at least of people on boards such as this, of people losing their language capacity while on buproprion. I've gone off Wellbutrin and am now only on Effexor. I don't feel much of a change in my vocabulary capacity and general slowness yet--Effexor has a history of the same effect, as do all SSRIs/SSNRIs. Everyone's different; I'm just hoping that Effexor, when it really kicks in (I've just started it) helps a little.
>
> I am a writer and this problem is especially troubling to me. It takes FOREVER for me to get the simplest ideas on paper. Complexity escapes me.
>
> What I'm interested in is this: is it possible to mitigate all this in some way by doing logic puzzles, vobaulary building exercises, any kind of "cognitive training"? I'll try anything. If there are supplements or foods I should be eating daily, I want to get on top of that because this is debilitating enough to wreck my career.
>
> I don't really have any advice except to share that these are the solutions I'm looking into. Each SSRI effects each individual differently--you're lucky that Paxil had that effect! Many people have the opposite. I remember when I was put on Zoloft in high school how much brighter and more articulate and more "myself" I felt. I'm hoping Effexor will have the same effect. Sadly, it's hard to tell whether that cognitive slump is the depression or something else--my molasses brain may just stem from bad circumstances, crappy friends, self doubt and an unchallenged mind.
>
> Good luck!
Posted by chemist on May 3, 2004, at 0:20:42
In reply to Re: ssri's effect on cognitive functioning???, posted by bobbiedobbs on May 2, 2004, at 23:47:37
> To Zeftie, particularly, but also to some of the other posters - The articulateness that you've "lost" isn't evident from your post, which was quite articulate and compelling - I can relate because I am a writer myself and am struggling with balancing relief from social anxiety brought on by SSRIs with mental numbness and can't find-the-word syndrome.
> That's the encouragement.
> My question: for folks who've tried various anti-anxiety meds, is there one that stands out as helping anxiety yet not causing dehabiligating fatigue and loss of sexual prowess (sorry, but that's not only imprecise but kind of obnoxious).
> Tried: Luvox, Proxzac, Lexapro - all caused sleepies (less so Lex; Nardil (the bomb) but problem with sides; Parnate (tolerable but eh)
> Considering: Effexor (different chemical profile), Zoloft (probably no as I don't dig stupor) and Marplan (another MAOI).
>
> Suggestions?
>
>
>
> > This problem is driving me crazy. I had it before I went on Wellbutrin and it has only worsened since then. Reading up about Wellbutrin scared me--there seemed to be a high incidence, at least of people on boards such as this, of people losing their language capacity while on buproprion. I've gone off Wellbutrin and am now only on Effexor. I don't feel much of a change in my vocabulary capacity and general slowness yet--Effexor has a history of the same effect, as do all SSRIs/SSNRIs. Everyone's different; I'm just hoping that Effexor, when it really kicks in (I've just started it) helps a little.
> >
> > I am a writer and this problem is especially troubling to me. It takes FOREVER for me to get the simplest ideas on paper. Complexity escapes me.
> >
> > What I'm interested in is this: is it possible to mitigate all this in some way by doing logic puzzles, vobaulary building exercises, any kind of "cognitive training"? I'll try anything. If there are supplements or foods I should be eating daily, I want to get on top of that because this is debilitating enough to wreck my career.
> >
> > I don't really have any advice except to share that these are the solutions I'm looking into. Each SSRI effects each individual differently--you're lucky that Paxil had that effect! Many people have the opposite. I remember when I was put on Zoloft in high school how much brighter and more articulate and more "myself" I felt. I'm hoping Effexor will have the same effect. Sadly, it's hard to tell whether that cognitive slump is the depression or something else--my molasses brain may just stem from bad circumstances, crappy friends, self doubt and an unchallenged mind.
> >
> > Good luck!
>
>
hi all, chemist here...cannot comment on SSRI but to a limited extent, but i can suggest an augmentation to your therapy to cope with cognitive impairment: nootropics, such as milnacipran, or aricept (donepezil), and many others......a cholinesterase inhibitor might well do the trick (or acetylcholinesterase inhibitor)...all the best, chemist
Posted by SpaceFairy on May 3, 2004, at 2:19:59
In reply to Re: ssri's effect on cognitive functioning???, posted by bobbiedobbs on May 2, 2004, at 23:47:37
Hi there!
In my experience individuals react to medications in different ways & the tolerance level of the adverse side effect profile is dependent upon a number of different factors including severity, impairment in typical functioning, etc. The first thing that I would say is to seriously consider the comaprison of your ability to cope without the medication versus your ability to cope/function with it. In my case I was unfortunate in that it induced seizures & thus the decision was forced upon me to cease treatment (after all they were life threatening). However, for many people the medication provides relief for their condition and thus they decide to tolerate the adverse effects that they experience.
The second thing that you need to do is discuss your concerns with a medically qualified professional who (a) knows your history, and (b) has a good knowledge of the adverse effects of the medications (I found this to be a sticking point as it was my case that educated my doctors about the adverse effects - they had previously believed to highly biased results of clinical trials carried out by the pharmaceutical companies). Researching on the net for other peoples experiences and opinions enables you to gain a more balanced picture - but at the end of the day you really need advice from a professional who knows you, as everyone is unique.
I can tell you how I now manage my sypmtoms (which arise from PTSD with a transitory SA component). I generally stay away from benzodiazapines due to their addicitve potential - however, if my condition has seriously deteriroated & the anxiety is causing significant problems I will use them on a very limited basis. On a more regular basis I use beta-blockers. They do not alleviate any of the maladaptive thoughts, but significantly reduce the physical symptoms associated with anxiety. To help with the negative thought processes I use self-help materials (I'm currently working on Dr. Richards CBT course). Such materials aren't instant fixes & require determination & perseverance - but they have been demonstrated empirically to be at least as efficious as medications in the short term, and have a lower rate of subsequent relapse. I also use diet and exercise to help stabalise my symptoms - no caffiene/alcohol - plenty of fish - avoid/decrease nicotine intake - drink plenty of water - undertake either gentle/aerobic exercise (depending upon capablities and current state). I must point out that this is what works for me & you may well be different. However, I have found that looking at things in terms of the long-term rather than the short-term I have shifted my focus of priorities & the beneficial effects have not only been noticed by me, but by just about everyone with whom I come in to contact.
Good Luck with it all,
SpaceFairy
Posted by bobbiedobbs on May 3, 2004, at 15:07:53
In reply to Re: ssri's effect on cognitive functioning??? » bobbiedobbs, posted by SpaceFairy on May 3, 2004, at 2:19:59
Spacefairy: Thanks for taking the time for a most thoughtful response with more the whole person/gestalt than I normally consider. Pretty articulate for a space fairy. Phil
> Hi there!
>
> In my experience individuals react to medications in different ways & the tolerance level of the adverse side effect profile is dependent upon a number of different factors including severity, impairment in typical functioning, etc. The first thing that I would say is to seriously consider the comaprison of your ability to cope without the medication versus your ability to cope/function with it. In my case I was unfortunate in that it induced seizures & thus the decision was forced upon me to cease treatment (after all they were life threatening). However, for many people the medication provides relief for their condition and thus they decide to tolerate the adverse effects that they experience.
>
> The second thing that you need to do is discuss your concerns with a medically qualified professional who (a) knows your history, and (b) has a good knowledge of the adverse effects of the medications (I found this to be a sticking point as it was my case that educated my doctors about the adverse effects - they had previously believed to highly biased results of clinical trials carried out by the pharmaceutical companies). Researching on the net for other peoples experiences and opinions enables you to gain a more balanced picture - but at the end of the day you really need advice from a professional who knows you, as everyone is unique.
>
> I can tell you how I now manage my sypmtoms (which arise from PTSD with a transitory SA component). I generally stay away from benzodiazapines due to their addicitve potential - however, if my condition has seriously deteriroated & the anxiety is causing significant problems I will use them on a very limited basis. On a more regular basis I use beta-blockers. They do not alleviate any of the maladaptive thoughts, but significantly reduce the physical symptoms associated with anxiety. To help with the negative thought processes I use self-help materials (I'm currently working on Dr. Richards CBT course). Such materials aren't instant fixes & require determination & perseverance - but they have been demonstrated empirically to be at least as efficious as medications in the short term, and have a lower rate of subsequent relapse. I also use diet and exercise to help stabalise my symptoms - no caffiene/alcohol - plenty of fish - avoid/decrease nicotine intake - drink plenty of water - undertake either gentle/aerobic exercise (depending upon capablities and current state). I must point out that this is what works for me & you may well be different. However, I have found that looking at things in terms of the long-term rather than the short-term I have shifted my focus of priorities & the beneficial effects have not only been noticed by me, but by just about everyone with whom I come in to contact.
>
> Good Luck with it all,
>
> SpaceFairy
Posted by SpaceFairy on May 4, 2004, at 4:29:27
In reply to Re: ssri's effect on cognitive functioning??? » SpaceFairy, posted by bobbiedobbs on May 3, 2004, at 15:07:53
Hi Phil!
Thanks for the message - it made me smile when I got up & read it this morning.
Just to let you know that I'm getting further in to the Dr. Richards CBT course that's specifically designed for SA & I'm finding it extremely useful - probably the most useful thing I've come across either professionally or personally - well worth a try in my opinion. Can I ask you where you are based & I may be able to offer some more appropriate info?
Take care,
Space Fairy :-)
Posted by bobbiedobbs on May 4, 2004, at 11:59:27
In reply to Re: ssri's effect on cognitive functioning??? » bobbiedobbs, posted by SpaceFairy on May 4, 2004, at 4:29:27
I'm located in Philadelphia, one of the anxiety treatment epicenters; small comfort. Is Dr. Richard's course the one from the social anxiety web site? - I remember looking at that sometime ago- I actually am in cognitive behavioral therapy to try to redirect some of the deep-seating negative spin I put on everything (although I can be quite charitable toward others). It's just so frustrating because I have been so self-absorbed for so many years that I seem to lack the cultural references and social cues that most acquire in day-to-day living. I'm not going to kick myself for not watching Survivor (I don't even get cable!) but I do feel like the Brother from Another Planet when it comes to knowing what folks are talking about.
Bicycling to Flin Flon, Manitoba right know seems like a wonderful opiate...
Sorry I've rambled. That's a glimpse of where I'm at in relation to this. Best wishes, Phil.> Hi Phil!
>
> Thanks for the message - it made me smile when I got up & read it this morning.
>
> Just to let you know that I'm getting further in to the Dr. Richards CBT course that's specifically designed for SA & I'm finding it extremely useful - probably the most useful thing I've come across either professionally or personally - well worth a try in my opinion. Can I ask you where you are based & I may be able to offer some more appropriate info?
>
> Take care,
>
> Space Fairy :-)
Posted by cateb on May 5, 2004, at 4:03:19
In reply to Re: ssri's effect on cognitive functioning???, posted by bobbiedobbs on May 2, 2004, at 23:47:37
Hey, Serzone is the one with the great sex and the strong anti- anxiety profile. Works for me with Lamictal.
Cateb
Posted by SpaceFairy on May 5, 2004, at 6:25:15
In reply to Re: ssri's effect on cognitive functioning??? » bobbiedobbs, posted by cateb on May 5, 2004, at 4:03:19
Hi!
Glad to hear that the meds are working for you. It's true that Serzone has not been reported to have the problems that other ad's have had regarding sex drive. However, did you know that it is being withdrawn by the manufacturers in Australia this month as it has been linked to fatal liver disease - leaving many people being forced to switch to an alternative? Similar problems have been reported in Canada & Europe. It may be worth investigating this with a fully trained medical professional - perhaps suggesting that you have frequent liver function tests to monitor your progress.
Take good care,
SpaceFairy
Posted by cateb on May 5, 2004, at 20:15:58
In reply to Re: ssri's effect on cognitive functioning??? » cateb, posted by SpaceFairy on May 5, 2004, at 6:25:15
Spacefairy, yes, I've been monitoring the liver thing since the black box warning. What's gone on in Australia? I see a pdoc regularly (how I get my meds, of course) and she said that they were keeping Serzone on the market in the US because there have not continued to be liver issues.
For me, Serzone is the only thing that's worked; I've been treatment resistant and had idiosyncratic reactions to many meds. Serzone and Lamictal. I try to take care of my liver in other ways e.g. no tylenol or booze.
Thanks, Cateb
Posted by mike lynch on June 20, 2004, at 0:15:52
In reply to Re: ssri's effect on cognitive functioning???, posted by cateb on May 5, 2004, at 20:15:58
I thought i'd bring this thread back, just so I can get an update as to how everyone is doing.
Have any of your cognitive deficts improved?? Or do you still feel as if no progress has been made? Have you found a med, that has helped alleviate any of your symptoms?
The main problem I am having is not so much with cognition (well I think it translates into a cognition problem and is probbly related)but I seem to have lossed my personality , I feel emotionless , I feel like I am no longer myself (I am not on any meds) me and my friends use to have great times together, I find my self constantly reminiscing about them. This makes me more depressed, because it seems as though all the good times are behind me, this med has seemingly taken away my identity and what makes me unique.I feel like a robot, I mine as well be a robot, I don't care about anything , I have no emotions.
I am having trouble reading stuff now, my eye tracking is screwed up, as I am typing this now I am sure I have left out many words in sentences (something i've been doing ever since the paxil) my memory is still shot, I don't seem to enjoy anything anymore.
Is this depression?? Yes. What caused the depression?? The meds completely scrambling my brain. Their were weeks where I felt fine, just trying to get back to my normal flow(after the meds). It never happened, and it seems as though I will be in this ditch forever.
My mom insists its depression and not the meds I WOULD LOVE TO BELIEVE THAT. It's really hard to believe that, my depression has some how altered in this state, when it has NEVER been like this before the meds. It's hard to believe, that even when I feel perfectly fine I still have extreme cognitive problems. It's hard to believe when I find a med that works, I still have problems. It's hard to believe the dozens of ancedotes I acquired online, all happen to be people who are on Paxil.
I am going on prozac now as a last ditch attempt. I just want to be normal again, before the meds...I had some great times, I just want to relive.
This is the end of the thread.
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