![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 22 to 46 of 49. Go back in thread:
Posted by Phillipa on November 12, 2007, at 18:19:19
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 11, 2007, at 21:30:27
No not bipolar MDD with anxiety. That's my official diagnosis thanks for the response. Phillipa
Posted by circusboy on November 13, 2007, at 15:15:02
In reply to Re: p.s. about MAOIs » linkadge, posted by War-Face on November 6, 2007, at 15:56:38
> I found Prozac, on the other hand, to be extremely motivating (probably from NE boosting properties), although after prolonged use, it did leave me feeling dumb and forgetful and tired, in a way similar to the well-articulated cycle of SSRI use above.
>Wanted to chime in and say I've had very similar experiences with Prozac. Pretty good in the short term, then the not-insignificant cognitive deficits start to move in. Also, the Prozac-induced anxiety (5-HT2C agonism? I can't remember which receptor subtype) starts to overwhelm the positive effects as well, and I become a nervous idiot in social situations.
I was prescribed methylphenidate to help with the concentration issues, but it took a very high dose (40 - 60 mg/day) which left me in irritable withdrawal every night. Once the Prozac was out of my system, I could have a very productive day on only 10 mg methylphenidate.
As a sort of aside... I know most of us believe this here, but it's worth repeating: the secondary affinities of "selective" drugs like the SSRIs are highly significant. Prozac at the NE transporter, Zoloft at the DA transporter, (Strattera at the kappa opiate receptor...not a SSRI, but still), Lexapro doing...something sleepy... all of these things are /supposed/ to be clinically insignificant, but those of us who have tried these drugs know they're not.
Posted by circusboy on November 13, 2007, at 15:34:42
In reply to you have a point, but I think it's not so bad. » Questionmark, posted by rgb on November 6, 2007, at 12:25:44
> I've been on sertraline for half a year and it's still working fine. Though I agree that the beginning was the best (I had some really nice feelings starting on day 3, but as you say, not the stimulant-kind euphoria, actually it slightly reminded me of 5-HT2A agonists :) A major advantage over dopamine euphoria is that there is zero desire to redose.).
>
> Maybe the apathy will slowly creep up on me, but for now I will stick with the sertraline and see how it affects me /personally/.
>After swearing off SSRIs forever for the reasons above, I've started another trial of Zoloft. It was the very first antidepressant I tried (10 years ago now), and, nostalgia aside, I think it was the most effective.
Two concerns: I was very depressed then, and didn't respond until we'd gone up to 200 mg and added Li. My depression is closer to dysthimia now (with the fun recent addition of obsessive thoughts), so hopefully this time I can stay at a low dose and avoid the lithium. Also, the sexual side effects were terrible. Again, I'm hoping I can cope with them at a low dose (25 - 50 mg).
Way back then when my pdoc switched me from Zoloft to Prozac (after a brief and ill-advised stop in Serzone land), my mood was dimmer and flatter. Prozac was better than Serzone and the sexual side effects were minimal, so I kept coming back to it when depression would descend on me again and the other drugs proved unsatisfactory. I still thought of Zoloft as the best... but those sexual side effects!
I -- like you -- am hoping that Zoloft's affinity for the DA transporter will at least partially counter the DA dampening effect of long-term SSRI use. If I have to take Ritalin too, so be it.
But I think -- and again, hope -- that sertraline may be the only drug in the class that can prevent or stave off SSRI apathy. We'll see.
-cb
Posted by Bob on November 13, 2007, at 15:45:34
In reply to Re: Prozac in particular » War-Face, posted by circusboy on November 13, 2007, at 15:15:02
"...all of these things are /supposed/ to be clinically insignificant, but those of us who have tried these drugs know they're not."
God knows, if I made a list of all the things that are supposed to be insignificant but often turn out to be show-stoppers for people on these drugs, I may never finish.
Posted by Questionmark on November 15, 2007, at 3:13:39
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Questionmark, posted by Phillipa on November 12, 2007, at 18:19:19
Oh, sorry. Then in that case the answer to your question "Why am I the only person they seem to do the opposite to rev me up and then horrible side effects?" is, in my thinking (and in the simplest of terms, of course), because your "serotonin system" (so to speak) is probably not very under-active, or at least maybe that certain of your serotonin receptors (specifically 5-HT2A[?]) are getting activated on a relatively normal to excessive level. Then with the SSRI it just resulted in too much 5-HT (esp.ly 5-HT2A?, for ex.) receptor activation and, hence, anxiety.
Or your dr. just put you on too high a dose of the SSRI than was necessary.
> No not bipolar MDD with anxiety. That's my official diagnosis thanks for the response. Phillipa
Posted by Questionmark on November 15, 2007, at 3:26:36
In reply to Re: Prozac in particular » War-Face, posted by circusboy on November 13, 2007, at 15:15:02
Yeah, Prozac acts on the 5-HT2C receptor (as well), i'm pretty sure. But remember part of what could contribute to its anxiogenic and more or less stimulating type of effects is that its metabolite... duloxetine, i believe (as opposed to Prozac/fluoxetine)... is a NRI-- and one with a significantly long half-life, if i'm not mistaken.
Also, do you know, does it pretty much sound like overall consensus here that Zoloft does have qualities different enough than other SSRIs in a way that feels like a dopamine reuptake inhibiting effect? That would be interesting because, yeah, the experts seem to think that its effect on the DA transporter would be negligible in terms of subjective effects.
Also, does Strattera really act on the kappa opioid receptor? I never heard that. That's really interesting if so.
> > I found Prozac, on the other hand, to be extremely motivating (probably from NE boosting properties), although after prolonged use, it did leave me feeling dumb and forgetful and tired, in a way similar to the well-articulated cycle of SSRI use above.
> >
>
> Wanted to chime in and say I've had very similar experiences with Prozac. Pretty good in the short term, then the not-insignificant cognitive deficits start to move in. Also, the Prozac-induced anxiety (5-HT2C agonism? I can't remember which receptor subtype) starts to overwhelm the positive effects as well, and I become a nervous idiot in social situations.
>
> I was prescribed methylphenidate to help with the concentration issues, but it took a very high dose (40 - 60 mg/day) which left me in irritable withdrawal every night. Once the Prozac was out of my system, I could have a very productive day on only 10 mg methylphenidate.
>
> As a sort of aside... I know most of us believe this here, but it's worth repeating: the secondary affinities of "selective" drugs like the SSRIs are highly significant. Prozac at the NE transporter, Zoloft at the DA transporter, (Strattera at the kappa opiate receptor...not a SSRI, but still), Lexapro doing...something sleepy... all of these things are /supposed/ to be clinically insignificant, but those of us who have tried these drugs know they're not.
Posted by circusboy on November 15, 2007, at 11:18:06
In reply to Re: Prozac in particular » circusboy, posted by Questionmark on November 15, 2007, at 3:26:36
> Yeah, Prozac acts on the 5-HT2C receptor (as well), i'm pretty sure. But remember part of what could contribute to its anxiogenic and more or less stimulating type of effects is that its metabolite... duloxetine, i believe (as opposed to Prozac/fluoxetine)... is a NRI-- and one with a significantly long half-life, if i'm not mistaken.
>Duloxetine is Cybalta, right? The only major fluoxetine metabolite I know about is norfluoxetine... I hadn't heard that it was extra-sticky at the NE transporter. That's interesting.
> Also, do you know, does it pretty much sound like overall consensus here that Zoloft does have qualities different enough than other SSRIs in a way that feels like a dopamine reuptake inhibiting effect? That would be interesting because, yeah, the experts seem to think that its effect on the DA transporter would be negligible in terms of subjective effects.
>
I don't know if it's the consensus here, really. My comments along those lines are as much hope as fact. :) I remember sertraline feeling subjectively (in retrospect) dopaminergic when I took it 10 years ago... we'll see what it does for me this time. So far (less than 1 week at 25mg) it's MUCH better in the motivation/concentration/energy department than Lexapro (the last SSRI I took, 6 months ago) was. Either that or I'm getting a healthy placebo effect.> Also, does Strattera really act on the kappa opioid receptor? I never heard that. That's really interesting if so.
>
Yep. Search pubmed for "atomoxetine kappa opioid" and it'll pop right up. (I recalled incorrectly -- it's actually an atomoxetine metabolite that has this action). Seems at least a possible mechanism for the crushing dysphoria Strattera caused in me and others. It also makes sense that it would be a metabolite, since the bad feelings didn't kick in for several days.
Posted by Phillipa on November 15, 2007, at 18:57:14
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Phillipa, posted by Questionmark on November 15, 2007, at 3:13:39
Questionmark explains why the starting dose of luvox 50mg is all I need. Anxiety leads to depression in me as then not able to do what I want to do. Thanks for the easily understood explaination. An example is when prozac first came out a pdoc gave me only avaiable dose 20mg. Day l wallpapered the foyer felt great, second day anxiety, day three panic attack all day flushed them away and took three days of xanax to come down. The pdoc thought it was an incredible fast response and begged me to take it every three day. I refused and continued on low dose xanax. Oh thyroid was still okay too. Phillipa
Posted by Robert Hoffman on November 17, 2007, at 8:23:19
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Dinah, posted by Questionmark on November 11, 2007, at 22:21:01
> Post Preface: So sorry if i'm posting too many consecutive posts at once! I now feel stupid. But i just wanted to respond to each reply post individually cuz -- well because i did.
> _____________________________________________
>
> That *is* a great link, and I'm glad you posted it so I can read it again and bookmark it. It's brilliant.... Or maybe not that brilliant but so refreshingly logical and common-sensical in an industry of such a frustratingly appalling lack of logic and common sense. (Oh, many highly intelligent people, but grossly lacking in logic for some reason, and with an overabundance of hubris-- and probably a great deal of corruption, ultimately, involved as well.)
> I was actually just going to read a bit of that and then ended up reading the whole article/page(?).
> I totally agree with so much in that article (or whatever it should be called). Many great and important points.
>
>
> > This is my favorite link on the topic:
> >
> > http://www.geocities.com/ss06470/index.htm
> >
> > I haven't read it for a while, so I should temper my endorsement to only the portion that points out that the way it works in very dissimilar conditions is similar.The reason this article is so relevant and many psychiatrists are not clearheaded is they are operating within a so called evidence based mode of thinking which categorizes patients by disease rather than as individuals with psychological issues. DSM IV has some usefulness, but it is based on operational definitions not true descriptions of illnesses in the sense that a strept throat will be cured by penicillin. In that case the cause of the illness is truly understood. As Dr. Sobo is saying, psychiatry is simply not at that point in its development. Yet "evidence based medicine" makes it appear there is more science to decision making than truly exists. It is ironic that some of the posters are trying to think their way through their symptoms on the basis of subtle neurotransmitters distinctions when this kind of science just doesn't exist. Speculations yes but not clear data.
The article is trying to say that the meds have an effect that is not specific for diagnosis, but rather works by having a psychological effect. You might want to check out Dr. Sobo's interesting description of the effect of dopaminergic drugs (such as Wellbutrin, Adderal (pure amphetamines) Ritaline etc in his article "ADHD and other Sins of Our Children" (also available on the internet) Or go to Bipolarworld.net (go to "news") which has most of his articles linked.
Posted by 49er on November 17, 2007, at 18:17:17
In reply to SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 6, 2007, at 2:42:33
Hi,
Before I started tapering off of all my psych meds, I was experiencing the same apathy even though none of my meds were specifically SSRIs. But a nurse explained that this is quite common with being on psych meds long term.
Anyway, I think the problems you mention with being addicted to a powerful drugs are due alot to tapering schedules that are way too fast. I learned on the Paxil Progress Boards that you should not be tapering more than 10% of the current dose every 3 to 6 weeks. I have admittedly gone faster than that without too many consequences but I wiould not recommend that anyone do what I did. The people on those boards who are having the most success are tapering very slowly.
I am not blaming you by the way as doctors are very ignorant about tapering schedules. My doctor was cooperative even though he didn't understand why I wanted to go slowly. I had to speed up because I couldn't find an affordable compound pharmacist to fill those oddball doses that you can't get at your local drug store. I then got frustrated in trying to cut a pill into 8ths.
Anyway, as one who never thought in a million years I could get off these meds a few years ago, I am writing to give people hope if they are looking for med alternatives. I don't promise it will be easy but it is doable. My life isn't a rose garden but I will take it any day over what I was previouisly on all these meds.
49er
Posted by linkadge on November 17, 2007, at 20:00:44
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by 49er on November 17, 2007, at 18:17:17
I think the SSRI induced apathy is multifacited. First the SSRI's usually mess with your hormones. Ie decreasing testosterone etc. They can also mess with your blood suguar.
Another issue is the possibility that prolonged REM supression actually produces the apathy. REM sleep may be depressogenic, but it is also when growth hormone release occurs. Supressing REM sleep with SSRI's could adversly affect motivation this way.
To reduce apathy, I would use the lowest possible dose. Try dosing in a way that is least disruptive to sleep. Exercise, and perhaps try some form of dopaminergic augmentation.
A low dose citalopram/burpopion combination might work.
Linkadge
Posted by linkadge on November 17, 2007, at 20:02:48
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by 49er on November 17, 2007, at 18:17:17
I also read an abstract that prolonged SSRI administration disrupted the serotoninergic regulation of growth hormone (via 5-ht1d or something).
Linkadge
Posted by 49er on November 18, 2007, at 8:11:47
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by linkadge on November 17, 2007, at 20:00:44
Hi Linkage,
Thanks for your advice.
Wellbutrin and Adderall were two of the drugs and it still occurred.
I have just come to the conclusion that the risks of these drugs outweigh any benefits. But hopefully, someone who is having these problems and wants to stay on the meds can benefit from what you said as it makes alot of sense.
Posted by 49er on November 18, 2007, at 8:14:43
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by linkadge on November 17, 2007, at 20:02:48
> I also read an abstract that prolonged SSRI administration disrupted the serotoninergic regulation of growth hormone (via 5-ht1d or something).
>
> LinkadgeLinkadge,
That sounds very interesting but is over my head. LOL. I am flattered though that you think I can speak the language.
49er
Posted by circusboy on November 18, 2007, at 9:49:44
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by 49er on November 17, 2007, at 18:17:17
>
> Anyway, as one who never thought in a million years I could get off these meds a few years ago, I am writing to give people hope if they are looking for med alternatives. I don't promise it will be easy but it is doable. My life isn't a rose garden but I will take it any day over what I was previouisly on all these meds.
>49er,
How long have you been off the meds? I might have written a post a lot like yours 7+ months ago. I spent a lot of time reading -- if not so much time posting in -- the Alternative board, looking for non-pharm solutions, spending hundreds of dollars at iherb.com. Also running a couple of miles nearly every day and eating pretty well.
It went OK for a while. And I felt so much better (so much *saner*) than I did on long-term Prozac. Some herbs and supplements would work (SAM-e and Rhodiola Rosea were the most effective), but the physical and psychological side effects were no good. SAM-e flattened my personality and raised my blood pressure. Rhodiola gave me insomnia (and poor sleep even when I could fall asleep). Other supplements made me *more* depressed or were otherwise flaky and inconsistent.
Still, I was fine for a while. Then I started getting obsessive thoughts (like I was going to hurt someone with my kitchen knife, or drive my car off the highway on purpose, screw up the company's website or delete the database). A new symptom for me! Yay! And the hallmark cognitive symptoms started creeping back: slow thinking, confusion while doing little everyday things things (shopping, driving), difficulty concentrating, slow recall, poor memory in general, very low motivation ... A sort of irrational dread started creeping over me at work. I couldn't take it anymore.
Looking back, except for part of when I was on SAM-e and most of the Rhodiola trial, I'd been just sub-syndromal for MDD. Solidly dysthymic. And I saw the warning signs of a full MDD episode coming on.
I don't really want to be, but now I'm back on an SSRI. I'm very afraid that the effects of long-term SSRI use will start to creep up on me again; I'm hoping (on little evidence... but there is some) that sertraline will be better than fluoxetine and the rest in the cognitive/apathy department. This study focuses on the elderly patient (and was sponsored by Pfizer, so take it with a spoonful of salt), but there's plenty of good info in it:
http://www.gjpsy.uni-goettingen.de/gjp-article-lane.htmSo. Maybe some of us do better on these drugs in spite of the side-effects? Linkadge's advice is excellent and well-taken. But maybe, MAYBE these terribly flawed drugs are the best tools we have to manage the chronic condition that is depression.
Posted by Dinah on November 18, 2007, at 14:33:33
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by Robert Hoffman on November 17, 2007, at 8:23:19
I guess I like the clarification that all these varying problems aren't necessarily *caused* by the same lack of serotonin. I never felt comfortable with someone telling me confidently that my this or that was caused by a lack of a neurotransmitter in my brain just because it can be helped by supplying that same neurotransmitter. Penicillin can cure an infection, but not by balancing an antibacterial imbalance in my body. Just because a range of psychological problems can be helped by SSRI's doesn't mean that they have the same cause.
People can definitely be *helped* by these medications. When I took Luvox, at that time in my life I needed the effect it gave. I was postpartum, and in hormonal upheaval, and the hypersensitivity was causing a vicious circle. But there were probably other classes of drugs that would have helped just as well. I currently use Risperdal as needed to stop the cycle of hypersensitivity when it occurs. It works as well, and I can use it just when I need it. While SSRI's can't really be used that way. So my issues can be helped by SSRI's, but they can also be helped by other medications that produce a subset of the same effects.
Or that's what I figure anyway. My biochemical knowledge is tiny. :)
Posted by 49er on November 18, 2007, at 16:09:59
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » 49er, posted by circusboy on November 18, 2007, at 9:49:44
Hi Circusboy,
I wrote you a long response that didn't go through for some reason. I am still tapering off of two meds to answer your question. Sorry to hear about your experiences as I hear your frustration.
Anyway, lack of sleep is catching up to me so when I am more clear headed, I will try to think about what I said initially.
> >
> > Anyway, as one who never thought in a million years I could get off these meds a few years ago, I am writing to give people hope if they are looking for med alternatives. I don't promise it will be easy but it is doable. My life isn't a rose garden but I will take it any day over what I was previouisly on all these meds.
> >
>
> 49er,
>
> How long have you been off the meds? I might have written a post a lot like yours 7+ months ago. I spent a lot of time reading -- if not so much time posting in -- the Alternative board, looking for non-pharm solutions, spending hundreds of dollars at iherb.com. Also running a couple of miles nearly every day and eating pretty well.
>
> It went OK for a while. And I felt so much better (so much *saner*) than I did on long-term Prozac. Some herbs and supplements would work (SAM-e and Rhodiola Rosea were the most effective), but the physical and psychological side effects were no good. SAM-e flattened my personality and raised my blood pressure. Rhodiola gave me insomnia (and poor sleep even when I could fall asleep). Other supplements made me *more* depressed or were otherwise flaky and inconsistent.
>
> Still, I was fine for a while. Then I started getting obsessive thoughts (like I was going to hurt someone with my kitchen knife, or drive my car off the highway on purpose, screw up the company's website or delete the database). A new symptom for me! Yay! And the hallmark cognitive symptoms started creeping back: slow thinking, confusion while doing little everyday things things (shopping, driving), difficulty concentrating, slow recall, poor memory in general, very low motivation ... A sort of irrational dread started creeping over me at work. I couldn't take it anymore.
>
> Looking back, except for part of when I was on SAM-e and most of the Rhodiola trial, I'd been just sub-syndromal for MDD. Solidly dysthymic. And I saw the warning signs of a full MDD episode coming on.
>
> I don't really want to be, but now I'm back on an SSRI. I'm very afraid that the effects of long-term SSRI use will start to creep up on me again; I'm hoping (on little evidence... but there is some) that sertraline will be better than fluoxetine and the rest in the cognitive/apathy department. This study focuses on the elderly patient (and was sponsored by Pfizer, so take it with a spoonful of salt), but there's plenty of good info in it:
> http://www.gjpsy.uni-goettingen.de/gjp-article-lane.htm
>
> So. Maybe some of us do better on these drugs in spite of the side-effects? Linkadge's advice is excellent and well-taken. But maybe, MAYBE these terribly flawed drugs are the best tools we have to manage the chronic condition that is depression.
Posted by deniseuk190466 on November 19, 2007, at 8:03:07
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by Questionmark on November 11, 2007, at 21:26:46
Hi,
I'm responding because I read your first note and could really identify with it.
I try to come off Seroxat and I'm ok for the first two weeks even though I have awful withdrawal affects but I always sort of convince myself that as soon as they go away, I'll be ok. But the truth is I'm not I'm horribly depressed and anxious, wretching all the time etc, to the extent that I couldn't even kill myself if I tried. With cognitive therapy or no therapy it couldn't help me come off them
It would be nice to be able to say that SSRIs had caused this but if I could go back to six years ago I was suicidal and I really don't know what else I could have done to help myself apart from medication. As far as I was concerned I'd been doing everything right, sleeping sensibly, eating sensibly etc etc and I really don't know what else I could have done.
If you could go back to when this started is there anything do you think that you could have done anything differently do you think that there is anything you could have done rather than go on the medication merry go round?
Denise
Posted by Robert Hoffman on November 19, 2007, at 9:09:01
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » Robert Hoffman, posted by Dinah on November 18, 2007, at 14:33:33
> I guess I like the clarification that all these varying problems aren't necessarily *caused* by the same lack of serotonin. I never felt comfortable with someone telling me confidently that my this or that was caused by a lack of a neurotransmitter in my brain just because it can be helped by supplying that same neurotransmitter. Penicillin can cure an infection, but not by balancing an antibacterial imbalance in my body. Just because a range of psychological problems can be helped by SSRI's doesn't mean that they have the same cause.
>
> People can definitely be *helped* by these medications. When I took Luvox, at that time in my life I needed the effect it gave. I was postpartum, and in hormonal upheaval, and the hypersensitivity was causing a vicious circle. But there were probably other classes of drugs that would have helped just as well. I currently use Risperdal as needed to stop the cycle of hypersensitivity when it occurs. It works as well, and I can use it just when I need it. While SSRI's can't really be used that way. So my issues can be helped by SSRI's, but they can also be helped by other medications that produce a subset of the same effects.
>
> Or that's what I figure anyway. My biochemical knowledge is tiny. :)Risperidal is an atypical neuroleptic used for schizophrenia originally but increasingly, like Seroquil, it is being used for depression when it is accompanied by a lot of anxiety. There is a small but real risk of tardive dyskinesia from it, but probably used as you are using it, unlikely. Do you find it more helpful than drugs like Xanax or Valium, which are safer when used on a prn basis (they are addictive when used regularly)? There may or may not be an antidepressant action from atypicals related to its effect on serotonin. It is hard to guide you without knowing more but I will also stand by what I wrote above, meds can be very helpful, but linking their use too religiously to diagnosis (rather than your specific psychological needs) I think is misguided.
Posted by Robert Hoffman on November 19, 2007, at 9:25:05
In reply to Re: SSRI Apathy- This is the *True* SSRI response! » circusboy, posted by 49er on November 18, 2007, at 16:09:59
> Hi Circusboy,
>
> I wrote you a long response that didn't go through for some reason. I am still tapering off of two meds to answer your question. Sorry to hear about your experiences as I hear your frustration.
>
> Anyway, lack of sleep is catching up to me so when I am more clear headed, I will try to think about what I said initially.
>
> > >
> > > Anyway, as one who never thought in a million years I could get off these meds a few years ago, I am writing to give people hope if they are looking for med alternatives. I don't promise it will be easy but it is doable. My life isn't a rose garden but I will take it any day over what I was previouisly on all these meds.
> > >
> >
> > 49er,
> >
> > How long have you been off the meds? I might have written a post a lot like yours 7+ months ago. I spent a lot of time reading -- if not so much time posting in -- the Alternative board, looking for non-pharm solutions, spending hundreds of dollars at iherb.com. Also running a couple of miles nearly every day and eating pretty well.
> >
> > It went OK for a while. And I felt so much better (so much *saner*) than I did on long-term Prozac. Some herbs and supplements would work (SAM-e and Rhodiola Rosea were the most effective), but the physical and psychological side effects were no good. SAM-e flattened my personality and raised my blood pressure. Rhodiola gave me insomnia (and poor sleep even when I could fall asleep). Other supplements made me *more* depressed or were otherwise flaky and inconsistent.
> >
> > Still, I was fine for a while. Then I started getting obsessive thoughts (like I was going to hurt someone with my kitchen knife, or drive my car off the highway on purpose, screw up the company's website or delete the database). A new symptom for me! Yay! And the hallmark cognitive symptoms started creeping back: slow thinking, confusion while doing little everyday things things (shopping, driving), difficulty concentrating, slow recall, poor memory in general, very low motivation ... A sort of irrational dread started creeping over me at work. I couldn't take it anymore.
> >
> > Looking back, except for part of when I was on SAM-e and most of the Rhodiola trial, I'd been just sub-syndromal for MDD. Solidly dysthymic. And I saw the warning signs of a full MDD episode coming on.
> >
> > I don't really want to be, but now I'm back on an SSRI. I'm very afraid that the effects of long-term SSRI use will start to creep up on me again; I'm hoping (on little evidence... but there is some) that sertraline will be better than fluoxetine and the rest in the cognitive/apathy department. This study focuses on the elderly patient (and was sponsored by Pfizer, so take it with a spoonful of salt), but there's plenty of good info in it:
> > http://www.gjpsy.uni-goettingen.de/gjp-article-lane.htm
> >
> > So. Maybe some of us do better on these drugs in spite of the side-effects? Linkadge's advice is excellent and well-taken. But maybe, MAYBE these terribly flawed drugs are the best tools we have to manage the chronic condition that is depression.
>
>
Technically, you suffer from OCD as well as depression. The SSRIs have probably been as good as any meds for this condition. I don't want to get too personal, but have you considered why you might feel the anger your symptoms represent, or do you believe these feelings represent nothing other than being part of a syndrome (to be addressed by meds) Have you tried insight psychotherapy? Just a thought
Posted by Dinah on November 19, 2007, at 10:46:48
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by Robert Hoffman on November 19, 2007, at 9:09:01
I think the difference is that the calm that klonopin gives me is a surface calm, but the calm risperdal gives me is a deep down to the bones calm.
Klonopin calms me down for the moment, but Risperdal seems to stop the cycle.
Major versus minor tranquilizer? Or maybe it just interferes with the obsessive thoughts that are causing the anxiety?
I don't know if Risperdal has an antidepressant effect, but if I've taken it for a week or so and quit, I feel tearful and sad for a while. It usually makes me want to run back and take another one, but I've found if I stick it out it passes and if I know it's coming I can tolerate it better.
Posted by circusboy on November 23, 2007, at 12:45:44
In reply to Re: SSRI Apathy- This is the *True* SSRI response!, posted by Robert Hoffman on November 19, 2007, at 9:25:05
> Technically, you suffer from OCD as well as depression. The SSRIs have probably been as good as any meds for this condition. I don't want to get too personal, but have you considered why you might feel the anger your symptoms represent, or do you believe these feelings represent nothing other than being part of a syndrome (to be addressed by meds) Have you tried insight psychotherapy? Just a thought
>Do I suffer from OCD? I've got some OCD-like symptoms (and have for as long as I can remember), but they've come and gone, and have always been minor. Only recently have they become bothersome... but I'm still not sure anyone would diagnose me with full-blown OCD. (At this point, no one would diagnose me with full-blown depression, either...but that's another matter).
And my OCD-like symptoms represent anger? I'm not up on any recent OCD research, so I can't say for sure... but that connection seems rooted in some kind of inherently problematic psychoanalytic theory. I don't feel any anger when the obsessions come on.
I've spent plenty of time in therapy (mostly CBT and mindfulness-type stuff), and have made an appointment with my old therapist for next week.
But even with excellent therapy, nothing gives me my brain back like an antidepressant (at least in the short term). I couldn't have written this post as quickly or coherently a few weeks ago. Still, I can't say *for sure* that my symptoms are best addressed by meds. Even after all these years, I'm still figuring it out.
Posted by Questionmark on November 29, 2007, at 23:27:11
In reply to If you could go back - To questionmark, posted by deniseuk190466 on November 19, 2007, at 8:03:07
Hi Denise.
These are questions i have thought about a lot. And i'm not sure about a lot of it. But i am fairly certain that i am one of those people who needed to be on something and who would overall do better with medication than without. One thing i definitely would have done differently is not go on such a high dose of Paxil (US Seroxat) back in the day. And, it's hard to tell for sure, but i think i might be a lot better off if i got on Nardil a lot earlier in my life than i did. And i think i probably wish i would not have been prescribed so much Ritalin, if at all, when I was 14.
Probably more than you wanted to hear, but, yeah.
Also, if you were suicidally depressed before getting on antidepressants, and you feel terrible when getting off them now, you probably need to be on something. My suggestion, of course, is give Nardil a try. But at least stay on an SSRI, or something, and maybe try augmenting.
> Hi,
>
> I'm responding because I read your first note and could really identify with it.
>
> I try to come off Seroxat and I'm ok for the first two weeks even though I have awful withdrawal affects but I always sort of convince myself that as soon as they go away, I'll be ok. But the truth is I'm not I'm horribly depressed and anxious, wretching all the time etc, to the extent that I couldn't even kill myself if I tried. With cognitive therapy or no therapy it couldn't help me come off them
>
> It would be nice to be able to say that SSRIs had caused this but if I could go back to six years ago I was suicidal and I really don't know what else I could have done to help myself apart from medication. As far as I was concerned I'd been doing everything right, sleeping sensibly, eating sensibly etc etc and I really don't know what else I could have done.
>
> If you could go back to when this started is there anything do you think that you could have done anything differently do you think that there is anything you could have done rather than go on the medication merry go round?
>
> Denise
Posted by Questionmark on November 30, 2007, at 2:22:45
In reply to Re: Prozac in particular, posted by circusboy on November 15, 2007, at 11:18:06
Ok no the metabolite of fluoxetine is *not* duloxetine but norfluoxetine, as you said. And it appears that norfluoxetine is an SSRI as well, from what info i could find on it. I don't know where i ever got that it was duloxetine or that either was a selective NRI. I'm an IDiot. Sorry.
Oh but norfluoxetine does have a very long half-life. i was right about that at least.
That's interesting that atomoxetine binds to the kappa opioid receptor. I still don't think that's the primary reason, if at all, for its dysphoric qualities though. That's also apparently common with reboxetine (unless it has a kappa effect too), and i had similar feelings on Parnate, which has strong catecholaminergic properties.
> > Yeah, Prozac acts on the 5-HT2C receptor (as well), i'm pretty sure. But remember part of what could contribute to its anxiogenic and more or less stimulating type of effects is that its metabolite... duloxetine, i believe (as opposed to Prozac/fluoxetine)... is a NRI-- and one with a significantly long half-life, if i'm not mistaken.
> >
>
> Duloxetine is Cybalta, right? The only major fluoxetine metabolite I know about is norfluoxetine... I hadn't heard that it was extra-sticky at the NE transporter. That's interesting.
>
> > Also, do you know, does it pretty much sound like overall consensus here that Zoloft does have qualities different enough than other SSRIs in a way that feels like a dopamine reuptake inhibiting effect? That would be interesting because, yeah, the experts seem to think that its effect on the DA transporter would be negligible in terms of subjective effects.
> >
> I don't know if it's the consensus here, really. My comments along those lines are as much hope as fact. :) I remember sertraline feeling subjectively (in retrospect) dopaminergic when I took it 10 years ago... we'll see what it does for me this time. So far (less than 1 week at 25mg) it's MUCH better in the motivation/concentration/energy department than Lexapro (the last SSRI I took, 6 months ago) was. Either that or I'm getting a healthy placebo effect.
>
> > Also, does Strattera really act on the kappa opioid receptor? I never heard that. That's really interesting if so.
> >
> Yep. Search pubmed for "atomoxetine kappa opioid" and it'll pop right up. (I recalled incorrectly -- it's actually an atomoxetine metabolite that has this action). Seems at least a possible mechanism for the crushing dysphoria Strattera caused in me and others. It also makes sense that it would be a metabolite, since the bad feelings didn't kick in for several days.
Posted by yxibow on December 3, 2007, at 0:06:23
In reply to Re: If you could go back - To questionmark » deniseuk190466, posted by Questionmark on November 29, 2007, at 23:27:11
> Hi Denise.
> These are questions i have thought about a lot. And i'm not sure about a lot of it. But i am fairly certain that i am one of those people who needed to be on something and who would overall do better with medication than without. .................
Well let's see... if I could go back, it wouldn't have been the beginning of the AIDS crisis and shame over being gay still existing quite strongly. I wouldn't have reacted to that, culminating (leaving out details) to one of the worst episodes of OCD seen, 7 hour showers, YBOCS nearly 40, etc. I would have still gone to a certain school X in Washington State and I would have had enough psychiatric support to stay there. I would have had a job when 9/11 hit and while I would have been miserable like the rest of the country I would have had nice friends and bounced back. Thus the current rare somatiform disorder would never exist and I wouldn't have had to take neuroleptics with unfun side effects to treat it, to this date "uncured" but mitigated in a guarded sense.
But it doesn't really do me justice to say oh, I want to go back to Washington at my graduation. Its almost 2008, my gosh and I have to live in the present. You can only live in the present. You will drive yourself into despair if you don't, and no, I'm not psychotic by any stretch of the word.
The sooner I accept my limitations and the sooner I recover from psychological trauma, the greater the chance I will have of the productive life I want. I may not be able to work 80 hours -- who needs the stress anyhow, not now anyway. But somehow through inside and goal oriented psychotherapy I can build a new and better me.
But that's just my story, in a nutshell.
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