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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by satsumas on July 11, 2008, at 10:52:24
Hi,
I just finished tapering off of effexor, and have been at 100mg of desipramine for the past two weeks. but for the past few days i have been crying and feeling intense sadness and grief. Usually when I'm depressed, I don't necessarily cry, even if I feel bad about something specific. This time, I can't figure out if what I'm feeling is "real grief" or is a function of the the fact that I no longer have any serotonin reuptake.I'm venturing towards the former, becuase i've experienced some real loss (relationship-wise, my fault) over the past six months -- but in some way I've been grieving this for a long time.
My current crisis is intense grief, crying (for days now), and suicidal ideation, and I am struggling on how to reconcile this with my antidepressant use and the depression i've been dealing with for so long. On the one hand, it's good to cry, and that's a part of grief. On the other hand, the real loss occurred months ago, so was the fact that I was on antidepressants just shielding me from accepting it? Or from not crying about it? I certainly felt bad and upset during that whole time, but it feels horrible and confusing and mind-splitting to not know whether the antidepressants were preventing me from acceptance of the loss (if so, then, that doesn't seem to be so good, and a real negative side effect of being on these things), or whether the fact that i'm off of Effexor is just amplifying already resolved grief -- the idea being that my brain, in it's current state, is "rationalizing" it's chemical imbalance by pulling up old regret and past losses and obsessing about them.
These meta-questions are almost just as bad as the pain itself, and I'd appreciate anyone's opinions. Part of me would hate to be on antidepressants long term if all they do is prevent proper processing of grief at the appropriate time, and are just generating unrealistic hope or denial as part of their "mood lifting" effects. All that seems to do would be to prolong pain, and replace short term grief with longer-term feelings of "malaise" or "not-working" antidepressant treatment (confusing inadequate processing of painful life events with inadequate a/d response).
Opinions? Anyone have any advice? Would a different class of drugs prevent this sort of emotional blunting (a.k.a. inability to process and grieve bad life events appropriately)? MAOIs?
Thanks much.
Posted by Phillipa on July 11, 2008, at 11:12:16
In reply to Off Effexor - compulsive crying and grief, posted by satsumas on July 11, 2008, at 10:52:24
I don't know what to say other than I'm sorry. Since the ad's don't seem to work for me I can't relate to the coming off of one. But sometimes if we keep busy enough we stuff our emotions and then when something like a med change comes up to grief seems to come up from the pitt of your stomach. And then the grieving begins. Stuffing something I did for years. Love Phillipa
Posted by Racer on July 11, 2008, at 19:41:17
In reply to Off Effexor - compulsive crying and grief, posted by satsumas on July 11, 2008, at 10:52:24
>> Opinions? Anyone have any advice? Would a different class of drugs prevent this sort of emotional blunting
My experience has been that any serotonin reuptake inhibitors blunt my emotions -- even at low doses. My guess is that an effective antidepressant of another class would be less likely to have this effect on you. Maybe the fact that you're in such rough shape on desipramine is a bad sign -- or maybe you just haven't reached a therapeutic dose yet. I've heard very good things about it, and would consider trying it again myself if something could be done to keep my blood pressure up. I hope it works for you.
As it happens, I just asked my psychopharmacologist about this sort of thing -- whether an effective anti-depressant would prevent me from being swallowed up by depression. His words, which I'm taking directly from his email: "... says that being beaten up long enough and/or hard enough can essentially inactivate medication or otherwise eradicate positive medication response." Not the most comforting idea, huh? In fact, not comforting at all...
What he did say which might be more comforting for you, is that TCAs rarely "poop out." If desipramine works out for you, it could be you won't have to go through this sort of thing again. And more news which might also comfort you: I didn't have trouble with emotional blunting on nortriptyline, so desipramine might be more pleasant for you in that area, too.
Best luck to you.
Posted by satsumas on July 11, 2008, at 19:47:17
In reply to Re: Off Effexor - compulsive crying and grief » satsumas, posted by Racer on July 11, 2008, at 19:41:17
thanks so much, very encouraging. i too have heard good things about desip but am wondering how much it will really help me with the core problems of self-esteem, optimism, romantic desire/capacity if it doesn't touch serotonin at all. it's so selective for NE that even if i double dose to 150 im guessing thats just going to double the NE aspect of things and not touch serotonin.
good to hear about less poop out on TCA. maybe i'll ask my dr. about another TCA. was just going to say "Nardilize me Sir" on Tuesday as i'm so tired of this medication merrygoround. Feel that that in and of itself is harmful.
Posted by Racer on July 12, 2008, at 1:38:32
In reply to Re: Off Effexor - compulsive crying and grief, posted by satsumas on July 11, 2008, at 19:47:17
> ... am wondering how much it will really help me with the core problems ... if it doesn't touch serotonin at all.
When you say that, is it because you've had good response to SSRIs in the past? Or is it based on an idea that serotonin imbalance is the root cause of depression? At this stage, despite the glib talk about serotonin being too low when someone is depressed, that's almost more hypothesis than theory -- no one has shown that that's the cause of depression, nor even that it is the serotinergic actions of antidepressants that create their benefits. Truly there's only the basic information -- these medications affect these receptor types; these medications improve symptoms of depression for many people.
If you've had good responses to SSRIs in the past, then it might be worth trying another SSRI instead of going the TCA route. If the Effexor was helpful, but pooped out, it might be worth giving Cymbalta a try -- for whatever it's worth, I found Cymbalta the friendlier drug. If none of the SSRIs worked well, and the Effexor wasn't helpful for you, then trying a new class of medication -- like TCAs -- makes a lot of sense. I'd give desipramine a good chance, because despite the benefits many people here on this site have reported with Nardil, the STAR*D study showed that MAOIs had a very high drop out rate because of intolerable side effects. It may help you, of course, and it's worth trying, but if I were to offer advice, it would be to make sure desipramine isn't going to be your friend before moving on to a medication which may not be as tolerable for you.
Best luck.
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