![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by Abby Cunningham on October 20, 2008, at 19:14:40
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by linkadge on October 15, 2008, at 14:38:03
Link,
Agree with you. I think most if not all psych drugs are not worth it for people with mild to moderate anxiety and even severe depression as I have. The benzos have ruined my life after 25+ years - anyone - who takes benzos - be warned you WILL reach tolerance/withdrawal eventually, early or later, and it is HELL.The "only way out is through" as Winston Churchill said--which is true for these brain drugs. Not saying they don't have a place for the very mentally ill, but on the whole, they all poop out or reach "TOLERANCE" people, where they stop working (?helping). I have seen people diagnosed with borderline personality disorder who are doing so much better OFF drugs than on them.
Sorry for the rant; been burned and iatrogenically addicted to benzodiazepines and will not let another mind destroying drug pass my lips unless it is absolutely proven to not be detrimental to my health ( notice I don't say proven to be helpful, since there is no drug YET that is proven to workfor years. EVERY PSYCH DRUG IS ADDICTIVE/CAUSES PHYSICAL DEPENDENCE to some degree or another. Today's medicine just does not have working psychiatric drugs for the vast majority of people; maybe in the next century. Look at the 50's and 60's when valium, barbiturates, ritalin and amphetamines were the panacea for all neurotic ills, and antipsychotics were thorazine that wonderful drug that chemically lobotomized so many patients, and today we have such things as Zyprexa which causes diabetes and HEART BLOCK which my father died from ---- all because a stupid doctor put him on it for his dementia from strokes.
No more drugs for me. I pray that everyone uses discernment before taking these experiments.
Abby
Posted by Phillipa on October 20, 2008, at 19:58:13
In reply to Re: Long-Term Users of SSRI's--Need Your Help » linkadge, posted by Abby Cunningham on October 20, 2008, at 19:14:40
Abby really no more meds for you? Love Phillipa
Posted by crittercuddler on December 16, 2008, at 3:12:52
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
Stephen Stahl recommends adding or switching to agents that act to increase NE or DA in order to combat the apathy syndrome or "apathetic recovery". I see that you said that your depression did indeed lift when you took Cymbalta, Effexor, Remeron, and Wellbutrin, which all work on NE, DA, or both... so that supports that theory. I am making that statement based on what I have read (and can see) from the book Essential Psychopharmacology by Stephen Stahl. (which is partly viewable online). You are having a problem with anxiety, insomnia, and jitteriness... Knowing that I would recommend you try augmenting an SSRI or an SNRI or Remeron as follows below....
SARIs play an important role as well. What is an SARI? This could be nefazodone or trazodone. This class of drugs is a potent antagonist of 5HT2A receptors. (The stimulation of these receptors is linked with the insomnia, anxiety, agitation, and akthasia (restlessness) that SSRIs can cause. So, by antagonizing these receptors SARIs can help with sleep and anxiety. Antagonism is also linked to helping depression. At the same time SARIs less potently inhibit serotonin and NE reuptake and thus work as an anti-depressant that way as well. And by inhibiting NE reuptake they can increase dopamine. Atypical antipsychotics and the TCA nortriptyline have 5HT2-A antagonism as well.
With that being said I am going to try and suggest some combinations....
a. SSRI at regular dose plus a SARI at a low to moderate dose (like trazadone)
b. SSRI at regular dose plus the TCA nortriptyline at a lower dose
c. SSRI at regular dose plus buspirone at regular dose (Buspirone is postulated to help reverse anti-depressant poop out)
d. Remeron plus Modafinil- (Remeron has 5HT2A antagonism) and you could take the Modafinil for the sleepiness
e. Effexor plus an atypical anti-psychotic that is a 5HT2A antagonist (like Risperdal, Seroquel, or Zyprexa)
f.Effexor with an SARI
g.Effexor with Nortriptyline
h.Buproprion and an SSRI?
This stuff is so hard for me to wrap my brain around tonight.
PLEASE by all means take these as suggestions to investigate further and ask your doctor about. From what I have read today I believe the combinations I suggested make sense... but I would clarify on your own and with your doctor and others on this forum to be doubly sure.
Posted by crittercuddler on December 16, 2008, at 3:14:02
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 16, 2008, at 3:12:52
I found this too...
Here are some tidbits I have found while researching. Perhaps they can be helpful.
1.Inositol may reverse desensitization in serotonin receptors. If I understand correctly that is the mechanism behind poop out, right?
Fux M, Levine J, Aviv A, Belmaker RH: Inositol treatment of obsessive
compulsive disorder. Am J Psychiatry 153:1219-1221, 1996."Inositol
As noted above, there is now considerable evidence that
pharmacologic manipulation of the serotonergic system may help with OCD
symptoms. Myo-inositol is a ubiquitous carbohydrate that is present in large
amounts in brain tissue and is involved in neuronal signaling and
osmoregulation (Vadnal et al, 1997) and, the phosphatidylinositol cycle is
the second messenger system for several neurotransmitters, including several
subtypes of serotonin receptors (Hoyter et al, 1994). In addition,
desensitization of serotonin receptors is reversed by the addition of
exogenous inositol (Rahman & Neuman, 1993). There are reports that exogenous
inositol was effective in controlled trials for patients with depression and
panic, and recently a research group performed a double-blind, controlled
crossover trial of 18 grams/day of inositol versus placebo for 6 weeks each
(Fux et al, 1996). The subjects had significantly lower scores on the YBOCS
when taking inositol than when taking placebo."Help anyone?????????????
Posted by desolationrower on December 16, 2008, at 10:46:42
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 16, 2008, at 3:14:02
> I found this too...
>
> Here are some tidbits I have found while researching. Perhaps they can be helpful.
>
> 1.Inositol may reverse desensitization in serotonin receptors. If I understand correctly that is the mechanism behind poop out, right?
>
> Fux M, Levine J, Aviv A, Belmaker RH: Inositol treatment of obsessive
> compulsive disorder. Am J Psychiatry 153:1219-1221, 1996.
>
> "Inositol
> As noted above, there is now considerable evidence that
> pharmacologic manipulation of the serotonergic system may help with OCD
> symptoms. Myo-inositol is a ubiquitous carbohydrate that is present in large
> amounts in brain tissue and is involved in neuronal signaling and
> osmoregulation (Vadnal et al, 1997) and, the phosphatidylinositol cycle is
> the second messenger system for several neurotransmitters, including several
> subtypes of serotonin receptors (Hoyter et al, 1994). In addition,
> desensitization of serotonin receptors is reversed by the addition of
> exogenous inositol (Rahman & Neuman, 1993). There are reports that exogenous
> inositol was effective in controlled trials for patients with depression and
> panic, and recently a research group performed a double-blind, controlled
> crossover trial of 18 grams/day of inositol versus placebo for 6 weeks each
> (Fux et al, 1996). The subjects had significantly lower scores on the YBOCS
> when taking inositol than when taking placebo."
>
> Help anyone?????????????
>
>Its hard to know how inositol is working...its involved in several cell processes, dowstream from several receptors being activated...There was research done into mood stabilizers Lithium, valproate, carbazapine on if they work by depleting inositol...its still an open question.
-d/r
Posted by JPHR on December 30, 2008, at 14:30:02
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
Others have posted some useful advice. I simply wanted to state that, yes, a so-called "apathy syndrome" does occur in some people (children, adolescents, & adults) after long-term use of an SSRI and that this syndrome can be quite disabling.
For me, the problem began about two years ago, after being on various SSRIs for (approximately) six years. The onset was so insidious that I did not realize what was happening until the fatigue and apathy/avolition had become quite severe. Around two years ago, I began to complain to various doctors of extreme lethargy, without getting any help from them (fatigue can be caused by so many things, including depression, that I can't blame them for not taking the time to figure out what was going on.)
About one year ago, I began to realize that I had almost no volition to complete even important tasks, and also felt very apathetic about this. I explained these major changes in my personality (I have always been a hard-worker and am used to taking on many responsibilities) as the result of "burn out": and it seems that I had convinced my psychiatrist of this, too. I had many work-related responsibilities and had been working at a fairly hectic pace for several years. As a result, last spring, I resigned from my most-challenging position and replaced it with some less-demanding duties .
Nonetheless, over the summer my apathy and fatigue became even worse. As a college-level psychology instructor, I was able to "get by" during this time because I wasn't required to work. But I still had a number of uncompleted projects hanging over my head--tasks that I had put off because of my lack of volition and my lethargy--yet I felt unable to work on them.
It was only at the end of the summer that my psychiatrist decided that I must be suffering from "apathy syndrome," which I had never heard of!! I put exclamation marks at the end of that sentence because I have taught a number of psychology courses (including psychopathology) and was trained in biological psychology--yet, I was completely unaware of this syndrome. It turns out that it is not well publicized and that little is known about its causes. The (too-brief) 2004 review article to which one respondent already referred emphasized these points.
My doctors' (and my own) ignorance of the SSRI-induced "apathy syndrome" led to two very frustrating--and even frightening--years in which I became increasingly unable to effectively perform my job responsibilities. The syndrome also had negative effects on my person life. What makes this all even worse is that it is very difficult to explain to others why I was having so much difficulty over this time, even to those whom I feel secure revealing my antidepressant use to. Apathy and avolition are negative attributes in our work-obsessed culture and, among the professionals with whom I work, they are reviled.
It is essential that those prescribing these medications be more aware of the symptoms of this syndrome; and, most important, that they be proactive in detecting these symptoms in any of their patients who have been taking SSRIs for at least several years.
Posted by Bob on December 30, 2008, at 15:50:18
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 14:30:02
> Others have posted some useful advice. I simply wanted to state that, yes, a so-called "apathy syndrome" does occur in some people (children, adolescents, & adults) after long-term use of an SSRI and that this syndrome can be quite disabling.
>
> For me, the problem began about two years ago, after being on various SSRIs for (approximately) six years. The onset was so insidious that I did not realize what was happening until the fatigue and apathy/avolition had become quite severe. Around two years ago, I began to complain to various doctors of extreme lethargy, without getting any help from them (fatigue can be caused by so many things, including depression, that I can't blame them for not taking the time to figure out what was going on.)
>
> About one year ago, I began to realize that I had almost no volition to complete even important tasks, and also felt very apathetic about this. I explained these major changes in my personality (I have always been a hard-worker and am used to taking on many responsibilities) as the result of "burn out": and it seems that I had convinced my psychiatrist of this, too. I had many work-related responsibilities and had been working at a fairly hectic pace for several years. As a result, last spring, I resigned from my most-challenging position and replaced it with some less-demanding duties .
>
> Nonetheless, over the summer my apathy and fatigue became even worse. As a college-level psychology instructor, I was able to "get by" during this time because I wasn't required to work. But I still had a number of uncompleted projects hanging over my head--tasks that I had put off because of my lack of volition and my lethargy--yet I felt unable to work on them.
>
> It was only at the end of the summer that my psychiatrist decided that I must be suffering from "apathy syndrome," which I had never heard of!! I put exclamation marks at the end of that sentence because I have taught a number of psychology courses (including psychopathology) and was trained in biological psychology--yet, I was completely unaware of this syndrome. It turns out that it is not well publicized and that little is known about its causes. The (too-brief) 2004 review article to which one respondent already referred emphasized these points.
>
> My doctors' (and my own) ignorance of the SSRI-induced "apathy syndrome" led to two very frustrating--and even frightening--years in which I became increasingly unable to effectively perform my job responsibilities. The syndrome also had negative effects on my person life. What makes this all even worse is that it is very difficult to explain to others why I was having so much difficulty over this time, even to those whom I feel secure revealing my antidepressant use to. Apathy and avolition are negative attributes in our work-obsessed culture and, among the professionals with whom I work, they are reviled.
>
> It is essential that those prescribing these medications be more aware of the symptoms of this syndrome; and, most important, that they be proactive in detecting these symptoms in any of their patients who have been taking SSRIs for at least several years.
- Uhhh... so what was done to alleviate the apathy?
Posted by JPHR on December 30, 2008, at 16:22:24
In reply to Re: Long-Term Users of SSRI's--Need Your Help » JPHR, posted by Bob on December 30, 2008, at 15:50:18
> Uhhh... so what was done to alleviate the apathy?
As I stated, other respondents already provided some useful advice, so I wasn't focusing on that issue in my post, especially since any actions taken to reduce/eliminate the symptoms successfully will vary over individuals (as the previous posts demonstrate).
But since you asked so politely, this is what I did: First, after speaking with my psychiatrist, I gradually reduced the dose of paroxetine (Paxil), which was at 60 mg; and he added 200 mg of buproprion (Welbutrin), which some studies (open-label and case studies, unfortunately) suggest may help. Because paroxetine has such a long half-life, it tskes several weeks (at least) to determine if dosage changes help.
In my case, even 10 mg caused too much fatigue: I still had an extremely difficult time getting up in the morning and was tired throughout the day. As for the apathy/avolition, I think there was some improvement, but it was difficult to be sure because I was so tired.
Thus, I stopped taking even the 10 mg dose a few weeks ago. I'm still withdrawing from the paroxetine, but I'm feeling well enough to contribute to this thread!! In other words, I'm less fatigued and apathetic, and feel much more motivated to tackle work-related and everyday chores (even with the fragmented sleep I'm getting, which probably is a result of the withdrawal).
However, I would not necessarily recommend this to anyone else: each person's physiology and psychological issues differ. I decided to go this route because my ability to function on paroxetine was so minimal. In other words, even if I develop problems because I'm no longer taking paroxetine (especially anxiety & depression), my functioning probably can't get any worse than if I had stayed on it.
If I'm wrong about this, then I'll try one of the non-SSRI medications that some research suggests do not lead to the apathy syndrome. Again, however, I know of no research on this issue that is well-controlled; and there also is a lot of variation among individuals. Thus, in the end, a trial-&-error approach (informed by whatever research is out there) must be used for each person.
Posted by crittercuddler on December 30, 2008, at 17:02:42
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 16:22:24
Which drug therapies are shown to not cause an apathy syndrome?
Posted by JPHR on December 30, 2008, at 17:31:23
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 30, 2008, at 17:02:42
> Which drug therapies are shown to not cause an apathy syndrome?
I'm definitely not an expert on any of this--just like you, I'm only at the beginning of trying to understand this problem--but some references I've looked listed several possibilities. For example, Barnart, Makela, & Latocha (2004) mentioned the following medications:
"It has been noted that patients who experienced apathy while taking an SSRI have not experienced such a result when treated with monoamine oxidase inhibitors or tricyclic antidepressants, or even clomipramine, despite the fact that clomipramine is a strong serotonin reuptake inhibitor. Garland and Baerg ... noted that they had not observed medication-induced apathy as a result of venlafaxine [Effexor] treatment"
And an online report by Lee and Keltner (2005) stated that, "It is important to note that AAS [Antidepressant Apathy Syndrome] has been observed with all SSRIs but not with monoamine oxidase inhibitors or tricyclic antidepressants."
Again, a good psychiatrist should know the relevant literature and be able to suggest possible alternatives to SSRIs.
REFERENCES
Barnhart, W.J., Makela, E.H., & Latocha, J. (2004). Selective serotonin reuptake inhibitor induced apathy syndrome: A clinical review. Journal of Psychiatric Practice, 10(3), 196-199.
Lee, S. I., & Keltner, N. L. (2005). Antidepressant apathy syndrome. RedOrbit News. Retrieved at: http://www.redorbit.com/news/display/?id=333128
Posted by JPHR on December 30, 2008, at 18:43:59
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 17:31:23
By the way, I read something written by "Dr. Bob" recommedning that newcomers might want to introduce themselves. Today is the first day that I've posted here. I came across the site when a Google search led me to the initial post in this thread. I read through the other posts and decided to share my experiences with "SSRI-induced apathy syndrome."
A few minutes ago, I read an old thread about the same issue ( started in 2002: http://www.dr-bob.org/babble/20020930/msgs/121851.html ) and was gratified to know that others have found these symptoms to be as frightening as I have and decided to share their experiences (along with helpful advice about how one might deal with these symptoms). It was difficult for me to realize that the beneficial effects of a medication--one that had helped me so much for so many years--could change so dramatically to mostly negative ones.
As some others in this thread have mentioned, psychotropic medications change the ways in which our brains work, and some of these changes may develop only after months or years. When medication effects change from being more-on-the-positive side to being more-on-the-negative side (as they did with me), even discontinuing the medication MAY not reverse some of these changes, or at least not completely. This is very difficult (scary) for those of us who have suffered from incapacitating depression, anxiety, and/or other problems.
It is a good thing to share these concerns with those who have or are going through similar experiences. I'm grateful that forums such as this one exist.
Thanks to you all.
Posted by elanor roosevelt on January 2, 2009, at 22:09:11
In reply to Long-Term Users of SSRI's--Need Your Help, posted by NewQuestions on October 15, 2008, at 14:26:24
this does not seem to be something the medical community understandsthe apathy and lethargy sneak up on you
for me it's like being a captive until i figure it out
Posted by Neal on January 4, 2009, at 1:02:17
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 16, 2008, at 3:12:52
Newbies should know that depression itself is a leading cause of apathy, so that being over or under medicated can cause problems.
Posted by Garnet71 on January 4, 2009, at 14:19:09
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 14:30:02
I can relate, JPHR. I believe this 'apathy' syndrome is being confused with treatment-resistant depression (or vice versa), or they are one in the same, etc.
As a long term user of SSRIs, I am terrified I can never go back to the person I once was before I started using them. I've repeatedly tapered myself off, and now experience extreme anxiety every time and end up going back on them.
Note that Wellbutrin and Effexor are included in meds I have taken. Years ago, I had a great result from Wellbutrin. I recently started it again, in addition to the Zoloft, and it does absolutely nothing for me. Note that also Wellbutrin was not avail. generic years ago; but I never had a problem with generic meds in the past.
Like you, I have no motivation. I don't want to get out of bed. Like someone else mentioned, I am not catatonic or anything--it's just that I do the bare minimum each and every day.
I also now attend a very demanding graduate school program, work 3-4 days a week, and am a mom. I go back to school next week, as my second semester in the program, and am scared that I will not get through it. Last semester was the absolute worst, I almost failed a class (and I was always a gifted student, As and Bs too) and professors would never understand and of course I have to do as well as anyone who is 'normal'.
I have an appointment with a new psychiatrist next week. My insurance co. has a small list of them--so I'm running out of options. Pdocs I've seen in the past don't think about anything..just prescribe you SSRIs w/o even knowing what the actual problem is.
I'll update if I find anything out from new Pdoc.
Right now, I'm trying a mostly whole foods/green diet--drinking green smoothies such as kale, parsely, etc, mixed with fruit each day. I am experimenting to see if those intense nutrients will help my situation. Good luck to all.
Posted by Garnet71 on January 4, 2009, at 14:21:11
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on December 30, 2008, at 14:30:02
I just wanted to mention--I found more information here than from any medical professional, psychiatrist, other website, etc. This site is amazing and I am so happy I found it.
There is really some out of the box information here; as far as alternative therapies, I've never seen such useful information from any other website.
Posted by JPHR on January 4, 2009, at 16:34:57
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by Neal on January 4, 2009, at 1:02:17
There are two reasons for suggesting a distinction between "apathy syndrome," which is thought to be a side effect of SSRI use (especially long-term SSRI use), and apathy as a symptom of depression. First, the emotional state of people suffering from apathy syndrome differs from that of people suffering from depressive apathy. To be specific, depressive apathy generally is associated with emotional distress, whereas SSRI-induced apathy generally is not. Second, a reduction in SSRI dosage often results in a decrease in the apathy of those suffering from apathy syndrome. This distinction between the two types of apathy was described in the review article by Barnhart, Makela, and Latocha (2004) mentioned in other posts in this thread. In the following, I will excerpt the relevant passage from that article (it can be found on page 196 of the article):
"Although apathy is conventionally defined as indifference, a clinical definition must be more specific, since there are many cases in which a manifest indifference would not be considered the result of apathy (e.g., intoxication, sedation). Marin [1991] suggested the following definition of apathy: a syndrome in which there is a primary absence of motivation that is not attributable to cognitive impairment, emotional distress, or diminished level of consciousness. Based on this definition, he suggests that the following conditions comprise the differential diagnosis of apathy: delirium, dementia, abulia [a lack of will or initiative resulting from a disease process], akinesia [an inability to initiate movement resulting from a disease process], despair, demoralization, and, perhaps most important for the purposes of this review, depression, since depressed patients are often characterized as being apathetic [Marin, 1990]. However, Marin noted that, although externally inactive, these patients may be in great emotional distress internally.
"There is subjective evidence that the inactivity or loss of interest experienced in depression is different from the apathy that may be experienced as a late-onset side effect in SSRI treatment. One patient noted that this experience was unlike the lack of motivation she had sometimes experienced during prior episodes of depression [Hoehn-Saric, Lipsey, & McLeod, 1990]. Another noted that her feelings of apathy bore no relationship to depression. Several adolescent patients who experienced such an effect reported being unconcerned or feeling 'fine' [Garland & Baerg, 2001]. Objectively, the data indicate that this effect diminishes with a decrease in SSRI dose, even when the dose has been titrated to a level that remains effective in treating the patients symptoms."
There is speculation, apparently supported by some evidence, that apathy syndrome is the result of decreased activity in the frontal lobes. Among many other things, frontal-lobe activity is important for goal-oriented behavior. People with damage to particular areas in the frontal lobes often show a great deal of apathy and avolition.
REEFERNCES
Barnhart, W.J., Makela, E.H., & Latocha, J. (2004). Selective serotonin reuptake inhibitor induced apathy syndrome: A clinical review. Journal of Psychiatric Practice, 10(3), 196-199.
Garland. E. J. & Baerg, E. A. (2001). Amotivational syndrome associated with selective serotonin reuptake inhibitors in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 11, 181186.
Hoehn-Saric, R., Lipsey, J. R., & McLeod, D.R. (1990). Apathy and indiffer-ence in patients on fluvoxamine and fluoxetine. Journal of Clinical Psychopharmacology, 10, 343512.
Marin, R. S. (1990). Differential diagnosis of apathy. American Journal of Psychiatry, 147, 2230.Marin R. S. (1991). Apathy: A neuropsychiatric syndrome. Journal of Neuropsychiatry and Clinical Neuroscience,3, 24354.
Posted by desolationrower on January 9, 2009, at 1:28:27
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by crittercuddler on December 30, 2008, at 17:02:42
I think the apathy is in some sense the way in which sris treat OCD. Its a strong sense of 'oh, who cares' and loss of interest.
-d/r
Posted by Bob on January 9, 2009, at 13:02:08
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by desolationrower on January 9, 2009, at 1:28:27
> I think the apathy is in some sense the way in which sris treat OCD. Its a strong sense of 'oh, who cares' and loss of interest.
>
> -d/r
That thought has often crossed my mind.- Bob
Posted by JPHR on January 10, 2009, at 13:31:15
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by desolationrower on January 9, 2009, at 1:28:27
> I think the apathy is in some sense the way in which sris treat OCD. Its a strong sense of 'oh, who cares' and loss of interest.
This is one possible explanation, but there are others. I wonder if any researchers have looked at this question?
Because I'm unaware of any research, all I can do is suggest another possible explanation based on my own experience with sertraline (Zoloft), which I took a number of years ago. A few weeks after I first began taking it, and while still on a low dose, I noticed with much surprise that I no longer felt anxious! I suffered from generalized anxiety and, therefore, feeling anxious was "normal" for me. In fact, I hadn't known how bad my anxiety was until it disappeared soon after beginning sertraline treatment.
At that point, I also noticed that I no longer cared very much how others responded to me in social situations (social anxiety had been a major problem for me since at least adolescence). This change didn't feel at all like apathy: it felt like I had been liberated from the inhibiting effects of generalized anxiety. In fact, I felt more able to concentrate on other things--things that were important to me.
In other words, I still cared very much about various aspects of my life (such as my work) and became better able to take effective action with respect to these aspects.
Thus, it's possible that, at least for some people taking SSRIs (including some of those with OCD), the "I don't care" feeling that may occur soon after starting the medications is sometimes the result of anxiety reduction--an effect that differs from the apathy that some (including myself) begin to experience years after beginning SSRI treatment.
Posted by Phillipa on January 10, 2009, at 20:11:48
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on January 10, 2009, at 13:31:15
That is very interesting and you could have a point. Phillipa
Posted by JPHR on January 10, 2009, at 22:14:09
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on January 10, 2009, at 13:31:15
I've been looking for research on the hypothesis that "apathy syndrome" is simply an exaggeration of the initial "I-don't-care" attitude that develops in some (many?) people soon after starting SSRI treatment. One respondent to this thread stated:
"I think the apathy is in some sense the way in which sris treat OCD. Its a strong sense of 'oh, who cares' and loss of interest."
In a later post, I offered what I thought to be a different explanation: that this initial "I-don't-care" attitude that develops soon asfter starting SSRI treatment was a consequence of anxiety reduction and, hence, not the same thing as the apathy experienced by some long-term users of SSRIs.
However, I just found an online article by David Healy (2003) that suggests that what I took to be two different explanations actually amount to the same thing--that is, they refer to varying degrees of "emotional blunting." Let me quote the relevant passage:
"The evidence that SSRIs cause emotional blunting lies in the fact that these drugs are used to treat a wide variety of anxiety states and that Seroxat [the trade name for paroxetine in the UK, called Paxil in the US] for instance advertises itself the anxiolytic antidepressant. An anxiolytic effect is by definition an instance of emotional blunting. The term blunting is applied when the degree of this effect gets to the extent that an individual perceives it to be excessive....
"The very many clinical trials that all SSRI companies have done on their drugs in anxiety states attest to the emotional blunting capacities of the SSRIs. This action of SSRIs is therefore in fact abundantly supported by randomized placebo-controlled trial evidence. This clinical trial evidence is supplemented by a growing body of case studies, which make it clear that the emotional blunting SSRIs produce, the fear reduction, can proceed too far and become an abnormal absence of fear that has consequences for behavior."
REFERENCE
Healy, D. (2003). Antidepressants and suicide. Retrieved at, http://www.socialaudit.org.uk/58090-DH.htm
Posted by Garnet71 on January 10, 2009, at 22:22:34
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on January 10, 2009, at 22:14:09
I mentioned an another thread, many believe psych meds, part. SSRIs cause pre diabetes and other blood sugar problems. I am having similar symptoms.
Now there is new theories that what you are experiencing is actually symptoms of bipolar disorder; read:
http://www.psycheducation.org/depression/02_diagnosis.html
I'm going through the same thing, and new PDoc thinks I need the med Lamictal, although he didn't tell me he suspects BPII, I have to guess and conclude that's what he thinks based on what he prescribed me (didn't communicate with me despite my asking many questions).
I don't buy any of it. Doctors know so little about the brain.
Posted by Phillipa on January 11, 2009, at 18:44:26
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on January 10, 2009, at 22:14:09
I thought seroxat was a combo of zyprexa and prozac will have to google that. But I proved to myself that they work for me as halved the dose of luvox was on had the brain zaps fell off my bike 62 years old and added back last night and was able to drive myself to shop for our business and ride with lots more energy. First time on luvox 250 couldn't have felt better. Then a celexa trial new med doc switched. And then had apathy. So my feeling is for some they increase energy especially with low dose of benzo for the anxiety. This is what helps me. Phillipa
Posted by Phillipa on January 11, 2009, at 18:51:25
In reply to Re: Long-Term Users of SSRI's--Need Your Help, posted by JPHR on January 10, 2009, at 22:14:09
My mistake sorry about that in other countries seroxat is paxil. Phillipa
Posted by JadeKelly on January 16, 2009, at 22:38:50
In reply to Re: Long-Term Users of SSRI's--Need Your Help » JPHR, posted by Phillipa on January 10, 2009, at 20:11:48
> That is very interesting and you could have a point. Phillipa
Wow, thanks Phillipa. Listen, I'm kinda in a hurry here, would you mind summarizing the above post and highliting the points that you feel are interesting? Hey, Thanks!
Love, Jade
This is the end of the thread.
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