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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Kizzie on July 25, 2011, at 4:19:40
Please forgive me if this has already been discussed. I did a search but couldnt find a thread on it. I have now been on ads for 12 years - seem unable to withdraw despite very very slow reductions - and very worried about impacts. Have also been very interested in the thread re. more likely relapse after AD's.
Would be very interested in views on this article:
---------------------Prolonged Exposure Of Antidepressant Drugs Can INDUCE Tardive Dysphoria
Treatment-resistant depression (TRD) may be related to inadequate dosing of antidepressants or antidepressant tolerance. Alternatively, there are reasons to believe that antidepressant treatment itself may contribute to a chronic depressive syndrome.
This study reports a case of antidepressant discontinuation in a TRD patient, a 67-year-old white man with onset of major depressive illness at the age of 45. He was homozygous for the short form of the serotonin transporter.
He was treated off and on until the age of 59 and had been on an antidepressant continuously until the age of 67. Over the previous 2 years he had been depressed without any relief by medication or 2 electroconvulsive treatments. His medications at the time of evaluation included paroxetine 10 mg daily, venlafaxine 75 mg daily and clonazepam 3 mg daily. His 17-item Hamilton depression score was 22. Over the subsequent 6 months, he was started on bupropion and then tapered off all antidepressants, including the bupropion.
His Hamilton depression score dropped to 18. The patient was not satisfied with his progress and sought another opinion to restart antidepressants. One year later, on duloxetine 60 mg daily, he continued to complain of unremitting depression.
A possible prodepressant effect of antidepressants has been previously proposed. Fava was the first to suggest that an antidepressant-related neurobiochemical mechanism of increasing vulnerability to depression might play a role in worsening the long-term outcome of the illness.
Understanding of potential mechanisms of this phenomenon can be gleaned from observations regarding the short form of the serotonin transporter (5HTTR). Patients with the short form of the 5HTTR and prolonged antidepressant exposure, may be particularly vulnerable to antidepressant-related worsening. In other words, prolonged exposure to antidepressants can induce neuroplastic changes that result in the genesis of antidepressant-induced dysphoric symptoms. The investigators propose the term 'tardive dysphoria' to describe such a phenomenon and describe diagnostic criteria for it.
Tapering or discontinuing the antidepressant might reverse the dysphoric state. Antidepressant discontinuation may not provide immediate relief. In fact, it is likely that transient symptoms of withdrawal will occur in the initial 2-4 weeks following antidepressant discontinuation or tapering. However, after a prolonged period of antidepressant abstinence, one may see a gradual return to the patient's baseline.
http://www.medicalnewstoday.com/articles/218435.php
Posted by floatingbridge on July 25, 2011, at 12:09:28
In reply to AD's causing Tardive Dysphoria, posted by Kizzie on July 25, 2011, at 4:19:40
There was a post few months backed called Tardive dysphoria. It was a bit more detailed. I had tried to attach the journal entry one of the original researchers was generuos enough to send me free of charge. Maybe I can clean it up and repost. I didn't understand the science, but he did suggest getting a specific genetic test that could circumvent years of frustration with ssri/snri trials.
I recall at the time of posting that folks reacted adversely to the term tardive dysphoria. I still feel, another catchy dx asside, that it is a vital question, one that big pharma did not fund and might be interested in sepressing. Will see what I can dig up for you.
fb
> Please forgive me if this has already been discussed. I did a search but couldnt find a thread on it. I have now been on ads for 12 years - seem unable to withdraw despite very very slow reductions - and very worried about impacts. Have also been very interested in the thread re. more likely relapse after AD's.
> Would be very interested in views on this article:
> ---------------------
>
> Prolonged Exposure Of Antidepressant Drugs Can INDUCE Tardive Dysphoria
>
> Treatment-resistant depression (TRD) may be related to inadequate dosing of antidepressants or antidepressant tolerance. Alternatively, there are reasons to believe that antidepressant treatment itself may contribute to a chronic depressive syndrome.
>
> This study reports a case of antidepressant discontinuation in a TRD patient, a 67-year-old white man with onset of major depressive illness at the age of 45. He was homozygous for the short form of the serotonin transporter.
>
> He was treated off and on until the age of 59 and had been on an antidepressant continuously until the age of 67. Over the previous 2 years he had been depressed without any relief by medication or 2 electroconvulsive treatments. His medications at the time of evaluation included paroxetine 10 mg daily, venlafaxine 75 mg daily and clonazepam 3 mg daily. His 17-item Hamilton depression score was 22. Over the subsequent 6 months, he was started on bupropion and then tapered off all antidepressants, including the bupropion.
>
> His Hamilton depression score dropped to 18. The patient was not satisfied with his progress and sought another opinion to restart antidepressants. One year later, on duloxetine 60 mg daily, he continued to complain of unremitting depression.
>
> A possible prodepressant effect of antidepressants has been previously proposed. Fava was the first to suggest that an antidepressant-related neurobiochemical mechanism of increasing vulnerability to depression might play a role in worsening the long-term outcome of the illness.
>
> Understanding of potential mechanisms of this phenomenon can be gleaned from observations regarding the short form of the serotonin transporter (5HTTR). Patients with the short form of the 5HTTR and prolonged antidepressant exposure, may be particularly vulnerable to antidepressant-related worsening. In other words, prolonged exposure to antidepressants can induce neuroplastic changes that result in the genesis of antidepressant-induced dysphoric symptoms. The investigators propose the term 'tardive dysphoria' to describe such a phenomenon and describe diagnostic criteria for it.
>
> Tapering or discontinuing the antidepressant might reverse the dysphoric state. Antidepressant discontinuation may not provide immediate relief. In fact, it is likely that transient symptoms of withdrawal will occur in the initial 2-4 weeks following antidepressant discontinuation or tapering. However, after a prolonged period of antidepressant abstinence, one may see a gradual return to the patient's baseline.
>
> http://www.medicalnewstoday.com/articles/218435.php
>
>
Posted by kizzie2 on July 25, 2011, at 12:44:05
In reply to Re: AD's causing Tardive Dysphoria » Kizzie, posted by floatingbridge on July 25, 2011, at 12:09:28
thanks so much floatingbridge - would be interested to read anything you have.
Posted by Phillipa on July 25, 2011, at 13:31:19
In reply to Re: AD's causing Tardive Dysphoria » floatingbridge, posted by kizzie2 on July 25, 2011, at 12:44:05
Is it in the archieves? Phillipa
Posted by floatingbridge on July 25, 2011, at 14:58:23
In reply to Re: AD's causing Tardive Dysphoria » floatingbridge, posted by kizzie2 on July 25, 2011, at 12:44:05
Kizzie,
Might appeat at the top of the board. It has your screen name in the thread title. I just posted it again.Best wishes.
Posted by kizzie2 on July 26, 2011, at 6:00:34
In reply to Re: AD's causing Tardive Dysphoria » kizzie2, posted by floatingbridge on July 25, 2011, at 14:58:23
Thank you! Will look for it now
Posted by kizzie2 on July 26, 2011, at 6:23:57
In reply to Re: AD's causing Tardive Dysphoria » kizzie2, posted by floatingbridge on July 25, 2011, at 14:58:23
I have read the whole article now.
I guess I just needto try and remain as rational as i can about the whole thing.
I am very frightened that long term ad use has had an untreatable negative impact on my brain chemistry.
But getting in a panic about that isnt going to help...
My position is that I dont appear to be able to stop ads without major relapse. (Despite very slow withdrawals.)
Previously I have been ok on relatively low doses but recently I now seem to be have 'break through' symptoms on these doses :(.
What I dont know is whether this would have happened anyway. Maybe its hormones. maybe it has nothing to do with ads?
I am going to continue trying to get on a slightly lower dose along with cbt/relaxation etc
Posted by floatingbridge on July 26, 2011, at 6:47:43
In reply to Re: AD's causing Tardive Dysphoria » floatingbridge, posted by kizzie2 on July 26, 2011, at 6:23:57
> I have read the whole article now.
>
> I guess I just needto try and remain as rational as i can about the whole thing.Let it sit for awhile. It's only theory right now.
>
> I am very frightened that long term ad use has had an untreatable negative impact on my brain chemistry.It could have. But even the authors eventually fall to the side of hope by their belief in neuroplastcity. They suggest mood stabilzers as helping when AD's are withdrawn, and that many brains 'reset' within a year. The original theorist Fava is more pessimistic, and the newer authors more optimistic. Perhaps lamictal with it's brightening properties is such a support agent.
>
> But getting in a panic about that isnt going to help...
>That's very true.
> My position is that I dont appear to be able to stop ads
without major relapse. (Despite very slow withdrawals.)
>
> Previously I have been ok on relatively low doses but recently I now seem to be have 'break through' symptoms on
these doses :(.Have you tried a mood stabilizer as the authors suggest?
>
> What I dont know is whether this would have happened anyway. Maybe its hormones. maybe it has nothing to do with ads?
>Yeah, I'm in the same boat :-/
> I am going to continue trying to get on a slightly lower dose along with cbt/relaxation etc
>
>I like cbt/dbt hybrids myself. Good luck to you! Take care not to chronically under dose. I say this because the authors might mention this as an exacerbating factor....
Posted by kizzie2 on July 29, 2011, at 11:14:15
In reply to Re: AD's causing Tardive Dysphoria » kizzie2, posted by floatingbridge on July 26, 2011, at 6:47:43
Hi - just re-read your reply adn saw the bit about risks of 'chronic underdosing'. Would you mind telling me a bit more of what you know about this.
Im guessing that is the one of the things i am risking by trying to keep my dose low ...
Thanks for all your input. There is very little discussion like this in Uk.
Posted by floatingbridge on July 29, 2011, at 12:54:50
In reply to Re: AD's causing Tardive Dysphoria » floatingbridge, posted by kizzie2 on July 29, 2011, at 11:14:15
Hi Kizzie, I'm just a person going through my own process, so this is subjective observation plus listening to (many) *experts* of varying true expertise, and reading articles over my ability to truly comprehend. However, I am happy to listen and discuss :-)
The chronic underdosing has come into my awareness in a number of avenues.
First, over the past 12 years of my psychiatric treatment
(psychiatric sounds so dire and serious, but I guess that is exactly an accurate enough term) I have not wanted to take medication. So I have not taken it as prescribed by self-withdrawing, cutting my dose w/o telling my treating physician. Most recently I was very underdosed in Xanax which, however one feels about a maintenance dose of a benzodiazepine, it's a reality for me that cannot be presently
wished away or grunted and sweated through. I think *some*
folks do not do well introducing medication into their system and then continually cutting back. In my case, fear of medication led me to constantly skimp, therefore putting myself unknowingly in an crisis of being underdosed. My new, so far very intelligent, well-read, non-pharma related
pdoc has finally gotten me to see this. It is the flip side of compliance. I was non-compliant by trying to underdose myself thereby undercutting any medical help and thrusting
myself into intermittent crisis.Secondly, and perhaps critical to all of this, I was underdosed
by my two ex-providers in whom I relied on for care. In
regards to Xanax, they threw the conversion charts away, they absolutely told me to my face that they did not follow any conversion charts regarding benzodiazepines. I was given three weeks at 10mg of Valium per day to withdraw from a ten year maintaince of 1.5mg of Xanax. They also began to say that since I am sensitive (fibromyalgia) I could not take
medication period. So that is really underdosing IMHO. In addition, it was concluded that since I have chronic PTSD (yes, it's true) that somehow that also indicated I needed
therapy and that also meant *no drug* could help me. So the long, TMI version of how one patient came to be under medicated. I have a great role to play in all this, so I hope
this isn't pure complaining and blaming.Underdosing can also be considered as a less than stellar practioner insisting someone stick with the basic ssri when it is not working and a patient is *begging* for relief. After years. I am not suggesting here someone trudge through the
polypharmacy I have in the past few years. It's just reasonable to consider other classes of agents in a sane fashion.I dunno. Why are you interested in this, may I ask? Do you
have treatment dissatisfactions? Back to your own concerns about underdsoing by keeping a low dose, I think it's very reasonable not to overmedicate. I have been and seen others to pushed passed any possible therapeutic window in the rush to ramp folks up to a preset dose. Like when I said Lyrica was causing me some trouble I didn't like, guess what? My doctor said jeez, let's titrate you up fast and had me double within the week. That's only the last time that happened to me. I had to get off that ASAP btw.BTW, when I reposted that aricle, it was so full of editing errors and repetitions, I was embarrassed. It's practically unintelligible. All I can say is that I apologize. I was trying to convert an attachment from the researcher through various devices, and finally had to break down and buy adobe PDF converter. But that doesn't mean I knew how to use it right away :-/
The topic of chronic ssri usage as being harmful *for only (only)* a select minority of patients is meaningful to me because I had come across the article *after* I had been off of any snri/ssri agent for three months and felt a bone deep relief. I thoughts, yeah, I'm nuts. My doc said, yeah, your nuts. But it was true. I said, I am still depressed and anxious but thank god something inside, a constant clockwork agitation without ever being able to touch the real dysphoria was like a sign of life. The use of dysphoria has been my own for the past few years. It did not come on board with that article. That article and the researcher generously sending it along was personal serendipity.
Hey, so are you new here? I apologize for not knowing you.
Very best.
fb
>Hi - just re-read your reply adn saw the bit about risks of 'chronic underdosing'. Would you mind telling me a bit more of what you know about this.
>
> Im guessing that is the one of the things i am risking by trying to keep my dose low ...
>
> Thanks for all your input. There is very little discussion like this in Uk.
Posted by kizzie2 on July 30, 2011, at 13:39:52
In reply to Re: AD's causing Tardive Dysphoria » kizzie2, posted by floatingbridge on July 29, 2011, at 12:54:50
Hi Floatingbridge - thank you so much for taking the time to type all that in reply.
How are you doing now - is the dysphoria still really affecting you? You said that you are off all ssris/snris - does that mean you are off all medication at the moment?
i am interested in the underdosing because that is what I have done for the last few years - tried to keep my dose as low as I posibly can because i am scared of the long term impacts of taking ads. Also I dont seem to do well on higher doses. I get many many side effects - and feel 'over' medicated.
In the past i have done well on this lowish dose but after 'another' failed withdrawal attempt last year - i havent stabilised in quite the same way so im nervous about what Ive done to my brain over the last 12 years (I was originally put on ad's for PND - not history of mental health problems before that.)
Anyway thanks again for replying in so much detail - i really appreciate it.
Im not particularly new here - i read the threads quite a lot but only post once in a while as i tend to terrify myself :-)
Take Care
Kizzie
Posted by floatingbridge on July 30, 2011, at 14:41:02
In reply to Re: AD's causing Tardive Dysphoria » floatingbridge, posted by kizzie2 on July 30, 2011, at 13:39:52
> Hi Floatingbridge - thank you so much for taking the time to type all that in reply.
>
> How are you doing now - is the dysphoria still really affecting you? You said that you are off all ssris/snris - does that mean you are off all medication at the moment?I am on Emsam transdermal 6mg. So far it is helping. I might need one bump up. I also restarted Xanax XR according pdoc's order. I can't say Xanax is a brain tonic in
anynway, but it's here to stay for awhile I guess. I went I think four months without an ssri/snri. My depression got worse, but not the odd dysphoria that I experienced. That article says to give it at least a year, but I couldn't. The Emsam is not feeling like the snri's so far :-|Are you off every medication yourself?
>
> i am interested in the underdosing because that is what I have done for the last few years - tried to keep my dose as
low as I posibly can because i am scared of the long term
impacts of taking ads. Also I dont seem to do well on higher doses. I get many many side effects - and feel 'over' medicated.
Top doses didn't work for me except for effexor once. I was able to max that one. Oddly, it's new cousin, pristiq was not as helpful, nor could I tolerate it above the starting dose of
50mg.>
> In the past i have done well on this lowish dose but after
'another' failed withdrawal attempt last year - i havent stabilised in quite the same way so im nervous about what Ive done to my brain over the last 12 years (I was originally put on ad's for PND - not history of mental health problems before that.)I am sorry about feeling stuck and concerned. I had issues
before my son was born, but after his birth, wow. That's the PND that you refer to?When you withdraw, well are you well supervised or self-withdrawing? And what have you most recently tried to
withdraw from? There is support here for people who would really like off meds if they desire it.(I have concerns about my brain health, too :-/)
>
> Anyway thanks again for replying in so much detail - i really appreciate it.
>ditto, and nice to meet you.
> Im not particularly new here - i read the threads quite a lot but only post once in a while as i tend to terrify myself :-)
>
> Take Care
>
> Kizzie
Posted by kizzie2 on July 31, 2011, at 7:42:54
In reply to Re: AD's causing Tardive Dysphoria » kizzie2, posted by floatingbridge on July 30, 2011, at 14:41:02
Hi - Im on 35mg of clomipramine/anafranil at the moment.
I was switched to this a few years ago because drs assumed my problems with withdrawal etc were related to ssri's. In the end that proved not to be the case as anafranil is a TCA (although very similar to ssri's apparently).
My withdrawals have all been supervised - and in more recent years very slow. Until this year I tended to be well on low doses but then crashed when got to Omg.
This time I am struggling to stabilise on the low dose but trying to stay optimistic.
I have always had real difficulty with severe side effects when I change dose or medication so hoping to avoid that if at all possible.
Yes re. PND - thats what post natal depression/anxiety is called in the UK. I think it might have a different name in US (?)
Nice to 'meet' you too.
Kizzie
This is the end of the thread.
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