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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Martinchen978 on January 22, 2019, at 13:31:06
So what's the general consensus on SSRIs? What is your SSRI-experience? Your opinion...
A funny doctor I know is famous in my mind for his quote that SSRIs makes people "lazy, uncaring, and anorgasmic". He says it tongue-in-cheek because it's ostensibly true. This is, in his reasoning, why he does not use that particular antidepressant unless his patients specifically ask for it, or it becomes necessary or if most other options have been exhausted.
Zoloft was intolerable because it made me feel like a zombie. It has stolen 1,5 years of my life. It turns out that SSRI medications can, in fact, cause an apathy/indifference syndrome. So I don't like them ^^
Most prescribers are not aware of this side effect of these drugs. This probably because apathy/indifference sounds a lot like lack of interest in formerly pleasurable activities or lack of energy or lack of motivation. All of these quoted symptoms are also part of major depression. So, it can be hard to know the difference between medication-induced apathy versus inadequately-treated depression. Also, the prescribing information for SSRI medications (which includes the official, FDA-reviewed statement of side effects) does not list apathy or indifference. On the other hand, the prescribing information does include fatigue and decreased libido. These could possibly be manifestations of apathy. Despite the general lack of awareness of this side effect, the medical literature nonetheless contains several case reports and reviews of SSRI-induced apathy. Notably, these reports often mention that the apathy worsens with increased dose of the drug. The presence of such a dose-response relationship supports the notion that the drug actually causes the apathy.
Posted by Christ_empowered on January 22, 2019, at 17:14:52
In reply to So what's the general consensus on SSRIs?, posted by Martinchen978 on January 22, 2019, at 13:31:06
the drugs are known to cause apathy. kind of like...in schizophrenia, one hears talk of 'negative symptoms,' but tranquilizers can cause those and/or exacerbate whatever deficits are already present. and yet...
ssris remain popular, and the neuroleptics are used for all kinds of 'issues.'
i think it is the disease model. if depression is treated as a disease, then treatment may have 'side effects,' but those are understood to be part of the package deal.
other psych experts want to shift back towards a drug-centered approach in dealing with people. truth be told, that's what many psych experts do, anyway. so, if by 'depression' someone means ruminations and anxiety, an ssri might be OK, perhaps. if 'depression' means fatigue and lethargy and anhedonia, then...no, no...please God, no.
this also plays into power issues. i now go to a clinic. if i didnt have a 'good family' behind me, id be pumped full of haldol via injections. but...while stigmatized and low status, i have higher status people protecting me, so i am a 'voluntary outpatient' on acceptable dosages of modern drugs. similarly...
go to a clinic, dont expect much more than Prozac. insurance...changes things. the no insurance, self-pay psych doctors are more apt to actually listen and tailor the drugs to what the person is seeking, but even there...
by virtue of being in the psych patient role, one loses some bargaining power. not too bad outpatient, can be hell inpatient.
and that is my take on it. :-)
Posted by bleauberry on January 23, 2019, at 8:43:56
In reply to So what's the general consensus on SSRIs?, posted by Martinchen978 on January 22, 2019, at 13:31:06
I think your post is spot on. Well said.
My opinion of SSRIs is that if they are to be used at all, they should be in much smaller doses. For example, 1mg of Lexapro instead of 20mg.
That's because if it truly were a situation of low serotonin - which it isn't - then we want to restore what is missing but not more than that, right? Current SSRI dosing is way more than that. Way more than merely restoring normal levels. They freakiing flood the brain in ways it was designed for.
I had a Lyme doc who had patients in remission on 1mg of Lexapro, after starting them at just one drop, which is 1/10th of 1mg. He was very proud of himself that he had figured out the right way to use these meds without creating the numbing effect. When we think that high doses are needed, where does that come from? Pharmaceutical companies. When everyone comes to believe the same myth, then everyone considers it a fact, right? Like for example it is a fact if you take Paxil and want to get better you need at least 10mg but probably 20mg, right? That's all hocus pocus nonsense in my world. Every human body is quite different.
I like SSRIs but only if they are in cocktails that offer some NE and DA balance, and only at relatively low doses.
I think if anyone is prescribed an SSRI, that it should also automatically come with a prescription for either Ritalin, Adderall, or Modafinil. That way there Is greater likelihood of real mood improvement - and rapid - as well as avoidance of the numbing.
> So what's the general consensus on SSRIs? What is your SSRI-experience? Your opinion...
>
> A funny doctor I know is famous in my mind for his quote that SSRIs makes people "lazy, uncaring, and anorgasmic". He says it tongue-in-cheek because it's ostensibly true. This is, in his reasoning, why he does not use that particular antidepressant unless his patients specifically ask for it, or it becomes necessary or if most other options have been exhausted.
>
> Zoloft was intolerable because it made me feel like a zombie. It has stolen 1,5 years of my life. It turns out that SSRI medications can, in fact, cause an apathy/indifference syndrome. So I don't like them ^^
>
> Most prescribers are not aware of this side effect of these drugs. This probably because apathy/indifference sounds a lot like lack of interest in formerly pleasurable activities or lack of energy or lack of motivation. All of these quoted symptoms are also part of major depression. So, it can be hard to know the difference between medication-induced apathy versus inadequately-treated depression. Also, the prescribing information for SSRI medications (which includes the official, FDA-reviewed statement of side effects) does not list apathy or indifference. On the other hand, the prescribing information does include fatigue and decreased libido. These could possibly be manifestations of apathy. Despite the general lack of awareness of this side effect, the medical literature nonetheless contains several case reports and reviews of SSRI-induced apathy. Notably, these reports often mention that the apathy worsens with increased dose of the drug. The presence of such a dose-response relationship supports the notion that the drug actually causes the apathy.
Posted by bleauberry on January 23, 2019, at 8:48:48
In reply to So what's the general consensus on SSRIs?, posted by Martinchen978 on January 22, 2019, at 13:31:06
I had been on Paxil for a year and my doc gave me the Depression Questionnaire to see how I was doing. I scored real well on everything except - interest in hobbies and activities, which scored the worst possible. And because of my total score on that test, my doc said I was in remission and my depression was gone.
Well wait a minute! If a person has no interest in anything in life, then that is not really a good therapy! Hello???
I think the goal of therapy should be to restore the person to who they were before. We don't really see that. What we see is "symptom management", crisis management, and nobody asking the most important question....what's wrong in this person's body causing the brain to misfire? Nobody is asking that, except maybe me and a bunch of Lyme doctors. And we have answers. Real answers.
> So what's the general consensus on SSRIs? What is your SSRI-experience? Your opinion...
>
> A funny doctor I know is famous in my mind for his quote that SSRIs makes people "lazy, uncaring, and anorgasmic". He says it tongue-in-cheek because it's ostensibly true. This is, in his reasoning, why he does not use that particular antidepressant unless his patients specifically ask for it, or it becomes necessary or if most other options have been exhausted.
>
> Zoloft was intolerable because it made me feel like a zombie. It has stolen 1,5 years of my life. It turns out that SSRI medications can, in fact, cause an apathy/indifference syndrome. So I don't like them ^^
>
> Most prescribers are not aware of this side effect of these drugs. This probably because apathy/indifference sounds a lot like lack of interest in formerly pleasurable activities or lack of energy or lack of motivation. All of these quoted symptoms are also part of major depression. So, it can be hard to know the difference between medication-induced apathy versus inadequately-treated depression. Also, the prescribing information for SSRI medications (which includes the official, FDA-reviewed statement of side effects) does not list apathy or indifference. On the other hand, the prescribing information does include fatigue and decreased libido. These could possibly be manifestations of apathy. Despite the general lack of awareness of this side effect, the medical literature nonetheless contains several case reports and reviews of SSRI-induced apathy. Notably, these reports often mention that the apathy worsens with increased dose of the drug. The presence of such a dose-response relationship supports the notion that the drug actually causes the apathy.
Posted by SLS on January 24, 2019, at 20:25:43
In reply to So what's the general consensus on SSRIs?, posted by Martinchen978 on January 22, 2019, at 13:31:06
If you must take an antidepressant, Trintellix (vortioxetine) 10 mg/day is worth a look at. It does a lot of things in addition to serotonin reuptake inhibition. It is a sort of serotonin modulator - although it may do things yet to be discovered. Trintellix is a pretty clean drug. Apathy, brain fog, weight-gain, and amotivation are not as problematic as is with SSRIs. The drug is pro-cognitive. It clears up thinking rather than blunting it. The clinical trials produced impressive statistics.
- Scott
Posted by Martinchen978 on January 25, 2019, at 7:56:48
In reply to Re: So what's the general consensus on SSRIs? » Martinchen978, posted by SLS on January 24, 2019, at 20:25:43
> If you must take an antidepressant, Trintellix (vortioxetine) 10 mg/day is worth a look at. It does a lot of things in addition to serotonin reuptake inhibition. It is a sort of serotonin modulator - although it may do things yet to be discovered. Trintellix is a pretty clean drug. Apathy, brain fog, weight-gain, and amotivation are not as problematic as is with SSRIs. The drug is pro-cognitive. It clears up thinking rather than blunting it. The clinical trials produced impressive statistics.
>
>
> - ScottIt's not available in Germany :=(
I thought about augmentation therapy with Nortriptyline, but doctors are pretty lame when it comes to combination therapy...
Posted by Ruuudy on February 23, 2019, at 2:23:15
In reply to Re: So what's the general consensus on SSRIs?, posted by bleauberry on January 23, 2019, at 8:48:48
"I think the goal of therapy should be to restore the person to who they were before."
As an almost 30 year Prozac/Fluoxetine consumer, it's extremely difficult to even begin to wonder what life used to be like prior to depression, which actually started 35 years ago. I am who I am. That's not to say I certainly have really wonderful days where it feels like I'm totally the very same person I have been since birth,,, but with just a few added quirks. I can deal with that!
Posted by Shar on April 3, 2019, at 23:17:52
In reply to Re: So what's the general consensus on SSRIs?, posted by Ruuudy on February 23, 2019, at 2:23:15
Right there with ya, Ruu. If it ain't broke don't fix it. I'm not sure if that's the kind of feedback you're looking for, but it's how I feel. Had I ever found an a/d that worked, I'd still be on it and holding tight. I'm an oldie (67) and when I was around 55 I just quit a/d's (as directed). I've been depressed since 15 years old (first suicide attempt) and started a/d's as soon as prozac hit the market. I was pretty desperate (Prozac didn't do much for me, dang it). In the subsequent years, I tried over a dozen a/d's and 'helpers' which is what Buspar came out as. I had luck with Zoloft til it pooped out, about 6 months. I had luck with risperdal until I started getting twitchy and worried about tardive dyskenesia (sp?).
I disagree somewhat about the quote regarding therapy goal. I think the initial goal of therapy is to put one's feet back under them. In later years of therapy, once your feet are under you, you can start collecting tools and info on dealing with this dreadful disease. The Bible refers to tartarus (sort of hell under hell) as a dark abode of woe which always seemed like a perfect description of depression to me.
Posted by Shar on April 3, 2019, at 23:19:33
In reply to Re: So what's the general consensus on SSRIs?, posted by Ruuudy on February 23, 2019, at 2:23:15
Right there with ya, Ruu. If it ain't broke don't fix it. I'm not sure if that's the kind of feedback you're looking for, but it's how I feel. Had I ever found an a/d that worked, I'd still be on it and holding tight. I'm an oldie (67) and when I was around 55 I just quit a/d's (as directed). I've been depressed since 15 years old (first suicide attempt) and started a/d's as soon as prozac hit the market. I was pretty desperate (Prozac didn't do much for me, dang it). In the subsequent years, I tried over a dozen a/d's and 'helpers' which is what Buspar came out as. I had luck with Zoloft til it pooped out, about 6 months. I had luck with risperdal until I started getting twitchy and worried about tardive dyskenesia (sp?).
I disagree somewhat about the quote regarding therapy goal. I think the initial goal of therapy is to put one's feet back under them. In later years of therapy, once your feet are under you, you can start collecting tools and info on dealing with this dreadful disease. The Bible refers to tartarus (sort of hell under hell) as a dark abode of woe which always seemed like a perfect description of depression to me.
Posted by chumbawumba on May 18, 2019, at 17:17:07
In reply to So what's the general consensus on SSRIs?, posted by Martinchen978 on January 22, 2019, at 13:31:06
That's funny and true "lazy, uncaring, and anorgasmic". But I'll take it over disabled, anxious, and suicidal.
Back in the day, low self esteem was a goal!
This is the end of the thread.
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