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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by Wanderer123 on August 30, 2009, at 18:51:08
Hello. I am not gonna write this long. I am just gonna cut to the chase. Years ago I was on Prozac. It gave me hypomania. I was upbeat and crazy. Then when I was taken off it, a few months later my emotions were shut down. I became like a zombie. My emotions didn't come back. I searched on the internet and found few cases where emotional apathy was permanately caused by any antidepressants.
I was wondering what could have happened to me?
What happened to my neurotransmitters?
Could the number of them permanately decreased or did the receptors decrease?
And is there any natural medicine to heal me?Help would be greatly appreciated.
Posted by Alexanderfromdenmark on September 7, 2009, at 10:30:58
In reply to How did Prozac cause my permanent Anhedonia, posted by Wanderer123 on August 30, 2009, at 18:51:08
http://www.definitivemind.com/2009/04/07/post-ssri-anhedonia-sexual-dysfunction-and-fatigue/
http://www.definitivemind.com/2009/04/09/post-ssri-anhedonia-sexual-dysfunction-and-fatigue-part-2/
Posted by metafunj on September 13, 2009, at 17:43:22
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by Alexanderfromdenmark on September 7, 2009, at 10:30:58
My theory is that taking prozac decreased your serotonin transporters. Stopping the drug does not restore this so you are left with lots of extra serotonin floating around.
At the same time prozac caused an increase in dopamine transporters so now any dopamine your brain is making is being removed from the synapse before you can enjoy it.
I posted an abstract about this phenomenon in two other threads about "dopamine depletion".
I found a study before, that I can't find now, which says that serotonin stays elevated even after drug cessation. Now your probably wondering why did you feel better on Prozac than off since in both cases you have increased serotonin. I think the reason you felt good on prozac is cuz prozac blocks the 5HT2C receptor and does something at the 5 HT2A receptor. This action causes increase in dopamine which makes you feel better and enjoy things.
When you came off instead of being blocked by prozac, the 5 HT2A/C receptors became flooded with serotonin, due to decreased serotonin transporters. They are now being agonized by serotonin which is decreasing dopamine in the prefrontal cortex, which probably is contributing to anhedonia as well as cognitive problems.
I haven't found anything natural that helps. You might try L Tyrosine, B-6, Ginkgo biloba(supposedly decreases serotonin release), and ginseng. Also exercise increases dopamine binding.
Basically my thought is you have TOO MUCH serotonin now. Sounds counterintuitive, but anything serotonergic just increases flatness, tiredness, and spaciness in me.
Posted by Alexanderfromdenmark on September 14, 2009, at 15:36:14
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by metafunj on September 13, 2009, at 17:43:22
> My theory is that taking prozac decreased your serotonin transporters. Stopping the drug does not restore this so you are left with lots of extra serotonin floating around.
>
> At the same time prozac caused an increase in dopamine transporters so now any dopamine your brain is making is being removed from the synapse before you can enjoy it.
>
> I posted an abstract about this phenomenon in two other threads about "dopamine depletion".
>
> I found a study before, that I can't find now, which says that serotonin stays elevated even after drug cessation. Now your probably wondering why did you feel better on Prozac than off since in both cases you have increased serotonin. I think the reason you felt good on prozac is cuz prozac blocks the 5HT2C receptor and does something at the 5 HT2A receptor. This action causes increase in dopamine which makes you feel better and enjoy things.
>
> When you came off instead of being blocked by prozac, the 5 HT2A/C receptors became flooded with serotonin, due to decreased serotonin transporters. They are now being agonized by serotonin which is decreasing dopamine in the prefrontal cortex, which probably is contributing to anhedonia as well as cognitive problems.
>
> I haven't found anything natural that helps. You might try L Tyrosine, B-6, Ginkgo biloba(supposedly decreases serotonin release), and ginseng. Also exercise increases dopamine binding.
>
> Basically my thought is you have TOO MUCH serotonin now. Sounds counterintuitive, but anything serotonergic just increases flatness, tiredness, and spaciness in me.
That's an interesting and scary thought. I hope it's not true, or that the brain eventually goes back to usual serotonin and dopamine metabolism. But that's how I feel right now. I feel like I'm still on a f*ck*ng SSRI, despite being a year off. No progress really. Wouldn't surprise me that some unfortunately individuals still have problems several year later.I've confirmed my long-term suspiscions that I'm hypothyroid + some other jazzy hormonal defiencies. I think low thyroid function is one of the main reasons why some are very sensitive to meds and others are not. Low thyroid function makes it impossible for the body to find it's it homeostatic reset. Which I think a lot of cases like post SSRi's problems have a little touch of. Not to bipolar, scizo, cfs, fibromyalgia, IBS.
Posted by Alexanderfromdenmark on September 14, 2009, at 15:37:21
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by metafunj on September 13, 2009, at 17:43:22
> My theory is that taking prozac decreased your serotonin transporters. Stopping the drug does not restore this so you are left with lots of extra serotonin floating around.
>
> At the same time prozac caused an increase in dopamine transporters so now any dopamine your brain is making is being removed from the synapse before you can enjoy it.
>
> I posted an abstract about this phenomenon in two other threads about "dopamine depletion".
>
> I found a study before, that I can't find now, which says that serotonin stays elevated even after drug cessation. Now your probably wondering why did you feel better on Prozac than off since in both cases you have increased serotonin. I think the reason you felt good on prozac is cuz prozac blocks the 5HT2C receptor and does something at the 5 HT2A receptor. This action causes increase in dopamine which makes you feel better and enjoy things.
>
> When you came off instead of being blocked by prozac, the 5 HT2A/C receptors became flooded with serotonin, due to decreased serotonin transporters. They are now being agonized by serotonin which is decreasing dopamine in the prefrontal cortex, which probably is contributing to anhedonia as well as cognitive problems.
>
> I haven't found anything natural that helps. You might try L Tyrosine, B-6, Ginkgo biloba(supposedly decreases serotonin release), and ginseng. Also exercise increases dopamine binding.
>
> Basically my thought is you have TOO MUCH serotonin now. Sounds counterintuitive, but anything serotonergic just increases flatness, tiredness, and spaciness in me.
COuld you link the studies showing the lingering effects of SSRI's? That's very interesting(and scary).
Posted by metafunj on September 14, 2009, at 21:13:21
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by Alexanderfromdenmark on September 14, 2009, at 15:37:21
Hey man, I'll try to find it. Unfortunately I think permanently elevated serotonin is the problem. I tried 5 HTP and it spaced me out then made me fall asleep. I recently tried Lexapro and 10 mgs made me too spacey, even 5mgs put some distance between me and the rest of the world.
My best guess for treating is using a stimulant or another drug to activate dopamine. Another option find a drug that antagonizes serotonin receptors preventing the constant agonize effect of elevate serotonin. In Europe you could also take tianeptine to decrease serotonin, buspar also does this. You might try Remeron again. I'm gonna try prozac at 2.5 mgs or Provigil.
I haven't found any natural remedies with much strength to combat this problem.
I have checked my thyroid, parathyroid, and some other functions like DHEA. Everything was ok hormonally. The one thing off is my liver bilirubin was high. I have something called Gilbert's syndrome which supposedly doesn't interfere with metabolism too much but i'm suspicious that it causes prozac to build up in me and prozac already gradually builds up in the body.
In your case your hypothyroidism could have made you depressed or anxious in the first place. Too bad docs don't even bother to look at these things. The increased prolactin seems like its related to SSRI use.
Posted by metafunj on September 14, 2009, at 23:22:01
In reply to Re: How did Prozac cause my permanent Anhedonia » Alexanderfromdenmark, posted by metafunj on September 14, 2009, at 21:13:21
Unfortunately I cannot find the study.
This is interesting though a patent claim for the treatment of SSRI induced anhedonia. It mentions the symptoms and some potential treatments and examples of drug regimens.
Posted by sowhysosad on September 15, 2009, at 21:03:29
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by metafunj on September 13, 2009, at 17:43:22
Fascinating theory.
> My theory is that taking prozac decreased your serotonin transporters. Stopping the drug does not restore this so you are left with lots of extra serotonin floating around.
So you're saying there are less transporters - an adaptive change under Prozac - so reuptake is inhibited, even when the drug is withdrawn?
> At the same time prozac caused an increase in dopamine transporters so now any dopamine your brain is making is being removed from the synapse before you can enjoy it.Why would there be an increase in dopamine transporters though? I know Prozac sensitizes D2 receptors in a region-specific manner, but I didn't know it affected the transporter cells.
Apparently the glut of serotonin in the synapse can also cause the dopamine transporters to reuptake serotonin, which can be released later and act as a false neurotransmitter. That would also fit with the theory.
> I found a study before, that I can't find now, which says that serotonin stays elevated even after drug cessation. Now your probably wondering why did you feel better on Prozac than off since in both cases you have increased serotonin. I think the reason you felt good on prozac is cuz prozac blocks the 5HT2C receptor and does something at the 5 HT2A receptor. This action causes increase in dopamine which makes you feel better and enjoy things.
>
> When you came off instead of being blocked by prozac, the 5 HT2A/C receptors became flooded with serotonin, due to decreased serotonin transporters. They are now being agonized by serotonin which is decreasing dopamine in the prefrontal cortex, which probably is contributing to anhedonia as well as cognitive problems.Makes a lot of sense - removing the 5-HT2C antagonism would cause a drop in dopamine release.
Posted by metafunj on September 15, 2009, at 21:51:53
In reply to Re: How did Prozac cause my permanent Anhedonia » metafunj, posted by sowhysosad on September 15, 2009, at 21:03:29
Yeh, I just hope I'm right. I've been dealing with this long enough.
I based this on the following study and also that the feelings I have are generally ones people feel on SSRIs who need a dopamine boost.
SERT and DAT availabilities under citalopram treatment in obsessive–compulsive disorder (OCD)
Abstract
"Serotonin and dopamine transporter (SERT, DAT) availabilities have prospectively been investigated using [123I]β-CIT and single photon emission computed tomography in subjects with obsessive–compulsive disorder under treatment with the selective serotonin reuptake inhibitor citalopram. SERT availability decreased by a mean 36.5%, whereas DAT availability increased by about 40%. The data point at a citalopram induced modulation of both serotonergic and dopaminergic activity and support the notion of functional interactions of monoaminergic systems in the human brain."
--------------------------------
Its interesting that Andrewfromdenmark feels the same as he did now as when on lexapro which is completely selective to the serotonin transporter while Wanderer and I only felt that way after stopping prozac thus removing 5HT2C antagonism.
I also read in another thread that andrew's anhedonia was improved by remeron which blocks the 5HT2/C and 5HT3 receptors. This blocks the agaonism of serotonin and causes a release of dopamine.
So if we want to base treatment on this theory:
1. we should take 5 HTA2/C or just 5 HT2C blocking drugs. ie low dose (2.5mg) prozac, remeron, Cyproheptadine.2. We could take serotonin reducing drugs like Buspar or Tianeptine. I think Buspar sounds better than a drug that acts on SERT like Tianeptine. When you already have less transporters you don't wanna go messing them up. Ginkgo is supposed to suppress the release of serotonin as well.
3. Dopamine boosters. Too many too name the stimulants, agonists, parkinson's restless leg drugs, provigil. ok maybe not that many :)
Any of these groups could help alone or in tandem with a drug from another group.
PS: I hope I've reflected andrew's and wanderer's experiences correctly.
Posted by sowhysosad on September 16, 2009, at 11:58:31
In reply to Re: How did Prozac cause my permanent Anhedonia » sowhysosad, posted by metafunj on September 15, 2009, at 21:51:53
> 2. We could take serotonin reducing drugs like Buspar or Tianeptine. I think Buspar sounds better than a drug that acts on SERT like Tianeptine.
But in higher doses buspirone is a D2 antagonist, which would defeat the object. In lower doses it does boost dopamine through presynaptic 5-HT1A agonism though.
Posted by metafunj on September 16, 2009, at 12:39:39
In reply to Re: How did Prozac cause my permanent Anhedonia » metafunj, posted by sowhysosad on September 16, 2009, at 11:58:31
Thanks for reminding me. I totally forgot about that. I don't think it blocks D2 quite as powerfully as an antipsychotic. No incidences of TDD have been reported with Buspar use. But a lower dose might be better. Unfortunately most of these drugs have mechanisms other than the ones we want.
Posted by g_g_g_unit on September 18, 2009, at 6:40:27
In reply to Re: How did Prozac cause my permanent Anhedonia » sowhysosad, posted by metafunj on September 15, 2009, at 21:51:53
to those who suffer from anhedonia, i am just curious whether it's accompanied by issues with cognition and executive + social function? in that way is a subset of depression or a separate issue entirely?
i have never really had any problems with the above three categories - to a certain extent. i mean, i suffer from OCD, but i never used to see it interfering with my ability to start and complete projects, etc. (in fact, it was probably the opposite). i just took much longer to complete things.
unfortunately, after being on Remeron for 2 weeks and finding that it pushed my anxiety to a kind of breaking point, i cold turkeyed off the drug and entered a weird 'brain fog'. my doctor said it was a symptom of depression, but i had never suffered from depression until that point, only anxiety. so i am wondering if it was a depression induced by the emotional intensity of the Remeron-anxiety or if there is a more precise chemical explanation for the 'brain fog' possibly?
i bought his theory, and after being on SSRI's (Prozac for a week, Luvox for 2 months, Lexapro for 2 months), i found that after coming off i began to experience difficulties with socializing, attention (i would sit down to work at my computer, but just quickly flit through webpages instead), etc. i found a little success with nortriptyline in helping me complete tasks, but did not like the overall feel of the drug.
i tried staying off drugs hoping exercise etc. would induce a recovery, but just found these problems getting worse, so i agreed to go on Nardil which was great for mood + socialization, but did not help executive function.
i then swore i would again try remaining drug free, but am just finding it too hard coping with no attention span (i used to thrive on reading, movies, writing), so am now trialling Parnate. part of my OCD means i can't really leave the cognition, etc. issues alone, but i feel like i'm sort of on the wrong path. i feel like with improved executive function, my mood would improve, rather than visa versa, or is that just too simple an explanation?
i am really interested in maybe testing some of the ideas proposed here if Parnate does not work out, though do not have the pharmacological know-how and sensitivity to my brain's inner workings that you guys seem too. i would be happy to try anything though given that i feel so irrevocably altered by med use already, and it's not like any of my psych's ideas are working out - they mainly feel like interventions to stop me killing myself.
would the low dose of prozac (2.5mg) + buspar in all likelihood be anxiogenic?
Posted by metafunj on September 18, 2009, at 15:28:18
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by g_g_g_unit on September 18, 2009, at 6:40:27
Perhaps Prozac + Buspar would be anxiogenic, although both drugs are prescribed for anxiety, so you would think together they help more with anxiety.
However the both increase dopamine and at a higher dose buspar blocked the D2 receptor.
I think you would have to play with the dosages. You would probably want a low dose buspar and maybe start at 2.5 dose prozac and if you feel nervous increase the prozac so more of the SRI kicks in.
For me anhedonia started when I came off of prozac the first time. After about 3 weeks the anhedonia started. I immediately went back on but the anhedonia remained. It wasn't until I stopped prozac and stayed off, that concentration and memory problems started. Hopefully this is due to the serotonin dominance we have been discussing here, because I am running out of ideas.
Posted by Wanderer123 on September 18, 2009, at 19:44:19
In reply to Re: How did Prozac cause my permanent Anhedonia » g_g_g_unit, posted by metafunj on September 18, 2009, at 15:28:18
Has anyone here ever tried this http://www.integrativepsychiatry.net/neurotransmitter_tests.html ?
Posted by metafunj on September 18, 2009, at 20:26:45
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by Wanderer123 on September 18, 2009, at 19:44:19
not me, are you gonna give it a try?
Posted by g_g_g_unit on September 18, 2009, at 20:32:58
In reply to Re: How did Prozac cause my permanent Anhedonia » g_g_g_unit, posted by metafunj on September 18, 2009, at 15:28:18
> Perhaps Prozac + Buspar would be anxiogenic, although both drugs are prescribed for anxiety, so you would think together they help more with anxiety.
>
> However the both increase dopamine and at a higher dose buspar blocked the D2 receptor.
>
> I think you would have to play with the dosages. You would probably want a low dose buspar and maybe start at 2.5 dose prozac and if you feel nervous increase the prozac so more of the SRI kicks in.
>
> For me anhedonia started when I came off of prozac the first time. After about 3 weeks the anhedonia started. I immediately went back on but the anhedonia remained. It wasn't until I stopped prozac and stayed off, that concentration and memory problems started. Hopefully this is due to the serotonin dominance we have been discussing here, because I am running out of ideas.
>i guess what i'm curious about is the nature of your concentration problems? maybe it's different because i have OCD, so would always have ruminations to deal with when trying to concentrate. but i felt like i had the ability to a certain extent, to "override" the ruminations and stay focused on something. now i feel like the window of my attention is a lot smaller, and i lack that prompting ability, so i struggle with things like maintaining more complex trains of thought, or even reading more descriptive sections of books because i get a bit lost and the words don;t 'stick' mentally. i guess it feels exactly like ADD.
i'm wondering if that sounds too severe for anhedonia?
Posted by metafunj on September 19, 2009, at 0:30:01
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by g_g_g_unit on September 18, 2009, at 20:32:58
I think I feel the same way without the ruminations. Like in the past if I sat and played guitar I could focus on practicing one part or listening to a song and learning one part. But now I just keep playing and noodling and lose focus really fast. I also seem to lack the will now to stop the noodling and get back on track. I noticed when I read that often I don't even understand what I'm reading until I've read it a few times and my mind gets into read mode.
I tried to read a "Tale of Two Cities" and the language is so superfluous that I failed epicly.
Even writing coherent sentences can be a struggle.
I also can't remember songs as well, or figure out songs easily, or play by ear very well anymore. I forget things more and have more "looking for the thing that is actually in your hand" moments. I can't remember houses that I pass or landscapes very well. A lot of things just seem to blur together.All these symptoms + motivation/fatigue and anhedonia both emotional and sexual point to a dopamine transmittion problem. Hopefully increasing dopamine in the PFC and the nucleus accumbens as well as reducing some of the serotonin noise will take care of all of this.
Posted by g_g_g_unit on September 19, 2009, at 0:53:49
In reply to Re: How did Prozac cause my permanent Anhedonia, posted by g_g_g_unit on September 18, 2009, at 20:32:58
i guess the way i feel is similar to the negative symptoms of schizophrenia - only minus the 'thought disorder'.
Posted by Wanderer123 on December 22, 2009, at 22:06:45
In reply to Re: How did Prozac cause my permanent Anhedonia » Wanderer123, posted by metafunj on September 18, 2009, at 20:26:45
> not me, are you gonna give it a try?
Gave it a try. Got very low serotonin and dangerously high glutamate. Can that cause anhedonia, chronic tire, and excess sleep?
This is the end of the thread.
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