![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 2 to 26 of 130. Go back in thread:
Posted by tilmann on March 14, 1999, at 21:50:14
In reply to Effexor Withdrawl, posted by Leigh on March 13, 1999, at 14:47:08
> Why wasn't I told when starting this medicine that it would be so difficult to get off of? I started on July 13, 1998. Did no one know then?
>
> I was taking 300 mg a day. The withdrawl symptoms nearly parallel my depression. Even right now, I feel nauseous and dizzy and my head hurts. The description I read earlier of "a migrane without the headache" is pretty accurate, but my head hurts now, too.If you do a search on effexor on the internet, you will find many discussions of trying to get off effexor. They are a little scary as you are describing. This has scared me since I have been taking effexor for 2 years (75 mg/day). Why are you getting off. Did it poop out on you? My dosage seems to be pooping out on me now. I'm not sure whether I should increase my dosage or get off and try something else.
Any thoughts? Good luck.
>
> And my dreams are scary. So real. I honestly don't know what part of "Armageddon" was real and what part I dreamed.
>
> I just read that Benadryl helps. How long can I expect to have these symptoms and are they physically dangerous to me? How long should I take Benadryl?
Posted by lisa on March 18, 1999, at 12:28:23
In reply to Re: Effexor Withdrawl, posted by tilmann on March 14, 1999, at 21:50:14
> > Why wasn't I told when starting this medicine that it would be so difficult to get off of? I started on July 13, 1998. Did no one know then?
> >
> > I was taking 300 mg a day. The withdrawl symptoms nearly parallel my depression. Even right now, I feel nauseous and dizzy and my head hurts. The description I read earlier of "a migrane without the headache" is pretty accurate, but my head hurts now, too.
>
> If you do a search on effexor on the internet, you will find many discussions of trying to get off effexor. They are a little scary as you are describing. This has scared me since I have been taking effexor for 2 years (75 mg/day). Why are you getting off. Did it poop out on you? My dosage seems to be pooping out on me now. I'm not sure whether I should increase my dosage or get off and try something else.
>
> Any thoughts? Good luck.
> >
> > And my dreams are scary. So real. I honestly don't know what part of "Armageddon" was real and what part I dreamed.
> >
> > I just read that Benadryl helps. How long can I expect to have these symptoms and are they physically dangerous to me? How long should I take Benadryl?My psychiatrist took me off effexor cold turkey. I felt as though I was coming off heroin. I had the shakes & felt like my body was being torn into a thousand pieces. I can totally relate with how you are feeling. I took about a week to feel better. I went directly on celexa.
Posted by Matt on March 28, 1999, at 7:07:16
In reply to Re: Effexor Withdrawl, posted by lisa on March 18, 1999, at 12:28:23
One thing that is supposed to help with coming off SSRIs (and Effexor, I suppose) is to take 20mg Prozac for one or two days. I've not tried this myself, but I've seen it indicated by a number of p-docs. (I have, however, abrubtly stopped an SSRI and went to Prozac and experienced no withdrawl.) In fact, I'm fairly sure I've seen discussion of it in psych. tips. So you may want to try a search there and see what you can find.
Best of luck coming off the drug. I'm sorry you weren't told about this feature of Effexor before you started it. (It does seem to be underreported, I've found--about the only time I see it discussed is when someone in just your condition is asking exactly what you asking, "Why in the world didn't someone tell me about this before I started on this drug?")
Matt
Posted by john on March 28, 1999, at 20:52:30
In reply to Re: Effexor Withdrawl, posted by Matt on March 28, 1999, at 7:07:16
It took me 8 weeks of bizarre nausea and dizziness to get off
of Effexor. It was a horrible experience, and one which somewhat
exacerbated my depression, but the effects weren't permanent. The slower I
went off, the less strong these effects were, albeit I knew that coming
down slowly meant prolonging the the whole experience. I was taking 500 mgs.
I hope getting off slowly will help you. Keep in mind that the
that the withdrawal effects will stop for good.
Posted by CMG on September 2, 2001, at 23:07:52
In reply to Re: Effexor Withdrawl, posted by john on March 28, 1999, at 20:52:30
Could someone please tell me what they mean by the zing feeling. I only take 75 MG once a day. If I miss more then one day I feel like my body is shorting out all over. I feel real sick, and strange. I was not told about and with drawls before I was put on to Effexor. That really ticks me off .
Posted by u08cad on December 16, 2001, at 20:38:24
In reply to Re: Effexor Withdrawl, posted by john on March 28, 1999, at 20:52:30
I took anoverdose of 26 Effexor XR 75mg capsules last week. I was submitted to hospital and monitored and released after 2 days. I had previously pnly taken two days capsules of the drug. I took the overdose because of unhappiness and weird thoughts but also because having experimented with cocaine in the past, found that i achieved a similar albeit much milder rush from the Effexor capsules with the same tingly feeling and in this state thought an overdose would be a nice way to go as it were. Since then however I have had terrible thoguhts, hallucinations and nightmares, have felt very spaced out and suffered weird pins and needles type feelings. I also feel very floaty and really not with it. Is this like the Effexor withdrawal symptoms you guys have been describing because it is all rather frightening?
Posted by CMG on December 17, 2001, at 21:18:28
In reply to Re: Effexor Withdrawl, posted by u08cad on December 16, 2001, at 20:38:24
> I would not know how it feels, because I have not OD on Effexor. I found out about the side effects as the doctors want to call it, when I missed taking it. I called my doctor, told her I wanted off of Effexor. Her come back was "Why would I want off of it." I told her I do not want to take any meds. that take months to get off of. So I had to go it alone. I break the pill in half twice. I can miss a day and thats it. I really don't like the withdrawl at all. I have head aches, a feeling of being shocked or zinged (I guess the shocked feeling is the same as zinged) and feeling Like I will throw up at any second. After thinking about it dizzy at times. I have taken Busbar and another one that I can't remember the name. I went right off with just some shakeness. I think doctors should do more studies on Effexor before giving it out. My mom is taking a form of it, but it is in a capsal. Mine is shaped like a house. I don't know what the difference is. If she misses a couple days she cries all the time. I would rather have the cring as a side effect then what I have.
Please no one take anything to try to end it all. There is always something new around the corner. What if it is a better way of life, you will miss out and not know it. Besides it is the chickens way out. Happiness isn't handed to us on a silver plater. Some times we have to work at it.
Posted by twiggy on December 18, 2001, at 10:23:22
In reply to Re: Effexor Withdrawl, posted by u08cad on December 16, 2001, at 20:38:24
As CMG stated with his mother, I also cry when I miss a dose or two. I have done this on maybe five occasions since June. It's weekends when I'm off schedule that I forget. I am only taking 75mg (capsule). Anyway, it becomes obvious when I either start feeling very irritable or overly emotional. It seems "dealable", however it is only a short time period. If I were withdrawing for good, I'll probably have more to contend with. I'd guess that all these odd reactions that you're getting is due to the incredible abundance that your body ingested. I'm sure that would take a while to adjust. If you're serious about getting well, for starters you should accept consequences for such an extreme action. I honestly hope you are receiving counseling. Sadly, it sounds like you have alot more to deal with than a simple medication can take care of. I wish you luck.
Posted by care on December 18, 2001, at 22:26:22
In reply to Re: Effexor Withdrawl, posted by twiggy on December 18, 2001, at 10:23:22
> As CMG stated with his mother, I also cry when I miss a dose or two. I have done this on maybe five occasions since June. It's weekends when I'm off schedule that I forget. I am only taking 75mg (capsule). Anyway, it becomes obvious when I either start feeling very irritable or overly emotional. It seems "dealable", however it is only a short time period. If I were withdrawing for good, I'll probably have more to contend with. I'd guess that all these odd reactions that you're getting is due to the incredible abundance that your body ingested. I'm sure that would take a while to adjust. If you're serious about getting well, for starters you should accept consequences for such an extreme action. I honestly hope you are receiving counseling. Sadly, it sounds like you have alot more to deal with than a simple medication can take care of. I wish you luck.
I just started taking effexor about three months
ago and my doctor did not mention anything about
any withdrawl symtoms. This scares me, I felt that way
before I started taking the medication I don't want
to feel that way again.
Is it just effexor that has really bad withdrawl symstems
or is it paxil too?
Posted by Cam W. on December 20, 2001, at 11:55:29
In reply to Re: Effexor Withdrawl, posted by CMG on December 17, 2001, at 21:18:28
CMG - The venlafaxine (generic name) that you are taking the regular Effexor™ and your mom is taking Effexor XR™. The difference is the half-life (the time it takes for half of the drug to leave your body). The half-life of Effexor is about 5 hours and the half-life of Effexor XR is about 15 hours. This means that your mom can take one dose per day, while you have to take at least 2 doses per day.
I actually do not recommend anyone taking the regular Effexor, as you can run the risk of starting to go through the serotonergic withdrawl within 8 hours of missing a dose. So, even though you are decreasing your dose in an effort to come off of the drug, you must still take multiple doses per day to minimize the risk of withdrawl symptoms. I do not recommend withdrawing from Effexor without having a doctor monitoring your doing so.
In actuality, most people do not have a problem withdrawing from Effexor, if done properly. Many people can even stop taking the drug cold turkey, if they are taking the Effexor XR in doses equal to or less than 75mg/day, with minimal withdrawl symptoms. The one's who do have problems are those who metabolize the drug faster (ie. have multiple repeats of the gene that encodes a liver enzyme called cytochrome-P450-2D6 or CYP-2D6).
The very fast metabolizers, thought to be about 5% of those of European decent, do need help withdrawing from Effexor (and Paxil™ [paroxetine], Luvox™ [fluvoxamine] and occasionally Zoloft™ [sertraline]). A doctor can prescribe Prozac™ 10mg or 20mg per day, to be taken with as low a dose as possible of Effexor XR (ie. the dose at which the withdrawl symptoms apppear). The Prozac and Effexor XR are taken together for a week, then the Effexor XR is stopped, and the Prozac is taken for another week. The long half-life of Prozac (4 to 6 days) prevents the appearance of serotonergic withdrawl symptoms, as the drug leaves the body very slowly, allowing the body to adapt to the lower levels of serotonin.
I believe that the appearance of withdrawl symptoms is (partially) an indication that the depression (or anxiety or obsessive/compulsive symptoms, etc.) has not resolved and the SSRI should be continued. In other words, the body has not started to produce enough serotonin on it's own, meaning that the situation that caused the depression has not been resolved (ie. in the case of a reactive or exogenous depression - not genetic depression - one has not dealt with and resolved the issues that caused the depression in the first place - usually through some sort of cognitive psychotherapy).
I hope that this helps you to understand what could be causing you to experience serotonergic withdrawl symptoms from Effexor. - Cam
Posted by IsoM on December 20, 2001, at 14:11:48
In reply to Re: Effexor Withdrawl » CMG, posted by Cam W. on December 20, 2001, at 11:55:29
Sorry Cam, but I've got another question.
I was wondering if relying on SSRIs to keep serotonin longer in the synaptic gap, would perhaps reset the brain's chemistry so that our own chemistry would be altered to not produce as much.
I'm thinking of people who aren't hypothyroidic (sp?) taking thyroxine. If they continue, the pituitary gland will send out less & less TSH. If they were to stop taking thyroxine, they'd have all the symptoms of hypothyroidism. Same with taking cortisone for prolonged periods. I know the body picks up later but it doesn't mean they still need to be on the hormones.
Is my thinking off because of factors I don't know?
**************************************************************************************************
> CMG - The venlafaxine (generic name) that you are taking the regular Effexor™ and your mom is taking Effexor XR™. The difference is the half-life (the time it takes for half of the drug to leave your body). The half-life of Effexor is about 5 hours and the half-life of Effexor XR is about 15 hours. This means that your mom can take one dose per day, while you have to take at least 2 doses per day.
>
> I actually do not recommend anyone taking the regular Effexor, as you can run the risk of starting to go through the serotonergic withdrawl within 8 hours of missing a dose. So, even though you are decreasing your dose in an effort to come off of the drug, you must still take multiple doses per day to minimize the risk of withdrawl symptoms. I do not recommend withdrawing from Effexor without having a doctor monitoring your doing so.
>
> In actuality, most people do not have a problem withdrawing from Effexor, if done properly. Many people can even stop taking the drug cold turkey, if they are taking the Effexor XR in doses equal to or less than 75mg/day, with minimal withdrawl symptoms. The one's who do have problems are those who metabolize the drug faster (ie. have multiple repeats of the gene that encodes a liver enzyme called cytochrome-P450-2D6 or CYP-2D6).
>
> The very fast metabolizers, thought to be about 5% of those of European decent, do need help withdrawing from Effexor (and Paxil™ [paroxetine], Luvox™ [fluvoxamine] and occasionally Zoloft™ [sertraline]). A doctor can prescribe Prozac™ 10mg or 20mg per day, to be taken with as low a dose as possible of Effexor XR (ie. the dose at which the withdrawl symptoms apppear). The Prozac and Effexor XR are taken together for a week, then the Effexor XR is stopped, and the Prozac is taken for another week. The long half-life of Prozac (4 to 6 days) prevents the appearance of serotonergic withdrawl symptoms, as the drug leaves the body very slowly, allowing the body to adapt to the lower levels of serotonin.
>
> I believe that the appearance of withdrawl symptoms is (partially) an indication that the depression (or anxiety or obsessive/compulsive symptoms, etc.) has not resolved and the SSRI should be continued. In other words, the body has not started to produce enough serotonin on it's own, meaning that the situation that caused the depression has not been resolved (ie. in the case of a reactive or exogenous depression - not genetic depression - one has not dealt with and resolved the issues that caused the depression in the first place - usually through some sort of cognitive psychotherapy).
>
> I hope that this helps you to understand what could be causing you to experience serotonergic withdrawl symptoms from Effexor. - Cam
Posted by Cam W. on December 20, 2001, at 15:35:47
In reply to CAM: SSRIs and Our Body's Synthesis of Serotonin » Cam W., posted by IsoM on December 20, 2001, at 14:11:48
IsoM - I would think that SRIs would force our bodies to produce more serotonin. SRIs block the reuptake of serotonin back into the presynaptic neuron, so the body is unable the reuse the neurotransmitter. The serotonin "trapped" in the gap is, for the most part, metabolized, but the levels of serotonin in the gap are still going to be higher while taking the antidepressant than they would be after the antidepressant is stopped. This would result in the serotonergic withdrawl syndrome that is seen; and the less serotonin the body is producing would result in more severe withdrawl effects. This would be exacerbated in those people who also are polymorphic for CYP-2D6 (ie. have multiple copies of the cytochrome-P450-2D6 enzyme gene).
This mechanism is different from adding levothyroxin (Synthroid™) in hypothyroidism, as you are not adding serotonin to the body with SRIs, you are blocking it's reuptake. The body is still responsible for producing all the serotonin that it is using.
That's the way I see it, anyway. - Cam
Posted by BobS. on December 20, 2001, at 19:18:28
In reply to Re: CAM: SSRIs and Our Body's Synthesis of Serotonin » IsoM, posted by Cam W. on December 20, 2001, at 15:35:47
Cam,
Are you saying that individuals who are "polymorphic for CYP-2D6" are more susceptable to SSRI withdrawal? If so, how does one determine if they harbor this genetic variation?
Thanks,
BobS.
> IsoM - I would think that SRIs would force our bodies to produce more serotonin. SRIs block the reuptake of serotonin back into the presynaptic neuron, so the body is unable the reuse the neurotransmitter. The serotonin "trapped" in the gap is, for the most part, metabolized, but the levels of serotonin in the gap are still going to be higher while taking the antidepressant than they would be after the antidepressant is stopped. This would result in the serotonergic withdrawl syndrome that is seen; and the less serotonin the body is producing would result in more severe withdrawl effects. This would be exacerbated in those people who also are polymorphic for CYP-2D6 (ie. have multiple copies of the cytochrome-P450-2D6 enzyme gene).
>
> This mechanism is different from adding levothyroxin (Synthroid™) in hypothyroidism, as you are not adding serotonin to the body with SRIs, you are blocking it's reuptake. The body is still responsible for producing all the serotonin that it is using.
>
> That's the way I see it, anyway. - Cam
Posted by Cam W. on December 21, 2001, at 0:12:21
In reply to Re: CAM: SSRIs and Our Body's Synthesis of Serotonin, posted by BobS. on December 20, 2001, at 19:18:28
Bob - I do know that they do test for it. I haven't seen the original study, so I don't know exactly how they do it, but I am certain they know where the gene is, I have read many reviews quoting that 5% of those of European decent (us honkies) are polymorphic. This would mean that any drug metabolized by CYP-2D6 would be metabolized faster. The problem with my theory is that Effexor is also metabolized, to a lesser extent, by CYP-3A4, CYP-2C19, and CYP-1A2. CYP-2D6 metabolizes venlafaxine to the equally active O-desmethylvenlafaxine (ODV).
I did read a article in which poor and extensive metabolizers of CYP-2D6 were tested in vitro (ie. not in living people, but in test tubes with a little and a lot of the CYP-2D6 enzyme to see if there was any difference in metabolic rate. The study concluded that there wasn't any difference in total exposure "to the sum of the two active species" (ie. venlafaxine and ODV).
So, what the above means is that both venlafaxine and ODV are active to a similar extent, in a test tube. This does not take into account the real life situation where ODV is peed off twice as fast as venlafaxine. So, since the in vitro study did not separate venlafaxine from ODV (they didn't think they had to because both molecules have similar potency). Since the extensive metabolizers produce more ODV sooner, they would pee more of this metabolite out, more quickly, than would the poor metabolizers. Therefore, extensive metabolizers should rid the body of venlafaxine faster.
Anyway, yes there is a way to test for CYP-2D6 polymorphism, I just don't know how or where you would get it done.
(Sorry for thinking out loud above) - Cam
Posted by Lucas on December 23, 2001, at 16:16:47
In reply to Re: Effexor Withdrawl, posted by CMG on December 17, 2001, at 21:18:28
> > I would not know how it feels, because I have not OD on Effexor. I found out about the side effects as the doctors want to call it, when I missed taking it. I called my doctor, told her I wanted off of Effexor. Her come back was "Why would I want off of it." I told her I do not want to take any meds. that take months to get off of. So I had to go it alone. I break the pill in half twice. I can miss a day and thats it. I really don't like the withdrawl at all. I have head aches, a feeling of being shocked or zinged (I guess the shocked feeling is the same as zinged) and feeling Like I will throw up at any second. After thinking about it dizzy at times. I have taken Busbar and another one that I can't remember the name. I went right off with just some shakeness. I think doctors should do more studies on Effexor before giving it out. My mom is taking a form of it, but it is in a capsal. Mine is shaped like a house. I don't know what the difference is. If she misses a couple days she cries all the time. I would rather have the cring as a side effect then what I have.
> Please no one take anything to try to end it all. There is always something new around the corner. What if it is a better way of life, you will miss out and not know it. Besides it is the chickens way out. Happiness isn't handed to us on a silver plater. Some times we have to work at it.Yes!
This is a very good posting. In my own experience, I have found doctors to be quite reckless when it comes to switching their patients' meds, and in giving advice in general. Granted, there is a lot that is not known about the effects of these drugs, but the great wealth of information on this website alone demonstrates that there is much to learn from patients' firsthand experiences, if only the doctors would take the time to listen, and to share what they have heard. Of course, most doctors surely don't demonstrate such carelesness and arrogance - just my luck of the draw, I guess.
My ranting aside, I wish you all the best on your journey with these meds. Try to remember that the side-effects WILL subside on their own (eventually). I've recently given up on antidepressants altogether. I'm in a far better emotional and psychological space than I was when I started, and besides - since I started taking these things, I've longed to feel like my old self again. Taking these meds is not a one-sided thing: You DO have to live with certain parts of your personality being 'numbed' - and not just the parts that relate to your depression. I'm an artist, and that's a compromise I am no longer willing to make.
Something my doctors never told me: You don't have to stay on these things forever!
Good Luck!
Posted by Ron Hill on December 24, 2001, at 1:29:15
In reply to Re: CAM: SSRIs and Our Body's Synthesis of Serotonin, posted by BobS. on December 20, 2001, at 19:18:28
Bob S:
I apparently sent my previous post twice and also gave the wrong home page address for Genelex. Oh well, I'm sure you found your way from the ordering page back to the home page. I wanted to include the home page link because they also have some other useful information on their site in addition to the test kit ordering.
For sake of completeness, let me try again:
Home Page: http://www.healthanddna.com/
There! That feels much better now that the anal OCD component of my personality has been satisfied by making the corrections!
-- Ron
------------------------------------------
> Cam,
> Are you saying that individuals who are "polymorphic for CYP-2D6" are more susceptable to SSRI withdrawal? If so, how does one determine if they harbor this genetic variation?
> Thanks,
> BobS.
> > IsoM - I would think that SRIs would force our bodies to produce more serotonin. SRIs block the reuptake of serotonin back into the presynaptic neuron, so the body is unable the reuse the neurotransmitter. The serotonin "trapped" in the gap is, for the most part, metabolized, but the levels of serotonin in the gap are still going to be higher while taking the antidepressant than they would be after the antidepressant is stopped. This would result in the serotonergic withdrawl syndrome that is seen; and the less serotonin the body is producing would result in more severe withdrawl effects. This would be exacerbated in those people who also are polymorphic for CYP-2D6 (ie. have multiple copies of the cytochrome-P450-2D6 enzyme gene).
> >
> > This mechanism is different from adding levothyroxin (Synthroid™) in hypothyroidism, as you are not adding serotonin to the body with SRIs, you are blocking it's reuptake. The body is still responsible for producing all the serotonin that it is using.
> >
> > That's the way I see it, anyway. - Cam
Posted by BobS. on December 24, 2001, at 9:21:20
In reply to Sorry for Mistakes -- It's Late » BobS., posted by Ron Hill on December 24, 2001, at 1:29:15
Ron,
Thanks for the multiple follow-ups. I wouldn't call it anal, just a nice guy.
> Bob S:
>
> I apparently sent my previous post twice and also gave the wrong home page address for Genelex. Oh well, I'm sure you found your way from the ordering page back to the home page. I wanted to include the home page link because they also have some other useful information on their site in addition to the test kit ordering.
>
> For sake of completeness, let me try again:
>
> Home Page: http://www.healthanddna.com/
>
> There! That feels much better now that the anal OCD component of my personality has been satisfied by making the corrections!
>
> -- Ron
> ------------------------------------------
>
>
> > Cam,
> > Are you saying that individuals who are "polymorphic for CYP-2D6" are more susceptable to SSRI withdrawal? If so, how does one determine if they harbor this genetic variation?
> > Thanks,
> > BobS.
> > > IsoM - I would think that SRIs would force our bodies to produce more serotonin. SRIs block the reuptake of serotonin back into the presynaptic neuron, so the body is unable the reuse the neurotransmitter. The serotonin "trapped" in the gap is, for the most part, metabolized, but the levels of serotonin in the gap are still going to be higher while taking the antidepressant than they would be after the antidepressant is stopped. This would result in the serotonergic withdrawl syndrome that is seen; and the less serotonin the body is producing would result in more severe withdrawl effects. This would be exacerbated in those people who also are polymorphic for CYP-2D6 (ie. have multiple copies of the cytochrome-P450-2D6 enzyme gene).
> > >
> > > This mechanism is different from adding levothyroxin (Synthroid™) in hypothyroidism, as you are not adding serotonin to the body with SRIs, you are blocking it's reuptake. The body is still responsible for producing all the serotonin that it is using.
> > >
> > > That's the way I see it, anyway. - Cam
Posted by stjames on December 24, 2001, at 23:59:41
In reply to Re: CAM: SSRIs and Our Body's Synthesis of Serotonin » IsoM, posted by Cam W. on December 20, 2001, at 15:35:47
> IsoM - I would think that SRIs would force our bodies to produce more serotonin. SRIs block the reuptake of serotonin back into the presynaptic neuron, so the body is unable the reuse the neurotransmitter. The serotonin "trapped" in the gap is, for the most part, metabolized, but the levels of serotonin in the gap are still going to be higher while taking the antidepressant than they would be after the antidepressant is stopped. This would result in the serotonergic withdrawl syndrome that is seen; and the less serotonin the body is producing would result in more severe withdrawl effects.
james here....
If mental illness were simply a lack or too much of something, I would suspect most of us would be cured. To me it is about regulation, stopping the meds means the body must rebalance itself, but not in the sence of making more or less NT.
Neurology is far from simple, so more NT=better/worse is also too simple. The end result
of mood is not a one step process from synaptic gap functions to mood changes. There are many other steps to the end result, mood.AD's seem to act at the gap but I have long felt AD's do not get at the root cause of clinical depression. If they did the sucess rate would be higher. Sometimes you can work out a problem by starting in the middle; AD's do work for many. The sucess of dirty drugs and polypharm seems to indicate, again, that the root cause is missed but by a shotgun approach can knock the system into a better state of functioning.
Or I could reason that there is no one root cause/treatment for clinical depression; those that do well on AD's are a "good fit". Agents that effect different parts of the chain of events resulting in mood are needed to treat
the non-responders and hard to treat.Cam, comments ?
j
Posted by IsoM on December 25, 2001, at 1:10:53
In reply to Re: James tangent, posted by stjames on December 24, 2001, at 23:59:41
I do agree with you, James. Neurochemistry is such a complicated subject & we've hardly begun to scratch the surface. What we know about neurotransmitters is just at the beginning stage. I did understand that SSRIs just inhibit the reuptake of serotonin (like the acronym says) but I wonder if it doesn't perhaps "reset" something in our brain chemistry still.
I noticed something about my use of antidepressants & because I'm open about my use of them, many other people that I know who may never have talked about their need of them, have opened up to me. I've seen a similar pattern develop among many users. If someone has been on ADs for a relatively short period & then tapers off them after their depression is judged clinically better, or "cured", the relapses seem to be much less than those who are on ADs for a couple of years or more.
I initially went on tricyclics to control my migraines. I had them as often as once or twice a week. Beta-blockers did nothing but give me a severe asthma attack as the dose was increased. Actually, the tricyclics didn't help the migraines, but I was surprised at my mood change. I wasn't seriously depressed before but felt really low in winter & had difficulty controlling my frustration & irritation if things didn't work out right. While the AD made a remarkable difference, I wouldn't have said my life was unbearable before.
But when I try to go off ADs now, my rage, irritation, & bleakness are SO powerful - frightening so. I can feel such a rage over little things, that I'd gladly drag a person from their car & beat them for failing to signal a left-turn at a light. I'm just a slight-boned woman but people honestly stepped around me when I felt like that. I'd always been easily stressed before & pretty low many times but could still feel real laughter & joy other times.
Now, it's as if the ADs are absolutely necessary. I DO like feeling as I do now (with the ADs working), but why the extreme change? And I'm not unique this way. Many others I've asked have also said the same thing.
**What's caused this change in our brains?**
And I KNOW & INSIST that it's not just that I can't properly remember how I felt before. I do remember never feeling so horribly negative before I ever started meds.
****************************************************************************************************
> > IsoM - I would think that SRIs would force our bodies to produce more serotonin. SRIs block the reuptake of serotonin back into the presynaptic neuron, so the body is unable the reuse the neurotransmitter. The serotonin "trapped" in the gap is, for the most part, metabolized, but the levels of serotonin in the gap are still going to be higher while taking the antidepressant than they would be after the antidepressant is stopped. This would result in the serotonergic withdrawl syndrome that is seen; and the less serotonin the body is producing would result in more severe withdrawl effects.
>
> james here....
>
> If mental illness were simply a lack or too much of something, I would suspect most of us would be cured. To me it is about regulation, stopping the meds means the body must rebalance itself, but not in the sence of making more or less NT.
>
> Neurology is far from simple, so more NT=better/worse is also too simple. The end result
> of mood is not a one step process from synaptic gap functions to mood changes. There are many other steps to the end result, mood.
>
> AD's seem to act at the gap but I have long felt AD's do not get at the root cause of clinical depression. If they did the sucess rate would be higher. Sometimes you can work out a problem by starting in the middle; AD's do work for many. The sucess of dirty drugs and polypharm seems to indicate, again, that the root cause is missed but by a shotgun approach can knock the system into a better state of functioning.
>
> Or I could reason that there is no one root cause/treatment for clinical depression; those that do well on AD's are a "good fit". Agents that effect different parts of the chain of events resulting in mood are needed to treat
> the non-responders and hard to treat.
>
> Cam, comments ?
>
> j
Posted by stjames on December 25, 2001, at 2:06:16
In reply to Re: James' Ideas - A Question » stjames, posted by IsoM on December 25, 2001, at 1:10:53
I noticed something about my use of antidepressants & because I'm open about my use of them, many other people that I know who may never have talked about their need of them, have opened up to me. I've seen a similar pattern develop among many users. If someone has been on ADs for a relatively short period & then tapers off them after their depression is judged clinically better, or "cured", the relapses seem to be much less than those who are on ADs for a couple of years or more.
I tend to feel if one has more than 3 relapses, it is a cronic depression. While AD's control depression, they do not halt it. This is much like diabetes; the meds control but do not halt
the progress of disease. So in the case of the person on AD's for years; I would say their depression has progressed and returns with greater effect. People who can get off the meds
quickly probably do not have as significant depresson, starting out.Chronic illness is measured in lifetimes, so it is difficult to draw conculsions based on a few years data. Now with 50 years data on AD's we will be able to draw better protocals for treatment. I am leaning toward treating it sooner and aggressively as being key to keeping people from lapsing into a chronic condition.
j
Posted by Cindylou on December 25, 2001, at 7:09:11
In reply to Re: James' Ideas - A Question » stjames, posted by IsoM on December 25, 2001, at 1:10:53
I started on ADs in 1988. The doctor told me after about 5 or 6 months, my brain would be "reset" as you put it, and my depression cured.
I relapsed back into depression within a few months after stopping the med.
Every time I've been on ADs and stopped, whether on them for a short time or a long time, the depression has come back. For me, it is a chronic illness.
I agree with James, that perhaps if I was treated earlier (when I was 13 instead of 25) I may have been able to overcome the illness -- maybe my brain would have been maleable (spelling on that one??) enough at age 13 to be able to be "reset."
Just a thought,
cindy
If someone has been on ADs for a relatively short period & then tapers off them after their depression is judged clinically better, or "cured", the relapses seem to be much less than those who are on ADs for a couple of years or more.> > james here....
> >
> > If mental illness were simply a lack or too much of something, I would suspect most of us would be cured. To me it is about regulation, stopping the meds means the body must rebalance itself, but not in the sence of making more or less NT.
> >
> > Neurology is far from simple, so more NT=better/worse is also too simple. The end result
> > of mood is not a one step process from synaptic gap functions to mood changes. There are many other steps to the end result, mood.
> >
> > AD's seem to act at the gap but I have long felt AD's do not get at the root cause of clinical depression. If they did the sucess rate would be higher. Sometimes you can work out a problem by starting in the middle; AD's do work for many. The sucess of dirty drugs and polypharm seems to indicate, again, that the root cause is missed but by a shotgun approach can knock the system into a better state of functioning.
> >
> > Or I could reason that there is no one root cause/treatment for clinical depression; those that do well on AD's are a "good fit". Agents that effect different parts of the chain of events resulting in mood are needed to treat
> > the non-responders and hard to treat.
> >
> > Cam, comments ?
> >
> > j
Posted by IsoM on December 26, 2001, at 1:35:27
In reply to Re: James' Ideas - A Question, posted by Cindylou on December 25, 2001, at 7:09:11
Ah well, I gave the idea a shot. I'm always trying to look at things from a new angle, perhaps get a different or new understanding of how things work.
I was just surprised to see how it had grown, untreated, from a mild depression & irritation, to such full-blown depression & irritation bordering on rage, untreated, over a period of 10 years or so. Always looking for answers.
Posted by Cam W. on December 26, 2001, at 18:19:26
In reply to Re: James tangent, posted by stjames on December 24, 2001, at 23:59:41
James - I see the NT thing as a side effect (coincidental effect? result?) of what is/are the true malfunction(s) we call depression. Adding back NTs to the system (however we do it) seems to resolve some of the "symptoms" of depression. As for Tx-resistant depression, I feel that, even though there may be a resulting lack of NTs in the synaptic gap, adding the appropriate NT does not circumvent the malfunction to enough (or any) extent in these instances.
We get back to that old problem (of which we have talked of, in the past) of the resulting symptoms of what we call "depression" are arrived at via multiple, independent pathways. We are still "splicing wires" in all of our treatments of any mental disorder, and we are doing it with "ice" (ie. none of our treatments, in themselves, are cures, therefore we must keep adding "ice" to the spliced wires, to replace the "melted ice", so that the symptoms do not return (as readily).
Just a thought - Cam
Posted by dove on December 28, 2001, at 11:49:15
In reply to Re: James' Ideas - A Question, posted by stjames on December 25, 2001, at 2:06:16
> If someone has been on ADs for a relatively short period & then tapers off them after their depression is judged clinically better, or "cured", the relapses seem to be much less than those who are on ADs for a couple of years or more.
>
>I just read an article or abstract within the last two months that stated quite a different opinion on this subject. It stated that extending the length of time on the AD treatment proved to lessen the number of relapses significantly in those who had either suffered from a relapse in the past; or, were at risk (in their opinion) for a relapse in the future due to circumstance, genetics, and/or any co-morbid diseases, even if they had been clinically dxed as "better".
I *believe* I read this somewhere on http://psychiatry.medscape.com . If I find it I will post it ASAP.
dove
Posted by stjames on December 29, 2001, at 14:36:31
In reply to Re: James' Ideas - A Question, posted by dove on December 28, 2001, at 11:49:15
> > If someone has been on ADs for a relatively short period & then tapers off them after their depression is judged clinically better, or "cured", the relapses seem to be much less than those who are on ADs for a couple of years or more.
To be honest, I have never found the above to be true.
> I just read an article or abstract within the last two months that stated quite a different opinion on this subject. It stated that extending the length of time on the AD treatment proved to lessen the number of relapses significantly in those who had either suffered from a relapse in the past; or, were at risk (in their opinion) for a relapse in the future due to circumstance, genetics, and/or any co-morbid diseases, even if they had been clinically dxed as "better".
And the above to be very true.Treating for 6 months to a year gives a better outcome that just a few months. Treating for just a few months makes it more likely to relapse.
j
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.