Posted by SLS on May 9, 2001, at 18:01:31
In reply to Re: Effexor: MY Conclusions, posted by Irene on May 8, 2001, at 15:19:20
Hi Irene.
> >Often, when someone in your position discontinues an antidepressant and relapses, the previously effective drug is no longer effective.
> Do you know why returning to a previously effective drug is often unsuccessful?
No.
I might be tempted to try to create the "hypothesis of the day", except that it would give the false impression that the brain is so readily understandable. That is not to say that the workings of the brain are still the total mystery that they were only a few decades ago. However, far less is known than unknown, and even less is understood. What is known is that the brain, like many other components of our biology, can and does change in response to varying stimuli. When a drug is introduced to the brain for the first time, it reacts strongly to it. It is said to be "naive" to that particular drug. As time progresses, the brain and its neurons make adjustments in an effort to compensate for these new forces. They try to function in the way they think they are supposed to instead of in the way they are being forced to. Neuroscience has observed that some of these compensatory changes involve the numbers and "stickiness" of neuron receptors, increases or decreases in the amount of neurotransmitters, and the excitability of the neuron to receive and send messages.
When some drugs are discontinued, the brain does not return exactly to the same state it was prior to their introduction. I guess this can be a good thing if some of the changes produced means that it is "holding" the remission of depression. However, if the need arises for the reintroduction of the same drug, it is not encountering the same brain. There are residual changes to the brain that have been produced by its previous exposure to it. These changes may persist for years. The brain is no longer naive it, and might not react to it in the same way or as strongly. I guess you could say that the brain is less likely to be fooled by the same magic trick.
> >The risk of relapse can be significantly reduced by coming off an antidepressant very gradually. So too can be the withdrawal effects. Most people do not do this. The most likely time until relapse, should it occur, is during the first 4 months.
> I'm not clear on the above. Do you mean that if one feels well after stopping a drug, and if he/she is going to relapse, it most likely would happen within 4 months of stopping previous medication?
Yes. Exactly.
> >It might be best for you to remain wary, and perhaps keep a mood diary. If you see yourself beginning to slide back towards depression, you might want to consider returning to Effexor as soon as possible and titrate the dosage up as quickly as you can tolerate.
> Now I'm concerned. Every time I decreased from 225 to 150; 150 to 75; 75 to 37, I always got well again after a few weeks of 'yuckiness', therefore believing my depressive episode was over - that my body was able to muster up the serotonin after all. I had no relief, however, decreasing from 37 downward. Does that mean that the 2 months of yuckiness I felt then meant it was the real depression and I should have gone back to increasing Effexor instead of waiting that long? and therefore Effexor will no longer be effective for me in the future? That would be awful, because Effexor worked wonderfully for me.
I really don't think you placed yourself in a position of risk to qualify for the scenario I described above because you have not stopped taking Effexor completely nor for very long. If you and your doctor have become convinced that you need to continue treatment, everything should be peachy-keen once you return to your optimal therapeutic dosage.
Something that was mentioned by a smart person whose name I don't recall was that one must be careful not to confuse the withdrawal effects of drug discontinuation with the return of depression. I find that some drugs can exert a stimulatory or activating effect. As the drug is withdrawn, there might be a sort of stimulant let-down and fatigue with each reduction of dosage. I get the impression that the dopamine effects of Effexor are underestimated, and that such a let-down upon its discontinuation is possible.
If you are indeed relapsing into depression, raising the dosage of Effexor again will do the trick. Don't worry. :-)
> PS, are you in medical field, or are you speaking from personal experience only?
I consider myself as being in the medical field in so far as it is the field where the doctors are playing their football game. I'm only the ball.
- Scott
poster:SLS
thread:13781
URL: http://www.dr-bob.org/babble/20010507/msgs/62285.html