Posted by Mr. SadPuppyDog on September 27, 2002, at 11:55:19
In reply to WHY do AD's poop out?, posted by tina on September 24, 2002, at 10:14:21
> What is the mechanism that makes them stop working all of a sudden?
> Please, no sarcastic remarks. I genuinely want to know.None of the answers you got answer your question. Nobody really knows why antidepressants stop working, but they do stop working sometimes. Unfortunately. This is dangerous for it can sometimes lead to a "treatment resistant depression" and chronic disability. Which is a dangerous situation to find yourself in to say the least.
Probably the biggest reason why ADs do not work good is coadminstration of depressant drugs such as benzos and alcohol. Many depressives continue taking benzos like klonopin or Xanax long after they should have stopped taking benzos. This is usually a big mistake. Benzos taken over the longterm almost always lead to worsened depression. Benzos are like booze basically, they just depress your nervous system more and more.
Also drinking booze, even in small amounts, can cause antidepressants to poop out. Just one or two beers a day can cause an SSRI to not work good. Its best to totally avoid booze if on antidepressants and the more severe your depression, the more important it is to avoid booze completely.
Again, any type of CNS depressant drug taken with an antidepressant can cause the AD to not work at full speed. Now if youve eliminated CNS depressant drugs from the picture, you then get into "true" antidepressant poop out, which is pretty scary actually when you think about it.
Probably the single biggest theory about why ADs poop out is dopamine depletion. Some theorize that when youve been on an antidepressant for a while, especially serotonergic ADs, that the subtle dopamine depletion results in loss of effectiveness and activation. Another thing that can cause antidepressants to stop working good is thyroid problems, but I think this is overhyped myself. Especially in male depressives. Thyroid probs are more common in female depression.
The subtle bipolar thing is also overhyped IMO. Many people who experience AD poopout go onto do the best on noradrenergic and dopaminergic antidepressants like MAOIs, high dose Wellbutrin, high dose Effexor, plain old speed (amphetamines) and of course ECT. ECT is VERY dopaminergic BTW, ECT creates so many brain changes you couldnt go into it all here.
Another thing to know ahead of time is anytime you get a Pdoc who tells you that your meds dont work cause you have some kind of personality disorder...run the other way. Fire the son of a bitch. Some Pdocs get frustrated with patients who dont respond good to antidepressants and start labeling you with all kinds of personality disorders. Most of the time this is unnecessary and bad psychiatry. Personality disorders are mostly BS anyway, mostly just label stuff, invented by psychologists. Personality disorders are not actual clinical mental illnesses, like major depression, manic depression or schizophrenia.
If you are doing everything right and your Pdoc starts making up reasons why your meds dont work good, find another Pdoc please. They are NO GOOD.
The bottom line is that the psychiatrists dont know...and really dont seem to care or be interested in finding out why antidepressants "poop out." They have a few theories, but again these are just theories...or better yet hypothesis. Opinions is more like it. Most psychiatrists are not very interested in the hard science of this stuff. You are on your own basically. If your med poops out, your best odds are the straightforward approach. Which means simply increasing the dosage works best. If that doesnt work, get your thyroid tested, maybe try lithium augmentation to rule out bipolar problems and if none of the above work...go have ECT done.
Mr. Sad PuppyDog
poster:Mr. SadPuppyDog
thread:120927
URL: http://www.dr-bob.org/babble/20020922/msgs/121226.html