Posted by bleauberry on December 6, 2009, at 9:50:28
In reply to Re: The Three Day Blip Of Antidepressants » Phillipa, posted by SLS on December 6, 2009, at 5:26:17
> > Could be the beginning of the mystery of the three day response to ad's. Have to start somewhere. Phillipa
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> > http://biopsychiatry.com/delay.htmMy theory of the 3-day blip is two-fold. First, the synapses feel good when they suddenly have more neurotransmitters than they are accustomed to. But then the feedback loops kick in, which takes about 3 days. At that time, I believe gene instruction for amino acid utilization is changed, receptor sensitivity is changed, and the production of neurotransmitters is slowed down or stopped. When production resumes after things have settled down in the new environment, that's when improvement comes...coincidentally it takes a few weeks...IF it is going to happen. That's a big IF, and a potential reason for nonresponse...the feedback loops rule and never adapt depending on one's genes.
The second part of my theory is that everything is tied to the immune system. Psych drugs can powerfully impact the pathways of inflammation, infection, and pain. Sometimes good, sometimes bad. But they do it. These things are not separate entities without any connection. Impacting one impacts the other.
As an example, a condition called Hidradenitis Supporativa..basically a chronic cluster of boils..can virtually disappear in days on a particular SSRI but not a different SSRI, and can be made profoundly worse on anything that boosts norepinephrine. Lyme patients can experience significant immunity from their infection symptoms, without actually killing the infections, on the right psych meds.
Whatever, I think it takes about 3 days for the altered neurotransmitters to begin the cascade of events that follows. By day 3, the synapses have become "immune" to the euphoric effects of the new levels of neurotransmitters, but the other cascade of events leading to remission have only just barely begun.
SLS mentioned no numbers to support his views (in quotes below), but there actually are some. I stumbled onto them months ago researching other stuff at pubmed. These were studies that tried to determine if an early response was in any way predictive of the final outcome. It was actually a highly significant predictor. It didn't guarantee the outcome, but strongly stacked the odds in your favor or against your favor. An early response...from days to 2 weeks, is strongly predictive of strong response at week 8 or week 12. Lack of appreciable response by the end of week 2 doesn't guarantee the med won't work, but the odds are statistically low...the patients in the studies who did not get well were the ones who did not get an early response, basically.
As a sidenote, almost all the studies fail to show which stable depressed patients actually got much worse when starting a med. So much worse they had to drop out. Of course, the dropout is almost always classified as "intolerable side effects", so we don't get to see that this drug actually can make some people a lot worse. It's kind of like that silent taboo no one wants to admit or talk about. The few studies that do include those numbers show the percentage to be in the range of 5% to 15%.
A bit off topic, but I believe with an early blip or without, trials are too short. Almost every single longterm study shows that whether there were benefits at week 8 or not, there was significantly more improvement at week 12, 16, 24, and 52.
I think someone can have a nice 3 day blip, lose it completely for 8 weeks, give up and stop the med, not knowing they only needed to wait 4 more weeks! Geez.
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> Awww. You remembered. Yes. The 3 day "blip" improvement that I often observe in others occurs IN THE FIRST WEEK rather than later in treatment. However, this usually disappears completely. I like to think that this blip represents a good prognosis, but I have no numbers to support that idea. Several studies indicate that a persistant improvement can occur as early as in the second week. However, once one goes beyond 4 weeks at a therapeutic dosage and without an improvement, the probably of eventual response decreases substantially.
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> - Scott
poster:bleauberry
thread:928269
URL: http://www.dr-bob.org/babble/20091206/msgs/928310.html