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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Denise528 on January 22, 2002, at 8:42:05
Hello,
I am really frustrated and confused and am searching for an answer. About 4 years ago I took Seroxat, they worked beautifully, very quickly and effectively. There was not doubt in my mind that they were working. Four years later I am now trying to get back on these drugs with very little effect. I tried seroxat, initially they made me very foggy anxious, almost like blind panic then weeks later nothing. I am now trying prozac and have experienced exactly the same thing, initially I felt suicidal and now that those effects have worn off I have no doubt that they are not doing anything, I feel as though I might as well be swallowing smarties. I don't even get the same side effects that I used to which was drowsyness and tremor. I asked my Psychiatrist why they are not working this time and he seems to think that maybe my blood levels are not high enough and the drugs aren't getting to my brain but I had a seizure the other day for the first time ever (as it happens that was a good day) so wouldn't that suggest that the drugs are getting to my brain.
I just don't understand how a drug that could once work so well now do absolutely nothing, zilch, zero. I guess I am looking for some sort of scientific explanation cause I'm pretty devastated.
Any advice would be greatly appreciated.
Denise
Posted by MB on January 22, 2002, at 15:16:56
In reply to Can somebody explain why they stop working., posted by Denise528 on January 22, 2002, at 8:42:05
The drugs don't change, our brains do. I don't know what that means. Maybe we go from being unipolar depressed to bipolar? Maybe years of unmedicated mental illness causes brain chenges? Maybe getting on and then off of drugs causes brain changes? I don't know but I hate it.
MB
Posted by TSA West on January 22, 2002, at 23:15:23
In reply to Re: Can somebody explain why they stop working. » Denise528, posted by MB on January 22, 2002, at 15:16:56
One possible answer is dopamine depletion over time with SSRIs: http://www.dr-bob.org/tips/split/Patients-who-lose-response.html
Another answer is that peoples' metabolisms change over time such that a drug gets metabolized too fast, and the legal limits prohibit a doctor from prescribing more medication than the Physicians' Desk Reference allows.
I don't think one can prove this happens as much with tricyclic antidepressants.
Be well and prosper,
TSA West, founder: William Booth ++++
Posted by MB on January 23, 2002, at 0:21:55
In reply to Possible answers » MB, posted by TSA West on January 22, 2002, at 23:15:23
> One possible answer is dopamine depletion over time with SSRIs: http://www.dr-bob.org/tips/split/Patients-who-lose-response.html
Would this dopamine depletion be mitigated or exacerbated by a psychostimulant like Adderall?
MB
Posted by jane d on January 23, 2002, at 1:57:53
In reply to Possible answers » MB, posted by TSA West on January 22, 2002, at 23:15:23
>and the legal limits prohibit a doctor from prescribing more medication than the Physicians' Desk Reference allows.
TSA - I don't think this is true. - Jane
Posted by jane d on January 23, 2002, at 2:00:43
In reply to Re: Possible answers » TSA West, posted by MB on January 23, 2002, at 0:21:55
> > One possible answer is dopamine depletion over time with SSRIs: http://www.dr-bob.org/tips/split/Patients-who-lose-response.html
>
> Would this dopamine depletion be mitigated or exacerbated by a psychostimulant like Adderall?
>
> MBMB - Trying to mitigate the dopamine depletion is one of the reasons for augmenting with a stimulant. The link itself discusses that. - Jane
Posted by MB on January 23, 2002, at 8:58:26
In reply to limits on amounts prescribed? » TSA West, posted by jane d on January 23, 2002, at 1:57:53
> >and the legal limits prohibit a doctor from prescribing more medication than the Physicians' Desk Reference allows.
>
> TSA - I don't think this is true. - JaneI'm with Jane: the PDR sayd no doses of Wellbutrin above 450mg/day, but many people go past that under the supervision of their doctor. Also, the PDR says no MAOIs with SSRIs, but I know a few brave doctors have been willing to try low dose combinations of those two classes. THis is just info I've picked up reading this board.
MB
Posted by MB on January 23, 2002, at 9:00:13
In reply to dopamine depletion and stimulants » MB, posted by jane d on January 23, 2002, at 2:00:43
> > > One possible answer is dopamine depletion over time with SSRIs: http://www.dr-bob.org/tips/split/Patients-who-lose-response.html
> >
> > Would this dopamine depletion be mitigated or exacerbated by a psychostimulant like Adderall?
> >
> > MB
>
> MB - Trying to mitigate the dopamine depletion is one of the reasons for augmenting with a stimulant. The link itself discusses that. - JaneAh--lazy me, I'm bad at hitting links...short attention span, you know. Anyway, hopefully the Adderall will potentiate my Prozac nicely.
Peace
(will read the article ;-)
MB
Posted by cmcdougall on January 23, 2002, at 9:22:57
In reply to Possible answers » MB, posted by TSA West on January 22, 2002, at 23:15:23
I take celexa, despipramine, and adderall. I worry about poop-out as it seems to always happen to me eventually. I have been thinking of augmenting w/ Memantine. This drug is supposed to protect the neurons from adapting to the SSRIs, Stims, etc. It is being tested for people w/ chronic pain who have to take a lot of opiates. This drug seems to prevent the need for dosage increases over time and inhibits opiate addiction. I think it is similar to Amantadine, an old anti-viral that is used for other indications now. Memantine has been used in Germany about 10 years for Alzheimers and senile dementia. Hey, if it improves my cognitive abilities and memory retention too, great. Maybe it will also help my libido...
I really like the drug combo I am on now and if I could take it indefinately w/out poop-out, I would be one happy girl.
> One possible answer is dopamine depletion over time with SSRIs: http://www.dr-bob.org/tips/split/Patients-who-lose-response.html
>
> Another answer is that peoples' metabolisms change over time such that a drug gets metabolized too fast, and the legal limits prohibit a doctor from prescribing more medication than the Physicians' Desk Reference allows.
>
> I don't think one can prove this happens as much with tricyclic antidepressants.
>
> Be well and prosper,
> TSA West, founder: William Booth ++++
Posted by jane d on January 23, 2002, at 11:12:01
In reply to Re: dopamine depletion and stimulants » jane d, posted by MB on January 23, 2002, at 9:00:13
>
> Ah--lazy me, I'm bad at hitting links...short attention span, you know. Anyway, hopefully the Adderall will potentiate my Prozac nicely.
>
> Peace
> (will read the article ;-)
> MBPeace to you too. You'll be happy to know it's not an article but a (short) selection of posts from a doctors only newsgroup.
Let me know if the adderal works for you. If it does I may try mugging a school kid. - Jane
Posted by spike4848 on January 23, 2002, at 12:03:49
In reply to Can somebody explain why they stop working., posted by Denise528 on January 22, 2002, at 8:42:05
Hey There,
I wonder how much our illness is involved with tolerance to medications/loss of effecacy with medications. The drugs usually stay the same ... unless your switched to a generic with different potency. So, maybe it is our illness/brain that is changing .... and our illness/brain is less responsive to medication. Most diseases are not stagnate .... they wax and wane overtime.
This idea I saw in previous posts ..... It makes sense in a way. People with HIV often develope resistant to medication over time. The drugs work the same .... just the HIV virus mutates to a form which is resistant to the medication. Most individuals with HIV go through several difference medication cocktails because of resistance.
Spike
Posted by spike4848 on January 23, 2002, at 12:08:39
In reply to Can somebody explain why they stop working., posted by Denise528 on January 22, 2002, at 8:42:05
Oh and personally ... my illness started with a very high anxiety component. Now after 7 years ... less anxiety and more depression. My symptoms have definately changed overtime. I am not sure if this means I am getting worse or just my disease is stable and just exhibiting different symptomatology.
Spike
Posted by Denise528 on January 24, 2002, at 5:46:08
In reply to Re: Can somebody explain why they stop working. » Denise528, posted by spike4848 on January 23, 2002, at 12:08:39
> Hi,
Thanks for the feedback, the frustrating thing is, the drugs were working fine when I came off them 4 years ago, they hadn't pooped out or anything. Infact part of the reason that I came off them was so that I wouldn't develope a tolerance to them so I assumed that I would just be able to start taking them again and everything would be fine. Only it hastn't turned out like that. Oh well, I guess I was just really lucky before and not so lucky now. I do agree with what your saying about the type of depression changing, I seem to be more anxious this time than before but I think that has something to do with the fact that I haven't taken anything for four years, when I did finally come crashing down the drop was much greater.
Thanks again for the responses,
Denise
This is the end of the thread.
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