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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Phillipa on December 6, 2009, at 0:02:28
Could be the beginning of the mystery of the three day response to ad's. Have to start somewhere. Phillipa
Posted by manic666 on December 6, 2009, at 4:27:07
In reply to The Three Day Blip Of Antidepressants, posted by Phillipa on December 6, 2009, at 0:02:28
in any antidepressant, you have to have the BALLS to go through the course, 2 weeks ,an ooooooo i carnt stand it no more this is not working.it probably is, but you havent go the threshholed power to carry on. I have never in the few that have soom effect on me,bailed out a trail. sertraline 12 weeks ,how many would live through 12 weeks of sh*t. i did an i finally got a responce.No even how bad// you must do the trial to iliminate it for the future,not 2 weeks an say it dont work for me, give me another, i have a list of 12 week failures up on a board, tested behond the call of duty. but tested to max an nuked.i can look at them an remember every side effect weight lost, bucket of vomit, the sh*t,s fever,cramp, sweat, frezzing,hair loss,jiont pain. ect ect an say i did it but never again on this med full trail an failed. im proud of that
Posted by SLS on December 6, 2009, at 5:26:17
In reply to The Three Day Blip Of Antidepressants, posted by Phillipa on December 6, 2009, at 0:02:28
> Could be the beginning of the mystery of the three day response to ad's. Have to start somewhere. Phillipa
>
> http://biopsychiatry.com/delay.htmAwww. 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.
- Scott
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
> >
> > 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.
>
> 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.
>
>
> - Scott
Posted by manic666 on December 6, 2009, at 11:00:47
In reply to Re: The Three Day Blip Of Antidepressants, posted by bleauberry on December 6, 2009, at 9:50:28
the thing that gets me mad,in england the meds are free but they dont give them out,till mabye you have seen a gp 4 times . . this is to stop scam,s in benifit for one. an the nhs puts a block on them do to cost.but you would be suprised at the people who dont persist they need med,s an give up visiting the gp.so a lot are scamming as the benifits are more cash for illness that out of work,some may get them an not take them without the gp knowing. they get away will the scam.an are signed on benifit were there gp wont call them in as they havent ant idea about mental illness so aviod the qeustions.THEN you get the people back an fourth to the surgery complaining the meds make them worse, these are mostly people mabye going through a minor blip in there life, an have never suffered a med side effect before.then they bail as they see what they let themselves in for an are not ill enough to take the start up crap.THIS was my favourit a guy came in the pharmacy he had read the side effects that may happen on his meds box paper, an would not take the med , he was in work so you have to pay a small cost to your meds, like £7 an he wanted his money back from the chemist, as if it was a store were you get a refund..I will just explain the meds payment system,OK if you are out of work through illness or unemployed your meds are free, but if you are in work you have to pay a small fee for you meds ,about £7 an item,so you can imaigine people on about 6 sort of meds an in work shell out a big chunk of money.£42for mabye the week, so a lot go to there pharmacy an get some inferior med at less than £7 , so there not really free if you are in work.but if you need ad,s benzos, heart tabs .diabetic tabs an so on an so on.they are all going to cost £7 each item.
Posted by SLS on December 6, 2009, at 11:02:25
In reply to Re: The Three Day Blip Of Antidepressants, posted by bleauberry on December 6, 2009, at 9:50:28
> My 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.
I disagree.
My theory: I think the loss of the blip improvement occurs as the consequence of a phenomenon known as accommodation. Basically, once the synaptic concentration of neurotransmitter surpasses a certain threshold, the postsynaptic neuron no longer has the time to fully repolarize and prepare itself for the next action potential. So, yes, there is an initial enhancement of neural activity, however, once the threshold of accomodation is reached, firings are reduced or cease, only to reappear two weeks later as postsynaptic receptors downregulate and allow for repolarization.
> 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.
I think the reduction in synthesis and release of neurotransmitter is immediate upon the initiation of treatment. This has nothing to do with gene expression. What is the result of gene expression is the downregulation of presynaptic autoreceptors. To allow the levels of neurotransmitter to recover. It is probably a matter of ratios between pre- and post- synaptic membrane sensitivities that determine the transduction and propogation of an action potential.
> SLS mentioned no numbers to support his views (in quotes below),Oops. No citations. Sorry. I had read this stuff a LONG time ago.
I guess we don't always have the time to search out citations to support all of our views, wouldn't you agree?
> 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.
People drop out of clinical trials for a variety of reasons, including the emergence of side effects. Some people are unable to continue beyond two weeks because they cannot tolerate the persistance of their depression. Some people feel worse because the drug makes them feel worse. Others will begin to respond early and acquire the psychic energy to contemplate suicide more actively. This is usually a passing phase, although a critical one. My guess is that it is unusual for someone to experience a true exacerbation of their depression initially and go on to respond well to treatment afterwards.> The few studies that do include those numbers show the percentage to be in the range of 5% to 15%.
I would be interested to see one of these studies.
- Scott
Posted by Phillipa on December 6, 2009, at 20:08:54
In reply to Re: The Three Day Blip Of Antidepressants » bleauberry, posted by SLS on December 6, 2009, at 11:02:25
Scott yes I remembered as I'm always looking for trends. My scientific mind I guess. And not a criticism of course but it was your meds that I first followed on babble why I joined as just on cymbalta. When your trial failed I also quit the med. But I'd been on it 60days already. And then the Deplin when I felt better on day three you mentioned the phenominum. And now the lithium? Back when I took tiny dose of benzos very tiny like .5 xanax a day felt really good was nursing. My pdoc had just gotten prozac new and asked me to try it. Since I'd never had an ad before agreed. Took 20mg first day and wallpapered a foyer hadn't wanted to do for three years, on day two anxiety increased, day three panic which I hadn't had in years. Spent the day on the phone with my then husbands ex-wife so that's how horrible I felt. I flushed them down the toilet took two days of higher xanax to get back to baseline. Now this was in VA Beach and the pdoc was great I worked with him and when told him what happened he begged me to take it every three days. I refused as that was how horrible I felt and scared. Then it was only available in 20mg gel capsules. So was this good or bad what happened? If it had been available in low doses would it have worked just speculation on your part as that is all you or anyone can do. Thanks Jan
Posted by manic666 on December 7, 2009, at 8:13:46
In reply to Re: The Three Day Blip Of Antidepressants » SLS, posted by Phillipa on December 6, 2009, at 20:08:54
listen if you have depression an by the time you seek help it is peaking,you arent going to get much worse are you/ unless they kill you.an that feels like a good idea at the time anyway, so you take a med the doc says, an battern down the hatch,s to ride the storm, if your not prepaired to do this ,dont waste the doc an your time.there is side effects in all ,so you get worse . as the old saying you get worse before you get better,you sit on the toilet with a bucket in your hand for weeks,not knowing which end a projectile will fly.then if your lucky after about 6 to 12 weeks you emerge from the abiss. if not its start again time you lucky people.if it behond your pain barrier ask for benzos till it kicks in.surely you carnt do endless gross over. every 2 weeks , s you will be a toxic dump.phillipa people have tried to get you to change your meds.your to scared to, is the answer , there is no ad that will make you well in 1 week.if your ill pick one out an go for it , no surrender.
Posted by Phillipa on December 7, 2009, at 19:21:11
In reply to i dont buy into this, posted by manic666 on December 7, 2009, at 8:13:46
Manic I don't buy the suffering you do by staying on one med as if you read the study positive in three days might predict a response. Love Phillipa
Posted by manic666 on December 8, 2009, at 4:07:06
In reply to Re: i dont buy into this » manic666, posted by Phillipa on December 7, 2009, at 19:21:11
even post above say studies say can take month,s for a responce.just like your 3 day responce.its all word,s on paper .The only one to no is the person takeing the med.As i say you near as always get worse to start with as the med fights with you body an brain. Sometimes yes to abort the med,bbbbut it has to be totally unbearable to stop in my opinion,like effexor was to me ,i drew the line finally when my hair fell out in clumps.but baby just plodding along through life is not what i want .so i test them to the max before nukeing them . i only have to face a new one.i learned this lesson years ago when a young lady doc changed my meds evert 2 weeks , telling me it must be not working,im talking 25 years ago . no one new the time it take,s some meds, she just overfed me meds till i was a wreck.that was my first basic lesson learned the hard way. you are forever chaseing something you wont get ,till you really try,so they make you ill for a time . so think how cool it is when one attually works. weeks down the line. just up the benzos to start with an dig in.
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