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Physicians Are Talking About: SSRI's and the Choice to Numb Out

9K views 15 replies 11 participants last post by  Monroee 
#1 ·
Selective serotonin reuptake inhibitors (SSRIs), mainstays of psychopharmacology, effectively eliminate suicidal ideation -- not to mention feelings of exhilaration, caring, and desire.

A recent study published in the British Journal of Psychiatry found that the majority of patients taking SSRIs experienced emotional detachment, feelings of indifference, personality changes, and a reduction in positive and negative emotions.[1]

Currently, tens of millions of patients in the United States take SSRIs daily. However, evidence pertaining to the long-term effects of these drugs is scant. "In a few decades, as many as 15% of the world's population might be on SSRIs," comments a psychiatrist. "Although the suicide rate might decrease, I wonder what the long-term effect will be."

The conjecture posited on Medscape's Physician Connect (MPC), an all-physician discussion board, launches a discussion about the apparent choice in SSRI use -- to be crippled by depression or functional and emotionally numb.

MPC contributors commented that their anecdotal experience aligns with that of the British study.

"In several patients on long-term SSRIs, I have noticed some subtle personality changes," says a psychiatrist. "Of course, there's no way of ascertaining cause and effect without a good, long-term study, but this is what I've observed: (1) SSRIs decrease pain (irritability, depression) but also seem to increase the threshold for what constitutes an exciting event (a person needs more novelty than previously for the same effect); and (2) SSRIs increase apathy and have the potential to decrease empathy."

"It would be unrealistic," adds another psychiatrist, "to think that taking a medication which significantly impacts a major neurotransmitter would not have, in some cases if not many, a significant effect on a person's personality, either short- or long-term." The psychiatrist comments that case studies documented in Peter Kramer's book Listening to Prozac indicate that SSRIs strongly impact a patient's feeling of "caring," which can affect the patient's relationships with friends and family.

An endocrinologist suggests that his colleagues view the film Numb, which documents filmmaker Phil Lawrence's struggle to stop taking the popular SSRI Paxil. In the trailer for the film, Lawrence says, "I'm flatlined. This isn't me. This is me on Paxil®."[2]

"These are the wonder drugs of psychiatry," argues a psychiatrist. "They continue to benefit people over the long term, even at low doses. They help with anxiety, much more robustly than with depression, but they help in depression too. If I had my way Prozac®, Zoloft®, and Celexa® would be sold over the counter." The psychiatrist comments that the life-time prevalence of depression is between 15% and 30%,[3] and most people remain untreated for fear of persecution and judgment formation about their need to take antidepressant drugs. Over-the-counter distribution, he reasons, would make SSRIs more readily available to people who need them.

"I disagree about the OTC [over-the-counter] issue," replies Stephen Grcevich, MD, a child and adolescent psychiatrist. "I think there are untoward effects of SSRIs that are still poorly understood, such as the very small but statistically significant risk of suicidal behavior in persons aged 25 and under. We also saw a subgroup of kids who displayed significant disinhibition and indifference to academics in a large, open-label, federally funded study looking at SSRI safety." He comments that he hopes to present the study data at the 2010 annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP).

An internist who frequently prescribes SSRIs, reports that she repeatedly experienced suicidal thoughts while taking an SSRI for depression. "I have been placed by my physician on Lexapro® 3 times. In each instance, my mood lifted and crying decreased. I could sleep. In 3 days' time, I started having thoughts that came out of the blue, such as 'I want to drive off this bridge.' Stopping the medication stopped the thoughts." She says that she tells her patients about this potential side effect, but no patient has related having a similar response.

"SSRIs and then SNRIs [serotonin noradrenaline reuptake inhibitors] nearly killed me," says an obstetrician/gynecologist. "They caused narcolepsy, and I fell asleep and drove off the road." He comments that his level of apathy while taking the drugs was so extreme as to appear parkinsonian. "In my opinion as a patient, mild to moderate depression should be treated by cognitive behavioral therapy, not meds."

A surgeon comments that, in many cases, SSRIs are given to patients who are only mildly depressed. "The drugs are given as mood elevators," he says. "We essentially are giving out the drug for the same reason people self-medicate or abuse alcohol."

"I do agree we are pushed to start meds too early on mild cases sometimes," says a family medicine physician. "We must ask the tough questions of patients about suicidal thoughts to determine the severity of their illness. Then start a multipronged approach to treatment and not just write a script and send them out the door."

A neurosurgeon comments that clearly there are a number of questions about SSRIs that need to be addressed:

Should we treat mild depression knowing the risks?
Are we educating patients about the possibility that they will experience apathy?
Are we increasing the risk for substance abuse in patients who attempt to counterbalance induced conditions of apathy and boredom?
Are the artificially high levels of serotonin caused by the use of SSRIs chronically changing the brain and making it impossible to withdraw from these drugs?
"I agree that higher doses and long-term use does blunt emotions," says a pediatrician. "I used Effexor® for about 7 years and tried to wean off during that time, but at very low doses would redevelop extreme sadness that resolved when I upped the dose." He says that working with his psychiatrist, he switched to Wellbutrin® and now experiences a wider range of appropriate emotions. "However, if I did not have another option, I would prefer Effexor® side effects over the chronic anxiety and sadness I experienced for much of my life without it."

The authors of the British study reported a similar finding. Many participants in the study considered whether they should stop taking their medication, but viewed the side effects as preferable to the illness for which they were being treated.

"And that is the problem, isn't it?" comments an MPC contributor. "We just don't have meds that treat without some side effects."
http://www.medscape.com/viewarticle/716929
 
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#3 ·
SSRIs sure didn't make me mentally numb. They did nothing (positive). Actually, I'd consider mentally numb an improvement to the hellish misery I've felt most of my life.

Thus far stimulants have been the only meds that have lifted the veil of dark misery that normally hangs over me.

To me they're like sugar pills but with the addition of sexual side effects. My brother is currently trying to get off Lexapro after a decade of SSRI use. He's not at all happy with the sexual side effects, but finds that stopping makes him nervous, so he continues at a dinky dose of 5 mg.

Long ago I knew a woman who took Zoloft for OCD. She told me of an emotional numbing effect, though I gather it worked for her OCD as I never witnessed any type of OCD behavior and I'm rather experienced with it, seeing how I and most of my family has OCD.

Are the artificially high levels of serotonin caused by the use of SSRIs chronically changing the brain and making it impossible to withdraw from these drugs?
That brings up another question. When SSRIs fail, as they so often do, is it because they failed to raise a patient's serotonin level or did they raise the level but serotonin wasn't the problem so raising it didn't help? My understanding was that SSRI effect was more complex than simply raising serotonin level since they do that with 24 hours, yet it takes weeks to see a clinical effect (when they work).
 
#5 ·
I'm apathetic and I don't feel any joy or excitement anymore. I dunno if it's from the 20-something psych meds I've been on over the past four years, or if I was destined to turn out a cold-hearted loser all along, ha.
 
#6 ·
This is an old article that has been around for some time. The long term effects of SSRIs are that they eventually stop working and that the pharma companies continue to make crap drugs that do little to treat symptoms and always have either weight gain or sexual side effects.
 
#16 ·
I'm not really sure if the SSRI I'm on really helps anything. I guess it kind of does. Before I used to have wicked feelings of despair and hopelessness and I was frightened that those would lead to suicide, since I definitely thought about it. Now, I don't really have those episodes, I'm just really mentally exhausted all the time. But then again, how do I know its not just the placebo effect that erased the episodes of hopelessness? The mind is very powerful, the placebo effect could change a lot. I wouldn't say that my thoughts of suicide are gone, but instead of feeling the urge, its rather just always in the back of my mind subdued.

Anyway.. SSRI's seem to be hit or miss for most people. But I do agree that I'm a little paranoid about the intentions of the pharmaceutical companies. How come they don't seem to want to experiment with other methods? Every doctor just wants to push SSRI's, isn't there different meds that affect different receptors, like dopamine or something? I don't really know much about medications, but how come they are so stuck on SSRIs?
 
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