SSRI's, the good, the bad, or the ugly?

[jakeforpresident]

There's a lot of research out there that says SSRI's work.

So why don't they sometimes?

My theory is that they aren't incredibly noticeable. They are def over-prescribed, and prob not adhered to very well for a long enough period of time to be fully working.

However, I'm still skeptical something so simple can actually work for long term.

So let's have an official debate on whether SSRI's work or not....

[BusterBluth]

[martyboi]

I think for people who are actually lacking in serotonin.....they work. I predict a lot of people who have SA have perfectly normal serotonin levels and the problem is being caused by some other chemical imbalance...possibly a dopamine deficiency or something else and taking an SSRI just does nothing but throw their whole system out of whack

[Neptunus]

Well, their efficacy depends on how well they react with your individual physiology. I've heard them referred to as "sugar pills" before on this board, which I find offensive. I've only taken paxil, but it has left me with permanent discontinuation syndrome and a condition call "benign fasciculation syndrome," link a disorder which effects my manual dexterity - and has almost completely robbed me of one my few joys in this world - my artistic ability.

I now take paxil (at a very low dose) just to control some of my symptoms - like the permanent "brain zaps" I experience whenever I look up and to the right. Does it still work for my anxiety? Yes. But it is truly a case of the cure being worse than the curse.

So, yes, I am the one in a million that experienced severe symptoms. But still, take my experience as a lesson - SSRI's are very powerful drugs and shouldn't be taken lightly. And, most often, people have to go through several before they find one that works with their chemistry...if they are so fortunate.

Anything that messes with your brain chemistry isn't a sugar pill!

[KurtG85]

SSRIs' effectiveness just depends on the individuals unique 'brain soup' of chemicals and pathways. No med is a one size fits all type deal and some negative drawbacks (side effects) are to be expected along with the positive (if any).

As mentioned, anyone stating with certainty that SSRIs have no greater effect than a sugar pill (for all people) is only proving their ignorance.

[Blackcompe]

Well, even if a person's depression was due to the catecholaminergic (NE, DA) pathways, I'd guess you'd still feel something right: insomnia, appetite changes, blah za, blah za, increase or decrease in anxiety, but not a reduction of symptoms in your particular disorder. So, they are working, but you need another class of anti-depressants. That's one scenario. Another, would be that intracellular stores of the biogenic amines are depleted due to increased MAO activity or precursor depletion, thus leading to minimal pre-synaptic release. So, blocking the transporter is basically useless (or won't add much benefit), compared to other forms of pharmacological therapy, because extracellular concentrations are incredibly low. This is all hypothetical of course.

[Vini Vidi Vici]

Originally Posted by jakeforpresident

There's a lot of research out there that says SSRI's work.

So why don't they sometimes?

My theory is that they aren't incredibly noticeable. They are def over-prescribed, and prob not adhered to very well for a long enough period of time to be fully working.

However, I'm still skeptical something so simple can actually work for long term.

So let's have an official debate on whether SSRI's work or not....

this debate is gonna be long, if people decide to chime in.. but this is nearly the same as debating whether or not there is a God/ultimate creator....but the real question is--- what is the definition of "work" ? SSRIs work. they are supposed to inhibit the reuptake of serotonin. they do this...thus they work....i think thats the only thing we can state with certainty.... i think of SSRIs as overall 50% ....they are crap, but they still help. they reduce anxiety greatly in many people, and help alleviate feelings of sadness.....they can reduce OCD, and reduce any emotion in general. this is the 50 % that does work......the other 50% is what, i believe, in many situations negates any beneficial effects..-- ....so, its kinda a win-lose situation with SSRIs.

[crayzyMed]

SSRI's have a terrible mode of action especially for SA they really suck... There are ppl that respond to them but those that respond usually only get a 50% response.
Agomelatine is ALOT better with ALOT less side effects. More meds like that is what i want to see.
MAOI's also are alot better then the SSRI's.

[jim_morrison]

http://www.mcmanweb.com/stard.html

This article may be of interest.

[kev]

Certain SSRI's are decent for generalized anxiety. Celexa works okay from my experience. I don't have diehard anxiety though like some people do. Depression is my bigger problem. In my opinion, SSRI's are less effective for social anxiety because it is less physical in nature and more psychological - antidepressants seem to fix purely physical problems better. Of course, relieving generalized anxiety can improve social anxiety indirectly. That's my unprofessional view at least.

As for depression, a minority of people have complete remission of symptoms, but most will have some improvement. An unlucky few will have none whatsoever or even a worsening of depression but When I first started taking antidepressants, I didn't think they were doing anything, but in fact they had changed my mood so gradually that I didn't even notice the difference. Unlike xanax that gives you instant relief, people are less likely to praise SSRI's because it is not a quick fix and doesn't provide complete relief. It is difficult to notice the changes that they make.

[RockiNToM]

Some really good posts here. I'd just like to chip in my experience.

Before trying Paxil, I had tried quite a few meds (see sig) and all of them pretty much did nothing or made things worse. Paxil is the only SSRI or medication for that matter so far, that did a complete reversal on my SA. I became very extroverted, and for the first time in my life I was going out and socialising and making lots of friends. Unfortunately it pooped out on me 2 years later and when I kept trying to go back on it for the same results again it just didn't happen. Since then all the other anti-depressants I've taken haven't done anything anywhere near as effective as what Paxil did.

For me I believe a lot of my SA is caused by my mood. I've had anxiety disorder all my life, which includes panic attacks and agraphobia. I also suffer from depression, and since SSRIs and anti-depressants focus in on depression, it made sense for me to take an SSRI. So I believe in my case, improving one will help the other, thus the response I got from Paxil.

The perfect medication for someone to take for SA or people with depression as well like me would be something like an SNDRI. Unfortunately where they do exist, they are not easily obtainable and when designed for the purpose we require, they don't seem to be coming any time soon. Until then, an SSRI and an amphetamine or a benzo is our best bet - if you can get them.

[crayzyMed]

This poop out thing is very strange... I wonder what causes it.

[Vini Vidi Vici]

Originally Posted by crayzyMed

This poop out thing is very strange... I wonder what causes it.

if you think about it.....SSRIs are to Serotonin just as Cocaine is to dopamine (a little less selective but who cares). So just like one would get tolerant to Cocaine, maybe they get tolerant to SSRIs? maybe Serotonin synthessis goes way down, and serotonin release is also lowered a whole lot,.....and the receptors still are gonna want to get to a normal level of stimulation, no matter what.

[crayzyMed]

Originally Posted by Vini Vidi Vici

if you think about it.....SSRIs are to Serotonin just as Cocaine is to dopamine (a little less selective but who cares). So just like one would get tolerant to Cocaine, maybe they get tolerant to SSRIs? maybe Serotonin synthessis goes way down, and serotonin release is also lowered a whole lot,.....and the receptors still are gonna want to get to a normal level of stimulation, no matter what.

Tolerance is not something that suddenly happends after several years.

[jakeforpresident]

Originally Posted by crayzyMed

Tolerance is not something that suddenly happends after several years.

I think we hit a critical concept here. Subjective attitude towards a medication has way more power than the pills themeselves have.

We SA'ers seem to need an excuse to be who we are and be extroverted, the rest of the time we seem to be wrapped up in our own negative or abstract thoughts.
So meds help, like SSRI's by placebo effect. Bad attitude or good attitude, they give you a REASON to your life. And that's for any drug for that matter.

So, SSRI's do work, just how much they actually do is dependant on your attitude, biology aside.

[crayzyMed]

Originally Posted by jakeforpresident

I think we hit a critical concept here. Subjective attitude towards a medication has way more power than the pills themeselves have.

We SA'ers seem to need an excuse to be who we are and be extroverted, the rest of the time we seem to be wrapped up in our own negative or abstract thoughts.
So meds help, like SSRI's by placebo effect. Bad attitude or good attitude, they give you a REASON to your life. And that's for any drug for that matter.

So, SSRI's do work, just how much they actually do is dependant on your attitude, biology aside.

I'm not wrapped up in any negative toughts and i've got SA. If srri's worked by placebo effect then they should work right away and not after trying 3 differend onces.

[jim_morrison]

Originally Posted by RockiNToM

The perfect medication for someone to take for SA or people with depression as well like me would be something like an SNDRI. Unfortunately where they do exist, they are not easily obtainable and when designed for the purpose we require, they don't seem to be coming any time soon. Until then, an SSRI and an amphetamine or a benzo is our best bet - if you can get them.

Yeah that would be good, did you ever try the prozac/wellbutrin combo? that would be interesting.

[gordonjohnson008]

Originally Posted by Neptunus

Well, their efficacy depends on how well they react with your individual physiology. I've heard them referred to as "sugar pills" before on this board, which I find offensive. I've only taken paxil, but it has left me with permanent discontinuation syndrome and a condition call "benign fasciculation syndrome," link a disorder which effects my manual dexterity - and has almost completely robbed me of one my few joys in this world - my artistic ability.

I now take paxil (at a very low dose) just to control some of my symptoms - like the permanent "brain zaps" I experience whenever I look up and to the right. Does it still work for my anxiety? Yes. But it is truly a case of the cure being worse than the curse.

So, yes, I am the one in a million that experienced severe symptoms. But still, take my experience as a lesson - SSRI's are very powerful drugs and shouldn't be taken lightly. And, most often, people have to go through several before they find one that works with their chemistry...if they are so fortunate.

Anything that messes with your brain chemistry isn't a sugar pill!

That's rough! Sorry to hear you got this severe side effect from Paxil. How long were you on the Paxil to get this severe side effect and the severe brain zaps? (I ask because I am on Paxil now)

[Guide 4 Dummies]

Originally Posted by jim_morrison

Yeah that would be good, did you ever try the prozac/wellbutrin combo? that would be interesting.

Pdocs are prescribing Prozac + Wellbutrin everywhere even though Prozac interacts with Wellbutrin's metabolism.

Originally Posted by Wikipedia

Since bupropion is metabolized to hydroxybupropion by the CYP2B6 enzyme, drug interactions with CYP2B6 inhibitors are possible: this includes medications like paroxetine, sertraline, norfluoxetine (the active metabolite of fluoxetine), diazepam, clopidogrel, and orphenadrine. The expected result is the increase of bupropion and decrease of hydroxybupropion blood concentration.

I'd imagine this would cause an accumulation of Bupropion every time you dose since its metabolism is significantly slowed down, yet it appears to be totally safe. What am I missing here?

[RockiNToM]

Originally Posted by jim_morrison

Yeah that would be good, did you ever try the prozac/wellbutrin combo? that would be interesting.

Unfortunately no, I'm not in the position to right now while taking this damn tramadol.