Posted by Angela on May 16, 2000, at 20:09:48
In reply to Re: Going back on a medicine you've taken before, posted by Adam on May 16, 2000, at 19:18:55
Adam,
first, holy cow! are you a doctor or in the medical arena? i've never heard half of those words used before by my doctor or anyone else for that matter.
you referred to the "poop out" of a medicine. the only reason i switched to celexa from zoloft was to get rid of the sexual side effects. the zoloft worked great for me. when i had my relapse while on celexa is when my pdoc changed me to the luvox. at first he had me on effexor xr then added the luvox. he didn't like what he was getting from the effexor (and i don't even remember what was wrong with it, even though this was only a month or so ago), so he dropped the effexor and added the norpramin, which works primarily on norepinephrine.
he wrote me a script for the lithium, but i really don't want to take it. i have an appt. with another doctor in town next monday and i'm going to see what he has to say about all the meds and taking lithium.
so, to summarize, he's putting me back on the zoloft for the OCD and the norpramin for depression.
thanks for your input, advice and help. :)
> That's a good question.
>
> I don't really understand what "poop-out" is, but have heard it described
> as a form of tolerance.
>
> I would have guessed that this "tolerance" was to the effects of dysregulation
> of the serotonergic system, where the compensatory adjustments made by the
> nervous system to enhanced serotonin neurotransmission (which are what some
> theories of antidepressant action implicate as the clinically relevant
> phenomena) are somehow "normalized". Since the number of serotnin-secreting
> neurons in the brain is quite small, and these neurons function largely to
> regulate other, larger structures containing neurons secreting other hormones
> like, say, dopamine, perhaps the difficulties have to do with desisitization
> of other neurotransmitter systems.
>
> Or maybe there is further adjustment of serotonin secretion months or even
> years after starting the medication. The theories I have heard proposed to
> explain the delayed onset of SSRI action involve negative feedback on
> serotonin production and secretion through stimulation of somatodendritic
> autoreceptors. There is an initial DECREASE in serotonin in the synapse after
> initiation of treatment, or, at least, no significant increase, due to this
> negative feedback. Eventually, though, the overstimulation of these
> autoreceptors causes their down-regulation, and the pre-synaptic neuron
> becomes "apathetic" to its own activity, returning to a normal level of
> serotonin secretion, the affect of which is now augmented by the inability
> of the cell to draw the hormone back in from the synapse. Maybe, somehow,
> this "apathy" is overcome, and serotonin secretion again decreases.
>
> Whatever the mechanism, it seems to me that simply replacing one SSRI immediately
> with another would be of little benefit, since the effects on serotonin are
> more-or-less the same.
>
> I would look into alternative classes of medicaion. Effexor might be one
> choice, since it has effects on the norepinepherine system too. You could
> try to augment Zoloft with Welbutrin, which acts primarily on dopamine and
> norepinepherine. Or you could switch to an MAOI, which acts on all three
> of the major psychogenic monoamines. Augmentation with lithium might kick-
> start something in the serotonin system. Addition of gabapentin seems to have
> helped some non- or partial responders to SSRIs for a variety of indications.
>
> There are a number of things one could try.
>
> But based on my totally unprofessional hypothesizing about these various
> neurotransmitter systems that nobody has worked out well yet, I wouldn't predict
> treating SSRI poop-out with another SSRI, or, for that matter, returning to
> the old "pooped-out" drug, would be the way to cure the problem.
>
> > my doctor isn't happy with the results the luvox has dealt me, so i asked him if we could switch back to zoloft. he agreed to it and told me to start titrating down tomorrow & gave me a whole schedule to follow.
> >
> > my concern is that the zoloft will not be effective on me anymore. what is the response when you go off a medicine then go back on it? i've been on the luvox for at least 6 weeks and i've gotten a little bit better, but not to the point i was at on zoloft or celexa.
> >
> > any experiences you've had would be great to hear about. thanks!
poster:Angela
thread:33667
URL: http://www.dr-bob.org/babble/20000508/msgs/33708.html