Posted by klein on April 26, 2014, at 1:49:54
In reply to Re: About SSRI-induced apathy » klein, posted by LouisianaSportsman on April 25, 2014, at 20:59:32
> What receptors? Tex will provide a paper about another subject yet provides no evidence for his pseudo-science claim.
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> You either got better by placebo, or amelioration of the reason you were prescribed 1mg. clonazepam.
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> I don't think it's wise to suggest to others that they they should seek an addictive benzodiazepine that causes some of the worst withdrawal syptoms of any medication.
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> Can you please provide any sources? Or, are you spouting psueudo-science that a member wrote 12 years ago that seems to have no other case reviews related?LOL Louisiana!! Ok, you sure gave me a workout here. I'm a bit surprised by the tone of your post, you must have your reasons. Anyway, I'll try to provide sources to back up my experience.
First of all, I'm certain that it wasn't a placebo effect. I keep taking ADs because they do help me, until they poop out and dump me into numbness. I've resorted to this method several times and it always works.
FWIW my pdoc has adopted it as well with patients suffering from SSRI-induced apathy, with generally good results.
I take Klonopin as a mood stabilizer, I've been on it for 8 years and never abused it. Like Phillipa mentioned, some of us take benzos long-term in a responsible way.
OK. Let me give this a try (bear with me, pure speculation, conjecture, over-simplified, just a few pointers)
Tex's theory is rudimentary but, according to recent research, there's a chance he might be right, his method might be effective in certain cases.
Let's go:
First of all, anhedonia is not depression (Marin, R.S. Apathy: A neuropsychiatric syndrome. J. Neuropsychiatry and
Clinical Neuroscience, 3:243-254, 1991.)
Anhedonia is thought to be a "meltdown" in the brain's reward center, caused by a dopamine defficiency:
(Keedwell P A, Andrew C, Williams S C R, Brammer M J, Phillips M L (2005) The neural correlates of anhedonia in major depression. Biological Psychiatry, 58(11), 843-853.)"Romanian Journal of Psychopharmacology (2009) The role of dopamine in depression, Delia Podea et al"
A lot of us know that SSRIs may eventually cause intractable apathy. It doesn't seem to happen to most people that take SSRIs (several studies available), the lucky ones, but there's evidence that some of us do indeed suffer from this syndrome:
"J Psychiatr Pract. 2004 May;10(3):196-9. SSRI-induced apathy syndrome: a clinical review"
"J Child Adolesc Psychopharmacol. 2001 Summer;11(2):181-6.Amotivational syndrome associated with selective serotonin reuptake inhibitors in children and adolescents. Garland EJ1, Baerg EA."
Why: Probably dopamine deficit = messed up mesolimbic reward pathway:
"Chronic 5-HT Transporter Blockade Reduces DA Signaling to Elicit Basal Ganglia Dysfunction. Emanuela Morelli"
"Problems associated with long-term treatment with selective serotonin reuptake inhibitors, Chantal Moret and Mike Isaac(2007)"
The usual recommendation is to raise the dose or to augment with yet another AD. Which for some of us only worsens the apathty.
But recently:
"Psychopharmacol Bull. 2010;43(4):76-9. Antidepressant induced apathy responsive to dose reduction"
"Ann Pharmacother. 2012 Mar;46(3):e8. doi: 10.1345/aph.1Q656. Epub 2012 Feb 21. Reversal of SSRI-associated apathy syndrome by discontinuation of therapy."
There are several papers that recommend treating apathy by augmenting with bupropion, modafinil, amphetamines... dopamine boosting agents. These strategies makes sense, and they might work for some of us. Personally, modafinil didn't cut it for me during my abulic states, bupropion takes a few weeks to kick in, and I don't have access to methylphenidate. Unfortunately.Anyway, here's where it gets interesting: There's emerging evidence that, contrary to wide-spread previous assumptions, benzos do in fact disinhibit dopamine release. Indirectly, via glutamate. This was briefly mentioned in a paper back in 1990 but didn't fly.
"Like opioids and cannabinoids, diazepam and other benzodiazepines take the brakes off activity of dopamine-producing neurons. April 19, 2012"
" New insights into the role of the GABAAbenzodiazepine receptor in psychiatric disorder DAVID J. NUTT, ANDREA L. MALIZIA, MRCPsych (2013)"
" Neurobiology of addiction and implications for treatment, ANNE LINGFORD-HUGHES, MRCPsych and DAVID NUTT, The British Journal of Psychiatry (2003)"
(and more but I'm too tired, lol)
So I'm thinking that maybe taking a high dose of benzos *for a short time* can kickstart a screwey, anhedonic brain's reward center by swiftly and potently increasing dopamine levels via further abrupt glutamate inhibition . Just enough to gain some motivation, get off the couch, shower for the first time in a week and clean up the house ;)
There's one catch though, this strategy might only work for people who are already taking a regular dose of benzos due to some complicated interplay between regular benzo intake and glutmatate/NMDA, which is ultimately responsible for the dopamine boost.
Tex's might have been right about those speculated receptors too, I'm thinking about the effect of enzos on NMDA receptors. Not to mention interneurons.
Wheew, okay, enough. I doubt any of this makes much sense. Pseudo-sciene mismash I know, lol, some of the stuff I've just finished reading is way over my head so I might be flat out wrong... And I'm certainly not encouraging people to binge on benzos, BTW. Like all meds, be judicious and careful. I'm just sharing what worked for me. Bottom line is, IME Tex's old post hit the nail on the head for me, and hopefully someone might benefit from this too.
But, as always, YMMV.
poster:klein
thread:1064752
URL: http://www.dr-bob.org/babble/20140419/msgs/1064795.html