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Dr. Bob is Robert Hsiung, MD,
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Posted by bleauberry on December 20, 2009, at 21:01:46
In reply to Is there hope for Post SSRI side effects?, posted by conundrum on December 20, 2009, at 11:48:10
This phenomenon has been experienced by perhaps half a dozen people or more at this board over the last 6 months. We've kind of given it the name post-ssri syndrome. It can happen with all the ssris, not just prozac.
I think somehow over longterm the heavy serotonin manipulation causes adaptive changes on the other neurotransmitter systems and genes.
The best things I have found all include a fairly strong focus on norepinephrine, but with a little bit of serotonin too. Those include:
1. Nortriptyline+Zoloft (very low dose zoloft, such as 6mg or 12.5mg).
2. Milnacipran (Savella) low dose (12.5 bid or 25mg bid).
3. Parnate any dose from 5mg to 80mg.Wellbutrin or Remeron? No, forget it. For an ex longtime ssri user these will work lousy or worse.
Mileage varies of course.
Posted by mtdewcmu on December 20, 2009, at 21:29:08
In reply to Is there hope for Post SSRI side effects?, posted by conundrum on December 20, 2009, at 11:48:10
I don't know if it was caused by the Prozac or not, but those are all symptoms of depression. So I would imagine that you should approach treating it exactly as you would treat depression.
Posted by conundrum on December 20, 2009, at 21:29:59
In reply to Re: Is there hope for Post SSRI side effects?, posted by bleauberry on December 20, 2009, at 21:01:46
Thats interesting because I thought remeron would work since it antagonizes various serotonin receptors.
Unfortunately I'll probably have to try what my pdoc wants me to try first, since I am the patient and he is the doctor, nevermind that its my body. This likely means an SNRI after my trip back from Europe.
Its weird, cuz I figured wellbutrin would give me an idea of what NRI would feel like but it seems to have its own feel not similar to other norepinephrine drugs.
I just hope to regain the color in my life. I used to be a musician and was studying music in college. Since stopping prozac I've switched majors and music just sounds like notes to me with no feeling. Christmas doesn't even feel like christmas, it feels no different to me than being at the beach this past summer except colder.
Well thanks for the support guys.
Posted by conundrum on December 20, 2009, at 21:32:17
In reply to Re: Is there hope for Post SSRI side effects? » conundrum, posted by Phillipa on December 20, 2009, at 18:48:18
Exactly. :/ Wish I had never taken them...
Posted by Newquestions on December 21, 2009, at 11:34:24
In reply to Re: Is there hope for Post SSRI side effects? » Phillipa, posted by conundrum on December 20, 2009, at 21:32:17
Go to paxilprogress.org/general discussion and read the posts there. There is a lot of good advice for people who have "pooped out" on SSRI's and are in protracted withdrawal.
If you really are in "poop out," or what benzo people call "tolerance withdrawal", then your serotonin receptors have adapted to the drug and other drugs that affect sertonin won't help and might make you worse. I think the cycle goes like this:
1. Long term use of SSRI
2. Brain adapts to drug and increased serotonin
3. SSRI stops working and may make you worse
4. Patient must stop SSRI
5. Patient experiences protracted withdrawal syndrome, including head pressures, cognitive problems, memory loss, fatigue and adedonia.If you are in this cycle, adding drugs will only cause more damage. You have to go off the drugs and stay off of them! TCAs, MAOIs, other SSRIs, SSNRIs will not help. Some people report that fish oil and magnesium can help but don't take any drugs that affect serotonin or other neurotransmitters. Your body has to heal!
Posted by conundrum on December 21, 2009, at 17:24:35
In reply to Re: Is there hope for Post SSRI side effects?, posted by Newquestions on December 21, 2009, at 11:34:24
Tried staying off and taking fish oil and magnesium for years. I used to be a member on a list like that. Didn't help much.
Posted by bleauberry on December 21, 2009, at 17:48:25
In reply to Re: Is there hope for Post SSRI side effects? » bleauberry, posted by conundrum on December 20, 2009, at 21:29:59
> Thats interesting because I thought remeron would work since it antagonizes various serotonin receptors.
Well, you could be right. I have the same scenario as you. Remeron actually did feel immediately helpful right away, set aside the intense sedation. But within a few days it was dreadfully obvious I was crashing bad on it.
>
> Unfortunately I'll probably have to try what my pdoc wants me to try first, since I am the patient and he is the doctor, nevermind that its my body. This likely means an SNRI after my trip back from Europe.You said it right, except you interpretted it backwards. That is, the patient is the boss, the doctor is not. Who is paying who anyway? YOU are the paying customer. HE is providing a service that YOU are paying for. HE works for YOU, you don't work for him. The customer is always the boss. Just because it happens to be mental health instead of cars or retail doesn't change anything. You are in charge. He is there to help you figure things out, make suggestions, and monitor your progress on joint team decisions that you both make together.
>
> Its weird, cuz I figured wellbutrin would give me an idea of what NRI would feel like but it seems to have its own feel not similar to other norepinephrine drugs.Wellbutrin really isn't much of an NRI. Very weak. Its mechanisms, as stated in all the literature and labels, is unknown. I have my own hunch it is more involved in the nicotinic and nitric oxide pathways than anything else. What we do know is that its NRI action is rather weak.
>
> I just hope to regain the color in my life. I used to be a musician and was studying music in college. Since stopping prozac I've switched majors and music just sounds like notes to me with no feeling. Christmas doesn't even feel like christmas, it feels no different to me than being at the beach this past summer except colder.
>
> Well thanks for the support guys.Yeah I hear ya. Color in life. How nice. I'm trying to think what it was in the last few years that allowed me to experience that color again. Let me see. They are not your ususal suspects.
Savella tiny doses.
DMSA (a mercury/lead chelation drug)...felt absolute remission while on it.
Ddoxycyline+tiny dose Hydrocortisone combination (antibiotic and supporting weak adrenals). What beautiful color.It just goes to show you, our symptoms can and do have causes that are not touched by psychiatric drugs, but are impacted positively by other drugs acting upon illnesses, diseases, or conditions we weren't aware we had.
Posted by mtdewcmu on December 21, 2009, at 18:39:22
In reply to Re: Is there hope for Post SSRI side effects? » bleauberry, posted by conundrum on December 20, 2009, at 21:29:59
> Thats interesting because I thought remeron would work since it antagonizes various serotonin receptors.
>
> Unfortunately I'll probably have to try what my pdoc wants me to try first, since I am the patient and he is the doctor, nevermind that its my body. This likely means an SNRI after my trip back from Europe.
>
> Its weird, cuz I figured wellbutrin would give me an idea of what NRI would feel like but it seems to have its own feel not similar to other norepinephrine drugs.
>To me, Wellbutrin feels like a very mild amphetamine. Not too surprising, since structurally, it is derived from amphetamine.
> I just hope to regain the color in my life. I used to be a musician and was studying music in college. Since stopping prozac I've switched majors and music just sounds like notes to me with no feeling. Christmas doesn't even feel like christmas, it feels no different to me than being at the beach this past summer except colder.
>
> Well thanks for the support guys.I wonder what tianeptine would do to you guys if your serotonin receptors have supposedly been damaged by taking SSRIs.
Posted by conundrum on December 21, 2009, at 21:12:56
In reply to Re: Is there hope for Post SSRI side effects?, posted by bleauberry on December 21, 2009, at 17:48:25
Just curious what country do u live in? Savella was just approved by the FDA in the US this past January, never really heard much about it, except that its an NSRI as opposed to an SNRI. Are you still taking it and does it help?
I guess chelation doesn't last forever so you are no longer taking that drug.
Also I was seeing a naturopathic doctor for while but stopped, maybe I should have kept seeing him. A lot of the nutritional stuff he told me to take like Omega 3s, zinc, Phosphatidyl serine, didn't do anything. He did a blood cortisol test which isn't very accurate and was I was at the low end of the normal range. I don't think I have low cortisol or adrenal dysfunction as I am borderline high blood pressure. It would be nice if something like that worked.
Posted by conundrum on December 21, 2009, at 21:14:46
In reply to Re: Is there hope for Post SSRI side effects?, posted by mtdewcmu on December 21, 2009, at 18:39:22
I think I could order it from overseas here in the US. I wonder if it would be the real deal or some scam since its not FDA regulated.
Posted by Bob on December 21, 2009, at 21:29:45
In reply to Re: Is there hope for Post SSRI side effects?, posted by SLS on December 20, 2009, at 13:57:25
> > For a period of 6 years after stopping prozac I have suffered from anhedonia(the world seems to lack color), low motivation, poor concentration and memory, sexual dysfunction, and low energy. Has anyone ever found anything to reverse this?
> >
> > Bupropion and Methylphenidate didn't do anything and SSRIs exacerbate the problem. Could an SNRI help. Has anyone on this board ever sucessfully cured themselves from the seemingly permanent post SSRI side effects?
>
> You could try a tricyclic or a MAOI. I would probably opt for nortriptyline first followed by the addition of Parnate (this is the preferred order). I am biased towards these drugs, so take my suggestions with a grain of salt. If you decide to go for an SNRI, don't forget that you can add Remeron as an adjunct.
>
>
> - Scott
>
Scott,I thought you had given up on Parnate. Aren't you switching to Effexor?
Bob
Posted by SLS on December 21, 2009, at 22:31:08
In reply to Re: Is there hope for Post SSRI side effects? » SLS, posted by Bob on December 21, 2009, at 21:29:45
> > You could try a tricyclic or a MAOI. I would probably opt for nortriptyline first followed by the addition of Parnate (this is the preferred order). I am biased towards these drugs, so take my suggestions with a grain of salt. If you decide to go for an SNRI, don't forget that you can add Remeron as an adjunct.
> I thought you had given up on Parnate. Aren't you switching to Effexor?
Yup.
I favor Parnate and nortriptyline for several reasons. The only extended remission (6 months) that I experienced was when I was on a combination of Parnate and desipramine. Unfortunately, this treatment no longer works.
- Scott
Posted by morganator on December 21, 2009, at 22:55:33
In reply to Re: Is there hope for Post SSRI side effects?, posted by bleauberry on December 20, 2009, at 21:01:46
>his phenomenon has been experienced by perhaps half a dozen people or more at this board over the last 6 months. We've kind of given it the name post-ssri syndrome. It can happen with all the ssris, not just prozac.
>I think somehow over longterm the heavy serotonin manipulation causes adaptive changes on the other neurotransmitter systems and genes
So I guess you don't think this is as likely to happen with medications like Nortriptyline?
Posted by conundrum on December 22, 2009, at 7:10:01
In reply to Re: Is there hope for Post SSRI side effects?, posted by morganator on December 21, 2009, at 22:55:33
For me prozac only "pooped out" after I stopped taking. When I find something that makes me feel normal again, I'll never stop taking it.
Posted by conundrum on December 22, 2009, at 9:14:35
In reply to Re: Is there hope for Post SSRI side effects?, posted by bleauberry on December 21, 2009, at 17:48:25
You said:
"You said it right, except you interpretted it backwards. That is, the patient is the boss, the doctor is not. Who is paying who anyway? YOU are the paying customer. HE is providing a service that YOU are paying for. HE works for YOU, you don't work for him. The customer is always the boss. Just because it happens to be mental health instead of cars or retail doesn't change anything. You are in charge. He is there to help you figure things out, make suggestions, and monitor your progress on joint team decisions that you both make together."Unfortunately mtdewcmu(mountain dew?) is correct in that most of my symptoms sound like depression, so it only makes sense from the doctors prospective to try some of the standard first line treatments. I've already failed two SSRIs recently and bupropion, but never tried an SNRI. Luckily my doc doesn't see the point in trying to drugs that are very similar. For instance if someone fails Zoloft he won't try prozac he'll move to an SNRI, and if that doesn't work add bupropion or ritalin(a drug that also failed).
But he does seem old school like he is the boss. When I started talking about receptor antagonists and things like that he told me I have OCD. I know I don't have OCD and no one around me believed that he said that. It was almost like saying, "stay out of my way."
Posted by SLS on December 22, 2009, at 9:35:37
In reply to Re: Is there hope for Post SSRI side effects?, posted by conundrum on December 22, 2009, at 9:14:35
> But he does seem old school like he is the boss. When I started talking about receptor antagonists and things like that he told me I have OCD.
When someone says something like that to me, I often respond that I am extraordinarily focused on attaining a successful treatment of my illness. This is something that my doctors have not yet been able to do. Once that is achieved, I will no longer have the need to educate myself further regarding the phenomenology of the illness.
- Scott
Posted by Newquestions on December 22, 2009, at 10:42:35
In reply to Re: Is there hope for Post SSRI side effects? » Newquestions, posted by conundrum on December 21, 2009, at 17:24:35
Well, then you know that that site would recommend staying off all drugs, that additional drugs will only cause additional damage...
Posted by morganator on December 22, 2009, at 17:59:07
In reply to Re: Is there hope for Post SSRI side effects?, posted by conundrum on December 22, 2009, at 9:14:35
I would get a new doc
Posted by conundrum on December 22, 2009, at 18:06:16
In reply to Re: Is there hope for Post SSRI side effects? » conundrum, posted by SLS on December 22, 2009, at 9:35:37
Hmm thats very true. I will just stop reading about pharmacology, hormones and whatnot and play my guitar, albeit obsessively. ;-)
Posted by conundrum on December 22, 2009, at 18:08:12
In reply to Re: Is there hope for Post SSRI side effects?, posted by Newquestions on December 22, 2009, at 10:42:35
Yes I am aware the site says that. But I disagree that staying of the drugs results in healing. The only thing that made me feel any better in the first two years was the emotional healing of getting a girlfriend. I really didn't improve at all other than that. Instead its been a gradual decline.
Posted by conundrum on December 22, 2009, at 19:27:21
In reply to Re: Is there hope for Post SSRI side effects? » conundrum, posted by morganator on December 22, 2009, at 17:59:07
I dunno maybe, my general view of psychiatrists is pretty low. My grandmom was diagnosed as manic depressive after becoming psychotic on Nardil. She explained about how the drug felt and he said the more she said the more he was convinced. He stuck her on haldol for awhile. In the end he was wrong and she just needed less Nardil which her GP recognized.
Posted by Phillipa on December 22, 2009, at 19:53:29
In reply to Re: Is there hope for Post SSRI side effects? » morganator, posted by conundrum on December 22, 2009, at 19:27:21
Your grandmother was a lucky woman how's she today? Love Phillipa
Posted by conundrum on December 23, 2009, at 5:38:58
In reply to Re: Is there hope for Post SSRI side effects? » conundrum, posted by Phillipa on December 22, 2009, at 19:53:29
She is doing ok thanks for asking. She is a bit of a homebody and still has some atypical depression symptoms like mood reactivity. ie. she feels more motivated when other people around her are motivated and she is sensitive to rejection and criticism.
Posted by Alexanderfromdenmark on December 23, 2009, at 9:34:40
In reply to Re: Is there hope for Post SSRI side effects? » Phillipa, posted by conundrum on December 23, 2009, at 5:38:58
What about ECT?
I dunno, I've got this and out of ideas. How does exercise work for you?
Posted by conundrum on December 23, 2009, at 17:45:17
In reply to Re: Is there hope for Post SSRI side effects?, posted by Alexanderfromdenmark on December 23, 2009, at 9:34:40
My memory is bad enough as is, I don't think shocking myself would improve that. Luckily I've only tried a fraction of the meds available. I've never tried a truly potent norepinephrine drug so maybe that would help. I noticed a little boost from low dose buspar, perhaps thats because it's metabolite increases NE.
How is agomelatine going?
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