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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 36. This is the beginning of the thread.
Posted by linkadge on March 15, 2010, at 11:03:10
I have been lately thinking that SSRI's might work better with less frequent dosing.
For instance, when I take an SSRI, I ususally feel a little bit worse initially. After the drug leaves the system, then I start to feel better than baseline.
Could it be that the improved mood actually occurs when the serotonin inhibition drops and there is the corresponding dopamine boost?
Similarly, people often report feeling better than usuall for a little while after withdrawl.
So, what about taking SSRI's less frequently? So that the transporter inhibition stops and the system has the opportunity to swing back the other way?
I seem to do better on escitalopram dosing every *other* day. But, if I go more than 2 or 3 days, then I start to feel worse.
Linkadge
Posted by Phillipa on March 15, 2010, at 13:12:31
In reply to SSRI - better response with less frequent dosing?, posted by linkadge on March 15, 2010, at 11:03:10
Seriously I've always thought that the side effects made you feel so much worse that when it leaves you system you just are so glad to have them out of your system not all but a lot that you feel better. Phillipa
Posted by manic666 on March 15, 2010, at 13:26:25
In reply to SSRI - better response with less frequent dosing?, posted by linkadge on March 15, 2010, at 11:03:10
why not just take a lower dose every day//surely thats a better idea
Posted by janejane on March 15, 2010, at 13:30:20
In reply to SSRI - better response with less frequent dosing?, posted by linkadge on March 15, 2010, at 11:03:10
Very interesting theory. I've been playing with prozac dosing and thought I felt a little better mood-wise after 2 days off. (Daily dosing or even every other day seems to lead to headaches.) I resumed after 2 days because I was afraid to be off for too long and to my chagrin, I felt worse again. Coincidence? I don't know. Will have to experiment more.
Posted by manic666 on March 15, 2010, at 13:53:08
In reply to Re: SSRI - better response with less frequent dosi » linkadge, posted by janejane on March 15, 2010, at 13:30:20
you no with prozac you never seen to top the 20mg any more an nothing happens that dont happen with 20mg /// any less an nothing full stop ///or is that just me//thats not in a combo but on its own
Posted by Phillipa on March 15, 2010, at 19:14:17
In reply to jane jane, posted by manic666 on March 15, 2010, at 13:53:08
Just you and maybe some others but lots take lower doses. Or alternate days as my pdoc wanted me to do. Phillipa
Posted by Bob on March 15, 2010, at 20:16:45
In reply to SSRI - better response with less frequent dosing?, posted by linkadge on March 15, 2010, at 11:03:10
> I have been lately thinking that SSRI's might work better with less frequent dosing.
>
> For instance, when I take an SSRI, I ususally feel a little bit worse initially. After the drug leaves the system, then I start to feel better than baseline.
>
> Could it be that the improved mood actually occurs when the serotonin inhibition drops and there is the corresponding dopamine boost?
>
> Similarly, people often report feeling better than usuall for a little while after withdrawl.
>
> So, what about taking SSRI's less frequently? So that the transporter inhibition stops and the system has the opportunity to swing back the other way?
>
> I seem to do better on escitalopram dosing every *other* day. But, if I go more than 2 or 3 days, then I start to feel worse.
>
> Linkadge
>I have always pondered this conundrum with frustration. Ever since the first time I ever discontinued an SSRI I've often gotten that positive rebound. It's quite fleeting... maybe one day, but undeniable. Since I began treatment those discontinuation windows of reprieve have been some of the best I've ever felt.
There is definitely something going on there where the steady state over time becomes crap, and then the discontinuation bounces my brain back into a good state for a fleeting moment.
My doctor has actually suggested what you have hypothesized here, that I take a little dose but less often than everyday. It has never really worked out in reality though for me. I never stabilized on or off the drug.
Posted by manic666 on March 16, 2010, at 4:53:28
In reply to Re: SSRI - better response with less frequent dosing? » linkadge, posted by Bob on March 15, 2010, at 20:16:45
not just me an a few others.// if your only on 1 med//the first rule is you dont take it whenever you like. how is that going to work//your body would say thanks for my med //an the next day where is me med// if in a combo like i said //yes you can do it to boost you meds//.but on 1 med you carnt say i feel great today i wont take my med//withdrawl then start up???????? not a great idea every other day.
Posted by linkadge on March 16, 2010, at 7:49:17
In reply to Re: SSRI - better response with less frequent dosing?, posted by manic666 on March 16, 2010, at 4:53:28
I disagree manic. I think that in certain cases taking meds more irregulalry can actually be of benefit.
Take xanax, if you only need it 2 times a week, why take it regularly?
Antidepressants, some people say they work as needed for them, so why take it 24/7 if you can take it as needed. AD's have been proven clinically to work (as needed) for certain disorders like PMDD.
I do agree with bob in that I've not been able to capture that feeling of SSRI withdrawl on a regular basis - but it just has me thinking.
Linkadge
Posted by manic666 on March 16, 2010, at 14:08:28
In reply to Re: SSRI - better response with less frequent dosing?, posted by linkadge on March 16, 2010, at 7:49:17
why are you takeing about xanax//thats a benzo an nothing to do with ssri,s //I thought the hole idea with depression an AD,s is to find the right one ,the right level for you illness //an keep the dose even in your body//fair enough if you need more or you need less//ajust acordingly,//but dont mess when its not broke// i have never heard a doc say take it when you like//i have seen them tell patient off for not taking there med at regular times//if you suffer premuture ejaculation by all means take when needed. i think if deeply depressed remembering what time you took your med is hard, imagine if you had to remember what day
Posted by Brainbeard on March 16, 2010, at 16:23:32
In reply to SSRI - better response with less frequent dosing?, posted by linkadge on March 15, 2010, at 11:03:10
SSRI withdrawal can cause hypomania or outright mania.
I think there was a report somewhere on this board of a woman who would raise and lower her SSRI (sertraline/Zoloft) regularly with approval of her p-doc and with good results.
But it will probably be very hard to find the right timing. May take a lifetime.
Posted by linkadge on March 16, 2010, at 16:37:41
In reply to Re: SSRI - better response with less frequent dosing?, posted by Brainbeard on March 16, 2010, at 16:23:32
All I know is that if I take the same dose of the same med day in day out, I almost routienly get worse.
When I mix things up a bit now and again (adjust the dose) add / subtract a med I do better.
Linadge
Posted by bleauberry on March 16, 2010, at 17:20:08
In reply to SSRI - better response with less frequent dosing?, posted by linkadge on March 15, 2010, at 11:03:10
Well, in the world of herbs many experts recommend pulsing doses or taking short holidays in order to keep the substance's effectiveness strong. I don't see why meds are any different.
I actually feel best on most ADs in the first couple days of starting, and then for a couple days after stopping. But if taken continually, not very good. So pulsing doses would make sense.
The problem with regular dosing is that it will cause significant changes in the brain and body. Proponents of ADs for depression will say that is a good thing, that is what we want to happen. But there is no way for us to know what changes are going to occur or whether they will be in our favor or not, until after the fact.
I personally see no problem with taking meds as-needed. It is completely dependent upon how the individual person feels on that med, the med's behavior on their physiology, and such. I am certainly not at all recommending anyone stop taking regular doses. That's not it. What I am saying is that if someone can tweek a med to help them feel better by managing doses in a manner that is different than the norm, then cool.
Me for example, I hate ssris, but if I had no choice except one of them, I know how they behave with me. Getting on feels good, getting off feels good, staying on feels bad. I do not want my brain to down regulate from constant serotonin overload. I want it to keep responding to waves of serotonin. It won't do that if I keep taking it. I'll instead go numb.
I do not believe however that this is a strategy for any newcomer to meds to be messing with. They should do what their doctor says, assuming it is a very good doctor. It is later in the game, when someone has been on a ton of meds and still having problems, and they have a lot of experience, that novel strategies are warranted. My opinion. Of course, that includes a lot of us.
Posted by Frustratedmama on March 16, 2010, at 17:52:01
In reply to Re: SSRI - better response with less frequent dosing?, posted by bleauberry on March 16, 2010, at 17:20:08
Just a thought.....what do you all think would happen if one were to alternate two similar preferred meds every other day (let's say that one responds to zoloft and prozac and every other day took the opposite one) would this work? Just wondering.....Haven't tried it but it sure would be nice to avoid this poop out stuff that keeps happening to the majority of us here.
Posted by conundrum on March 16, 2010, at 22:42:33
In reply to Re: SSRI - better response with less frequent dosing?, posted by bleauberry on March 16, 2010, at 17:20:08
How bout D-amphetamine? It boosts serotonin, noradrenaline, and dopamine and only lasts for part of the day. Doesn't give your mind as much time to downregulate. Also you can take some days off it.
Posted by manic666 on March 17, 2010, at 4:43:00
In reply to Re: SSRI - better response with less frequent dosing? » bleauberry, posted by conundrum on March 16, 2010, at 22:42:33
playing god with your meds, if new to them is crazy/// its like saying i may as well take the hole months worth in one go an then i dont need any for a month///how stupid is that //now look at your own question if new on meds.???????????????
Posted by Brainbeard on March 17, 2010, at 5:27:20
In reply to SSRI - better response with less frequent dosing?, posted by linkadge on March 15, 2010, at 11:03:10
I'd like to add to Linkadge's original contribution that daily dosing schedules are based on practical considerations, not on what actually happens in the brain. The half-life of a drug and its blood plasma levels aren't predictive in a simple, one-on-one manner of its effects on receptors in the brain.
An example: Geodon's (ziprasidone's) half-life is very short, about 6-8 hours, but the half-life of its binding to 5HT2A-receptors is about 20 hours. Receptor binding typically lasts much longer than a drug's half-life.
It's just that for most people, having non-circadian dosing schedules would be too difiicult and lead to non-compliance.
Posted by manic666 on March 17, 2010, at 7:36:59
In reply to Re: SSRI - better response with less frequent dosing?, posted by manic666 on March 17, 2010, at 4:43:00
yes i no what linkage is saying, im just makeing sure the newbies dont get idea,s above there station//an try something dangerous
Posted by Brainbeard on March 17, 2010, at 7:53:59
In reply to Re: SSRI - better response with less frequent dosing?, posted by manic666 on March 17, 2010, at 7:36:59
With all due respect, Manic, I wasn't replying to you.
I don't think, by the way, that unconventional dosing strategies are dangerous per se - not more dangerous than conventional dosing, except perhaps in the case of bipolar disorder.
Posted by linkadge on March 17, 2010, at 8:11:27
In reply to Re: SSRI - better response with less frequent dosing?, posted by manic666 on March 17, 2010, at 4:43:00
I don't think its "playing god with your meds". Surely, if god were involved in my medication magement, my recovery might be a little more flavorful.
Nevertheless, I think the fear of taking charge and experimenting a little is what keeps some people in a bad place.
With no patient experimentation, how can anyone know what works? I mean, as we are finding out these days, there is a stark contrast between what actually helps patients and what is purported to help in the literature.
Those who follow orders to a T, rarely make new discoveries.
Linadge
Posted by manic666 on March 17, 2010, at 9:55:57
In reply to Re: SSRI - better response with less frequent dosing?, posted by Brainbeard on March 17, 2010, at 7:53:59
of course not in the right hands,but there are plenty of people like me who are self taught to read an right an dyslexic// giveing me advice is like lighting the blue touch paper an run.????i did have a cool affect,when tappering from sertraline to citalapram somewere in the middle was a cool place//but i hit on that buy accident an could not remember the exact dose/// an that was when in remission f*** knows when im not an dont remember the year ,never mind day an month//no direspect to anyone im looking after the thick dorks like me.
Posted by bleauberry on March 17, 2010, at 17:30:16
In reply to Re: SSRI - better response with less frequent dosing?, posted by manic666 on March 17, 2010, at 9:55:57
When it comes to dermitology or urology or something like that, I would need some help from a very knowledgeable doctor.
But when it comes to psychiatry, I disagree with the view of "playing God". Nobody can do that. Only God can play God. I see it instead as being "in charge of personal health management". For that, no doctor can do that better than I can. Sorry, that's just the bare naked truth of the matter. And in fact, if you invite God into your life, He can help you be wiser and stronger in doing just that.
A note to manic in case you missed it in my previous post, there was a warning for nerbies to not try this at home.
Posted by Phillipa on March 17, 2010, at 20:28:00
In reply to Re: SSRI - better response with less frequent dosing?, posted by Brainbeard on March 17, 2010, at 7:53:59
Now that makes perfect sense as the worst thing a bipolar can do is skip a med. Conventional is fine. Docs suggest it a lot at least mine has. Phillipa
Posted by Dr. Bob on March 17, 2010, at 20:41:19
In reply to Re: SSRI - better response with less frequent dosing?, posted by manic666 on March 17, 2010, at 4:43:00
> how stupid is that
Would anyone like to try to show manic how he might interpret things more charitably or otherwise encourage him to rephrase or apologize? You may have the power to help him avoid being blocked again.
Bob
Posted by manic666 on March 18, 2010, at 5:01:35
In reply to Re: SSRI - better response with less frequent dosing?, posted by manic666 on March 17, 2010, at 4:43:00
playing god with your meds, if new to them is crazy/// its like saying i may as well take the hole months worth in one go an then i dont need any for a month///how stupid is that //now look at your own question if new on meds.??//////////// Right bob i asume you read this post yourself//it says how stuid is that,///not how stupid are you.//i am refering to nobody just makeing a statment of fact.an apoiligy from you would go down well //but thats not going to happen/// i try to take your dieing forum from the brink of collaspe with some meaty debates hurting no one, an posting on soicial just to keep it alive..//for a stupid statment you made its plain you want me out and an easy life until babble dies.///tell you what bob i quit //you keep your poster that screw every newbie that enters babble, an goes sraight out the door. i dont want newbies being told by people that clearly belong in a mental hospital what to do,//people liked my straight talk it a refreshing change for the suck up aproach//whatch it die again like it did in my 5 week ban RIP
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