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Dr. Bob is Robert Hsiung, MD,
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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?
Posted by SLS on December 23, 2009, at 18:53:19
In reply to Re: Is there hope for Post SSRI side effects? » Alexanderfromdenmark, posted by conundrum on December 23, 2009, at 17:45:17
>I noticed a little boost from low dose buspar, perhaps thats because it's metabolite increases NE.
That might be an indicator that you would respond to Remeron.
- Scott
Posted by conundrum on December 23, 2009, at 21:03:19
In reply to Re: Is there hope for Post SSRI side effects? » conundrum, posted by SLS on December 23, 2009, at 18:53:19
Thats what I thought and also that I found prozac stimulating the first time, possibly from 5-HT2C blockade. My doc said he doesn't like to prescribe it because of weight gain and he doesn't know if I have depressive disorder. (only seen me 3 times) He prescribed nefazodone which i never filled though, and that has killed people. go figure.
Posted by conundrum on December 26, 2009, at 10:22:18
In reply to Re: Is there hope for Post SSRI side effects?, posted by SLS on December 20, 2009, at 13:57:25
for SLS, bleauberry and anyone else who has suffered from this post SSRI syndrome, did you find that taking noradrenergic drugs restored your ability to concentrate and remember things? My ability to hold knew information and move it to longer term memory is really bad since coming off prozac. Also are you able to feel love? I know intellectually that I love someone but can rarely feel it. Have you seen any improvements in these areas, if you had these symptoms?
Posted by SLS on December 26, 2009, at 10:38:09
In reply to Re: Is there hope for Post SSRI side effects? » SLS, posted by conundrum on December 26, 2009, at 10:22:18
> for SLS, bleauberry and anyone else who has suffered from this post SSRI syndrome, did you find that taking noradrenergic drugs restored your ability to concentrate and remember things? My ability to hold knew information and move it to longer term memory is really bad since coming off prozac. Also are you able to feel love? I know intellectually that I love someone but can rarely feel it. Have you seen any improvements in these areas, if you had these symptoms?
The things that you describe can be symptoms of depression. Depression often gets worse over time. It can also morph from being an illness that is primarily of negative affect to one of impairments of cognition and memory.
I am not challenging the existence of a post-SSRI syndrome. I have not researched it to form an opinion.
Did you experience these things while you were taking Prozac, or did they appear only after you discontinued it? Did these things exist prior to your first exposure to antidepressants?
- Scott
Posted by conundrum on December 26, 2009, at 10:42:58
In reply to Re: Is there hope for Post SSRI side effects? » conundrum, posted by SLS on December 26, 2009, at 10:38:09
The cognitive problems only appeared after stopping prozac completely. I did not have them during or prior to treatment. They did not improve upon reinstatement of the drug.
Posted by SLS on December 26, 2009, at 10:56:01
In reply to Re: Is there hope for Post SSRI side effects? » SLS, posted by conundrum on December 26, 2009, at 10:42:58
> The cognitive problems only appeared after stopping prozac completely. I did not have them during or prior to treatment. They did not improve upon reinstatement of the drug.
Are you currently depressed?
Were you depressed while you were taking the Prozac?
What other drugs might you be taking?
- Scott
Posted by conundrum on December 26, 2009, at 11:36:21
In reply to Re: Is there hope for Post SSRI side effects? » conundrum, posted by SLS on December 26, 2009, at 10:56:01
I would say I'm depressed because I'm anhedonic and unmotivated and don't take much pleasure in life. I'm not on any meds now, I'm taking a break because I will be away for a month.
I have tried:
Prozac(again)
Lexapro
Budeprion
BusparThe only thing I noticed helping was 5mgs buspar with 2.5 mg prozac. I felt more motivated then.
Posted by morganator on December 26, 2009, at 11:44:57
In reply to Re: Is there hope for Post SSRI side effects? » SLS, posted by conundrum on December 26, 2009, at 10:42:58
I have some questions. If you were not depressed when taking Prozac, why did you decide to get off? Please don't take this the wrong way, I have done the same thing and realized that it was a mistake at the time and I should have waited until I was ready or had a really good plan for transitioning from being on a medication to being off. I was not suffering from any real side effects other than maybe being a bit thirsty more than the average person. So, I definitely should have waited or just stayed on Zoloft for good.
I have some suggestions as far as your cognitive issues go if you are willing to spend some money and give these things some time. There are several supplements out there that can greatly improve cognitive function:
Acetyl-L-Carnitine - highly recommend-500 mgs upon waking on an empty stomach-may want to consider taking R Lipoic Acid with this as they work synergistically.
Ginko Biloba-Nature's Made GinkoGold is by far the best most clinically proven Ginko product on the market. May take up to 4 to 6 weeks before noticing a difference.
Bacopa Monniera-Ayuverdic herb that can both improve memory and relieve anxiety and has been studied clinically. May also take anywhere from 3 to 12 weeks to receive full benefit.
Piracetam-Very interesting compound that may not only improve cognition but also improve creativity. People like me that are bipolar can be sensitive to it and begin to feel too stimulated in an agitated way. Otherwise it is a very benign substance and has not shown to be hardly toxic.
I would strongly recommend looking into these options. Acetyl L Carnitine(ALCAR), R lipoic acid, Ginko biloba, and Bacopa(I think I am already feeling the effects of this after one week!) are my favorites. I may try Piracetam again when I feel I have stabilized more. When I tried it the first time I was NOT feeling stable at all. The first time I took it I felt so good I could not sleep all night. Then I continued to take it but did not feel so hot. For anyone that is not sensitive like I am it is definitely worth trying.
Just google all of these and see what you come up with.
Posted by morganator on December 26, 2009, at 11:51:20
In reply to Re: Is there hope for Post SSRI side effects? » SLS, posted by conundrum on December 26, 2009, at 10:42:58
Are you taking fish oil? That can also help with brain function. I would recommend something with a higher than normal EPA to DHA ratio. Vitamin Shoppe MegaFishOil is a good deal, the rest are way too expensive. Otherwise, if you belong to CostCo, the cheapest and still fairly high quality fish oil around is Kirkland's. I would spend a few extra bucks on the enteric coating capsules. I took Kirkland's fish oil for years and felt fine but lately I think I do better on one with a higher EPA to DHA ratio, say 4:1 instead of 3:2-which is what most fish oil products have.
There is also a product sold by Himalaya called MindCare. It actually has Bacopa in it along with some other potentially helpful herbs, including Ashwaghanda. You may not only find yourself thinking better but also feeling better on this product and the others I mentioned.
Good luck!
Posted by conundrum on December 26, 2009, at 11:53:22
In reply to Re: Is there hope for Post SSRI side effects?, posted by morganator on December 26, 2009, at 11:44:57
Interestingly I have tried some of those. Right now I take 180 mg of ginkgold a day. I had taken gingko before for 2 years without much improvment. I took acetyl l carnitine as well. It just gave me headaches however.
I may consider pircatam if nothing that helps depression helps memory. I'll google Bacopa and see what that does.
Posted by morganator on December 26, 2009, at 12:01:46
In reply to Re: Is there hope for Post SSRI side effects? » SLS, posted by conundrum on December 26, 2009, at 10:42:58
One more thing! Exercise, exercise, exercise! If you want to rebuild your brain, especially in those areas such as the hippocampus that deal with learning and memory, exercise is one of the best ways to do that.
If you find that you feel so bad you can't exercise, try some of the other things I suggested for a while as they may give you more energy and make you feel better. And, think about getting back on a medication if you are not doing so already. If you can get yourself to exercise, start off slowly and give yourself time to build up to more moderate or intense levels. You only need about 20 to 30 minutes of good cardio to get benefit. Then a good meditative stretch is helpful after. Actually, if you can find a way to sort of meditate and close your eyes briefly and breath through your mouth then nose while doing cardiovascular exercise, you may find yourself getting more of that "high" and increase in oxygen and blood flow to your brain. These are just things that I do that I find helpful. Also, during exercise try to take all negative thoughts and turn them into positive ones. Or just wipe out the negative for the time and try not to think about anything. It may be hard but it works for me and many others I have talked to.
>They did not improve upon reinstatement of the drug.
Does this mean that you are on Prozac again now?
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Dr. Bob is Robert Hsiung, MD,
[email protected]
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