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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by SLS on January 15, 2019, at 6:20:08
I have seen it written by many that the psychobiology generating the antidepressant responses to SSRIs is the result of the emergence of emotional blunting, numbing, amotivation, and apathy. In the absence of these effects, SSRI drugs would not work to improve depression. I really don't see this happening.
The explanation given for the antidepressant effect of SSRI-induced apathy is that feelings of depression will be diffused simply because you don't give a damn anymore. I don't agree with this. I see emotional blunting, amotivation, and apathy as being nothing more but unwanted side effects. For me, Zoloft caused a great deal of these side effects, even though I also experienced an antidepressant response. Lexapro had almost zero side effects, and I responded to it. I did not respond to Prozac or Paxil. For these two drugs, emotional blunting, amotivation, and apathy were prominent.
With a SSRI, if someone experiences significant emotional blunting, amotivation, and apathy, shouldn't they also experience a robust antidepressant response? If this were true, should we encourage everyone to take Paxil?
If we were to conceive of serotonin reuptake inhibition as always producing emotional blunting, amotivation, and apathy, what happens to these effects when SNRIs (Effexor, Pristiq, Cymbalta? are applied? I have responded better to Effexor and Cymbalta (SNRI) than to Paxil and Prozac (SSRI). I experienced not apathy and amotivation at all with SNRIs.
Question: Of the true SSRIs, which one do you think is the worst for producing emotional blunting, amotivation, and apathy?
- Scott
Posted by Hordak on January 15, 2019, at 12:01:59
In reply to SSRIs work by numbing emotions? - Myth?, posted by SLS on January 15, 2019, at 6:20:08
Probably true.
Dopamine firing inhibition is inherent to (S)SRIs. It affects everyone who's taking (S)SRIs, but the question is to what degree... some turn into walking zombies, others are only minimally affected...
> The explanation given for the antidepressant effect of SSRI-induced apathy is that feelings of depression will be diffused simply because you don't give a damn anymore.
Posted by Hordak on January 15, 2019, at 12:25:51
In reply to SSRIs work by numbing emotions? - Myth?, posted by SLS on January 15, 2019, at 6:20:08
Yes, but these are comparable with the sexual side effects from SSRIs... that's what Serotonine Reuptake Inhibition does.
> I see emotional blunting, amotivation, and apathy as being nothing more but unwanted side effects.
Posted by Hordak on January 15, 2019, at 12:33:14
In reply to SSRIs work by numbing emotions? - Myth?, posted by SLS on January 15, 2019, at 6:20:08
More like a "depressant" response.
Those are core symptoms of depression ;=)> With a SSRI, if someone experiences significant emotional blunting, amotivation, and apathy, shouldn't they also experience a robust antidepressant response? If this were true, should we encourage everyone to take Paxil?
Posted by rjlockhart37 on January 15, 2019, at 12:35:05
In reply to Re: SSRIs work by numbing emotions? - Myth? » SLS, posted by Hordak on January 15, 2019, at 12:01:59
i've read this too, it's like it saturates the synapse with serotonin and lowers the other DA and NE
fluoxetine ..been on for years, and did notice when it started working a warm feeling with the mood, it never really made me flat, and it improved social skills and being in the mood to talk. It gets out of the dark mood, and feel better to talk, and go through out the day. fluoxetine is least selective of SSRIs. Zoloft blunted me out, but also zoloft is a dopamine reptake inhibtor at higher doses, it has a dopamine effect at 200+ mgs
paxil, and other heavy serotonin SSRIs i think can cause flatness, the most selective ones
well that's just my 2cents, there no medical evidence behind that
Posted by Christ_empowered on January 15, 2019, at 13:50:55
In reply to Re: SSRIs work by numbing emotions? - Myth?, posted by rjlockhart37 on January 15, 2019, at 12:35:05
i think the 'emotional novocaine' effect is a big part of the 'antidepressant effects,' and i think that's one reason these drugs have fda approval for so many indications and they are still used extensively, off-label, for others...
it reminds me of those old Librium ads, aimed at doctors: "Whatever the diagnosis, LIBRIUM!"
if psychiatry was a rational discipline, ssri use would have long ago been restriced to cases of phobias, ocd-type problems, ruminations and agitation associated with forms of depression. interestingly enough...
these are many of the same indications that marked people/patients as good candidates for lobotomies.
it isn't even necessarily the case that the numbing effect is what the -person- is after...
especially in hospitals, group homes, prisons+jails, foster care, nursing homes...or dealing with low status people...
the numbing effect is often what those who control the 'medicated' individual want.
having said that, some of use get forms of despair that...well, since its not legal to just go out and get a valium or a vicodin or a dexamyl...these 'life saving medications' are often the only available option.
when i had intense agitation, ruminations, etc...celexa was OK, for a couple months. then I became too placid and too...celexa'd, i suppose. i wasnt jumping for joy over an ssri, but what option do most people have, especially with the dea declaring war on any substance that might make someone feel good (especially non-rich, non-white people...) ?
it seems -most- psych drugs work by numbing the emotions, tranquilizing, sedating...subduing, subtracting, basically. i would say that the stimulants are a major exception, but...even there, the uppers are mostly used to improve conformity, with school, work, etc. :-(
i vaguely remember reading "Listening to Prozac" . Not that most profound book ever, but...interesting, nonetheless.
Posted by Hordak on January 15, 2019, at 15:01:39
In reply to SSRIs work by numbing emotions? - Myth?, posted by SLS on January 15, 2019, at 6:20:08
NRIs have some downstreaming effects which boost dopamine transmission.
That is also true for 5HT2 and 5HT3 antagonists...That is why the combo Sertraline + Nortriptyline is so effective. Another good one is Clomipramine.
> what happens to these effects when SNRIs (Effexor, Pristiq, Cymbalta? are applied? I have responded better to Effexor and Cymbalta (SNRI) than to Paxil and Prozac (SSRI). I experienced not apathy and amotivation at all with SNRIs.
Posted by Hordak on January 15, 2019, at 15:03:56
In reply to Re: SSRIs work by numbing emotions? - Myth?, posted by rjlockhart37 on January 15, 2019, at 12:35:05
Fluoxetine has some 5HT2C antagonism going on... so that might be the reason ;-)
> i've read this too, it's like it saturates the synapse with serotonin and lowers the other DA and NE
>
> fluoxetine ..been on for years, and did notice when it started working a warm feeling with the mood, it never really made me flat, and it improved social skills and being in the mood to talk. It gets out of the dark mood, and feel better to talk, and go through out the day. fluoxetine is least selective of SSRIs. Zoloft blunted me out, but also zoloft is a dopamine reptake inhibtor at higher doses, it has a dopamine effect at 200+ mgs
>
> paxil, and other heavy serotonin SSRIs i think can cause flatness, the most selective ones
>
> well that's just my 2cents, there no medical evidence behind that
>
>
>
Posted by linkadge on January 15, 2019, at 15:55:03
In reply to SSRIs work by numbing emotions? - Myth?, posted by SLS on January 15, 2019, at 6:20:08
I agree with the notion that SSRIs can reduce the range of emotional experience, but I also agree that this is not the primary or intended effect.
The SSRI induced reduction in dopamine seems like a plausible explanation. For example, SSRIs can cause sexual dysfunction, which alone would make it difficult to experience a certain facet of human emotion.
I only notice this because I have tried other medications which either don't have this effect, or have it to a lesser degree.
For example, I noticed the effect was minimal for, say, 10mg of citalopram, but more prominant at 20mg. Citalopram alone disrupted my sleep, which could certainly contribute.
I noticed the effect was significant with citalopram, and less so with prozac and sertaline. I never tried paxil long enough to say for sure.
Linkadge
Posted by linkadge on January 15, 2019, at 19:28:09
In reply to Re: SSRIs work by numbing emotions? - Myth? » SLS, posted by Hordak on January 15, 2019, at 12:01:59
Just to add along the lines of Hordak. A lot may depend on the original biochemical imbalance. For example, for somebody whose depression is associated with low levels of dopamine functioning, SSRIs may be more likely to induce apathy.
Linkadge
Posted by linkadge on January 15, 2019, at 19:33:05
In reply to Re: SSRIs work by numbing emotions? - Myth?, posted by linkadge on January 15, 2019, at 15:55:03
There are other receptors that are involved too. Activation of 5-ht7, 5-ht6, 5-ht1d, for example, may reduce the dimensions of emotion. Excessive 5-ht1d activation as well, can reduce growth hormone release. It's not just suppression of dopamine. Reduced acetylcholine function can reduce the ability to experience pleasure.
However, I don't agree with the notion that the effect is due to the induction of apathy. Although, for some with emotional over-reactiveness, apathy may be welcome.
Linkadge
Posted by Hordak on January 16, 2019, at 7:19:15
In reply to Re: SSRIs work by numbing emotions? - Myth? » Hordak, posted by linkadge on January 15, 2019, at 19:28:09
Agreed.
> Just to add along the lines of Hordak. A lot may depend on the original biochemical imbalance. For example, for somebody whose depression is associated with low levels of dopamine functioning, SSRIs may be more likely to induce apathy.
>
> Linkadge
Posted by Hordak on January 16, 2019, at 9:38:52
In reply to Re: SSRIs work by numbing emotions? - Myth?, posted by linkadge on January 15, 2019, at 15:55:03
That's the mystery. Why does it happen with some SSRIs, but not with others?
I don't have a clue ^^> I agree with the notion that SSRIs can reduce the range of emotional experience, but I also agree that this is not the primary or intended effect.
>
> The SSRI induced reduction in dopamine seems like a plausible explanation. For example, SSRIs can cause sexual dysfunction, which alone would make it difficult to experience a certain facet of human emotion.
>
> I only notice this because I have tried other medications which either don't have this effect, or have it to a lesser degree.
>
> For example, I noticed the effect was minimal for, say, 10mg of citalopram, but more prominant at 20mg. Citalopram alone disrupted my sleep, which could certainly contribute.
>
> I noticed the effect was significant with citalopram, and less so with prozac and sertaline. I never tried paxil long enough to say for sure.
>
> Linkadge
>
>
>
>
Posted by Hordak on January 16, 2019, at 9:41:09
In reply to Re: SSRIs work by numbing emotions? - Myth?, posted by linkadge on January 15, 2019, at 19:33:05
Possibly.
Are there ongoing studies on the subject?I know a few papers, but most of them only focus on the Dopamine-theory.
> There are other receptors that are involved too. Activation of 5-ht7, 5-ht6, 5-ht1d, for example, may reduce the dimensions of emotion. Excessive 5-ht1d activation as well, can reduce growth hormone release. It's not just suppression of dopamine. Reduced acetylcholine function can reduce the ability to experience pleasure.
>
> Linkadge
Posted by linkadge on January 16, 2019, at 15:09:11
In reply to Re: SSRIs work by numbing emotions? - Myth? » linkadge, posted by Hordak on January 16, 2019, at 9:41:09
I don't think there is much interest in really studying the issue. Its easier for doctors to just write it off as being an underlying symptom of depression.
The apathy syndrome didn't seem to be a common side effect of older medications TCAs / MAOIs. Also, it seems less common (or nonexistent) with some of the mixed monoamine drugs - mirtazapine, trazodone, serzone, bupropion, duloxetine, Fetzima, vilazodone etc.
Linkadge
Posted by SLS on January 17, 2019, at 10:56:44
In reply to Re: SSRIs work by numbing emotions? - Myth?, posted by Christ_empowered on January 15, 2019, at 13:50:55
> i think the 'emotional novocaine' effect is a big part of the 'antidepressant effects,
What makes you say this?
- Scott
This is the end of the thread.
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