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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by Angela on May 16, 2000, at 17:41:05
my doctor isn't happy with the results the luvox has dealt me, so i asked him if we could switch back to zoloft. he agreed to it and told me to start titrating down tomorrow & gave me a whole schedule to follow.
my concern is that the zoloft will not be effective on me anymore. what is the response when you go off a medicine then go back on it? i've been on the luvox for at least 6 weeks and i've gotten a little bit better, but not to the point i was at on zoloft or celexa.
any experiences you've had would be great to hear about. thanks!
Posted by tina on May 16, 2000, at 18:41:05
In reply to Going back on a medicine you've taken before, posted by Angela on May 16, 2000, at 17:41:05
Hey Angela: I was on moclobemide about 6 years ago for a panic disorder I had then. The psych thought it might be linked to dysthimia or mild depression so she tried me on this "revolutionary" (haha) new drug called Manerix. It worked like a charm then but when I started to get panicky and depressed again a few years later I tried going back on it. The stuff did nothing, nothing whatsoever. Actually, come to think of it, it worsened the depression. I had to take a totally new direction with the meds, went on Celexa. Won't bore you with that subject, suffice it to say that I'm still looking. Anyway, this is just my experience. Same med might work for you, worth a try anyway. Good luck, keep us posted.
> my doctor isn't happy with the results the luvox has dealt me, so i asked him if we could switch back to zoloft. he agreed to it and told me to start titrating down tomorrow & gave me a whole schedule to follow.
>
> my concern is that the zoloft will not be effective on me anymore. what is the response when you go off a medicine then go back on it? i've been on the luvox for at least 6 weeks and i've gotten a little bit better, but not to the point i was at on zoloft or celexa.
>
> any experiences you've had would be great to hear about. thanks!
Posted by Adam on May 16, 2000, at 19:18:55
In reply to Going back on a medicine you've taken before, posted by Angela on May 16, 2000, at 17:41:05
That's a good question.
I don't really understand what "poop-out" is, but have heard it described
as a form of tolerance.I would have guessed that this "tolerance" was to the effects of dysregulation
of the serotonergic system, where the compensatory adjustments made by the
nervous system to enhanced serotonin neurotransmission (which are what some
theories of antidepressant action implicate as the clinically relevant
phenomena) are somehow "normalized". Since the number of serotnin-secreting
neurons in the brain is quite small, and these neurons function largely to
regulate other, larger structures containing neurons secreting other hormones
like, say, dopamine, perhaps the difficulties have to do with desisitization
of other neurotransmitter systems.Or maybe there is further adjustment of serotonin secretion months or even
years after starting the medication. The theories I have heard proposed to
explain the delayed onset of SSRI action involve negative feedback on
serotonin production and secretion through stimulation of somatodendritic
autoreceptors. There is an initial DECREASE in serotonin in the synapse after
initiation of treatment, or, at least, no significant increase, due to this
negative feedback. Eventually, though, the overstimulation of these
autoreceptors causes their down-regulation, and the pre-synaptic neuron
becomes "apathetic" to its own activity, returning to a normal level of
serotonin secretion, the affect of which is now augmented by the inability
of the cell to draw the hormone back in from the synapse. Maybe, somehow,
this "apathy" is overcome, and serotonin secretion again decreases.Whatever the mechanism, it seems to me that simply replacing one SSRI immediately
with another would be of little benefit, since the effects on serotonin are
more-or-less the same.I would look into alternative classes of medicaion. Effexor might be one
choice, since it has effects on the norepinepherine system too. You could
try to augment Zoloft with Welbutrin, which acts primarily on dopamine and
norepinepherine. Or you could switch to an MAOI, which acts on all three
of the major psychogenic monoamines. Augmentation with lithium might kick-
start something in the serotonin system. Addition of gabapentin seems to have
helped some non- or partial responders to SSRIs for a variety of indications.There are a number of things one could try.
But based on my totally unprofessional hypothesizing about these various
neurotransmitter systems that nobody has worked out well yet, I wouldn't predict
treating SSRI poop-out with another SSRI, or, for that matter, returning to
the old "pooped-out" drug, would be the way to cure the problem.> my doctor isn't happy with the results the luvox has dealt me, so i asked him if we could switch back to zoloft. he agreed to it and told me to start titrating down tomorrow & gave me a whole schedule to follow.
>
> my concern is that the zoloft will not be effective on me anymore. what is the response when you go off a medicine then go back on it? i've been on the luvox for at least 6 weeks and i've gotten a little bit better, but not to the point i was at on zoloft or celexa.
>
> any experiences you've had would be great to hear about. thanks!
Posted by Angela on May 16, 2000, at 20:09:48
In reply to Re: Going back on a medicine you've taken before, posted by Adam on May 16, 2000, at 19:18:55
Adam,
first, holy cow! are you a doctor or in the medical arena? i've never heard half of those words used before by my doctor or anyone else for that matter.
you referred to the "poop out" of a medicine. the only reason i switched to celexa from zoloft was to get rid of the sexual side effects. the zoloft worked great for me. when i had my relapse while on celexa is when my pdoc changed me to the luvox. at first he had me on effexor xr then added the luvox. he didn't like what he was getting from the effexor (and i don't even remember what was wrong with it, even though this was only a month or so ago), so he dropped the effexor and added the norpramin, which works primarily on norepinephrine.
he wrote me a script for the lithium, but i really don't want to take it. i have an appt. with another doctor in town next monday and i'm going to see what he has to say about all the meds and taking lithium.
so, to summarize, he's putting me back on the zoloft for the OCD and the norpramin for depression.
thanks for your input, advice and help. :)
> That's a good question.
>
> I don't really understand what "poop-out" is, but have heard it described
> as a form of tolerance.
>
> I would have guessed that this "tolerance" was to the effects of dysregulation
> of the serotonergic system, where the compensatory adjustments made by the
> nervous system to enhanced serotonin neurotransmission (which are what some
> theories of antidepressant action implicate as the clinically relevant
> phenomena) are somehow "normalized". Since the number of serotnin-secreting
> neurons in the brain is quite small, and these neurons function largely to
> regulate other, larger structures containing neurons secreting other hormones
> like, say, dopamine, perhaps the difficulties have to do with desisitization
> of other neurotransmitter systems.
>
> Or maybe there is further adjustment of serotonin secretion months or even
> years after starting the medication. The theories I have heard proposed to
> explain the delayed onset of SSRI action involve negative feedback on
> serotonin production and secretion through stimulation of somatodendritic
> autoreceptors. There is an initial DECREASE in serotonin in the synapse after
> initiation of treatment, or, at least, no significant increase, due to this
> negative feedback. Eventually, though, the overstimulation of these
> autoreceptors causes their down-regulation, and the pre-synaptic neuron
> becomes "apathetic" to its own activity, returning to a normal level of
> serotonin secretion, the affect of which is now augmented by the inability
> of the cell to draw the hormone back in from the synapse. Maybe, somehow,
> this "apathy" is overcome, and serotonin secretion again decreases.
>
> Whatever the mechanism, it seems to me that simply replacing one SSRI immediately
> with another would be of little benefit, since the effects on serotonin are
> more-or-less the same.
>
> I would look into alternative classes of medicaion. Effexor might be one
> choice, since it has effects on the norepinepherine system too. You could
> try to augment Zoloft with Welbutrin, which acts primarily on dopamine and
> norepinepherine. Or you could switch to an MAOI, which acts on all three
> of the major psychogenic monoamines. Augmentation with lithium might kick-
> start something in the serotonin system. Addition of gabapentin seems to have
> helped some non- or partial responders to SSRIs for a variety of indications.
>
> There are a number of things one could try.
>
> But based on my totally unprofessional hypothesizing about these various
> neurotransmitter systems that nobody has worked out well yet, I wouldn't predict
> treating SSRI poop-out with another SSRI, or, for that matter, returning to
> the old "pooped-out" drug, would be the way to cure the problem.
>
> > my doctor isn't happy with the results the luvox has dealt me, so i asked him if we could switch back to zoloft. he agreed to it and told me to start titrating down tomorrow & gave me a whole schedule to follow.
> >
> > my concern is that the zoloft will not be effective on me anymore. what is the response when you go off a medicine then go back on it? i've been on the luvox for at least 6 weeks and i've gotten a little bit better, but not to the point i was at on zoloft or celexa.
> >
> > any experiences you've had would be great to hear about. thanks!
Posted by tina on May 16, 2000, at 21:29:36
In reply to Re: Going back on a medicine you've taken before, posted by Angela on May 16, 2000, at 20:09:48
> Adam,
>
> first, holy cow! are you a doctor or in the medical arena? i've never heard half of those words used before by my doctor or anyone else for that matter.If you think HE'S scary, wait till you get a response from CAM!!!
>
> you referred to the "poop out" of a medicine. the only reason i switched to celexa from zoloft was to get rid of the sexual side effects. the zoloft worked great for me. when i had my relapse while on celexa is when my pdoc changed me to the luvox. at first he had me on effexor xr then added the luvox. he didn't like what he was getting from the effexor (and i don't even remember what was wrong with it, even though this was only a month or so ago), so he dropped the effexor and added the norpramin, which works primarily on norepinephrine.
>
> he wrote me a script for the lithium, but i really don't want to take it. i have an appt. with another doctor in town next monday and i'm going to see what he has to say about all the meds and taking lithium.
>
> so, to summarize, he's putting me back on the zoloft for the OCD and the norpramin for depression.
>
> thanks for your input, advice and help. :)
>
> > That's a good question.
> >
> > I don't really understand what "poop-out" is, but have heard it described
> > as a form of tolerance.
> >
> > I would have guessed that this "tolerance" was to the effects of dysregulation
> > of the serotonergic system, where the compensatory adjustments made by the
> > nervous system to enhanced serotonin neurotransmission (which are what some
> > theories of antidepressant action implicate as the clinically relevant
> > phenomena) are somehow "normalized". Since the number of serotnin-secreting
> > neurons in the brain is quite small, and these neurons function largely to
> > regulate other, larger structures containing neurons secreting other hormones
> > like, say, dopamine, perhaps the difficulties have to do with desisitization
> > of other neurotransmitter systems.
> >
> > Or maybe there is further adjustment of serotonin secretion months or even
> > years after starting the medication. The theories I have heard proposed to
> > explain the delayed onset of SSRI action involve negative feedback on
> > serotonin production and secretion through stimulation of somatodendritic
> > autoreceptors. There is an initial DECREASE in serotonin in the synapse after
> > initiation of treatment, or, at least, no significant increase, due to this
> > negative feedback. Eventually, though, the overstimulation of these
> > autoreceptors causes their down-regulation, and the pre-synaptic neuron
> > becomes "apathetic" to its own activity, returning to a normal level of
> > serotonin secretion, the affect of which is now augmented by the inability
> > of the cell to draw the hormone back in from the synapse. Maybe, somehow,
> > this "apathy" is overcome, and serotonin secretion again decreases.
> >
> > Whatever the mechanism, it seems to me that simply replacing one SSRI immediately
> > with another would be of little benefit, since the effects on serotonin are
> > more-or-less the same.
> >
> > I would look into alternative classes of medicaion. Effexor might be one
> > choice, since it has effects on the norepinepherine system too. You could
> > try to augment Zoloft with Welbutrin, which acts primarily on dopamine and
> > norepinepherine. Or you could switch to an MAOI, which acts on all three
> > of the major psychogenic monoamines. Augmentation with lithium might kick-
> > start something in the serotonin system. Addition of gabapentin seems to have
> > helped some non- or partial responders to SSRIs for a variety of indications.
> >
> > There are a number of things one could try.
> >
> > But based on my totally unprofessional hypothesizing about these various
> > neurotransmitter systems that nobody has worked out well yet, I wouldn't predict
> > treating SSRI poop-out with another SSRI, or, for that matter, returning to
> > the old "pooped-out" drug, would be the way to cure the problem.
> >
> > > my doctor isn't happy with the results the luvox has dealt me, so i asked him if we could switch back to zoloft. he agreed to it and told me to start titrating down tomorrow & gave me a whole schedule to follow.
> > >
> > > my concern is that the zoloft will not be effective on me anymore. what is the response when you go off a medicine then go back on it? i've been on the luvox for at least 6 weeks and i've gotten a little bit better, but not to the point i was at on zoloft or celexa.
> > >
> > > any experiences you've had would be great to hear about. thanks!
Posted by Adam on May 16, 2000, at 23:06:35
In reply to Re: Going back on a medicine you've taken before, posted by Angela on May 16, 2000, at 20:09:48
> Adam,
>
> first, holy cow! are you a doctor or in the medical arena? i've never heard half of those words used before by my doctor or anyone else for that matter.
>
> you referred to the "poop out"...Holy cow is right. Sorry about that. I somehow got your post mixed up
with another I saw, which somehow led me to believe that your most current
post had something to do with the other thread. Now I don't know what the
thread I originally looked at was. Golly-bum dang, didn't mean to make
you read all that for no good reason. I'd be happy to try to define some
terms if you like. I don't use "those words" for any other reason than
it's the best way to express the concepts, and I think if it takes a little
effort to learn what they mean (I had to), it's worth it, because you can
become so much more fluent in the language some doctors and researchers
use. This makes reading original sources much easier. I think it's so
useful to be able to read the literature critically. No one knows your
condition better than you, and no one will do more research about it than
you. If your doctor is a team player, you can help her or him, I think,
just by being able to express yourself more clearly, if nothing else. You
might even pull a good suggestion for treatment out of your hat.I've read some cam, tina. Is "scary" the word :). I don't mean to be. I
find science and thinking about it a lot of fun. But, no, I'm not a doctor
and I'm not in any other way connected to medicine except that I do work in
a lab performing biomedical research. Most of what I do is cellular and
molecular biology, largely in vitro, and thus pretty far removed from the
clinical setting. When I do "operate", I'm afraid it's on poor little bunnies
and rodents, and I try to avoid doing that like the plague, if I can help it.
I could almost do a balloon angioplasty at this point (or at least give you
a bad case of restenosis), I think, but, as they say, mice are not men.What I know about psychiatry I have experienced as a patient, read about, or I
just plain guess, like my last post here. No more than that.
Posted by JohnL on May 17, 2000, at 4:50:01
In reply to Going back on a medicine you've taken before, posted by Angela on May 16, 2000, at 17:41:05
> my doctor isn't happy with the results the luvox has dealt me, so i asked him if we could switch back to zoloft. he agreed to it and told me to start titrating down tomorrow & gave me a whole schedule to follow.
>
> my concern is that the zoloft will not be effective on me anymore. what is the response when you go off a medicine then go back on it? i've been on the luvox for at least 6 weeks and i've gotten a little bit better, but not to the point i was at on zoloft or celexa.
>
> any experiences you've had would be great to hear about. thanks!In my experience I have seen one of two things happen...either the medication works as expected like it did the first time around; or it doesn't work nearly as well as it used to. Either scenario could happen. I don't think anyone knows why this strange phenomenon occurs.
It's just my non-professional opinion, but I do not like the idea of returning to a previous drug that was so-so, while ignoring others that haven't been tried yet that have the potential to be fantastic. I see no sense in returning to a previous medication unless all other avenues have failed. Then it makes sense to go back to the best of the bunch for a second look-see. Settling for OK results is not acceptable to me. I want superior results. If a previous med did not provide that, then I'll keep looking. After all is said and done, I can always return to the best of the bunch, even if that was just OK. At least I would know I didn't overlook something.
But that's just me. If you're comfortable going back to Zoloft or Celexa--kind of like getting back to the comfort zone--then that's probably the right thing to do. Perhaps stabilizing on one of them for a while will give you a chance to research and ponder other avenues that might be better to try. Until then, stability is a good thing. If Zoloft or Celexa can do that for you, then I think that's a good thing.
JohnL
Posted by Cecilia on May 19, 2000, at 22:32:26
In reply to Going back on a medicine you've taken before, posted by Angela on May 16, 2000, at 17:41:05
My experience with going back on a medicine I`ve taken before--both times I`ve tried this the side effects were MUCH worse the 2nd time. (I went back on meds I`d tried before in order to try "augmenting" them with other meds, in both cases, before even adding the augmenting agent, the side effects were far worse. Can`t say about effectiveness-no med I`ve ever tried has helped.)
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