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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by shar on November 26, 2000, at 10:09:59
I've seen a lot of posters here talk about Zoloft pooping out after a few months. I also experienced that and my p-doc said it was pretty common. I know that NOT everybody experiences poop out.
The sad part is I felt GREAT on Zoloft. Never have felt so good before or after Zoloft. I've heard that attempts to go back to it can go either way if you've been off it for awhile.
I'm wondering why it poops out, and what is it about Zoloft that makes it work so well for some people.
Posted by SLS on November 26, 2000, at 11:37:48
In reply to Anybody know WHY Zoloft poops out?, posted by shar on November 26, 2000, at 10:09:59
> I've seen a lot of posters here talk about Zoloft pooping out after a few months. I also experienced that and my p-doc said it was pretty common. I know that NOT everybody experiences poop out.
>
> The sad part is I felt GREAT on Zoloft. Never have felt so good before or after Zoloft. I've heard that attempts to go back to it can go either way if you've been off it for awhile.
>
> I'm wondering why it poops out, and what is it about Zoloft that makes it work so well for some people.
Good question.
Regarding poop-out...Complex answer:
SSRI (Zoloft) poop-out may involve a "burn-out" of downstream serotonergic-regulated dopaminergic pathways in the mesolimbic and prefrontal cortex - areas of the brain known to be involved in mood and cognition. Either there is a depletion of DA stores in this area or there is a latent adaptive change in the sensitivity of dopamine (DA) receptors there. I think the latter is more likely. There might be an upregulation of presynaptic receptors or a "reset" of postsynaptic receptors via second messenger systems and nuclear events. After so much time spent in the SSRI-induced change in functional dynamics, the postsynaptic neuron becomes convinced that this new status-quo represents the nominal biological condition and mobilizes the genetic machinery of the cell to act as if nothing had ever changed. The neuron thus reverts to its "default" settings and downregulates its postsynaptic receptors to the level they were before the SSRI was introduced.
Not as complex answer:Zoloft works by using serotonin to force dopamine function to change. After a while, the dopamine area either spends too much DA and becomes depleted (goes broke), or the neurons get "smart" and go back to the way they were before taking Zoloft.
Least complex answer:I don't know.
- Scott
Posted by Bradley on November 26, 2000, at 18:18:43
In reply to Re: Anybody know WHY Zoloft poops out?, posted by SLS on November 26, 2000, at 11:37:48
That's just the facts maam. I like most everyone like to have answers. But allthough many people have theory's on upregulation, downregulation, receptor site changes and a gamut of other minutiae. It absolutely positively is unknown. Progress is being made, but lets not jump the gun when the proof is not in the pooding.
> > I've seen a lot of posters here talk about Zoloft pooping out after a few months. I also experienced that and my p-doc said it was pretty common. I know that NOT everybody experiences poop out.
> >
> > The sad part is I felt GREAT on Zoloft. Never have felt so good before or after Zoloft. I've heard that attempts to go back to it can go either way if you've been off it for awhile.
> >
> > I'm wondering why it poops out, and what is it about Zoloft that makes it work so well for some people.
>
>
> Good question.
>
>
> Regarding poop-out...
>
> Complex answer:
>
> SSRI (Zoloft) poop-out may involve a "burn-out" of downstream serotonergic-regulated dopaminergic pathways in the mesolimbic and prefrontal cortex - areas of the brain known to be involved in mood and cognition. Either there is a depletion of DA stores in this area or there is a latent adaptive change in the sensitivity of dopamine (DA) receptors there. I think the latter is more likely. There might be an upregulation of presynaptic receptors or a "reset" of postsynaptic receptors via second messenger systems and nuclear events. After so much time spent in the SSRI-induced change in functional dynamics, the postsynaptic neuron becomes convinced that this new status-quo represents the nominal biological condition and mobilizes the genetic machinery of the cell to act as if nothing had ever changed. The neuron thus reverts to its "default" settings and downregulates its postsynaptic receptors to the level they were before the SSRI was introduced.
>
>
> Not as complex answer:
>
> Zoloft works by using serotonin to force dopamine function to change. After a while, the dopamine area either spends too much DA and becomes depleted (goes broke), or the neurons get "smart" and go back to the way they were before taking Zoloft.
>
>
> Least complex answer:
>
> I don't know.
>
>
> - Scott
Posted by coral on November 26, 2000, at 19:52:41
In reply to Anybody know WHY Zoloft poops out?, posted by shar on November 26, 2000, at 10:09:59
Dear Shar,
How high was the dosage? After a number of failures w/tri's, I started on Zoloft, but had to get up to 200 mgs for six months before it "broke through" the depression and another year on Zoloft to heal. During the second depressive episode, I felt the results starting in 3 days, and jump-started the dosage up to 100 mgs and it worked...
Just a thought or two....
Coral
Posted by shar on November 26, 2000, at 21:32:15
In reply to Re: Anybody know WHY Zoloft poops out?, posted by coral on November 26, 2000, at 19:52:41
How long have you been on Zoloft this time? Still working, so you've said. Have you upped or lowered your dose this time?
I don't remember my dosage, but we were pretty much up there for a couple of months and I was still not responding.
Thanks for the info--
S
> Dear Shar,
>
> How high was the dosage? After a number of failures w/tri's, I started on Zoloft, but had to get up to 200 mgs for six months before it "broke through" the depression and another year on Zoloft to heal. During the second depressive episode, I felt the results starting in 3 days, and jump-started the dosage up to 100 mgs and it worked...
>
> Just a thought or two....
>
> Coral
Posted by coral on November 27, 2000, at 7:58:02
In reply to Re: Anybody know WHY Zoloft poops out? » coral, posted by shar on November 26, 2000, at 21:32:15
Dear Shar,
Re: the second depressive episode, I was on Zoloft for 8 weeks, have been off for 4 weeks.
I have such a weird system that I shouldn't advise anyone on meds! :)
My mistake during the second episode was not ramping up fast enough on the Zoloft.
Coral
Posted by AndrewB on November 29, 2000, at 10:53:43
In reply to Anybody know WHY Zoloft poops out?, posted by shar on November 26, 2000, at 10:09:59
Of course Bradley is right, it seems no one really knows with any authority what causes drugs like Zoloft to poop out. And there isn't necessarily just one single process that explains everyone's poop out. I agree with Scott that, considering the (extended) time it takes for poop out to occur, secondary systems within the postsynaptic dopamine (D2/D3) neurons (changes in peptide function, to name one) or through other neurotransmitter systems acting on the these dopamine neurons may explain (at least in many cases) poop out of drugs like Zoloft. The dopaminergic system is perhaps a relatively complex neurotransmitter system with an often frustrating ability to regain homeostasis, that is, it returns to its original functional state, through the various regulating mechanisms it possesses. One can often initially raise the levels of activity in a particular part of this system, only to be disappointed some time later when the system manages to readjust its level of activity downward again.
But theories aside, the knowledge isn't out there to use theory as a means of coming up with pharmacological remedies for poop out. Rather we are left with to rely on a pool of anecdotal evidence, that is, what worked for others with similar conditions. Because we have to rely on this anecdotal evidence, boards like this, and sections like Dr. Bobs tips section are important resources. (I was so glad to hear Dr. Bob is going to update and improve the tips section. It has helped so many as it is.) For the same reason, it is important to have psychiatrist who is knowledgeable of the various potential ways to deal with poop out. He needs to have a large base of case histories gleaned from his own practice and from exchange with other professionals on what has worked in various situations for poop out. Often the psychiatrists who have the most complete knowledge in such matters are termed psychopharmocologists.
There are so many options to deal with poop out; higher dosages, switches between other serotonergic agents, add-ons like stimulants and dopaminergic agonists (bromocriptine, Mirapex).... the list goes on. Presuming one’s doctor is aware of the various options, one hopes he has the experience to know which approaches, given an individual’s situation, are most promising and to be tried first, and when and what is best to try next if the first attempts at dealing with poop out fail. It is my opinion, that when dealing with issues secondary to depression like poop out, one should seek the most experienced and qualified psychiatrists out there.
AndrewB
This is the end of the thread.
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