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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by tina on September 24, 2002, at 10:14:21
What is the mechanism that makes them stop working all of a sudden?
Please, no sarcastic remarks. I genuinely want to know.
Posted by cosis on September 24, 2002, at 10:51:41
In reply to WHY do AD's poop out?, posted by tina on September 24, 2002, at 10:14:21
Any certain AD's your talking about? A believe your body builds a tolerance to some like Xanax if taking to much
Posted by tina on September 24, 2002, at 13:43:07
In reply to Re: WHY do AD's poop out?, posted by cosis on September 24, 2002, at 10:51:41
SSRI's, MAOI's, tricyclics etc. What happens? Why do they just stop working very suddenly?
Posted by Peter S. on September 24, 2002, at 14:43:15
In reply to Re: WHY do AD's poop out? » cosis, posted by tina on September 24, 2002, at 13:43:07
For some people it seems that they continue to work. For others (like myself) they poop out. For those who lose the effect, it may be that other things are going on- one possibility is mild bipolar features in which case it may be worth trying mood stabilizers (lithium, Lamictal, Neurontin, or depakote)
> SSRI's, MAOI's, tricyclics etc. What happens? Why do they just stop working very suddenly?
Posted by Eddie Sylvano on September 24, 2002, at 15:54:49
In reply to WHY do AD's poop out?, posted by tina on September 24, 2002, at 10:14:21
> What is the mechanism that makes them stop working all of a sudden?
> Please, no sarcastic remarks. I genuinely want to know.
----------------------------I'm no doctor, but I would guess that the brain becomes conditioned to the presence and effects of these drugs after time, just as it does to other psychoactive drugs (alcohol, caffeine, etc.). There are many feedback loops in the body that ensure balance. If one neurotransmitter suddenly increases in presence, the body eventually makes less of that chemical, or tunes down the extent that it pays attention to it. The brain gets, in a sense, sensitized to the change.
Aside from those mechanisms, the liver also ramps up it's attempts to break down any unwanted chemical that it comes across frequently.
Posted by Arthur Gibson on September 25, 2002, at 6:50:08
In reply to Re: WHY do AD's poop out?, posted by Eddie Sylvano on September 24, 2002, at 15:54:49
Although ADs are good in the short term, it is probably a good thing that they "poop out" after a while. Our bodies must know that they will be damaged by their continued action.
I find the OMEGA 3 faty acid fish oils to be very effective and I am told that the effect does not "poop out" as it is a natural food.
Posted by Bill L on September 25, 2002, at 8:33:00
In reply to WHY do AD's poop out?, posted by tina on September 24, 2002, at 10:14:21
About 6 years a go, I started on Prozac 20mg. It pooped out after 10 months. I believe that if I had raised the dose to 30mg, it would have kept working.
I started on Celexa 20mg 3 years a go. It pooped out after a year, so I raised it to 40mg. That pooped out after a year so I raised it to 60mg. For the past year I have been on 60mg feeling fine. I do not think that the 60 will poop out since the 40-60 range works for most people. I'll never know because I just switched to Lexapro 20mg which is a purified version of Celexa. It works really well.
To summarize my feelings on poopout, just raise the dose. It can't hurt and it wil probably help so you have nothing to lose.
Posted by cybercafe on September 25, 2002, at 16:17:19
In reply to Be glad that they do poop out, posted by Arthur Gibson on September 25, 2002, at 6:50:08
> Although ADs are good in the short term, it is probably a good thing that they "poop out" after a while. Our bodies must know that they will be damaged by their continued action.
>
> I find the OMEGA 3 faty acid fish oils to be very effective and I am told that the effect does not "poop out" as it is a natural food.
if you want natural, go with lithium :)
Posted by jay on September 25, 2002, at 16:31:31
In reply to Re: Be glad that they do poop out, posted by cybercafe on September 25, 2002, at 16:17:19
> > Although ADs are good in the short term, it is probably a good thing that they "poop out" after a while. Our bodies must know that they will be damaged by their continued action.
> >
> > I find the OMEGA 3 faty acid fish oils to be very effective and I am told that the effect does not "poop out" as it is a natural food.
>
>
> if you want natural, go with lithium :)Good point :-). I'd also say that Omega oils are far from being any kind of perfect answer (Please check out my comments "re: Fish oils..", above). They are as much a shot in the dark as any other therapy (Medications included.) I'd think that a combined approach, using Omega oils with medication, might be worth a shot.
Posted by FredPotter on September 25, 2002, at 18:33:16
In reply to Re: WHY do AD's poop out?, posted by Eddie Sylvano on September 24, 2002, at 15:54:49
I don't think the liver has much relevance to synaptic levels of serotonin since there's tons of serotonin in the gut, but this doesn't cross the blood brain barrier (BBB). I think SSRIs poop-out more than others don't they? I found Moclobemide did it too, but that could have been because I was abusing alcohol. As regards Xanax, the word on the street is that tolerance to anxiolytic affects does not occur, only to the sedating side-effects
Posted by FredPotter on September 25, 2002, at 18:35:48
In reply to Re: WHY do AD's poop out?, posted by Bill L on September 25, 2002, at 8:33:00
>To summarize my feelings on poopout, just raise the dose. It can't hurt and it wil probably help so you have nothing to lose.
Only your sex life
Posted by FredPotter on September 25, 2002, at 18:41:19
In reply to Re: Be glad that they do poop out, posted by cybercafe on September 25, 2002, at 16:17:19
>if you want natural, go with lithium
If we naturally get very small quantities of a metal or a fatty acid in our water and diet, there is nothing natural about consuming relatively huge amounts. There is evidence however that our diet up until modern (neolithic) times was higher in omega-3 FAs than it is now. Our diets and habits seem to change quicker than our metabolism and structure
Posted by cybercafe on September 25, 2002, at 23:24:36
In reply to Re: Be glad that they do poop out » cybercafe, posted by FredPotter on September 25, 2002, at 18:41:19
in neolithic times we may have gone days without eating and lived outside in the middle of freezing winter -- no thanks mate!
(btw stress studies show that, of all stressors, cold increases NE without increasing ACTH or adrenaline!) ... i feel wonderful (other than the cold) when i'm cold, but screw nature, i say!
> If we naturally get very small quantities of a metal or a fatty acid in our water and diet, there is nothing natural about consuming relatively huge amounts. There is evidence however that our diet up until modern (neolithic) times was higher in omega-3 FAs than it is now. Our diets and habits seem to change quicker than our metabolism and structure
Posted by Eddie Sylvano on September 26, 2002, at 8:55:51
In reply to Re: WHY do AD's poop out? » Eddie Sylvano, posted by FredPotter on September 25, 2002, at 18:33:16
> I don't think the liver has much relevance to synaptic levels of serotonin since there's tons of serotonin in the gut
------------------------------You're right, but I was referring to the liver forming more enzymes to degrade the SSRI itself, and it's metabolites, which shortens the half-life.
Posted by Mr. SadPuppyDog on September 27, 2002, at 11:55:19
In reply to WHY do AD's poop out?, posted by tina on September 24, 2002, at 10:14:21
> What is the mechanism that makes them stop working all of a sudden?
> Please, no sarcastic remarks. I genuinely want to know.None of the answers you got answer your question. Nobody really knows why antidepressants stop working, but they do stop working sometimes. Unfortunately. This is dangerous for it can sometimes lead to a "treatment resistant depression" and chronic disability. Which is a dangerous situation to find yourself in to say the least.
Probably the biggest reason why ADs do not work good is coadminstration of depressant drugs such as benzos and alcohol. Many depressives continue taking benzos like klonopin or Xanax long after they should have stopped taking benzos. This is usually a big mistake. Benzos taken over the longterm almost always lead to worsened depression. Benzos are like booze basically, they just depress your nervous system more and more.
Also drinking booze, even in small amounts, can cause antidepressants to poop out. Just one or two beers a day can cause an SSRI to not work good. Its best to totally avoid booze if on antidepressants and the more severe your depression, the more important it is to avoid booze completely.
Again, any type of CNS depressant drug taken with an antidepressant can cause the AD to not work at full speed. Now if youve eliminated CNS depressant drugs from the picture, you then get into "true" antidepressant poop out, which is pretty scary actually when you think about it.
Probably the single biggest theory about why ADs poop out is dopamine depletion. Some theorize that when youve been on an antidepressant for a while, especially serotonergic ADs, that the subtle dopamine depletion results in loss of effectiveness and activation. Another thing that can cause antidepressants to stop working good is thyroid problems, but I think this is overhyped myself. Especially in male depressives. Thyroid probs are more common in female depression.
The subtle bipolar thing is also overhyped IMO. Many people who experience AD poopout go onto do the best on noradrenergic and dopaminergic antidepressants like MAOIs, high dose Wellbutrin, high dose Effexor, plain old speed (amphetamines) and of course ECT. ECT is VERY dopaminergic BTW, ECT creates so many brain changes you couldnt go into it all here.
Another thing to know ahead of time is anytime you get a Pdoc who tells you that your meds dont work cause you have some kind of personality disorder...run the other way. Fire the son of a bitch. Some Pdocs get frustrated with patients who dont respond good to antidepressants and start labeling you with all kinds of personality disorders. Most of the time this is unnecessary and bad psychiatry. Personality disorders are mostly BS anyway, mostly just label stuff, invented by psychologists. Personality disorders are not actual clinical mental illnesses, like major depression, manic depression or schizophrenia.
If you are doing everything right and your Pdoc starts making up reasons why your meds dont work good, find another Pdoc please. They are NO GOOD.
The bottom line is that the psychiatrists dont know...and really dont seem to care or be interested in finding out why antidepressants "poop out." They have a few theories, but again these are just theories...or better yet hypothesis. Opinions is more like it. Most psychiatrists are not very interested in the hard science of this stuff. You are on your own basically. If your med poops out, your best odds are the straightforward approach. Which means simply increasing the dosage works best. If that doesnt work, get your thyroid tested, maybe try lithium augmentation to rule out bipolar problems and if none of the above work...go have ECT done.
Mr. Sad PuppyDog
Posted by Mr. SadPuppyDog on September 27, 2002, at 12:00:29
In reply to Be glad that they do poop out, posted by Arthur Gibson on September 25, 2002, at 6:50:08
> Although ADs are good in the short term, it is probably a good thing that they "poop out" after a while. Our bodies must know that they will be damaged by their continued action.
Really? I found that severe depression did much more damage to my body than any antidepressant I took. You seem to be heavily influenced by some of the anti-psychiatry literature out there.
>
> I find the OMEGA 3 faty acid fish oils to be very effective and I am told that the effect does not "poop out" as it is a natural food.Its obvious you never had severe depression before. I find your posts inflammatory to those with severe mental illness.
Mr. Sad PuppyDog
Posted by Dr. Bob on September 27, 2002, at 19:32:26
In reply to Re: Be glad that they do poop out, posted by Mr. SadPuppyDog on September 27, 2002, at 12:00:29
> Personality disorders are not actual clinical mental illnesses...
To repeat, please don't exaggerate or overgeneralize.
> Its obvious you never had severe depression before. I find your posts inflammatory to those with severe mental illness.
And don't post anything that could lead others to feel accused or put down.
Bob
Posted by FredPotter on September 29, 2002, at 17:07:45
In reply to Re: WHY do AD's poop out?, posted by Mr. SadPuppyDog on September 27, 2002, at 11:55:19
One clue to the cause of poop-out might be to notice which kinds of drugs are implicated the most. Am I right in saying that SSRIs are the worst, possibly followed by the RIMA Moclobemide? How about MAOIs, Tricyclics, SNRIs and the rest (Serzone, Remeron, Tianeptine, Effexor). From what little I know it seems that the more serotonin-specific a drug is, the more likely it is to poop-out, although this doesn't explain why Moclobemide does it
This is the end of the thread.
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