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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 Bissie66 on April 23, 2002, at 11:19:22
Is 4 weeks long enough for me to know this one isn't working well? With other SSRIs I've gotten an immediate "kick" and started feeling markedly better. Not this one. Any chance some benefits will kick in after 4 weeks?
Posted by tex1 on April 23, 2002, at 13:29:56
In reply to SSRI's - general question, posted by Bissie66 on April 23, 2002, at 11:19:22
> Is 4 weeks long enough for me to know this one isn't working well? With other SSRIs I've gotten an immediate "kick" and started feeling markedly better. Not this one. Any chance some benefits will kick in after 4 weeks?
Unfortunately all the antidepressant effects of the ssri (as of the tryciclic) will vanish with time (God only know why....) and the peak effect is usually felt after few days. So I might tell you to tell to your pdoc to switch to another ssri.Best luck
Posted by crepuscular on April 23, 2002, at 14:09:38
In reply to Re: SSRI's - general question, posted by tex1 on April 23, 2002, at 13:29:56
hmm. peak after a few days?
always poop out?i'm not sure this is representative of most people's experience with AD's. some take several weeks to kick in, and for many, the AD effect lasts for many years.
Posted by tex1 on April 23, 2002, at 17:18:51
In reply to Re: SSRI's - general question, posted by crepuscular on April 23, 2002, at 14:09:38
> hmm. peak after a few days?
> always poop out?
>
> i'm not sure this is representative of most people's experience with AD's. some take several weeks to kick in, and for many, the AD effect lasts for many years.I don't know...I've noticed many people saying ADs pooping out after few months or even sooner and the effect just lasted for a few weeks. I think many of us continue to beleive in the effect of ADs even if they have no more....kind of placebo.
Tex
Posted by tex1 on April 24, 2002, at 3:03:48
In reply to Re: SSRI's - general question, posted by tex1 on April 23, 2002, at 17:18:51
> > hmm. peak after a few days?
> > always poop out?
> >
> > i'm not sure this is representative of most people's experience with AD's. some take several weeks to kick in, and for many, the AD effect lasts for many years.See, what I believe about ADs effect depends on the serotonin level in the synapse. We all have some negative feedback inside our body. Receptors downregulation is just one of these. According to what is commonly believed about depression, this illnes is due to an imbalance in the serotonine trasmission. Deeper to a decrease in the serotonine concentration in the synapse. Now, what SSRI do is just to increase the serotonin levels. But with time here is the receptors downregulation. Some say that that this is the beginning of the therapeutic effect. I don' think so. The beginning of therapeutic effect is when in the synapse you have more serotonin. That's it. So, the body reacts by depleting receptors caused by an increased amount of serotonin into the synapse. This is when the med starts to poop out. It all depends on how much time does your body reacts to an increased amount of serotonin. Some people takes months, some jsut weeks. That's it.
Tex
Posted by crepuscular on April 24, 2002, at 10:50:56
In reply to Re: SSRI's - why they loose their effect..., posted by tex1 on April 24, 2002, at 3:03:48
interesting. i've come to the opposite conclusion.
i see the effect of AD's as not specific to the transmitter system affected, nor the amount present in the synapse, nor even the direction of inhibition (+ serotonin, - serotonin). rather, i see the brain's response to these agents, and the subsequent gene products/neurotrophic factors created as the final common pathway of the effect.
how else might we explain antidepressants that work by *reducing* serotonin? or the myriad of transmitter systems that are all tweakable as potential AD action sites? same goes for ECT.
i'm not a giant fan of using the specificity of modern AD's as explaining depression as "low serotonin" though in some people, this is indeed the case...
Posted by Denise528 on April 26, 2002, at 11:45:53
In reply to Re: SSRI's - why they loose their effect..., posted by crepuscular on April 24, 2002, at 10:50:56
My experience with ADs is that if they are going to work they've worked within a few days and have continued to work for years. Otherwise, if they are not going to work, I initially experience extreme adverse reactions (this has happened with drugs that once worked) and after these have died down there has been little else in the way of benefits. Why have some people (like myself) experienced quick results or nothing and yet other people are told to wait at least 6 weeks. I don't understand this, can someone explain? Surely if the reason for the positive effects is an increase in serotonin and if this happens pretty quickly then why doestn't everyone experience relief from depression within days rather than weeks?
Denise
Posted by crepuscular on April 26, 2002, at 12:57:45
In reply to Re: SSRI's - why they loose their effect..., posted by Denise528 on April 26, 2002, at 11:45:53
for some people - but not all, and probably not most - simply elevating serotonin will relieve depression. in fact, a few hours after taking an SSRI, inter synaptic serotonin is increased. but people generally do not feel the effect within hours.
it appears that the brain responds to antidepressants in some kind of poorly understood cascade. after about two weeks on an AD, several transmitter turnover rates and BDNF levels are increased. this change usually corresponds to the lifting of depression and suggests that widespread metabolic changes in brain chemistry are producing the subjective effect.
so it is this "cascade" that antidepressants seem to cause, and it can be started by a number of different transmitter systems, hence the wide variety of meds.
This is the end of the thread.
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