Starting or stopping anti depressant use can be an unpleasant experience

To many with panic, anxiety, and/or depression, SSRIs are a gift -- a ticket to contentment, to an ease of mind that makes life liveable again. But anti-depressant use can be unpleasant, especially as you're beginning or stopping usage, as one recent article discusses:

Difficulties can develop at any time in the course of antidepressant therapy, but they seem to cluster at the beginning and the end.

Although it usually takes weeks for a therapeutic response, many adverse reactions—nausea, headache, somnolence, and agitation—appear soon after the first dose.

On the other hand, when some of the most widely used agents are discontinued, multiple symptoms across diverse bodily systems are common.

Early and late difficulties may be understood in terms of antidepressant neurobiology, said Dr. Pierre Blier, professor of psychiatry at the University of Ottawa.

“When serotonin reuptake inhibitors [SRIs] are initiated, there's an immediate surge in the neurotransmitter throughout the brain,” Dr. Blier said.

“It appears to be accentuated in certain regions [such as those that regulate nausea], while in areas involved in depression, like the hippocampus and frontal cortex, the surge of serotonin goes down because of negative feedback actions.”

Specifically, autoreceptors on serotonin neurons are activated by elevated levels of the neurotransmitter, inhibiting its release. Over time—the weeks before an effective response—these receptors become desensitized, allowing serotonin to rise in a consistent manner.

Discontinuation phenomena probably involve multiple neurotransmission systems that must adapt to reduced serotonin, Dr. Blier said.

I can speak to the unpleasantness of starting and stopping SSRIs from personal experience. While I've never experienced the heightened anxiety that some report when starting a new SSRI, I've definitely gone through the frustration, discussed in the article, of waiting for an SSRI to start working ("It's like purgatory," as I told my psychiatrist). And when coming off Paxil last year, I was in a constant dizzy-zombie state, punctuated by occasional moments of feeling like there was an electrical storm passing through my brain. (Apparently, this is called "the zaps," and I'm not the only one to have experienced 'em.)

Overall, though, in my experience the good of SSRIs far outweighs the bad; I'm very happy to have the opportunity to use SSRIs as part of my efforts to manage my panic, anxiety, and depression.

Double Standards for Brand Named vs Generic Drugs in Literature Reviews Use of Medication in Borderline Personality Disorder

In the free psychiatric "journal" Psychiatric Annals (Psychiatric Anals?) of August 15, 2015 - no doubt financed by PhARMA - one article correctly points out that studies on medications used for symptoms of Borderline Personality Disorder have been very small, extremely infrequent, very short-term, poorly controlled, and of limited usefulness. (And done without ANY consideration for comorbid disorders like panic disorder, which is seen in about 40% of subjects, I might add).

It also points out, again correctly, that there are no medications for the disorder itself, and that psychotherapy is the treatment of choice for that. Nonetheless, most of these patients do take medications for certain symptoms of the disorder: most usually the mood instability, irritability, and impulsivity that lead to such other problems such as self-injurious behaviors like cutting.

The review of the studies that have been done is fairly complete, although I notice that they left out an extremely important articleon the use of Prozac for the symptom of "impulsive aggression" by Coccaro and Kavoussi from 1997.

During its rather limited review of studies of the use of antidepressants in the disorder, it says things like, "The authors found a reduction in anger among the fluoxetine (Prozac) recipients," "Fluvoxamine (Luvox) improved rapid mood shifts," "Sertraline (Zoloft) was more effective in decreasing symptoms of depression, hypersensitivity in interpersonal relationships, and obsession," and "superior efficacy for phenelzine (Nardil, and MAO inhibitor) on measures of depression, borderline psychopathologic symptoms, and anxiety."

In the summary of this part of the review, it nonetheless says, "No statistically significant effects were observed for the selective serotonin reuptake inhibitors (SSRIs) or phenelzine." So what on earth were those that they had just listed?

Yet, after discussing similar weak data for mood stabilizers, it makes the following summary: "RCT's (randomized controlled studies) involving the mood stabilizers were limited by low statistical power. Divalproex sodium (Depakote) shows an effect for anger and interpersonal sensitivity. Topiramate (Topamax) and lamotrigine (Lamictal) were found to have an effect on anger."

And for atypical antipsychotics, after reviewing even weaker evidence, the summary says: "Olanzapine (Zyprexa) has the most supporting data of the antipsychotics; studies have shown its use can lead to reductions in anger, paranoia, anxiety, and interpersonal sensitivity. Effects were found for aripiprazole (Abilify) on impulsivity, anger, anxiety, psychosis, and interpersonal problems."

Misleading double standard for summarizing the effect of brand-named versus drugs available as generics, ya think?