SSRIs and SNRIs for depression?

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Adolescent Depression [And information for adults, too], New York Times, April 16, 2011.
http://health.nytimes.com/health/guides ... tions.html

“Selective serotonin-reuptake inhibitors (SSRIs) are now the first-line treatment of major depression. . . There are no significant differences among SSRI brands in effectiveness for treating major depressive disorder, although individual drugs may have different side effects or benefits for specific patients.

“SSRIs take, on average, 2 - 4 weeks to be effective in most adults. They may take even longer, up to 12 weeks, in the elderly and in those with dysthymia. . .

“Side Effects of SSRIs. Side effects may include:
• “Nausea and gastrointestinal (GI) symptoms usually wear off over time.
• “Agitation, insomnia, mild tremor, and impulsivity occur in 10 - 20% of people who take SSRIs. These symptoms may be particularly problematic in patients who also suffer from anxiety, sleeplessness, or both.
• Drowsiness affects about 20% of SSRI-treated patients. Newer SSRIs, such as escitalopram (Lexapro), may have fewer of these adverse effects.
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. [five other side effects and potential side effects are listed]
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• "Sexual side effects include delayed or loss of orgasm and low sexual drive. They are a well-known side effect of SSRIs. Taking a supervised drug "holiday" on the weekend may improve sexual function during that time. Some of the newer SSRIs or other antidepressants may cause less severe impairment of sexual function.
• "Paroxetine (Paxil) may cause birth defects if taken during the first 3 months of pregnancy. . . Venlafaxine (Effexor) may also be associated with birth defects. . .

“The dose of the antidepressant should be slowly reduced before stopping. . . ”
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“Dual Inhibitors. Dual inhibitors act directly on two neurotransmitters -- norepinephrine and serotonin. These drugs are also known as serotonin norepinephrine reuptake inhibitors (SNRIs).

“Venlafaxine (Effexor) is similar to Prozac in effectiveness and tolerability for most patients. . . Some patients report severe withdrawal symptoms, including dizziness and nausea. In 2006, the drug’s manufacturer warned of an increased overdose risk and advised doctors to prescribe their patients only small amounts of venlafaxine pills. [other side effects are listed, as with any medication] . . .

“Duloxetine (Cymbalta) also acts on both serotonin and norepinephrine. Side effects are generally mild and include dry mouth, nausea, and sleepiness. Patients with narrow-angle glaucoma or patients with liver or kidney diseases should not take duloxetine. Because duloxetine can cause liver damage, patients who drink large quantities of alcoholic beverages should not take it. . . ”
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Reviewed By: Paul Ballas, DO, Department of Psychiatry, Thomas Jefferson University Hospital . . . Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Don't think my doc has read this reserach, she just given me 58 Vanlafaxine pills! Good job I'm not suisidal!

It's funny though that Venlafaxine is seen as simular to Prozac in tolerability; as some of you know I ended up in hospital after my aniexty levels rose so much on Prozac and yet, although Venlafaxine made me feel quite sick in the early days, it has reduced my aniexty level to nearly normal!

Guess things things aren'r a pricise science.

Okay, to try and put it in informal 'country' terms, not a doctor in the world, not Dr. Paul Ballas of Tom Jefferson Hospital, nor even the very best neurobiologist in Madras India (hey, let’s be multicultural about it!) can predict in advance, for example, whether an SSRI will work for a particular patient or not. In a very respectable sense, it is trial and error. ‘Hey, let’s try it for a couple of weeks and see how it goes.’ That kind of thing.

And a person needs a doctor with a light touch and it sure helps to have one you can halfway talk with. For example, if you tend to react strongly to medicine and would like to start with a smaller dose, sure helps if you can talk with your doctor and ping-pong it back and forth. Okay, maybe let’s try that way.

And you can start with either a psychiatrist or an internist or a family practitioner. It is your choice.

And if an SSRI is not working, or is tending to make a person more agitated or has other unacceptable side effects, an SNRI might work wonders. It’s all part of the trial and error.

Good luck everyone who's struggling with this stuff, as I sometimes do. And let's keep talking.

No, not exact science at all. I mean, we're a long way from Dr. Beverly Crusher and her tricorder! Just where the science is at this time.

Now, your doctor does sound good in other ways. She does sound like she has the ability to ping-pong it back and forth and adjust, and not be a stick in the mud.

Maybe, just as an idea, you could print out this article and show it to her? I mean, that might get more effect than just saying, read an article someplace. Or, it might be too heavy-handed, your judgment call. But it does sound like she's pretty good at conversation.

Always good talking with you, Jacs. Hope things are going well. Sure, some days are good days, some days are bad days. That very much is my experience. Now, if this is working (and it is kind of funny and oddball that something very similar didn't but this is), maybe next time you get a refill, if you feel more comfortable, in casual, offhand manner just arrange a smaller bottle? (or the pharmacy might have trouble with this! Institutions can be clumsy and 'clunky' and any change from the status quo they can resent as extra 'work.' Go figure. Some days, a person just can't win)

Yeah my Doc is pretty cool but not sure about showing her the article. Am really no good at these 'judement calls' and wouldn't want to offend her.

I think she just gave me so many pills because in England you have to pay, per item, a set fee for you meds i. e one box of 14 pills would costs me £7.30 , where as one box of 58 pills would still only cost me £7.30. So may be she was just trying to save me some cash?

It is really interesting though. In some ways I would have loved to have gone to med school, just two prob 1. I didn't get the grades needed and 2. I hate the sight of blood and usually faint so would probably have ended up needing more treatent the paient!

Well, okay, then probably hold back, and maybe just way, well, I read an article that says people can overdose. And see if she picks up on it and suggests an alternative. And she doesn't need to be perfect although she sounds pretty good.

Now, about the price per bottle, and yeah, I kind of see what you're saying. Well first off, hooray for British 'socialized' medicine. I for one would welcome that over here in the States (fair number of my fellow citizens disagree). So, a pound about two dollars, right? So fifteen bucks a bottle, popping that a couple of times would impact my monthly expenditures.

And yeah, about medical school, I'm not sure I could do it even if I could time warp back to age 18, and be as smart as I am now, know the things I know, but have the energy of an 18 yr old. I tend to rabbit hole into topics. For example, I've read some about efforts to make a 'universal flu vaccine' where the antibody is to the stalk of the protein which doesn't change that much, as opposed to the head which does (flu virus has little stalky proteins on its surface). Well, a person might make progress and might not, a lot of luck involved. I tend not to be as good as learning something broadly and getting an 85 on a test, and that broad skimming seems to be what institutions generally reward. I am adding to my skill set and keeping preferred skills.

I do think us 'aspies' should be open to professions, where potentially we can be appreciated and make goodly money.

Maybe down the road for me, maybe beyond a kind of amateur medical journalism (and I do think I'm rather good at excerpting an article) maybe something in a professional capacity. And maybe, maybe, something like getting a masters or PhD in something like microbiology and teaching and research. Sure why not.

I tried some generic type of prozac once and it was one of the most horrible drug experiances I ever had. So no more of that for me ever, and also the side effects really do suck.

http://thehealthyskeptic.org/the-dark-s ... epressants
http://thehealthyskeptic.org/treating-d ... ugs-part-i

I had some cool side effects while on Prozac in Summer 1991. I'd stay awake for 22 hours at a time and sleep for two hours, then repeat the cycle. I stopped the med, but the side effects lasted for another two weeks. Got a lot done, but I also started to get insomnia hallucinations after a while. I remember a piece of molten lead landed on my thigh and I just watched it burn.

So perhaps one of the 'mixed' antidepressants?
(which is my term for it since it affects more than one neurotransmitter)

" . . Dual inhibitors act directly on two neurotransmitters -- norepinephrine and serotonin. These drugs are also known as serotonin norepinephrine reuptake inhibitors (SNRIs). . "
http://health.nytimes.com/health/guides ... tions.html

First time I went on anti-depressants, I tried something like 7, and then the 8th one finally did what I wanted. (Or was it 8 and 9th?) They all either didn't hit the depression, or made me so dopey that I'd never get any work done.

Lesson? Everyone's brain is different. Within reason, it's worth trying different meds for depression and/or ADHD (or any other brain issue) until you find one that works. But your doc (and the rest of your support network) needs to monitor you carefully; too many people (including one friend of mine) commit suicide on a drug change if their depression is bad enough.

I'm not much on the "anti-pill" thing that some people are. I don't want to take meds I don't need; OTOH, without my meds, I'd not get out of bed, and my life would suck much more in that case. I LIKE my $90k/yr job, even when it's really boring, thank you very much.

I'm currently on Lexapro, an SSRI, and Trazodone, which is an SARI (serotonin antagonist and reuptake inhibitor), and also helps put me to sleep ('cause otherwise my optimal sleep schedule would be 0400 to 1200, which doesn't work very well with the "real" world ... damn morning people, who put them in charge?). I'm also on Strattera, an SNRI, for ADHD. My shrinks don't like the idea of giving me a "proper" stimulant (e.g. Ritalin) for the ADHD, since I have some addiction problems. (Behavioural, not drug, although give me uppers and that might change Very Quickly.)

Side effects? Paxil messed up my sex life some ... it's one thing to have better staying power, but it's another thing when you Can't Have An Orgasm To Save Your Life. Desipramine gave me some REALLY great nightmares; stuff that would make Akira look like Bambi. Funnily, they didn't scare me; I'd just wake up, bolt upright (never happens for me), think "Whoa, that would make a really cool movie!", and then crash back to sleep.

I've gained a lot of weight, but I don't think that's the anti-depressants' fault; unless, of course, you count my regular use of chocolate chips as anti-depressants. %-)

My condolences for the loss of your friend.

Same here... Just out of curiousity, did they make you feel numb? SSRI's have made me experience the worst feeling I have ever had - extreme apathy. Nothing inspired any emotion in me. My special interests were suddenly not special. For me that was true hell.

To this day I am constantly worried that one day I will wake up and inexplicably feel that way again and have no means of escaping it.

I have had that extreme numbing happen with all of the SSRI's I tried (about 6, IIRC). Tricyclics have not given me that side effect, fortunately. And I've not tried any SSRI's in about 15 years and that apathy has not come back, thank g-d.

And, yes, that is a horrible feeling. Supposedly, it's due to SSRI's somehow indirectly causing inhibition in some dopamine pathways in the brain (presumably including the pleasure pathway).

Oh yes. The extreme apathy was the primary reason why I felt I had to come off the SSRI's. No real pleasure in anything, every day just like the one before it and no prospect of ever achieving anything or getting back to work ever again.

As far as I'm concerned Citalopram was a drug devised in the most fiendish pits of hell.

I've been on paxil and clonazpam for 2 months now. At first I experienced some pretty strong apathy and some other side-effects (amazingly no sexual ones), but around the 3rd week all the side-effects were gone. These 2 have done wonders for my anxiety, I have more motivation than I ever had on any stimulant, and more self confidence. I just hope they continue to work this way because looking back on how I was before these two medications I realize how low my threshold for social activities and stress really were.

I don't know if anyone can relate to this but before I was medicated it felt as though when talking to people I felt them more than I heard them. I would react to how they sounded and presented themselves rather than to what they were actually saying. I'm pretty bad with metaphor sometimes but, I don't really know how else to describe it =)

gl to anyone trying ssri's or anything else for that matter!