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Question about short term SSRI use and brain chemistry

J

Jiraiya

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Aug 20, 2013
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Melbourne, Australia.
Hi all.

You all may remember me from my post a few weeks ago about MDMA neurotoxicity. I've moved past this now and am starting to worry about other things (lol).

About two and a half weeks ago I was put on Citalopram aka Celexa (20mg per day), and some Lorazepam which I only took for a week. I noticed myself not feeling great on these, so my doctor has decided to take off them. I've been weening down for a week (5mg every four days) which is fine, haven't noticed any withdrawals as far as I know (it's hard to tell because I have anxiety regardless), in fact for a few days after weening down I even felt better. I've been on 10mg for the last four days, and I go down to 5mg tomorrow for the last four days.

Haven't noticed any increase in symptoms, just my anxiety is REALLY bad. But then again it was a few weeks ago before I even started the meds.

Now I happened to stumble across this article last night, which of course scared the pants off of me. Here is the article in it's unholy glory.

https://www.psychologytoday.com/blo...chronic-depression-has-name-tardive-dysphoria

I guess the question I want to ask is this: would the short term use I have described changed my brain chemistry significantly? And I know everyone is different, but how long would it take for my brain to restore itself to homeostasis functioning after such short term usage? I guess it's a hard question to answer.

The other question is that if it has, how can I speed up the recovery process? I am doing a mindfulness retreat next week, and I will be taking up exercise and eating very healthily - which will all help I suppose.

TL;DR version. I am worried that short term use of SSRI's/benzo's will have changed my brain chemistry, and as a result I will be left depleted of serotonin/GABA. Also worried that it may have caused some irreversible changes?

Thanks all!
 
Oh yeah, tardive dysphoria! I've really waited for something like this term to come up. Have yet to read through the linked article that seems to be really into something and also think more about it, but short-term SSRI use (less than some months) very probably won't re-wire anything. Give yourself some more weeks to recover.
 
The article in that link is horrible.

First, Medical Hypotheses is one of the worst journals. The articles are not peer reviewed. "Tardive dysphoria" is not a real syndrome. If something is only described in Medical Hypotheses then that implies that it is BS.

Think of all the confounds in the Psychology Today article. Is it really all that surprising to find that patients who take antidepressents for a relatively long period are more likely to relapse compared to someone on short-term treatment? The duration of antidepressant treatment is likely to correlate with the severity of depression -- people with severe depression are probably more likely to relapse compared with someone with moderate depression.
 
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This is the original one I read, http://freepdfs.net/tardive-dysphoria-the-role-of-long-term/32076ecdcc5d52d1c1c65bf7cb6f65ae/ but once again, Medical Hypotheses. It's also been posted on PubMed and other sites

http://www.ncbi.nlm.nih.gov/pubmed/21459521

I guess it is a load of BS. I also guess that is people solely rely on meds then they aren't really getting to the root of this issue, which is why they maybe relapse more.

The main part that fucked with my head was this.

In his discussion, El-Mallakh notes that people without any history of depression who are prescribed an antidepressant for other reasons—anxiety, panic disorder, or because they are serving as “normal controls” in a study—may become depressed, with that depression at times persisting for a fairly long period of time after the antidepressant is withdrawn. The reason that antidepressants may have a “prodepressant effect,” El-Mallakh writes, is that “continued drug treatment may induce processes that are the opposite of what the medication originally produced.” This is the “oppositional tolerance” that Fava has written about, and this process may “cause a worsening of the illness, continue for a period of time after discontinuation of the medication, and may not be reversible.”
 
It takes longer than 2.5 weeks to develop the compensatory mechanisms that cause SSRI withdrawal. You also don't have symptoms of SSRI withdrawal -- dizziness and electric shock sensations linked to head movements are the primary symptoms. Some people may experience anxiety, but usually that occurs as a reaction to the withdrawal symptoms. It is also very simple to treat the withdrawal when it does occur -- just switch to fluoxetine and do a long taper.
 
Yeah you're right I don't have dizziness and electric shock sensations. Fuck I just read another one. I'm guessing this one is bullshit too? It relates to brain damage more than withdrawal.

http://ireport.cnn.com/docs/DOC-420197

I'm going to quit Google now, it's not doing me any good haha. Do you think that 5-HTP would be helpful to relieve the lack of sleep/anxiety?
 
5-HTP is not to be mixed with SSRIs but once they are out of your system you could try it, though it's not absorbed into the brain very well. Watch out for it causing restlessness and such, very rare but it has been reported.

I really wouldn't worry about the SSRIs having changed your brain chemistry permanently, it will probably take just a couple weeks for things to get back to normal concerning both the SSRIs and lorazepam. The same changes that occur with chronic SSRI use (down regulation) will be undone with up-regulation shortly, it could be a matter of weeks but not months.

Might I add, in many cases downregulation is therapeutic concerning excitatory kinds of serotonin like 5-HT2A which you could consider bad (there is often too much 5-HT2A in depressed/anxious people, and it can cause insomnia, so hence more serotonin from say 5-HTP is not always a good thing). So when we're talking about compensating effects of SSRIs the downregulation of 5-HT2A is supposed to be one of the good compensations that involves LESS serotonin activity with chronic SSRI use (pointing this out because depression/anxiety issues are largely thought of as a lack of serotonin by the public), but it only happens with long term administration, it can make things worse for a while at first when it increases 2A activity but you still have lots of receptors, it takes a while for the brain to downregulate serotonin 2A.

The slight-withdrawal from lorazepam could be a culprit regarding insomnia and anxiety. I think some people are very sensitive to benzos and become very slightly addicted if they take them every day for a short period of time. Of course your brain will recover from this just fine as well. They aren't neurotoxic drugs at all, they just cause things to down regulate and your brain needs time to up regulate receptors after you come clean off them.

I definitely recommend mindfulness and meditating on the breath!! It is essential to train the mind to shut down when you want to sleep and focus on what you want it to pay attention to (and not what you don't want it to pay attention to), mindfulness meditation can help you achieve this if you practice it daily and give it time. Good luck on your retreat :) Not all problems can be solved with drugs ;) I also highly approve of some cardio, it is amazing for the brain and increases neurogenesis. It will help you age healthily. Any questions are welcome, especially if you're interested in trying out some non benzo medications for sleep. Don't drive yourself nuts with these studies btw! Toodles!
 
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Jiraiya said:
Yeah you're right I don't have dizziness and electric shock sensations. Fuck I just read another one. I'm guessing this one is bullshit too? It relates to brain damage more than withdrawal.

http://ireport.cnn.com/docs/DOC-420197

I'm going to quit Google now, it's not doing me any good haha. Do you think that 5-HTP would be helpful to relieve the lack of sleep/anxiety?
Click to expand...

Patients treated with SSRIs don'r show evidence of motoneuron disease, so why worry about their findings? The study was conducted in vitro, so it may not be relevant to in vivo.
 
Hi Cotcha! Great to hear from you again. Thanks for your reply.

I've been off the Lorazepam for about two weeks now, so I'm probably through the withdrawal phase for that, or through the worst of it anyways. I no longer need sleeping pills to fall asleep, although I'm still averaging 5 hours sleep - I think the anxiety might be the culprit there though. I was only on it for a week, but it was a reasonable dose.

I'm actually going on a mindfulness retreat in a couple of days, which I'm really looking forward to! It's very nutrition based too, so I will be on a very healthy diet and will be taking up an exercise regimen while I'm there - running every day for about 20-30 minutes.

I do have a few questions for you though!

1) Would exercise and diet help with recovery speed? Currently I'm not exercising, and my diet could be alot better for sure. I also started smoking again due to the stress of the anxiety, however I've made a promise to myself that this is my last packet!

2) Do the changes to serotonin receptors with SSRI use come over time? Meaning that, because I was on it for only a short time, I will recover quicker than say someone that was on it for 3+ months? It's been three weeks today since I started, and I started the weening process about 10 days ago. I was only on the full dose (20mg) for 12 days. I actually worked it out (a tad obsessive haha) and by the time I've come 'clean' I would have had around 18-19 pills.

3) My main worry is that when I stop the SSRI, I am going to fall into a deep depression. Is this a likely scenario.

Just on a side note, do you study Neuroscience? You seem to be very knowledgeable about the subject! It's impressive :)
 
Exercise is an excellent natural anti-depressant, I can't stress enough just how good cardio is for the mind! I should add, the harder it is the more that you need it ;) Nutrition is beneficial as well but exercise will be a lot bigger factor than nutrition. But they do go hand in hand and benefit from each other, exercise and nutrition.

The changes to the serotonin receptors do indeed happen over long periods of time, typically many months, your short period of use isn't enough time to withdraw from SSRIs. If anything, when SSRIs don't work well, coming off them is a relief, sort of like an anti-withdrawal.

I highly highly doubt you're going to see any problems related to this extremely small use of SSRIs once you come off them, especially if they didn't benefit you much to begin with. You might have to deal with whatever problems were there to begin with however, which I believe should be adressed with mindfulness, exercise, and probably a little better nutrition. But opening up the wound so this time it can close and heal properly might be just what you needed.

If you're still having sleep issues a while from now that you can't seem to manage with mindfulness meditation I think you should examine that a little closer, possibly pursuing a sleep study (especially if you snore) before you consider a sleeping medication such as low dose Trazadone but sleeping medications are always an option if you're still getting 5 hours. 5 hours ain't enough! Especially if it's crappy sleep. I would hope you end up getting closer to 7-8 solid hours, though some rare people might only have a physiological need for 6 hours. Meditation will likely be the key to better sleep.

Hahaha I'm not too good at neuroscience all things considered, I'm mainly into medicine, I've just learned along the way with my own health issues. But I'd be happy to try to help with whatever, best of luck on your retreat and meditation :) Shut off that voice in your head :D
 
Cool, thanks for that, very helpful. Hopefully this retreat can change my perspective on everything, I'm a bit of a slave to the old mind right now. I'm sure it's just the extreme anxiety that is making me think this way. Whenever I am on a good stretch of normality I'm never this paranoid. I only started getting like this again when I returned from my Europe trip two months ago. Before then I was way more concerned with other things, like getting pissed and meeting girls haha.

Getting to sleep isn't the issue so much, it's waking up early. I'm probably not helping myself as I tend to go to bed quite late 1-2am, as I find the night to be calm and tranquil. My sleep hygiene is pretty poor.

I was actually asking a few questions on a website called survivingantidepressants.org, however I have a feeling that alot of the people there might be a bit nuts, or hypochondriacs - but then again I can't really talk can I haha I probably fit into that category. But one of them posted a topic, I'll paste the topic/text below. Is what he says accurate?

http://survivingantidepressants.org/index.php?/topic/1160-brain-remodeling/

This is something I posted somewhere else and then saved. I know it's all stuff I've said before, but it bears repeating and further discussion. A lot of people, including healthcare practitioners; in fact, I guess, most people-- are operating from entirely the wrong paradigm, or way of thinking, about these meds. They're thinking of them like aspirin--as something that has an effect when it's in your system, and then when it gets out of your system the effect goes away.

That's not what happens with medications that alter neurotransmitter function, we are learning. What happens when you change the chemistry of the brain is, the brain adjusts its chemistry and structure to try to return to homeostasis, or biochemical and functional balance. It tries to restabilize the chemistry. For example: SSRI antidepressants work as "serotonin reuptake inhibitors." That is, they cause serotonin to remain in the space between neurons, rather than being taken back up into the cells to be re-used, like it would be in a normal healthy nondrugged brain. So the brain, which wants to re-establish normal signaling and function, adapts to the higher level of serotonin between neurons (in the "synapse", the space between neurons where signals get passed along).

It does this by removing serotonin receptors, so that the signal is reduced and changed to something closer to normal. It also decreases the amount of serotonin it produces overall. To do that, genes have to be turned on and off; new proteins have to be made; whole cascades of chemical reactions have to be changed, which means turning on and off OTHER genes; cells are destroyed, new cells are made; in other words, a complex physiologic remodeling takes place. This takes place over time. The brain does not grow and change rapidly. This is a vast oversimplification of the amount of adaptation that takes place in the brain when we change its normal chemistry, but that's the principle.

When we stop taking the drug, we have a brain that has designed itself so that it works in the presence of the drug; now it can't work properly without the drug because it's designed itself so that the drug is part of its chemistry and structure. It's like a plant that has grown on a trellis; you can't just yank out the trellis and expect the plant to be okay. When the drug is removed, the remodeling process has to take place in reverse. SO--it's not a matter of just getting the drug out of your system and moving on. If it were that simple, none of us would be here. It's a matter of, as I describe it, having to grow a new brain. I believe this growing-a-new-brain happens throughout the taper process if the taper is slow enough. (If it's too fast, then there's not a lot of time for actually rebalancing things, and basically the brain is just pedaling fast trying to keep us alive.) It also continues to happen, probably for longer than the symptoms actually last, throughout the time of recovery after we are completely off the drug, which is why recovery takes so long.

With multiple drugs and a history of drug changes and cold turkeys, all of this becomes even more complicated. And if a person is started on these kinds of drugs at an early age before the brain has ever completely established normal mature functioning--well, it can't be good. (All of which is why I recommend an extremely slow taper particularly to anyone with a multiple drug history, a history of many years on meds, a history of past cold turkeys or frequent med changes, and a history of being put on drugs at a young age.)

This isn't intended to scare people, but hopefully to give you some idea of what's happening, and to help you respect and understand the process so you can work with it; ALSO, because you are likely to encounter many, many people who still believe these drugs work kind of like aspirin, or a glass of wine, and all you need to do is stop and get it out of your system. Now you can explain to them that no, getting it out of your system is not the issue; the issue is, you need to regrow or at least remodel your brain. This is a long, slow, very poorly understood process, and it needs to be respected.

I'm a bit confused by what he is saying, and I don't want to re-read it incase I misinterpret it, plus it's a bit of an anxiety trigger to read. But the question is this, is what he says accurate? And is he saying that the change takes place over time during the course of using SSRI's, or is he talking about the 'recovery' takes place over time.

Like I said, I don't want to re-read it myself because it seems to be an anxiety trigger.

Promise this is my last question! Haha. Anyone feel free to chime in and answer this, I need all the perspective I can get!

Thanks again :)
 
Love your comment, ssris get me half way there I have to work on the rest.
Benzos make me feel better but they make things worse and
 
Anyone able to answer my above questions? And lastly - this study that I posted above- the one that is totally fucking with my head.

https://www.cchrint.org/pdfs/ssri-induced-persistent-postwithdrawal-reactions.pdf

It says here that one lady only started experiencing withdrawals two weeks after she stopped taking SSRI's - WTF??
And the others say they have been experience withdrawal for 5+ years. Once again - WTF!!!

My mind is extremely suggestible at the moment and I keep thinking oh fuck this is me. It's doing my head in I'll tell you that. I've stayed away from reading any more studies because it's just making me so miserable.

Can someone please help me shed some light on my post above, and the article/study I just posted? Thanks again everyone.
 
Don't read that stuff when you're in this state of mind, really, it makes you go crazy without any real reasons.

It says here that one lady only started experiencing withdrawals two weeks after she stopped taking SSRI's
Click to expand...
Didn't read the passage for now, but if it's about Prozac / Fluoxetine - this one has such a long half life that it's because of that. But serotonergic after effects are weird indeed, they don't follow any clear rule like dopaminergic, adrenergic, opioid etc. ones if you ask me.

And the others say they have been experience withdrawal for 5+ years.
Click to expand...
Negative learning is mighty. Like pain memory or addiction memory.

There might really be something about tardive dysphoria and protracted SSRI withdrawal really for some people (don't know for sure if I'm one of these, especially with the latter probably I am), even if the article isn't well done. But this is not the kind of effect you have now, Jiraiya. :)
 
Too right it does. It sucks haha.

The lady was on Escitalopram (lexapro), it has a similar half life to the one I'm on although my one is slightly longer. If I'm already down to a quarter of the dose with my taper then surely I would have experienced withdrawals by now?

Ahhhh this is fucking with my head.
 
I think some of these people are experiencing their normal depression once they come off anti-depressants. Not necessarily rebound depression, but for those who really have a biological depression it's not something they can get through very well with mental tools alone, then take for example anxiety, I think it's much more accepted that you don't fix anxiety very well with pills because it's more psychological and you should use mental tools and coping skills more. I should point out its more frequently the individuals with anxiety that have problems after MDMA abuse, keep in mind their brains did not suffer any more damage than other people's, yet they are worse off, how could this be? The psyche is very powerful.

I think you probably really have anxiety and your anxiety is feeding into your depression. So I wouldn't worry about all this medication stuff, I would focus on the anxiety and the mental tools / coping skills and mindset adjustments, because damn you have a lot of anxiety!! Hahaha. Basically, don't worry about the SSRIs, just start thinking about the reasons why you ever took drugs (both illegal and legal) in the first place. Were you trying to self-medicate an anxiety disorder or something else?

I totally agree with Dopamimetic that negative learning is powerful. When you're on SSRIs for years, those brain cells that are firing together, are wiring together. These are people with mental illness we're talking about here, they are already pretty good at negative learning. People develop the same exact symptoms of prolonged withdrawal (anxiety disorders /bi polar etc.) without having ever touched drugs. But as powerful as negative learning is, positive learning is just as powerful.

Best of luck with the meditation. I firmly believe that once an individual is proficient with meditation they carry a bit of a "meditation mindset" everywhere, and this will help stop random thoughts and worries from popping into your head.

Edit: I just thought I would reassure you that you barely been on SSRIs and that you're not going to have withdrawal, and definitely not a prolonged withdrawal ;) It probably takes being on a strong dose for years to get prolonged withdrawals.
 
Thanks for the reply Cotcha, yeah it definitely is feeding my anxiety badly.

One of the guys on the post on survivingantidepressants.org posted this on my thread and really scared the shit out of me!

It can take weeks for withdrawal to hit. That is why we suggest monthly reductions.

You are tapering rapidly. Withdrawal symptoms may occur as a result of cumulative reductions.

I've only been on the drug for a few weeks so how the hell am I tapering so rapidly? Fuck these guys seriously. I've been tapering for two weeks, and I've got four more 2.5mg doses to take.
 
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