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Feeling worse before feeling better on SSRIs


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#1 hollywoodfreaks

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Posted 26 July 2005 - 03:42 AM

Can someone explain why an SSRI might cause a temporary worsening of depression before causing improvement?  It is really baffling to me.

My own experience:

Start taking 1/4 of a Lexapro pill.  Mood slides down until I hit rock bottom a week later.
Start taking 1/2 pill.  Nothing weird this time.  Mood improves.
Start taking whole pill.  Notice mood sliding downward again.  What the hell?

Maybe this could just be my own cycling?  It seems like my mood cycles a lot, usually from mildly to moderately depressed and occassionally to "normal."
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.


#2 Fiona

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Posted 26 July 2005 - 08:06 AM

Sometimes what happens is that you're so depressed you just don't care -- you aren't feeling much or have much energy. Then when the med starts working, you go up slightly and that's the active suffering part. So you 'feel' worse because you're actually 'feeling' the weight of depression. Then, as the med continues to work, you start to feel actually 'better.'

This is also why the highest risk point for suicide is just after people start treatment. The active misery and the energy to actually kill youself comes back before the feeling well enough to not want to kill yourself happens.

So, hold on!

Fiona
Why not give today a chance? You can always kill yourself tomorrow.

The truly courageous choices are the ones a person makes over and over and over again, knowing the cost but facing the same burden again tomorrow. (M. A. Pakulak)

~~~N.B. Nothing I say can or should be mistaken for actual medical advice. Nope. Not me. Not any of it.~~~
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#3 scream_phoenix

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Posted 26 July 2005 - 10:36 PM

i don't know if i buy that whole "you finally have energy to kill yourself" business.  i think that's just explaining it in purely psychological terms and eliding what's happening in the brain.  there was a thread about this on the old crazytalk board, and what i gleaned from the whole discussion is that starting the meds forces your brain to rewire, so all the extra available serotonin doesn't overstimulate it, and this involves pruning back the number of serotonin receptors a bit.  so at the beginning there's a net loss between increased serotonin available because of the serotonin reuptake inhibition and the loss of receptors so the brain isn't overstimulated from all the extra serotonin.  eventually the tide turns because the medicine keeps cranking up the available serotonin in the synapses and you feel the positive effects of the meds.  but in between then there is a shaky time when you may not have as much serotonin as you need, or you get periodic dips for whatever reason.  there is a physiological battle going on in your brain, its not all just a matter of now you can actually "feel" more depressed.

that's my understanding anyway.  i don't have fancy pubmed articles i can point to so you all know i'm right, i'm not really sure what the research is out there about it.  but as tomtyger pointed out in the pharmacology geeking out section:

http://www.crazyboar...?showtopic=2406

neurons in the brain are changing all the time, and the introduction of a new factor like serotonin reuptake inhibition, probably significantly alters the directions of this process - eventually for the better we assume, but i think there's still a definite biological explanation for why you feel worse before you feel better on ssris.

Dx: OCD, PTSD (Depression and Anxiety throughout)

Rx: Klonopin 1mg x 2.5 day, Celexa 60 mg, Lamictal 200 mg, Seroquel 300 mg


#4 Fiona

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Posted 27 July 2005 - 10:02 AM

i don't know if i buy that whole "you finally have energy to kill yourself" business.  i think that's just explaining it in purely psychological terms and eliding what's happening in the brain. 

<{POST_SNAPBACK}>

Of course there's a biological explanation for this, just as there is for every other psychological experience. We don't know, necessarily, what biology goes with what psychological state or why -- working in human brains is limited.

I often find the psychological explanations, that describe what I experience since I can't directly feel things about serotonin and such, more satisfying.

I do recall information about the biology on the old board, if you search for my posts you should find some my partner, who's a neurobiologist, gave me the information for to try to explain some of this stuff.

Fiona
Why not give today a chance? You can always kill yourself tomorrow.

The truly courageous choices are the ones a person makes over and over and over again, knowing the cost but facing the same burden again tomorrow. (M. A. Pakulak)

~~~N.B. Nothing I say can or should be mistaken for actual medical advice. Nope. Not me. Not any of it.~~~
~~~For medical advice, call your doctor!~~~


#5 hollywoodfreaks

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Posted 27 July 2005 - 09:05 PM

Very interesting explanation scream_phoenix, thanks. 
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.

#6 Kablume

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Posted 27 July 2005 - 09:16 PM

I cannot explain things in terms like that. I just speak from the experience of a crazy BP. I know it can take 3-4 weeks before some of these meds work. And also, the mixed state, agitaion and depression, is the most dangerous state to be in for suicide. But yours sounded nice scream. You still have intelligence.
"Insanity runs in my family. It practically gallops."
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DX: Bipolar I

#7 hollywoodfreaks

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Posted 29 July 2005 - 09:50 PM

I had to call my pdoc about it.  I've only been on this new dose for a week but it feels like an eternity.  I'll see what she says about it.
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.

#8 scream_phoenix

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Posted 29 July 2005 - 10:05 PM

how much lexapro are you taking?  you may just be going to slow.  those pills aren't very easy to split in half from what i remember, and its not a very precise way of going about things.  i remember the first month i started taking lexapro i had some pretty bad dips regardless.  i think for some reason it just isn't a steady increase in serotonin levels, you get some major dropoffs for whatever reason.  this is  the 2nd week i've been on prozac and sometimes i feel really good - like i'm restored back to sanity, and then sometimes i feel so bad i wish i hadn't started taking the med at all.  i don't know what the hell is going on. 

my only recommendation - and it will probably sound pretty stupid - is to eat turkey whenever you can, and try to restore at least some of the serotonin.  sometimes after i eat a turkey sandwich, it feels like everything's back to normal and i feel good again.  and turkey's the only thing you can eat - as far as i know - that is a metabolic precursor of serotonin.  or eat a pretty much all carbohydrate or sugar meal:
http://news.bbc.co.u...lth/3522903.stm

doesn't always work but sometimes you can really feel the effect.  i guess its like trying to cheat the chemical processes in your body, but hey, whatever will help.  hope things start feeling better

Dx: OCD, PTSD (Depression and Anxiety throughout)

Rx: Klonopin 1mg x 2.5 day, Celexa 60 mg, Lamictal 200 mg, Seroquel 300 mg


#9 hollywoodfreaks

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Posted 30 July 2005 - 04:41 AM

I'm taking 10mg right now, whole pills.

Bipolar does run in my family so that could explain why I'm responding weirdly.  But you would think I would have the opposite reaction if that were the case--all agitated and anxious and irritable, or high and happy.  But instead it's making me want to just crawl under the covers and sleep all the time.  I had to drag my ass out of bed today after 11 hours of sleep.

I don't want to give the wrong impression though--I have noticed a lot of positive effects as well.  It makes me chill. I haven't been driving myself insane with worry.  It has taken away the extreme sadness that used to knock me on my ass for long periods of time.  But I can still get just as depressed without the sadness, if that makes sense.
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.

#10 scream_phoenix

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Posted 30 July 2005 - 08:20 PM

i think i know exactly what you mean.  for me lexapro never really took away the depression.  it just killed emotion, but i could still feel depressed, if that makes sense.  i really didn't like anything about it - except maybe that it didn't give me any horrible side effects, and it did pretty much knock out my anxiety.  it just seemed like an incomplete pill though.  i went up to 30 mg at one point - and for like half a day i felt that pleasurable "ah, i don't care about anything in the world" feeling, but i think that was too much serotonin for me.  and i still never really felt any 'mood brightening' properties. i really don't see why its such a great pill - but i know you can find others on this board who would vouch for its awesomeness.  i guess it just doesn't treat everybody's mental illnesses. 

are you planning to go up to 20 mg?  and what are you taking it for primarily?  depression or anxiety?  like i said i'm on prozac 20mg  and for the first week i felt like 'hey this feels really good' at times, but now that feels like its leveling off and i'm back at normal again - but starting to feel teh side effects.  so i don't know if i need to go up or what.  dagnabbed ssri's - i'm starting to think they're not so great at all, but maybe i've just outlived their usefulness. 

Dx: OCD, PTSD (Depression and Anxiety throughout)

Rx: Klonopin 1mg x 2.5 day, Celexa 60 mg, Lamictal 200 mg, Seroquel 300 mg


#11 dreamweaver

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Posted 30 July 2005 - 08:28 PM

i really didn't like anything about it - except maybe that it didn't give me any horrible side effects, and it did pretty much knock out my anxiety. 

<{POST_SNAPBACK}>


scream_phoenix,

Did you find the lexapro helped quell fearful thoughts and anticipatory anxiety/nameless dread, if you suffered from those things?

Thanks. 

#12 hollywoodfreaks

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Posted 30 July 2005 - 11:41 PM

I don't know if I'm going to try 20mg or not.  I guess if the pdoc really wants me to I might do it.  I'm sure I need to give this dose more time though.
20mg prozac is a pretty low dose right? And Prozac tends to take more time to kick in too.  So it sounds like you have more experimenting to do.

I would say that I'm taking it primarily for depression and maybe social phobia but I don't have a diagnosis yet. I do know though that if I'm not depressed it makes anxiety bearable.  So I would say not being depressed is the most important thing.  It sure is nice not driving myself nuts with worry though.
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.

#13 nicedream

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Posted 01 August 2005 - 01:50 PM

Can someone explain why an SSRI might cause a temporary worsening of depression before causing improvement?  It is really baffling to me.


Not sure why, but it has definitely been the case for me too.

Your description of you mood changing from mild/moderate depression to occaisionally feeling normal could just as easily be for me.  I have been taking Lexapro for about 1.5 years (10mg) when my depression and panic attacks started coming back.  I upped my dose to 20mg daily, and for the first week nothing changed.  Then I hit the utter depths of hell for about 2 weeks.  I was about to see the doctor and ask for something new, but suddenly I started to feel pretty good again.  It's been about a week....we'll see if it keeps up.  Hang in there! ;)

#14 pharmamania

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Posted 01 August 2005 - 03:28 PM

I too have been experiencing the mood swings...up a couple days, then days where nothing is interesting, don't want to talk or see anyone, want to sleep all the time to escape life.

I too am on lexapro, 20 mg for depression. Still depressed.  Paxil as well and just started it a week ago, and now feeling worse than i did before.

Hard to stop drinking, only thing that numbs my thoughts.

Don't have any suggestions as I am too having the same problems.

Take care!


I was sure i was BP but diagnosed last week, AD and depression.

#15 hollywoodfreaks

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Posted 01 August 2005 - 08:21 PM

Pharmamania, are you saying that you are taking both Lexapro and Paxil?
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.

#16 hollywoodfreaks

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Posted 03 August 2005 - 08:04 PM

Well I talked to the pdoc.  She said this has never happened to a patient of hers and she doesn't know what caused it.  C'mon, NEVER?  I'm disappointed but not surprised that this was her response.
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.

#17 scream_phoenix

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Posted 05 August 2005 - 03:23 PM

never happened that someone felt worse taking an ssri?  pdocs are fucking liars.  fucking boldfaced liars.  maybe they feel they have the symbolic protection of all the pharmaceutical reps and their drug company overlords behind them when they spit that through their teeth.  maybe they pop a pill shortly after teh appointment to forestall any guilt they might feel afterwards.  the brain and ssri's effects on it are too little understood, and pdocs appreciation of their patience's experiences are too cursory for them to make that kind of judgment.

i asked my pdoc yesterday in kind of an emergency appointment my mom set up yesterday, because prozac has been making me feel a LOT worse this past week, and at first he kind of shrugged off when i said that ssri's make people feel worse before they feel better, but i advanced my own theory about ssri's causing your brain to scale back its serotonin receptors, and he said that really they don't know.  it could be your brain creates more serotonin receptors to accomodate all that extra serotonin, or your brain could cut back its serotonin receptors.  considering its a completely technical question with no bearing on a patients chances for feeling better or feeling worse, i guess they're justified in not fucking knowing the answer after 20-30 years of experience with these pills!

who knows, i'm sure the drug companies have had plenty of money set aside over the years to brush under the rug all these adverse cases and make them simply not exist.  prozac and the ssri's can't cause anything bad to happen.  they're an unmitigated boon for all humanity.  how can anything bad happen from tampering with the bodies serotonin system in ways we hardly understand?  surely only happiness can be the result.   

Dx: OCD, PTSD (Depression and Anxiety throughout)

Rx: Klonopin 1mg x 2.5 day, Celexa 60 mg, Lamictal 200 mg, Seroquel 300 mg


#18 hollywoodfreaks

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Posted 05 August 2005 - 08:23 PM

Aww, I'm sorry you're having such a terrible time with Prozac.  It really doesn't feel great either when you ask why this is happening and they have no clue.  All I know is that for me, at least at this point in my life, I have to choose between the unknown effects and mechanisms of psych drugs and living a life of paralyzed abject misery.  I'm assuming it's the same for you and it's a sucky position to be in.  So are you tapering off the Prozac then?
dx: Major depression Current rx: Wellbutrin XL 300 mg, Cymbalta 60mg, Xanax XR .5mg. Just started Ritalin 5mg 2x daily, tapering off of 200mg Lamictal. For sleep: trazodone. Past rx: Lexapro, Zoloft, Cytomel.





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