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Medical Forum / General / Pharmacy / July 2005

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Do SSRIs/SNRIs cause sensitivity to depression & anxiety later in life?

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Timbertea - 05 Jul 2005 01:31 GMT
Have there been any objective studies looking at this?   I'm aware of
some work showing that neuroleptic agents like thorazine do cause
sensitivity to psychosis later in life, and continual dosing may
actually increase the risks of psychosis later and need for
rehospitalization.  I haven't been able to find good long term
comparisons for SSRIs vs non-drug therapies or alternative (TCA/MAOI)
therpaies in longer term outcomes even though SSRIs have been around for
a considerable length of time now.   Surely someone has looked at this?

-Tim

--
If you want to protect your freedom to use digital media, don't buy
Intel Chipsets, Intel Processors, any Sony product
period, and strongly encourage your friends & everyone you know to do
the same.  We are the product, and if we walk away
the media companies have no eyes for DRM enabled systems. This is our
once chance to fight back, I suggest we use it.
Dr. Wayne Simon - 05 Jul 2005 06:33 GMT
> Have there been any objective studies looking at this?   I'm aware of some
> work showing that neuroleptic agents like thorazine do cause sensitivity
[quoted text clipped - 6 lines]
>
> -Tim

this is a very good question. Theoretically the only studies I've seen
suggest that chronic ssri use may help in producing new synapse connections
which will help do the opposite, and make one less susceptible to
depression. But I find the data and argument less than compelling.   I had
found the data a few months ago looking at PET scans on the internet of
patients on chronic ssri therapy.  The scans were more compelling than the
data.  I do not remember the site, but I'm sure with some effort one can
find the site.

> --
> If you want to protect your freedom to use digital media, don't buy Intel
[quoted text clipped - 3 lines]
> the media companies have no eyes for DRM enabled systems. This is our once
> chance to fight back, I suggest we use it.
MobiusDick - 05 Jul 2005 15:02 GMT
I think most data are anecdotal insofar as this question, but the real
question is do we have accurate long tern data of short term use of
SSRI's and have these drugs really helped that many people who have had
short term reactive depression. IMHO, the answer is no. Most people who
are on SSRI's today, once a diagnosis is made, continue to have their
medication altered and titrated to a theoretically effective plateau.
Is there such a plateau? I am not sure the data support this.

Long term double blind studies that would give us truly acceptable data
inasmuch as these types of drugs go, is simply not possible to obtain
for ethical and logistical reasons. So answers that are truly valid
within the confidence limits of modern biostatistics are just not, and
never will, be available. One example of problems related to this type
of data IMHO is the situation with Ritalin, Adderall and ADD/ADHD. It
seems to me that anecdotally, we set these children up (in other words
we prime them) for drug addiction susceptibility later in life. I
include myself in this subset. All I have are anecdotal data, but it
seems to me that we can predict a higher likelihood of addiction to
opiates and cocaine with childhood Ritalin use; however, I do not see
an increase in methamphetamine or  benzodiazepine (or other
sedative/hypnotic dependence including alcohol) from Ritalin.

Anyone who has similar anecdotal perceptions, please chime in>

(Dr.) MobiusDick
Dr. Wayne Simon - 05 Jul 2005 16:58 GMT
> I think most data are anecdotal insofar as this question, but the real
> question is do we have accurate long tern data of short term use of
[quoted text clipped - 21 lines]
>
> (Dr.) MobiusDick

Very anecdotal.  There are already articles published comparing ADD adults
who were not treated with methylphenidate and those that were, and it seems
the were nots have a greater incidence of self medication and addiction,
both groups being higher than the non-add population as a whole.
MobiusDick - 06 Jul 2005 15:30 GMT
Of course, retrofit studies are not double blind, but even so do you
have any references that are not from drug company data? These seem to
be all I can find, but I talk to a lot of addicts in my personal as
well as professional life, and I think susceptibility to opiate and
cocaine, when filtered out from other addictions such as alcohol,
benzodiazepines and methamphetamine, seem to be much higher in
childhood Ritalin users.

I am not one of these pharmacologists who say that there is absolutely
no proof that ADD/ADHD exists, but I think some brain imaging data
using PET or fMRI would be appropriate before subjecting people to
childhood use of potent sympathomimetic drugs. But Ritalin today does
seem to be used more as a baby sitter than a true treatment modality.

MobiusDick
Dr. Wayne Simon - 08 Jul 2005 03:08 GMT
Computerized brain mapping studies have been available since the late 1980's
and the effects of ritalin on kids with ADHD are quite remarkable.
MobiusDick - 08 Jul 2005 16:06 GMT
I know they alter the brain image. That is not the question. But are
the brains of most children who get diagnosed with ADHD different from
the brains of "normal" children? Virtually no physicians do brain
imaging before placing a child on Ritalin.

I have seen many brain imaging studies of Ritalin's affect on the
brain, and certainly there are differences in areas using
norepinephrine involved in attention like the RAS and the LC; but the
criteria for placing a child on Ritalin or Adderall seem to be very
weak. A note from the teacher suggesting a problem is all it takes.

MobiusDick
MobiusDick - 08 Jul 2005 20:47 GMT
Here is a reference regarding possible addiciton related issues to
dopaminergic stimulation and neuroplasticity in the developing brain:

Windows of vulnerability to psychopathology and therapeutic strategy in
the adolescent rodent model.
Behavioural Pharmacology. 15(5-6):341-352, September 2004.
Adriani, W.; Laviola, G.
MobiusDick - 08 Jul 2005 20:52 GMT
As well as nicotine. See the article not just the abstract.

MobiusDick
Charles - 05 Jul 2005 22:09 GMT
>Have there been any objective studies looking at this?   I'm aware of
>some work showing that neuroleptic agents like thorazine do cause
[quoted text clipped - 6 lines]
>
>-Tim

anecdotal from me, a consumer of ssri.  What is described sounds like
a progression of the depression, maybe from not being on the ssri as
long as proper.
Signature

Charles

Does not play well with others.

 
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