Question:
Could it be that Prozac and the other SSRIs actually don’t poop out and that it’s possibly a fluctuating depressive episode that may last a few months or years that may increase and decrease in severity? Maybe the SSRI poop out is just a worsening depression that isn’t caused by SSRIs but rather the depression itself. I hope this is the case because I’m going to need my Paxil 30 mg. to work for a very long time. Paxil is saving my life at this moment. I tried not taking Paxil for 6 months and just my Adderall 30 mg. a day, and my life just fell apart. This all started when I was 14 and has never got better. It’s sad to say that my last memories of truly being happy were in the 8th grade. I’m 24 now. Anyhow, what do you think about my theory? Is is crap or does it make sense. I’d like to hear from people. Phil
Response:
Thanks for the info, Eric, you really know a lot about this stuff. For some reason I think there has to be a balance between serotonin and dopamine with an increase in one or the other causing different mental and physical disorders. I wonder how or why they think dopamine depletion happens. I never had a problem going on and off Paxil over the last 5 years. I was always taking 10 mg. I went on and off it maybe 4 or 5 times, always briefly but it worked for me the same way. I’m taking 30 mg. now to try and fully get rid of depression and anxiety, 10 mg. just wasn’t enough I guess. Combining alcohol with SSRIs I found out is a dangerous thing to do, nearly killed me. Alcohol merely creates other problems like depression, mania, anxiety, schizophrenia, ect. Sleep is without a doubt one of the most important things you need to stay healthy. Also my emotions don’t go flat when I’m on Paxil, when I’m not taking it I don’t have any emotions. Paxil seems to put color in my black and white world. I’m finally starting to feel alive again. Take it easy Eric Phil
Response:
<< Even after a short of time on Prozac, I do feel more emotionally flat. But I think that is more due to being excessively emotional before, rather than unemotional now. >> I totally agree. That change started shortly after starting Prozac.I believe I, too, was excessively emotional before, i.e. react too strongly to things. That’s why when I start crying again, I know the Prozac is pooping. Marilyn
Response:
I’m fascinated with what everyone is saying. I’ve been on 40 mg. of Prozac for 9 years. About a year ago, I started feeling more depressed and upped the dose to 60, which didn’t help. Now I’m back down to 40 again with the addition of 60mg Buspar, as prescribed by my psychiatrist. I’m still not the way I was, really feeling good, a few years ago. By the way, the loss of emotion started for me a long time ago-definitely from the Prozac. I used to cry over every commercial, movie,s ong, etc. Then I couldn’t cry at all. Then I started crying alot a few months ago. That’s when I knew Prozac pooped out. Marilyn
Response:
> I’m fascinated with what everyone is saying. I’ve been on 40 mg. of Prozac for > 9 years. About a year ago, I started feeling more depressed and upped the dose > to 60, which didn’t help. Now I’m back down to 40 again with the addition of > 60mg Buspar, as prescribed by my psychiatrist. I’m still not the way I was, > really feeling good, a few years ago.
I know it does happen but I’m just hoping it’s rare enough to pass me by. > By the way, the loss of emotion started for me a long time ago-definitely from > the Prozac. I used to cry over every commercial, movie,s ong, etc. Then I > couldn’t cry at all. Then I started crying alot a few months ago. That’s when I > knew Prozac pooped out.
Even after a short of time on Prozac, I do feel more emotionally flat. But I think that is more due to being excessively emotional before, rather than unemotional now. Bruce.
Response:
> Smart move. You will be OK, you have good judgement despite your depression. > Part of my problem is when my depression gets severe, my judgement and decision > making abilities go also.
It definitely affects mine too at the worst of the depression. And even when I do do the right thing, it takes me 10 times longer to come to the decision. Depression sucks. Bruce.
Response:
> Yes, when I am off meds and my depression crashes I become extremely confused > and unfocused. Ever get like that?
I lost the ability to concentrate on virtually anything and everything. I had trouble watching TV, listening to others, even reading. My brain became locked on negative thoughts at a million miles a second, and nothing else could easily penetrate. It was like trying to concentrate next to a jack hammer. I lost control of the direction my thoughts would take. > Making decisions is hard, just thinking > clearly is hard. That is the truly dangerous part of depression in my opinion. > Its not the fact you are super sad and hopeless and stuff, its the fact you > cant think clearly, focus or remember. That makes you basically unemployable > and makes you susceptible to all kinds of mistakes and bad things to
happen. Yes, it took my memory too. I had to review notes and emails at work to remember stuff I’d done mere days before. And I knew I couldn’t continue to work unless I improved and improved soon. The fears of losing my job and being unemployable exploded in my brain and just made everything 100 times worse. I came within a heartbeat of admitting defeat and quitting my job. I figured, why put off the inevitable? > I think this cognitive deterioration mainly occurs in only the more severe > "chemical imbalance" kind of mood disorders. I dont think it occurs too much in > dysthymia or milder depressions.
I KNOW there was something wrong with my brain. My thoughts turned 100% negative and my sleep dropped to 2-3 hours per night. That lasted for weeks before I finally crawled to the doc pleading for help. He gave me Trazodone for the sleep, which helped, and then decided to put me on Prozac a few months later after I broke down in his office. Bruce.
Response:
> And, each time you become depressed, the "kindling" effect tends to make your > depression more difficult to treat. This means that even though Prozac worked > for you the first time, it may not work again, or it may not work as well, > because of changes which have occurred in your brain.
That makes a certain amount of sense. I know my first bout of depression definitely changed the way I interact with and feel about life. I assume the depression has had some long term effects on the way I think. > For me, Prozac became ineffective after about 9 months to a year of steady > treatment. I was already at 60mg. Going up to 80 didn’t help much, and it kept > me from sleeping. I don’t know why it stopped working.
So what did you do? > I do buy the kindling theory, however.
It does sounds like it may be part of it. There’s no doubt several contributing factors and that may be one of them. > No one has to tell me that my brain chemistry is different than it > used to be. It’s obvious.
Amen to that! There’s no doubt that who I am as been changed dramatically. Thanks, Bruce.
Response:
> Bruce, Im not necessarily saying you need to be on Prozac for the rest of your > life. I didnt imply that if you thought I did.
I did misunderstand you. Thanks for restating it for me. I have no intentions of stopping or changing the Prozac anytime soon assuming my doc keeps prescribing it. While I don’t want to take any drug for longer than I have to, I also know that Prozac probably saved my life and had a dramatic effect on my mood. So I’m also dreading the day if and when the doc wants to take me off of it. I know that if I slip back in to depression, than it may take up to a month again for it to start working again, and I’d much rather avoid having to live through that again. For the moment, I’m operating under the "if it ain’t broke, don’t fix it" mode, and the Prozac is definitely working. > I never said you will necessarily need to be on the drug lifetime though. Maybe > you will, but the odds are you wont.
That is encouraging. Thanks! Bruce.
Response:
> It can–and does. Some people have been on it 13+ years without any > depression.
Very cool. > The one drawback for me–and some might consider this a poop-out of > sorts–is that after several years on the drug I have become fairly > apathetic–a bit less emotional. I don’t have the inspiration to paint like > I used to. This is a fairly common reaction to the SSRIs. > Before Prozac, I cared *too much* about things–obsessing and ruminating > constantly. And this is better by far.
I know what you mean. I’ve always been a perfectionist and a worrier. I could stand to lose some of that. 
And perhaps some of that may be a normal part of aging instead of the Prozac. I know I’ve been getting more mellow over the years even before the depression struck. Thanks, Bruce.
Response:
> Dont stop it > periodically to try to "save its use" as many people find out the hard way that > when they return to an antidepressant the second or third time that it doesnt > work as well each return trip. Sometimes people find the AD doesnt work at all > when they return to it, especially if they have stopped and started three or > four times. Which believe it or not is quite common (and very stupid).
I hate to have yet another lifelong drug (stomach acid, cholesterol, blood pressure), but if that’s the way it’s gotta be, so be it! Thanks Eric! Bruce.
Response:
It happened to me after four years on it–I raised the dose to 40mg/day and have been fine since (been on it 8 years). Looking back, I realize I should have been at 40mg the whole time–at 20mg I was still experiencing minidepressions.
– Hide quoted text — Show quoted text -> I’ve read that up to 50% of the people taking Prozac experience Prozac poop > out, where the drug loses effectiveness over time. > Does anyone know how long that can take? > Any personal experiences? > Thanks, > Bruce.
Response:
> Just go on the Prozac, stay on it steadily, take it everyday religiously and > dont go up and down on it repeatedly. I dont think you will develop Prozac poop > out if you avoid playing games with your meds. Make any changes slowly, > steadily and methodically.
You’re right. I would have assumed that taking breaks from the Prozac would help prevent a tolerance build up, rather than contributing to it. Thanks very much for the advice! Bruce.
Response:
> It happened to me after four years on it–I raised the dose to 40mg/day and > have been fine since (been on it 8 years). > Looking back, I realize I should have been at 40mg the whole time–at 20mg I > was still experiencing minidepressions.
Cool. It’s nice to know that it can work for that many years! Thanks, Bruce.
Response:
It can–and does. Some people have been on it 13+ years without any depression. The one drawback for me–and some might consider this a poop-out of sorts–is that after several years on the drug I have become fairly apathetic–a bit less emotional. I don’t have the inspiration to paint like I used to. This is a fairly common reaction to the SSRIs. Before Prozac, I cared *too much* about things–obsessing and ruminating constantly. And this is better by far. JM
– Hide quoted text — Show quoted text -> It happened to me after four years on it–I raised the dose to 40mg/day > and > have been fine since (been on it 8 years). > Looking back, I realize I should have been at 40mg the whole time–at 20mg > I > was still experiencing minidepressions. > Cool. It’s nice to know that it can work for that many years! > Thanks, > Bruce.
Response:
I’ve read that up to 50% of the people taking Prozac experience Prozac poop out, where the drug loses effectiveness over time. Does anyone know how long that can take? Any personal experiences? Thanks, Bruce.
Response:
It really depends on the individual. Often the poop out can be fixed by raising the dose of the Prozac. John — John Lundquist
– Hide quoted text — Show quoted text -> I’ve read that up to 50% of the people taking Prozac experience Prozac poop > out, where the drug loses effectiveness over time. > Does anyone know how long that can take? > Any personal experiences? > Thanks, > Bruce.
Response:
> It really depends on the individual. Often the poop out can be fixed by > raising the dose of the Prozac.
Thanks John. Do you know if there any pattern at all? Like less than a year or more than 10 years? Bruce.
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