Restarting SSRI's [Archive]

will402

15-08-20, 10:25

Hello,

I'm thinking of restarting Zoloft. I last took it 8 years ago and it worked great, I stopped them once I felt better. 6 years ago I went on Celexa, same thing I stopped them after six months once I felt better.

I remember reading that every time you stop and start SSRI's they reduce their ability to work again? Is there any truth in this? If both of these SSRI's worked for me once then they should work again right? They didn't stop working it was me who chose to stop them.

If anyone has any info I'd be glad to hear.

Thank you,

Will

panic_down_under

15-08-20, 13:33

6 years ago I went on Celexa, same thing I stopped them after six months once I felt better.

Most antidepressant (AD) guidelines recommend taking them for at least 12 months the first time and 18 months to 2 years the second and, imho, this is good advice, Will. ADs work by stimulating the growth of new brain cells (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC60045/) (neurogenesis) to replace cells killed, or prevented from growing by high brain stress hormone levels. The therapeutic response is produced by these new cells and the stronger interconnections they forge, not the meds directly, and it pays to give the process plenty of time to work. For a more detailed explanations see: Depression and the Birth and Death of Brain Cells (PDF (https://www.americanscientist.org/sites/americanscientist.org/files/20057610584_306.pdf)) and How antidepressant drugs act (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3025168/).

I remember reading that every time you stop and start SSRI's they reduce their ability to work again? Is there any truth in this? If both of these SSRI's worked for me once then they should work again right? They didn't stop working it was me who chose to stop them.

Unfortunately, there is evidence antidepressants, especially the SSRIs, may become progressively less effective every time they are stopped and restarted, often requiring higher doses to achieve the previous level of control, or not working at all. They may also produce more severe, and/or different, initial side-effects. Two studies, Amsterdam JD (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5123793/), 2016 and Amsterdam JD (http://www.karger.com/Article/FullText/226611), 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC (https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/30041180/), 2018; Amsterdam JD (http://www.ncbi.nlm.nih.gov/pubmed/18694599), 2009; Leykin Y (http://www.ncbi.nlm.nih.gov/pubmed/17469884), 2007; Paholpak S (https://www.ncbi.nlm.nih.gov/pubmed/12501907), 2002).

That said, it is likely that sertraline (Zoloft) will still work well for you. Unfortunately, the only way to know is by trying it. In addition to maybe requiring a higher dose, it may also take a little longer to kick-in than the first time.