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Thread: How SSRIs work, and why you feel worse initially.

  1. #11
    Join Date
    Jan 2012
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    169

    Re: How SSRIs work, and why you feel worse initially.

    Interesting, thank you.
    Don't suppose anyone knows how long you should keep trying before you bite the bullet and give up with an SSRI either because you continue feeling worse or because it's just not helping?? 3 months..... 6 months???

  2. #12
    Join Date
    Nov 2011
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    180

    Re: How SSRIs work, and why you feel worse initially.

    Hi

    I have been on most SSRIs , and gave each of them between 4 to 6 months before accepting they weren't going to work.

    I think by that time you should at least start to feel some benefit. I found I just got worse and worse the longer I was on SSRI's. Not a good place to be!

    I am now on Pregabalin and Duloxetine, with good results.

    Hope this helps.

    Loreen x

  3. #13
    Join Date
    Feb 2012
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    66

    Re: How SSRIs work, and why you feel worse initially.

    Do not wait a month for an SSRI to work if you are chronically mentally ill. Especially if you have a job and responsibilities. January and February was a write off for me because I was have activation syndrome on my Zoloft. At the time I didn't know it was the Zoloft. My doc said the same thing above - 'you will initially get worse on dose increase', but she was wrong. I didn't start feeling better till I was off that drug.

    The above theory is a nice one but it is pseudoscience. No scientist knows how SSRI's work. Not even the manufacturer - they even admit that in the drug information leaflet. There is currently no way to measure Serotonin levels in a living brain. Knowing this the theory becomes even more wobbly.

    Why do some people feel worse when starting and others do not?? Maybe it is in part because of the Placebo effect.

    There was another newer theory that trumps the chemical imbalance theory posted above - that is that the Antidepressants somehow stimulate brain growth (like jogging does) and that is the reason it may take weeks or a couple of months to work while it causes your brain to grow again and then it can cope with the depression. Who knows if that is even true also.

    All the doctors know (and that the patient needs to know) is that in chronic depression and other mental illnesses SSRI's seem to be more effective than a placebo in treating bad depression and some other mental illness. Remember that the LONG TERM side effects of SSRI's are not known yet. But I am sure they will be known soon when someone does a follow up study because there would be people on the original Prozac-Fluoxitine that started taking it in the 80's and have never stopped. In my mind that makes Prozac currently the safest.

  4. #14
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    Jan 2012
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    510

    Re: How SSRIs work, and why you feel worse initially.

    If you give a SSRI say 10-12 weeks and it has done nothing, I would switch.

  5. #15
    Join Date
    Mar 2010
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    151

    Re: How SSRIs work, and why you feel worse initially.

    for info about ssris's - please go to paxilprogress.org

  6. #16
    Join Date
    Apr 2012
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    475

    Re: How SSRIs work, and why you feel worse initially.

    I find all this fascinating. While I do think that the theories are all pretty much 'best guesses' I think they probably all have some truth in them.

    One thing that is intriguing me is how SNRIs work, particularly for anxiety disorders? Surely having more noradrenaline would exacerbate them, not treat them (as they have been shown to do)?

    A layman's guess would be it's to do with quality of neurotransmission, rather than sheer amount..? Having more transmitters sit around for longer might enable the 'message' to be transmitted more successfully from nerve cell to nerve cell, rather than being transmitted more often?

    But I really don't know what I'm talking about here, wild stabs in the dark - That question of SNRIs/anxiety is curious though.

  7. #17

    Re: How SSRIs work, and why you feel worse initially.

    Quote Originally Posted by Schtopper View Post
    Hi,

    I've been reading these forums for a while, and I've been taking SSRIs for the last 3 years (Cipralex). One of the concerns I've noticed most people have when starting an SSRI or increasing it's dose is how crap they feel to start with. This causes a great deal of stress for the person as they begin to wonder whats happening, is their disease just getting worse and worse, are these drugs doing absolutely nothing for them?? etc etc.

    So having not seen a real explanation of exactly how an SSRI works I thought I'd make this post to hopefully show people exactly WHY you often feel so aweful to start with.


    First to understand this we need to know a little bit about the brain and about how nerves work.

    The brain is essential a big dense bundle of nerves, nerves as we know carry electrical signals around our brain and body. Nerves are made up of nerve cells (called neurons but that doesn't really matter).

    The important part to remember here is that nerve cells do not touch each other, there is a small gap between each cell (called a synapse, again not important). This gap prevents the electrical signal from going from one cell to another. So how does the signal get from one cell to another?

    This is where neurotransmitters come in, these are chemicals released by nerve cells that tell a neighbouring nerve cell to pass the signal along. A bit like pass the parcel, where the signal is the parcel and the neurotransmitters are the people passing it around (essentially anyway).

    Serotonin is one such neurotransmitter.

    So when an electrical signal reaches the end of a nerve cell that deals with serotonin that cell releases serotonin into the gap (synapse), serotonin then crosses the gap and interacts with the nearby nerve cell and tells it to pass the signal along.

    Once the serotonin has done it's job parts of the nerve cell then reabsorb the serotonin from the gap so that no more signals are passed until the next one comes down the nerve (if it stayed in the gap it would invoke more signals and for longer).

    SSRIs, (Selective Serotonin Reuptake Inhibitors) interfere with this reabsorbtion process and thus serotonin stays in the gap longer, which equates to more serotonin and more signals. This is good for people with low serotonin levels (us).


    That's all very interesting I'm sure but why do I feel like crap??

    Well here's the thing, along with the releasing serotonin, and reabsorbing it, nerve cells also have parts that detect an increase in serotonin level and tell the nerve cell to stop producing anymore serotonin until the level drops. These are called autoreceptors.

    Autoreceptors are the reason you feel like shit, so when you feel like crap blame them.

    As I've said taking an SSRI will increase the amount of serotonin in your brain, or more specifically increases the amount in the synapses between nerve cells. Unfortunately the autoreceptors of the nerve cell pick up on this increase and tell the nerve cell to stop producing serotonin.

    The result of this is that when you first start taking an SSRI your serotonin levels DROP.

    How do they go up again??


    Eventually with continuous use of SSRIs the autoreceptors become desensitised, that is to say they've continually told the nerve cell to stop producing serotonin but yet serotonin is still there. In short they simply give up. They stop telling the nerve cell to stop producing serotonin and your serotonin levels start to increase.

    This desensitisation takes time, it doesn't happen over night and it won't even begin to happen until the SSRI levels have stabilised (which we already know takes 5-7 days anyway).

    This is why you feel so bad, it's why your mood drops and your anxiety increases (fueld by the fear of not knowing whats going on).


    I hope this isn't too complicated but it really helps me to understand why I feel so bad when i increase dose or start taking them, so to summarise:

    SSRIs cause your serotonin levels to drop when you first start taking them.

    Your serotonin levels will not rise until the autoreceptors in your brain have stopped working (become desensitised).

    This takes time. For some people it could be a couple of week, for others a month or more.



    I hope this helps some people to understand what these drugs are doing and why you don't get instant results. Other drugs work in different ways and that's the reason they can have a more immediate effects (benzos for example).
    This is the single most helpful thing I've read - Thank you! I like to understand 'why', I always have done & this gives me hope! Thank you X

  8. #18

    Re: How SSRIs work, and why you feel worse initially.

    A really informative and helpful post. Thanks for posting!

  9. #19
    Join Date
    Dec 2015
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    1,147

    Re: How SSRIs work, and why you feel worse initially.

    I know this is an old post but it has really helped me understand possibly why I feel so absolutely dreadful after a month on my increase. Thank you to a certain member on this forum for directing me to this post!

  10. #20
    Join Date
    Dec 2015
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    1,276

    Re: How SSRIs work, and why you feel worse initially.

    Quote Originally Posted by Mojo61 View Post
    I know this is an old post but it has really helped me understand possibly why I feel so absolutely dreadful after a month on my increase. Thank you to a certain member on this forum for directing me to this post!
    It's a great post isn't it? I find it really helpful and hope where I am right now is still all the neurons adjusting as it's only been 4 weeks.

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