Originally Posted by
Windywel
Hi PDU I’m trying to stay focussed on your advice about why ADs take so long to work but there does seem to be a lot of research that says they do work within 4-6 weeks?
If you plot AD time to response you usually get a bell curve with the peak at around 6 weeks. This is for the first exposure to ADs. It may take longer the second time around.
Some do seem to respond quickly, but this seems to owe more to the placebo effect than the med and they often, ime, end up crashing within a month, or two and become non responders. The placebo response in most drug trials is usually around 30-40%.
To quote from the findings of Star*D, the largest and longest AD drug trial so far undertaken:
"In addition, patience is required. While some people may experience benefits in the first six weeks of a treatment strategy, full benefits may not be realized until 10 or 12 weeks have passed. During this time, doctors should work with their patients to adjust dosages so as to find an optimal level, and avoid stopping a treatment prematurely."
I’m fact I saw one that said if no response within 2 weeks then you should increase dose or shift as it’s a marker that they won’t work!
And what mechanism do they propose to account for this, given it takes, in the case of citalopram, 7 days just for plasma levels to stabilize and about 7 weeks for hippocampal cells to bud, grow and mature?:
"Adult neurogenesis can be divided into four phases: a precursor cell phase, an early survival phase, a postmitotic maturation phase, and a late survival phase."
"The precursor cell phase serves the expansion of the pool of cells that might differentiate into neurons. The early survival phase marks the exit from the cell cycle. Most newborn cells are eliminated within days after they are born. The postmitotic maturation phase is associated with the establishment of functional connections, the growth of axon and dendrites, and synaptogenesis. The late survival phase represents a period of fine-tuning. It has been estimated that the entire period of adult neurogenesis takes ~ 7 wk.
Another one said that it appeared that SSRIs worked in anxiety first and depression much later
Undoubtedly true, SSRIs seem to be more effective anti anxiety meds than they are anti depressives.
but they don’t seem to have worked on either for me after 5 weeks.
I'm not surprised, even if the authors of what you've been reading might be.
I know I shouldn’t have googled
Sage advice, imho.
but succumbed after a difficult weekend with lots of crying spells
Are you still taking lorazepam daily? Has any consideration been given to trying alternatives such as mirtazapine, or propranolol instead as I've suggested?