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Pharmacol Res. 2018 Oct 29. pii: S1043-6618(18)31201-5. doi: 10.1016/j.phrs.2018.10.025. [Epub ahead of print] The Emergence of loss of efficacy during Antidepressant Drug Treatment for Major Depressive Disorder: An Integrative Review of Evidence, Mechanisms, and Clinical Implications. Fornaro M1, Anastasia A2, Novello S3, Fusco A4, Pariano R5, De Berardis D6, Solmi M7, Veronese N8, Stubbs B9, Vieta E10, Berk M11, de Bartolomeis A12, Carvalho AF13. Abstract at https://www.ncbi.nlm.nih.gov/pubmed/30385364 The re-emergence (i.e. 'breakthrough') of depressive symptoms despite maintenance treatment of depression with antidepressant drugs is a complex clinical phenomenon referred to as tolerance. Herein we critically appraise evidence from both pre-clinical and clinical studies, focusing on putative mechanisms as well as clinical correlates and implications of the emergence tolerance during antidepressant treatment for major depressive disorder (MDD). It is firstly unclear to what extent this phenotype reflects a pharmacological effect of an antidepressant, is driven by non-adherence, is a marker of latent bipolarity or another comorbidity, a marker of neuroprogression of the underlying disorder or the intrusion of the impact of psychosocial variables into the clinical course. The operational definitions of tolerance and its related phenomena have also been largely inconsistent. Several protective clinical indicators have been proposed, including a rapid-cycling course and comorbid chronic anxiety, whilst poor treatment adherence, proneness to emotional blunting and sub-threshold bipolarity have been identified as possible correlates of tolerance to antidepressant treatment in MDD. Putative neurobiological underpinnings include adaptations in the hypothalamic-pituitary-adrenal (HPA) axis and the serotonergic system. Due to the clinical and diagnostic challenges imposed by the emergence of tolerance to antidepressants, there is an urgent need for upcoming international guidelines to reach a consensus on operational definitions for this complex clinical phenomenon, thus enabling a more precise appreciation of the incidence and correlates of tolerance to antidepressants. Taken together, the present review underscores the need to cautiously weight benefits and risks prior to considering long-term antidepressant treatment for patients with MDD as tolerance may emerge in a subset of patients.
Hi I am Hopefulstill and new. I started at 20 mg. Paxil...... Now years later on 50 mg. but seems to have pooped out. I am going to try tapering off. Started with 46 mg. yesterday Here goes! Glad I found this site
From: verywell.com What is "Prozac poop-out"? If it seems like your Prozac (or another SSRI such as Zoloft, Paxil, or Celexa) stopped working, why might that be, and what can you do? What Exactly is Prozac Poop-Out? When we talk about the phenomenon of Prozac (fluoxetine) poop-out, what we mean is that a person's antidepressant has simply stopped working as well as it once did, causing a relapse of depression symptoms. Although this phenomenon is most commonly referred to as "Prozac poop-out," it can actually occur with any SSRI. An selective serotonin reuptake inhibitor or SSRI is a type of antidepressant medication which is able to prevent nerve cells from taking back up a mood-regulating neurotransmitter called serotonin. This allows more serotonin to be available in the spaces between nerve cells where it can be used, possibly helping depression. Other SSRI's which may cause Prozac poop-out include: Zoloft (sertraline) Paxil (paroxetine) Celexa (citalopram) Lexapro (escitalopram) To read the rest of the article, click on this link to the source web page: https://www.verywell.com/what-is-prozac-poop-out-1067022 .
StrangeAnimal posted a topic in Introductions and updatesGreetings to all members of this community... I am a new member. Unfortunately, I have joined this forum during a time of personal crisis, as I assume is often the case. Before requesting your advice and input on my current predicament, I would like to make it clear that I fully intend to participate in this community as a source of comfort and support when my personal experience is relevant, not just a beneficiary of the comfort and support that I have noticed is such a defining aspect of the courageous individuals that define this community. In the fall of 1999 during the first semester of my first year in University, I saw a Psych and I was diagnosed with OCD (Mostly Pure O) and panic disorder and prescribed Paxil. I'm hoping my medication history appears as a signature once I post this discussion, I included it while signing up. In a nutshell, after 15 years on Paxil my psych believes I've reached tolerance and wants me to switch to another medication. I am extremely concerned about this. First of all, I always intended to ween myself "properly" off paxil one day, regardless of how long it took to succeed. Unfortunately, this has to be the worst relapse I have ever experienced; my anxiety and OCD are terrible, I'm very depressed, I feel extremely depersonalized, and I'm really lacking focus and concentration. I literally feel like I'm losing my mind. Because of the way I feel, my main objective at the moment is simply to feel better. This has always been my main focus during past relapses, however, the one significant difference this time around and a major addition to my anxiety is the fear that now consumes me regarding the length of time and long term effects of being on an SSRI. It may not mean too much with regards to the long term damage I've most likely suffered, but I always took a little comfort in knowing that the first psychotropic drug (Paxil) I was prescribed had worked and remained the only one I'd ever been on. I had always felt for sufferers who had been through the chemical gambit of multiple SSRI's, SNRI's, Benzo's and other drugs, desperate for just a little salvation. To wrap this up, what clearly concerns me the most at the moment is the lack of clarity in mental health with regards to next steps. Notwithstanding my strong intention to get off this crap one day, what I'm hoping for at the moment is advice and input as to what you guys believe is the quickest and smartest option for me to reach mental stability. I just want to feel somewhat sane again. Below is a list of options that I've compiled, the first two were received as "professional" advice. Please feel free to ignore them all if you favour an additional option. 1. Stop the Paxil cold turkey and immediately switch to another SSRI or SNRI the next day - My Psych's preference 2. Increase the Paxil to 40mg, then to 50mg if necessary - A 2nd opinion I sought from my family doctor 3. Gradually withdrawal off the Paxil while starting and gradually increasing a new medication at the same time - Information I came across. 4. Add Wellbutrin as an add-on medication to help boost the Paxil's effect and deal with the depression component - Information I came across. 5. Just stop the Paxil and withdrawal properly - Not sure how I'd feel better any time soon with this option Thank you in advance for any advice and/or comforting support. Cheers