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  1. #1

    Building a tolerance to Anti-Depressants?

    I recently heard that it may be possibe that one CAN build an addiction and therefore, an intolerance, to anti depressants that were previously thought to be completely non addictive.

    Anyone else heard anything about this?

    I'm asking because I still seem to have an incredible amount of anxiety even though I'm on 225mg Effexor, 25mg Trazodone and until recently 25mg of Seroquel before bed. I wondered if my body has become dependent on one of my medications.

  2. #2

    Re: Building a tolerance to Anti-Depressants?

    It's not an addiction or dependence per se.

    There are two things that can happen with certain SSRIs, however:

    1. some people (they are sometimes called "rapid metabolizers") show a pattern of a normal response to the medication initially but after a time the medication becomes less effective for reasons not entirely understood; for some of these, switching to a different SSRI may resolve the problem although other will simply repeat the process with each successive new medication

    2. on discontinuing an SSRI suddenly, some people experience an unpleasant "discontinuation effect" which subjectively can feel like withdrawal, with a variety of unpleasant symptoms - this does not happen with all people or with all medications, but it is most likely to happen to people taking Paxil followed by Effexor (and probably least likely to happen with Prozac due to it's long half life) - discontinuation effects can be avoided or minimized by tapering down the dose of the medication over a period of two weeks or so

    The other possibility, of course, is that due to life events or the season or other factors you may simply be experiencing a worsening of symptoms of depression and/or anxiety - some people who suffer from SAD find they need a higher dose in the winter months than in the summer. In your case, you have mentioned a couple of factors if memory serves that may be contributing to increased anxiety: a family issue and an anticipated return to work (or school?).

    Finally, you mentioned that "until recently" you were taking 25 mg of Seroquel. How long ago did you stop taking that and how did you go about stopping it? There is a possibility that you may be experiencing some rebound anxiety from discontinuing Seroquel if it was recent.

    The other thing I wonder about is that you say you "still" have a lot of anxiety. I am interpreting that to mean it has become worse recently but that may be incorrect. Are you saying rather that it just hasn't got better? or hasn't improved as much as you had hoped? or has it actually worsened?

  3. #3

    Re: Building a tolerance to Anti-Depressants?

    Hi Dr Baxter,
    Thanks for your reply.

    My anxiety has stayed the same and has definitely worsened recently. It's affecting my breathing, eating and sleeping.

    Regarding Effexor - I recently learned that it's not an SSRI, but instead an SNRI. Is there much of a difference?

    You remembered correctly, I've definitely had some external factors that have contributed to an increase in anxiousness recently. However, it still seems to be more than I image would be appropriate?? Also, it feels very physical this time. I'm feeling it in my stomach and lungs. And I feel like I'm "buzzing" or have had a couple POTS of coffee all the time. And it's CONSTANT.

    It could be the external events combined with recently reducing the seroquel though.

    I needed to stop the seroquel because I was sleeping 12-14 hours per night ---every night. With me needing to be ready for work, while continuing to do everything else, I couldn't afford to sleep that long everynight. I definitely had some serious insomnia come back again after reducing the seroquel, so I've been taking 1/4 - 1/2 of a 25mg pill before bed. Haha..I sleep too much or not at all. I'm laughing, but it's actually really frustrating.

    But last night I took 1/2 of a 25mg because I new I had to be up for an important meeting today and I didn't want to risk insomnia. I was really looking forward to this meeting and really wanted to go, however I slept right through my alarm and woke up "naturally" after 14 hours of sleep (and 2 hrs after the meeting!).

    One other thing... when I wake up I really feel medicated. Not just dopey, but like....well, actually, it reminds me of when I was a teenager and used to do acid/LSD. There's "tracers" and everything's sort of tingly or buzing or something. I seem to notice it's more noticeable when I'm not taking the seroquel.

    Is this normal?

  4. #4

    Re: Building a tolerance to Anti-Depressants?

    Regarding Effexor - I recently learned that it's not an SSRI, but instead an SNRI. Is there much of a difference?
    Actually it's both. Most of the medications in this family are Selective Serotonin Reuptake Inhibitors, which effectively increase the amount of available serotonin in the synapse. Effexor does this too, but it has a dual action effect: It is also a Selective Norepinephrine Reuptake Inhibitor, so it directly increases levels of available norepinephrine as well.

    For some people, this has a stronger or more rapid effect in treating depression or anxiety. However, for others it's simply too much - it can cause sleep disruption (either insomnia or hypersomnia) in some but not all people and it can increase anxiety in some people.

    How long have you been taking Effexor now?

  5. #5

    Re: Building a tolerance to Anti-Depressants?

    Interesting.

    I've actually been on effexor for about 11 years. That's why I was wondering if maybe my body is reacting to it differently somehow.

    What's the function of norepinephrine again? Actually...I can look it up if you don't happen to have quick answer. It's just easier to ask you instead of looking it up ops:

  6. #6

    Re: Building a tolerance to Anti-Depressants?

    Hey - one other thing...

    Yesterday I felt like I HAD TO move around - like excercise or something. It was like I had some pent up energy that had to be released or something. Particularily within my muscles. It felt like I had more strenght than normal. And although it was good for my abs (I decided to do every form of situp/crunch I know) it was a bit strange.

    I don't know if it's related but thought I'd mention it. :icon_flower:

    PS - This emoticons are fun.

  7. #7

    Re: Building a tolerance to Anti-Depressants?

    There are three major neurotransmitters that you'll hear about: serotonin, norepinephrine, and dopamine. Normal cognitive and emotional functioning requires that there be sufficient quantities of these available to the brain and that they be in the proper balance (neither too high nor too low).

    Medications like Effexor act to "boost" one or more of these neurotransmitters directly (serotonin for most, serotonin + norepinephrine for Effexor, dopamine for Wellbutrin) but there also seems to be an indirect effect on the others. The neurotransmitters are linked to one another so that changes in one gererally will produce changes in the others as well in a sort of domino effect. It gets even more complicated because the neurotransmitters interact not only with each other but also with the endocrine system (hormones), so together you can have these huge domino effects as one element or factor changes and sends ripples through the systems affecting other elements. (This is one of the reasons for PMS or post-partum depression.)

    The restlessness you're experiencing isn't uncommon and again suggests that you're reacting to a withdrawal or reduction in medication.

  8. #8

    Re: Building a tolerance to Anti-Depressants?

    I just found this note:

    A recent "Drug Alert" showed that diphenhydramine (Benedryl) and Effexor are contraindicated together.
    I vaguely remember someone recently talking about having a cold - not sure if it was you or someone else. If so, and you are taking any cold medicines, look to see if that ingredient is in them.

  9. #9

    Re: Building a tolerance to Anti-Depressants?

    Thanks for the info, Dr Baxter.

    Your vague memory is pretty good, it was me that mentioned I had a cold. I'm not taking anything for it though.

    However, something clicked when you mentioned hormones and neurotransmitters. I'm not PMS'ing but I do have some issues with my cervix and perhaps that triggers hormonal imbalances which then triggers changes with my neurotransmitters.

    It sounds like I'm having some withdrawal effects and it's probably compounded by the other external stressors. I'd like to go back on the seroquel, but that won't solve my 14hr sleeps. I'll talk more about it with my therapist on Monday and make an appointment with the psychiatrist.

    Aaaaaannd I'm learning about maintaining causes in my anxiety management group -so, I'll also throw in some positive self talk and diaphragmatic breathing so that I don't escalate a panic attack.

    Thanks.

  10. #10

    Re: Building a tolerance to Anti-Depressants?

    Norepinephrine is a neurotransmitter. It's sometimes called a "stress hormone". It's involved, with epinephrine, in the fight-or-flight response, wherein the sympathetic nervous system is activated, increasing heart rate, fat burning, and muscle readiness.

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