I've lost count of the number of people who have called me in tears saying that their "antidepressant had stopped working," so they took themselves off of them, and now they feel a thousand times worse.
I believe them.
Over the years, I've developed my own understanding of why their antidepressants "stopped working," why they felt worse when they stopped them, and how to improve their health when it happens. Read on for a brief explanation.
Have a great week!
Why Antidepressants "Stop Working"
And what to do about it
Let me get right to the point. When an antidepressant, such as an SSRI like Zoloft or Prozac stop working, there are three possible reasons:
1. the serotonin levels have fallen so low that bIocking its reuptake makes little difference.
2. the immune system has become hypersensitized to the patient's own SSRI, serotonin, serotonin receptors, or serotonin reuptake pumps, creating a lot of havoc and deficiency to the serotonin system as well as increasing inflammation. This leads to increased depression and anxiety.
3. the blocked serotonin reuptake pumps simply increased in number on the cell membrane, negating the serotonin blocking effects of the medication.
4. all or a few of the above.
Under any of these circumstances, stopping the SSRI will simply make the situation worse. When a patient stops the SSRI/antidepressant, more serotonin reuptake pumps become unblocked. This leads to a faster rate of serotonin reuptake after the neurotransmitter has been released. With less time to bind to the receptor, the patient will have less of an effect from serotonin stimulation and activation, and the depression or anxiety will worsen.
Most people are taught not to take an SSRI with 5-HTP because it can create serotonin syndrome, which is associated with too high a level of serotonin. I also think "serotonin syndrome" may include some patients who have a bad inflammatory reaction to SSRIs.
In a situation where a patient has been taking an SSRI for many years, it is highly improbable that the patient has high levels of serotonin when they had not supplemented with 5-HTP. Unless the person has developed a hypersensitivity reaction to the serotonin system, it's helpful to add 5-HTP with vitamins and minerals to help the patient replenish their supply of serotonin.
If a patient has developed a hypersensitivity to their own serotonin system after years of exposure to an exogenous, non-bioidentical, xenobiotic that binds to the serotonin reuptake pump (what an SSRI basically is) then my approach is to start the patient with a homeopathic serotonin. A homeopathic serotonin carries the information of serotonin, but not the actual substance. This will support the patient's serotonin system without increasing inflammation.
Because 90-95% of the serotonin is found in the gastrointestinal (G. I.) tract, the patient will need G. I. support. Generally, I will provide either Ion Gut Health by Ionbiome.com and/or a good probiotic (Seed.com or Perque Digesta Guard Forte 10). Smoothies are very helpful since they are easily digestible and are high in nutrient content.
If the number of serotonin reuptake pumps has increased, I believe that the best way to improve the serotonin effect is to build more serotonin through the use of 5-HTP, vitamins, and minerals. You can increase the dosage of the medication, of course, but that just adds more xenobiotic into your body, increasing inflammation and the need for detoxification.
Often times, traditional psychiatrists will change the medication that has "stopped working" with another SSRI or an SNRI, like Effexor or Cymbalta. By doing so, they are removing the hypersensitization that the patient has developed over time to their old SSRI and replacing it with another, slightly different form of SSRI. In time, the immune system will come to recognize and develop a hypersensitivity to the new medication as well.
With an SNRI, the blockage of the reuptake pumps includes both the serotonin and catecholamine neurotransmitter pathways. In time, both systems will run out of their neurotransmitters and the patient will be right back to where they started, except now they don't have enough neurotransmitters for two, not just one system.
That's why patients feel awful when they stop these medications.
If you were a member of my family, my advice to you would be to avoid going on these medications in the first place and use holistic methods that build up your health. If you have been on these medications for years, then realize that you should not stop taking your medication. Instead, you should go seek help from an integrative or holistic psychiatrist who will do more for you than take you on a decade long carousel ride from one SSRI/SNRI to another.
Hope this helps.