Discussion in 'Serious' started by Cthippo, 8 Apr 2007.
Isnt zoloft supposed to make you calm and not want to shoot people?
Nope. Zoloft, like all SSRIs, has pretty paradoxical effects.
How SSRIs work is still poorly understood (if not outright misunderstood). The idea is that they boost the effect of the neurotransmitter Serotonin in the frontal lobes, thus making a person feel more energetic and upbeat in mood. However in reality they appear to work by promoting axonal sprouting (the formation of connections between the neurons) in the frontal and temporal lobes. This is a slow process which is why one needs to take SSRIs for about three to five weeks before they kick into action --well after there is a measurable increase in serotonergic activity.
The problem is that the frontal lobes are a big chunk of brain with many circuits, and just "boosting" its activity can therefore have pretty diverse effects. There are both inhibitory systems and initiating systems, with one half of the lobes dedicated to just keeping the other half in check (think of your brain as a train rolling downhill with the brakes on). SSRIs can upset that balance. Someone who is too depressed to commit suicide may just get that little boost from SSRIs to go ahead and do something. And given that in many cases depression is really just anger turned inwards... well, you get the idea. This is particularly a risk with young people, and psychiatrists are advised caution when prescribing SSRIs to them (there are also problems with the elderly).
Moreover, people tend to naively assume that if too little Serotonin makes you depressed, and more Serotonin makes you feel better, then lots of serotonin makes you feel really good. In fact, the relationship is much more like a bell-curve, with an optimal level of serotonin for feeling good, while either too little or too much makes you feel depressed. This is because it has differing effects on the inhibitory and initiating systems (compare this to alcohol, which is a "depressant": at first it makes you feel more exuberant and removes inhibition before you hit the downer). With a three-week lag of clinical action it is easy to overshoot the mark, and personally I have observed that with people with a history of frontal lobe brain damage the effects of SSRIs are particularly unpredictable, with people either becoming more depressed or going manic.
Finally, SSRIs are not the wonderdrug people assume they are. In large-scale comparative studies it has been found that 60% of depressed people prescribed SSRIs respond well, compared to about 35% who are prescribed a placebo. This means that 35% of depressed people get better just because they believe the medication will help them. Combining those data, it means that in the clinical population only about 40% of people experience a real, chemical benefit from SSRIs, whereas 20% believes that it works, and 40% experiences no benefit at all.
Yeah, I wish you would go and explain that to the quacks who had me on a cocktail of medicines growing up.
If too much serotonin is bad for you, why is it that MDMA has such a happy euphoric effect on a person? From what I understood of the drug it made it easier for serotonin to move from one part of the brain to another, and basicly gave you a big rush of the stuff. The come down the next day being the time when the body has to produce more because basicly you spent all a couple of days serotonin in a few hours the night before. Probably made a few mistakes there, but the basic idea of lots of serotonin = uber happy would appear to follow from MDMA :/
Soooo... in not so many words, Zoloft isn't always the answer? Who would have thought. I love how many people just feel the need for a pill - any pill - in order to get better. 20%? Worrying insight into how society functions today.
And probably the same in the UK.
This is one of the reasons the most powerful medicine I take is Calpol (it tastes nice too).
Not as straightforward, I'm afraid; it works differently for different people. MDMA does not only boost serotonin but also dopamine and noradrenalin, so there is a whole lot of stuff going on.
Many users experience post-MDMA depression, often starting on the second day after taking the drug and lasting for up to 5 days, whereas others experience lifted mood. A small percentage of users report these depressive symptoms to last for weeks afterwards, whereas other users report feeling better than normal for a week or so.
I was on Seroxat (another in-famous SSRI) for over 6 months; it did its job fine, but it wasn't without side affects. It never caused me to harm myself or anyone else, but there were a number of quite distinct side-effects while I was taking it, and quite pronounced withdrawal symptoms too.
The point is that these are powerful drugs and even few Doctors know much about them - I was taking 30mg per day and stopped abruptly which goes against the latest advice.
Isn't this basically how some illegal drugs work, namely ecstasy? It's obvious once your serotonin levels are depleted you enter a "comedown" basically you're in a ****** mood. How then, does this work for Zoloft, how does it kept you happy for several hours? There must be a serious flaw in the design of anti-depressants and how they operate on the human body.
In terms of long term effects I definately can't see Zoloft being any good.
Zoloft does not keep you happy for several hours. Zoloft will give you an upper (for better or occasionally, for worse) that is ongoing, provided that you have first persisted in taking it for about three weeks before it has any clinical effect.
The reason for this delay is that Zoloft does not work through an increase of serotonergic activity, although that is its immediate effect. It works through a promotion of the sprouting of new connections between neurons (conversely, depression is associated with a reduction in these connections and neuron death, particularly in the hippocampus which deals with memory and emotion). This is a slow process, hence the obscured delay in effect.
Ecstasy works somewhat differently. It boosts a whole bunch of neurotransmitters: serotonin, dopamine and noradrenalin, so its effects are more instant and widespread. Nevertheless long-term neurological changes are observed, not so much in serotonin depletion (the body makes new serotonin all the time) but in the number of serotonin receptors on the neurons, which goes down in response to a repeated increase of the neurotransmitter, and in a reduction in their connections. There may also be neuron death --Ecstasy is neurotoxic.
It all boils down to the common misunderstanding that if an increase in serotonin makes you feel better, then a really big increase makes you feel wonderful. As I said before, this is not so. It is a bell-curve and Ecstasy widely overshoots the mark. It is a hammer to the feather of Zoloft.
MDMA ****s your brain up. Trust me - I used to take it every few days for a year, and ended up incredibly depressed. I've only just got myself back together.
Too much serotonin is a baad thing.
At least you realised and got yourself back together.
As for the kid in the article I really don't know what to say about his situation. I mean he is reponsible for what he did however this whole talk of "Zoloft" affecting his decisions and actions seems to be a really vague part of how we understand drugs work.
[If it doesn't make sense, it's because it's late at night]
hmm.. if 40% doesn't work and 20% only thinks it does.. then how are the defendants going to argue that there was only a 40% chance that the drug had an effect on the boy?
You can blame anything on a drug these days :shrug:
Problem is that there is a small percentage chance that it had really unpredictable effects on the kid --a small percentage still large enough to result in the official recommendation to prescribe SSRIs to young people only with caution.
Separate names with a comma.