4 ms·

This over-simplification has made it hard to find out what my prescriptions might actually be doing for (or maybe to) me. I'm about to say things as a hopefull

This over-simplification has made it hard to find out what my prescriptions might actually be doing for (or maybe to) me. I'm about to say things as a hopefully decently informed patient. Hopefully it'll more useful than "serotonin = happy," but it'll probably contains errors. Corrections and additional information would be greatly appreciated! My GP prescribed two drugs at the same time: citalopram, an SSRI, to treat depression, and hydroxyzine as a sleep aid. I thought that was interesting because hydroxyzine is a 5HT-2a antagonist, which seemed like it'd interfere with the SSRI. It took quite a bit of digging to learn that it probably wouldn't, which still surprises me. My current understanding is SSRIs play a long game—at first, the lower reuptake rate extends serotonin's effect in synapses (but specific subtypes, because boosting the wrong ones makes you puke), but then autoreceptors (feedback mechanism for the transmitting neuron) undo that by causing less serotonin to be transmitted in the first place. But then, eventually they reset, and then the other end of the synapse gets to down-regulate its sensitivity to serotonin, at which point the SSRI's done its actual job. But the reading I did didn't leave me thinking researchers are terribly confident that that's a complete explanation. It would explain the side-effect profile though—especially the absurd increase in anxiety. Treatment is increasing 5HT-2a activity, apparently intentionally, when another drug is a potent anxiolytic blocking 5HT-2a activity. I quit taking the hydroxyzine, but while I was taking it it seemed to be an SSRI side effect off switch. It also made me a zombie the whole next day, which is why I stopped taking it. And of course, the biggest thing I learned: don't let the drugs be alone in their battle against depression. Odds of successful treatment are much better with the combination of drugs and therapy.

jrapdx3 12y ago
Medications are tools not answers. All drugs have multiple effects most of which have received little or no study at all. We are not fortune-tellers. It's impossible to predict exactly what effects a drug will have in a given individual. Hydroxyzine is an old drug, with antihistaminic, anticholinergic, and some degree of 5HT2a antagonism. It can have moderate anti-anxiety effect, and may reduce discomfort of opioid withdrawal symptoms. However, some people respond poorly, or even become agitated with use of such agents. While SSRIs block presynaptic 5HT reuptake, this is also known to be a transient effect. Antidepressant action is associated with "downstream" intracellular neuronal changes that are extremely complex and incompletely understood. Specifically, 5HT2a effects are diffuse and connection to particular symptoms tenuous at best. A quick look here should illustrate this point: https://en.wikipedia.org/wiki/5-HT2A_receptor https://en.wikipedia.org/wiki/5-HT2A_receptor Pragmatically, if a medication produces troublesome effects, don't try too hard to "explain" the problem, but definitely don't suffer in silence. Talk it over with the doctor and try other approaches. Psychotherapies can be effective. I agree, it's not an "either-or" situation, rather "all-of-the-above". By all means use the whole range of effective and tolerable tools at your disposal.

jrapdx3 12y ago

Medications are tools not answers. All drugs have multiple effects most of which have received little or no study at all. We are not fortune-tellers. It's impossible to predict exactly what effects a drug will have in a given individual. Hydroxyzine is an old drug, with antihistaminic, anticholinergic, and some degree of 5HT2a antagonism. It can have moderate anti-anxiety effect, and may reduce discomfort of opioid withdrawal symptoms. However, some people respond poorly, or even become agitated with use of such agents. While SSRIs block presynaptic 5HT reuptake, this is also known to be a transient effect. Antidepressant action is associated with "downstream" intracellular neuronal changes that are extremely complex and incompletely understood. Specifically, 5HT2a effects are diffuse and connection to particular symptoms tenuous at best. A quick look here should illustrate this point: https://en.wikipedia.org/wiki/5-HT2A_receptor https://en.wikipedia.org/wiki/5-HT2A_receptor Pragmatically, if a medication produces troublesome effects, don't try too hard to "explain" the problem, but definitely don't suffer in silence. Talk it over with the doctor and try other approaches. Psychotherapies can be effective. I agree, it's not an "either-or" situation, rather "all-of-the-above". By all means use the whole range of effective and tolerable tools at your disposal.