# Building a tolerance to Anti-Depressants?



## healthbound (Jan 29, 2006)

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.


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## David Baxter PhD (Jan 29, 2006)

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?


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## healthbound (Jan 29, 2006)

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?


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## David Baxter PhD (Jan 29, 2006)

> 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 *S*elective *S*erotonin *R*euptake *I*nhibitors, 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 *S*elective *N*orepinephrine *R*euptake *I*nhibitor, 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?


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## healthbound (Jan 29, 2006)

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


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## healthbound (Jan 29, 2006)

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.


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## David Baxter PhD (Jan 29, 2006)

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.


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## David Baxter PhD (Jan 29, 2006)

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.


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## healthbound (Jan 29, 2006)

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.


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## ThatLady (Jan 31, 2006)

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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## healthbound (Jan 31, 2006)

Well, It'd sure be nice if that fat burning component would kick in a bit more! Although .... I haven't been very hungry lately.

I talked to my therapist today and she's leaning more towards me just experiencing more anxiety at this time. I'm aware that there are many external stressors and changes going on right now (and Dr Baxter, you mentioned that too) and that I could just be experiencing increased anxiety. But sometimes it really does seem like it's out of control ---and actually, unbearable. I think that's the part that I struggle with the most - When it gets to the point where I feel like I can't take the anxiety anymore and I just want it to stop.

The fact is, anxiety is really uncomfortable. And although it's definitely part of my reality it's super challenging to handle sometimes.

But, I AM handling it. And I'll continue to handle it. I do find it difficult to accept that it's "just" anxiety when it gets to such a height though. Guess that norepinephrine is workin' overtime. When I get to the point where I'm seriously "anxiety-overloaded", I do my breathing, stretching, exercise and positive self talk. When that doesn't work, I begin thinking of other ways to stop it. And some of those ways WILL stop it, but they're destructive and either too temporary or too permanent. And then I feel panicked because I'm even THINKING about those destructive options...and round and round and round and round and round and round...

Theeeeen, I just sit with it. And it seems unbearable.

And then I remember that just because it SEEMS unbearable - does that mean it actually is? Maybe not. I mean I AM bearing it, aren't I? I AM handling it, right? And based on what I've experienced in the past, it should diminish at SOME point. Man, making friends with anxiety really sucks sometimes.


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## David Baxter PhD (Jan 31, 2006)

Still, it makes me wonder if you've been taking Effexor for that long and you are still have this much anxiety how much is it helping you? It's not like Effexor is the only game in town... maybe it's time to look at some of the alternatives to see if they'll work better for you? Some of the medications available weren't even on the market 11 years ago.


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## healthbound (Jan 31, 2006)

Hi db,

I can't help but wonder the same thing. I guess that's where I struggle. I'm not sure how I'm "supposed" to feel. I've got no reference to normalcy. What I DO know is that over the past while I've been experiencing anxiety levels that I've never experienced before. It seems different to me --- more chemical or something. When I say "more chemical" I mean that it feels like I'm coming down off of LSD or have had way too much cocain (yes...I had a very "colourful" yout).

I'm scared to try different meds, but I am wondering if I have built some dependency or resiliency to effexor. ---or maybe it's the trazodone???

Although ---- I just remembered when I tried coming off the trazodone late last year - I had similar reactions to my coming off the seroquel this year. At the time, I thought it just meant that I needed the trazodone. And then recently I even wondered if I was experiencing withdrawl from seroquel. BUT --- when I asked my therapist about a dependency on seroquel - she said I couldn't build a dependency on it.

SOOOO....I'm wondering if the trazodone and seroquel are helping mask the negative effects of the effexor and THAT'S what I was experiencing in both cases. It just doesn't make any sense to me that I would be experiencing such a heightened anxiety with 225mg of effexor. And by the way, I'm still using the trazodone and seroquel...I literally couldn't handle staying off of them.

The last possibility I thought of is that maybe I have other chemical imbalances going on that aren't being treated ---- that the seroquel and trazodone are curbing? Because when I went off of them, I noticed that I really couldn't concentrate on anything other than how I was feeling physically and all the scared thoughts in my head. Maybe I'm manic or maybe even might experience psychosis if I went off the meds? I'm always scared of this -my mom had psychosis.


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## David Baxter PhD (Jan 31, 2006)

> I'm wondering if the trazodone and seroquel are helping mask the negative effects of the effexor and THAT'S what I was experiencing in both cases.



That's exactly what I'm wondering. Many people are taking Effexor without any unpleasant side-effects at all but there are many others who simply don't tolerate it well for various reasons.

You use the word "therapist": Is this a psychiatrist? If not, I would request a referral to one for a consult/second opinion on medication needs. If you were my client, that's what i wqould be doing at this point.


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## healthbound (Jan 31, 2006)

OK.

Ya, I don't see a psychiatrist regularily anymore. The therapist I see works meets with their program's psychiatrist weekly and can use the opportunity to discuss issues with him at that point. But, I was thinking that it's time for me to see him personally.

Say he agrees that I might not be tolerating the effexor well anymore and say we decide to try another medication...how does one go about doing that? Would I need to come off the effexor completely before introducing an new anti-depressant?

That sounds scary. But maybe it won't be as scary as how I've been feeling lately!


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## David Baxter PhD (Jan 31, 2006)

No. Not if it's in the same family (i.e., another SSRI). 

The procedure would be to start by decreasing the Effexor (ideally while remaining on the trazodone and Seroquel) gradually over approximately 10-14 days (perhaps even a bit longer since you've been on it for a long time and because of the symptoms you're experiencing). Once you are down to perhaps 150 or 75 mg of Effexor (your psychiatrist will advise you there), then you would introduce a small amount of the new medication. Then as you further decrease the Effexor, you increase the new medication.

The only time this would not be advisable is if you were switching to one of the older antidepressants, which might require that you be completely free of the Effexor for two weeks before making the switch. Under the circumstances, I can't see any reason why your doctor would want to go this route - highly unlikely.


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## healthbound (Jan 31, 2006)

That's actually a relief...I was wondering if I'd have to check myself into the hospital for a month while switching meds!

However, one last question...even though effexor is an SNRI - it is still similar enough to the SSRI's that I could over-lap them?

Thanks for explaining all this to me.


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## healthbound (Mar 4, 2006)

Sooo...my appointment to see the psychiatrist finally arrived yesterday. Instead of lowering the effexor....he INCREASED it! Hahaha...just goes to show what I don't know . So, as of today, I'm taking 300mg of effexor. We'll see how that goes.

I've been having lots of confusion lately. Also, I find I'm having difficulties organizing my day or priorities. And I'm actually feeling a bit -what's the word...I want to say hopeless, but that doesn't sound right. I kind of feel like giving up - so, if theirs one word that describes that "feeling", then that's what I'm looking for .

Hopefully the effexor will help with my cognitive confusion and organization a bit. But, again the most predominant feeling is intense fear. Always that damn fear. I hate it.


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