How does my antidepressant work?

There are a variety of different types of antidepressants, all believed to work slightly differently in the treatment of depression. These medications affect the major depression neurotransmitters serotonin, norepinephrine and dopamine. Perhaps you or someone you know have been on one or more of these:

Selective Serotonin Reuptake Inhibitors (SSRIs)
-Usually a first line of defense
-Increase serotonin in the brain by preventing it from being reabsorbed
-Common SSRIs: Prozac, Paxil, Lexapro, Celexa, Zoloft
-Common Side Effects: drowsiness, dry mouth, nervousness, anxiety, insomnia, decreased appetite, weight gain and sexual dysfunction
-In My Opinion: This is one of the more likely candidates for weight gain, although if one is eating to mask their feelings, this may actually cause weight loss (such as in binge eating disorder)

Norepinephrine Reuptake Inhibitors (NeRIs)
-Increases norepinephrine in the brain by preventing it from being reabsorbed
-Common NeRIs: Edronax
-Thought to increase alertness and and concentration besides benefiting mood
-Common Side Effects: dry mouth, constipation, headache, drowsiness, dizziness, excessive sweating and insomnia
In My Opinion: These drugs are not considered addictive because they do not affect dopamine; this being said, I doubt most doctors would prescribe this considering many people still use these recreationally to boost mental alertness, energy and for an appetite suppressant; these can be used in the treatment for ADD in replacement of drugs such as Ritalin or Adderall (which are addictive)

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
-Second line of defense after SSRIs
-Increase Serotonin, Norepinephrine and possibly affect Dopamine levels
-Common SNRIs: Effexor, Cymbalta
-Common Side Effects: Similar to SSRIs
-In My Opinion: Less likely to cause weight gain than SSRIs and do produce similar side effects as SSRIs

Norepinephrine-Dopamine Reuptake Inhibitors (NDRIs)
-Increases dopamine in the brain, and also slightly increases serotonin and norepinephrine
-Common NDRIs: Wellbutrin
-Common Side Effects: Restlessness, agitation, insomnia and seizures
-In My Opinion: Loved the way I felt on this drug, until I had a seizure - I had quite a bit of energy and lost weight, I would say I have controversial feelings about this drug

Tricyclic Antidepressants
-Used if the above medications do not work
-Increases serotonin and norepinephrine in the brain
-Common Side Effects: increased heart rate, drowsiness, dry mouth, constipation, urinary retention, blurred vision, dizziness, confusion, and sexual dysfunction
-Because of the potential toxicity/lethal nature of this drug if ingested at great amounts, it is less commonly used
-In My Opinion: I have never been on any of these, because after researching them I learned that most people gain an enormous amount of weight on them; they can also be used for the treatment of nerve pain I believe

Monoamine Oxidase Inhibitors (MAOIs)
-Increase serotonin and norepinephrine by blocking monoamine oxidase which breaks them down
-More affective than tricyclics but not commonly used because they have life threatening interactions with certain foods/medications
-To use this drug a patient must avoid certain foods that could cause a life threatening interaction (often foods containing tyramine) - this is a fairly strict diet and is much more involved than many of the other drugs
-Common MAOIs: Nardil, Marplan, Parnate
-Common Side Effects: dizziness, blurry vision, dry mouth, headache, lethargy, sedation, insomnia, weight loss/gain, nausea, diarrhea/constipation, urinary retention, muscle tremors, herpthermia, sweating, hypertension/hypotension, hepatitis, and sexual dysfunction
-In My Opinion: I have never been on these drugs either, because at the time I was not willing to go on a special diet. These drugs would not fit into my current diet either. I think these are a great risk, but at one point I was very interested in one group of them because of their affect on tyrosine. 

A good reference for deciding what potential side effects a drug could have is to research the effects of the neurotransmitter it is working on.

This information was obtained using:
http://en.wikipedia.org/wiki/Antidepressant#Selective_serotonin_reuptake_inhibitors_.28SSRIs.29
Gutman, S. A. (2008). Quick Reference Neuroscience. Thorofare, NJ: SLACK Incorporated.

I am not a physician, and this information is not meant to treat or diagnose. 

Some Very Important Brain Chemicals....Called Neurotransmitters

I believe that in this day and age, with so many people taking antidepressants, it's very important to do a little research about what you are putting into your body. I'm sure many people look up a drug they are going to take before they take it (I hope at least), to make a mental note of the side effects they might experience, but they might not really understand how it works. It is not necessary to understand exactly how every drug works, but I think most people would benefit from a general understanding. First, people must have a general understanding of how brain chemicals work. There are 8 major brain chemicals called neurotransmitters:
Acetylcholine (ACh)
Gamma aminobutyric acid (GABA)
Glutamate ( GLU)
Dopamine (DA)
Serotonin (5-HT)
Norepinephrine (NE)
Substance P
Endorphins

ACh - is usually excitatory and plays a role in muscle movement as well as regulating heart beat
GABA - is a major inhibitory neurotransmitter that helps with anxiety, insomnia and epilepsy
Glutamate - is a major excitatory neurotransmitter helpful for learning and memory
Dopamine - Usually excitatory, effects movement, cognition and motivation/reward (addiction)
Serotonin - important for sleep/wake cycle, depression, anger, OCD, appetite and eating disorders
NE - excitatory neurotransmitter used for alertness/wakefulness, stress and depression
Substance P - Most importantly involved with sensation of pain, but has other functions as well
Endorphins - Body's natural pain killers

It is important to note that all of these neurotransmitters are very complex, have many different roles (many of which I have not mentioned) and work collaboratively to achieve a balanced state of mind. It is when things become unbalanced, perhaps by too much of one excitatory/inhibitory neurotransmitter that one often feels ill effects. I encourage you to research these in further depth, and hopefully you will become as interested in them as I have!


A special thanks to my neuroscience book for the above information!

Gutman, S. A. (2008). Quick Reference Neuroscience. Thorofare, NJ: SLACK Incorporated.

Getting out of a slump...

Since I've been experiencing a slump lately, brought on by my battle to discontinue Topamax, I've started thinking about how I could dig my way out. Quitting my Topamax is proving more difficult than I had originally anticipated. I knew it would be challenging, but the challenge is testing my limits. I have realized during all of this, that I need to remain patient. Unfortunately, patience is NOT one of my strong suits. I want things to happen right away, and I want to see changes immediately, or I am not satisfied. This however, is not a good attitude for my health. I originally thought that I would be off this medication in no time, and that everything would be fine, WRONG. I have had numerous side effects from just tapering my dosage. On this note, I have decided that perhaps my body is not ready for another drastic reduction in my medication, and I need to be happy that I have cut my dose in half and am handling that well. I think the lesson I'm learning is that I need to listen to my body, and keep in mind that it is resilient. My body doesn't understand what I have in mind, or what I want it to do. It has been on this medication for years, and so unfortunately my body doesn't know how to cope without it. I think I will try to keep in mind all of positives about how far I have come, and give my body some time to cope before I ask more out of it than it can handle...I think patience and listening to your body is the key to health. 

Candida Friendly Chocolate Cake!

Anyone who has been on the candida diet, or who lives with food allergies in general, understands what it's like to watch everyone else eat sweet treats and have none yourself. This is extremely frustrating, and can make these specialty diets quite difficult at times, and sometimes seemingly unmanageable. It's hard to give up your favorite desserts, and have to watch others eat them in front of you. Having felt this way myself, my mother went online and found a wonderful chocolate cake recipe! Since then, I have made this cake during holidays and to calm my sweet tooth. It's totally candida diet friendly, unlike many other desserts, which makes it a wonderful and tasty indulgence. Here is a link to the recipe:
http://healthyindulgences.blogspot.com/2009/05/healthy-chocolate-cake-with-secret.html

Note: I do not include vanilla extract when making this recipe and have had no problems with it turning out right, and even though I use cocoa powder, you could substitute carob if you are sensitive to caffeine. If you are in a hurry, you could try making just the frosting and dipping almonds in it, this is what I do most of the time!

An Interesting Take on Health....and Cholesterol

I recently watched 'Fat Head', a documentary which was a response to the ever so popular 'Super Size Me'. 'Fat Head' aims to show the faults and contradictions of the 'Super Size Me' documentary, exposing it for what it really is, a lie. So the filmaker decides to eat fast food for 30 days to prove that you can lose weight by using your head, and making healthy choices. Throughout the process, he consults with physicians and experts that give their opinions and such, and touches on not just weight, but also cholesterol. He provides a new perspective on how to lower cholesterol, which is quite different than what the typical doctor would recommend. I loved this documentary, and have to say, I agree with just about everything in it. I have had many of these same thoughts for quite a while now, and am glad someone is stepping up to talk about them. I recommend taking a look at this film, and keeping an open mind while watching it. It is quite controversial, but if you just sit down and think about it, it really makes sense. Don't discredit what he is saying because it is different or opposite of what you have heard before, just take in the information and ponder it, that's all I ask.
Here is a link to 'Fat Head', which can be watched for free on Hulu:
http://www.hulu.com/search?query=fat+head&st=1&fs=

Dopamax

Ever since the beginning of my eating disorder, psychologists have been advising me to go on antidepressants. For many years I was completely against this idea, even though I lived with constant depression accompanied by my obsessions/compulsions related to my body image. It was not until several years into my eating disorder that I finally decided to try some of these 'wonder drugs'. Luckily enough for me, I was seeing a psychiatrist who was in full control of prescribing these medications to me (as oppose to a general practitioner). She was great about finding a medication that would work 'for' my eating disorder, instead of against it. This included finding a medication that would not cause massive weight gain. I started out on an SSRI, then changed to another....only to find these medications made me feel spacey and out of it. After failing on a few medications I tried Wellbutrin, loved it! It gave me energy and helped me lose weight, which only added to my obsessive thinking (I'm not sure it did what it was actually supposed to). After some time on Wellbutrin, I unfortunately had a seizure, which has been attributed to the medication. Although a rare side effect, it is still real, and happened to me.  I was taken off this drug immediately, and the search began for something to replace it. Wellbutrin was in a class all its own, so my psychiatrist consulted with me and I decided to try Topamax.

 Topamax is used to treat epilepsy, migraines and mood regulation (off label use). It seemed like a wonder drug, because I needed mood regulation, I had frequent migraines and it just happened to have the bonus side effect of dramatic weight loss. It seemed too good to be true, and you know what that usually means. I lost around 10 lbs. on Topamax before my weight leveled off, but even more dramatic was that it seemed to raise my metabolism. I could eat more than I had previously, and still maintain my lower weight. I think I was so enthralled by the weight loss effect, that I failed to care or even notice all of the other side effects I was having. I've been on Topamax for a few years now, and I've noticed dramatic fatigue, spaciness, memory problems and and a general feeling of not caring about anything. Dopamax is known for these kinds of symptoms, and because of this has been nicknamed dopamax or stupimax on numerous forums and blogs.

These many symptoms finally prompted me to take my health into my own hands. After I started healing my body by changing my diet, I decided that this medication would have to go if I wanted to feel my best. My first thought was sheer panic! All I could think was what would happen to my body if I stopped taking my 'diet' medication, would I get fat? After failing several times to quit Topamax, I finally researched the medication extensively to see if I could find a way to quit successfully without gaining weight. The results of my search were not promising, nearly everyone I read about gained all the weight they lost back when they quit. One person mentioned that the medication should be tapered very slowly, and the body will adjust better. I decided to try this method, instead of going cold turkey as I had done in the past, and in conjunction with my extremely healthy diet, I had hopes that I could quit Topamax successfully without weight gain.

I started out tapering from 100mg to 75mg, and stayed there for a week or two. My weight stayed stable, so I brought myself down to 50mg. This is where I am currently, and my weight has not changed. I think this method may actually prove successful. I am already feeling less fatigue and spaciness, I have hopes of being off Topamax completely in the coming month!    

I do not endorse discontinuing medications; if you wish to do so consult a physician first. This information is not intended to treat or diagnose.

The Scale is My Friend, The Scale is My Enemy

An important part of my recovery, as I have spoken about in previous posts, is balance. I have tried to incorporate health into my life on a daily basis, while still juggling some of my many underlying obsessions. Possibly the greatest obsession I still have is with the scale. I have a love/hate relationship with this object, as I'm sure most women can relate to. Even though I find it a security blanket, my relationship with it can sometimes get over the top. I do not think that weighing yourself is necessarily unhealthy, but I think that it should be limited to once or twice a week in most cases. I struggle with this concept, realizing that I weigh myself numerous times daily, and that this is an unhealthy amount. This is probably the reason why many professionals have sought to 'get me off the scale'. My reason for continuing to weigh myself, against advice not to, is that it keeps me from repeating the eating disorder cycle. If I never weigh myself, I often feel out of control, unable to know whether what I am eating or doing is affecting my weight. This fear may be unfounded, but it is in fact one I face daily. If I were to go for a long time without weighing myself, only to find I had gained weight, I would truly struggle to keep myself from going on a severely restricted diet. So I find myself realizing that I must trust my body, in a way that my obsessions don't like me to. At this point I think weighing myself only once daily will be a goal I will try to obtain as a healthy start. As I have seen in the past, weening myself off of these compulsions helps to clear my head and help me see the big picture.