Actually, I wasn’t at all sure how to explain what the question really was in the length of a subject line. What I’m actually wondering about is why there’s such a HUGE difference between the length of time it takes antidepressants to work (any of them, actually, not just SSRI’s) and the length of time it takes a stimulant like Ritalin or Adderall to work. Antidepressants normally can take weeks or even months. Stimulants, OTOH-- well, let’s just say that you know within an hour if they’re going to be right for you. Now, understand, I’m not talking about bouncing off walls, being up for 3 days, getting extremely hyper, or anything else that a normal person would experience from something like Ritalin. I mean the profound sense of calm and peace and connectedness that the few, the proud, the truly ADHD get from it. There are theories that the way methylphenidate also increases serotonin is actually responsible for this, but in that case, it really doesn’t make any sense. If that was it, then why wouldn’t it take anywhere near the same length of time to kick in as the SSRI’s??
So why this dramatic difference? If stimulants really do work by increasing dopamine, then why doesn’t it take just as much time as with SSRI’s, or even a hundredth as much time, to see a lot of improvement? Either way, you’re talking about a neurotransmitter. Unless that’s not really what gives stimulants most of their effect?
A lot of SSRI’s are not directly psychoactive (or at least are not directly SSRIs) but are rather a precursor that has psychoactive metabolites. However, when it takes weeks or months to show effect is not referring to the fact that your neurotransmitter reuptake is not going to be inhibited quickly, but rather that your long term symptoms of depression are not going to just disappear and it will take a while for your brain to stabilize. They start doing stuff as soon as psychoactive component (be it the substance itself or metabolite) crosses the blood-brain barrier, it’s just that the stuff they’re doing cannot always be described as “working”. This is especially evident if an antidepressant triggers a manic or hypomanic state in a seemingly depressed individual. Suddenly they will be bouncing off walls, but that doesn’t mean they’re cured or that the medication is working. IANAD, etc.
That does make sense. What I still don’t understand at ALL, though, is why the stimulants do work so quickly. I felt a huge difference right away, and had great results within a couple of days even though the dosage wasn’t right yet. What exactly is it that a stimulant is affecting that causes it to work so differently? I’ve asked my doctor about it, and I still don’t really think I understand this point.
I am not sure how much you understand about neurons or neuroscience in general but I will try to make it very basic. Neurons are the cells most responsible for brain functioning. They typically fire many times a second each but the neuron itself is covered in things called receptors where both natural neurotransmitters and psychoactive drugs bind and influence the rate that the neuron fires. Stimulants typically get absorbed and work directly on receptors very quickly. They either bind directly or influence other systems that do. This only takes as long as it takes for the drug to pass into the brain and start doing its things on cells and whole brain systems.
SSRI’s (selective serotonin reuptake inhibiters) work differently. They don’t generally bind to receptors to do their thing. They actually rewire cells so that their little reuptake processes don’t work as quickly. That leaves extra serotonin floating around in the synapse which also influence brain function but not in the same way as stimulants. SSRI function has a much longer onset because it isn’t doing anything directly. Instead, it is causing the neurons themselves to adapt to an environment where more serotonin is hanging around outside of the cells.
All oft this is very general of course and much of neuroscience is poorly understood. SSRI’s just seem to work for many people even if they aren’t fully understood down to the smallest level of detail.
Um, well, that would be not a lot. Not an impressive amount. Thanks for keeping it basic. It’s a fascinating subject, for sure. And it has practical application, to say the least, because so many people are on one of these drugs. Maybe there’s one sentence that sums it all up, and it’s on the detailed package insert for Focalin (dexmethylphenidate): “The mechanism by which this drug works is unknown.” The mind is a mystery!
That sentence is on the insert of nearly all antidepressants, which accounts for their dismal efficacy. I heard an interview on NPR with the director of NIMH, and he admitted they only have the desired therapeutic effect on 30% of patients.
Well, I don’t know one way or the other about that, but Focalin isn’t an antidepressant, of course. It’s one of the CNS stimulants, which are AMAZING. Astonishing. Miraculous. Did I mention that I like them? Focalin is the gold standard for me, of course, but they’re all good. When they work, when a person actually has what they’ve been prescribed for, they don’t just help a little bit-- they change everything. They open the door to peace and groundedness. They last. They’ve been around a long, long time. And they don’t have nasty side effects (very nice ones, in fact.) However, your life may turn into a nightmare of fighting with your insurance company to get what your doctor prescribed. It’s interesting, because I think the attitude and beliefs about stimulants can be radically different from the one of antidepressants. Stimulants seem to be so much more suspect. My doctor told me that I’d probably do very well on Desoxyn, but he admitted frankly that he didn’t want to put me through the ordeal of trying to find it and get it. Focalin is hard enough!! But it’s all worth it.
I don’t think it’s particularly interesting – the Government spent millions on demonizing stimulants as street drugs, so a doctor prescribing them creates instant cognitive dissonance in everybody’s mind. The logic in the average person’s brain seems to be that since they are so bad that the conditions of prescribing them should be that you’re extremely sick. This is a logical problem on two counts – the premise that stimulants are very bad is not true, making the argument unsound, and even if it was, the argument is also invalid because it does not follow.
I am willing to bet that if Desoxyn is still prescribed for children, most if not all parents of those children who are aware of what Desoxyn is (methamphetamine) have a firm belief that it is somehow fundamentally different from the street meth. It is not, and the same reason their kids are deriving a benefit from oral Desoxyn is probably the same reason for the psychological (maybe only initial) aspects of street meth addiction. The only pharmacologically significant differences are purity of product, dosage control and route of administration.
Another major one is cocaine. It is so demonized in our culture that I’ve heard people say phrases like “I’ve had nasal surgery so bad that they had to use cocaine to get the swelling down” which is just wrong on so many counts that it makes me cringe. They used cocaine because the ENT surgeon decided it was the appropriate anesthetic – it is not inherently better, worse, stronger or weaker than procaine, lidocaine, tetracaine, etc just because it’s a demonized street drug as well. Cocaine is a good anesthetic with good vasoconstrictor properties, and it having systemic psychoactive effects does not necessarily affect it’s usefulness as an anesthetic.
This effect is detrimental to our health. Drugs, and patients, are stigmatized and I firmly believe that even in cases of abuse this approach does more harm than good. All the people I’ve run into abusing prescription opiates are a testament to that – they’re slowly(or sometimes quickly) poisoning themselves with acetaminophen. I am not saying combining acetaminophen with an opiate is not better pain relief than either one by itself, but while intentions might be good the end result is not much better, or maybe even worse, than street dealers cutting their supply with strychnine.
The median dose of acetaminophen that causes serious liver damage is about 25g (with some recorded adult fatalities of less than 15g) , or about 50 standard Vicodin (5/500) tablets. In contrast 50 of those pills only have 250mg of hydrocodone, which is not even an acute overdose. In fact, you can’t even find any good toxicological data on hydrocodone in humans because it seems nobody has ever ODed on it. The rat LD50 is 375mg per kg of body weight.
I hate putting acetaminophen in my body – it makes me nauseated and sleepy, and I know the stuff is poison. I can’t take aspirin/NSAIDs because of a sensitivity. I hate opiates, but at least they’re not poison, have tolerable side effects and aren’t likely to kill me, but then I can’t ask anybody to prescribe me just an opiate without looking like a junky. I’m sorry for venting, but I had a tooth infection a few days ago and sat there in agony looking at the prescribed Vicodin like it was the antichrist. At first I caved but when the inflammation subsided and the pain got a little better (I didn’t have to vocalize it anymore), I switched to diphenhydramine (Benadryl) to just knock me out instead. I really don’t see modern society falling apart if you made 15mg pure codeine pills an over the counter medication.
I am not a doctor, etc.
P.S. I just saw something funny and relevant to my hijack (but not the OP, sorry). According to this Wikipedia entry
Two or more ingredients, but it doesn’t matter which ones? Sounds like a misguided attempt at regulation rather than any kind of medical reasoning. Somebody must’ve thought “So that junkies or drug dealers <blank>” and I can’t think of any <blank> other than “get liver damage and die instead of getting addicted and high”.
groman, I wish I knew more about medications and what not to take in the way of perscription drugs. I have a perscription for Vicodin and I am very cautious about using it. (Codeine makes me a little ill.)
One of my problems is that it is hard to tell one pill from the others just by looking. These pills are all so pale looking and as I age, that’s a problem. Just this week, I thought I was getting three topomax from a bottle. Instead, I was getting three generic sleeping pills that also started with the letter t. (I had already set aside my usual bedtime sleeping pill which is pretty strong and works quickly.) Add to that three xanax, two anti-depressants and an assortment of BP meds. But four times the perscribed sleeping medication? It was such an easy mistake to make. Thank goodness I noticed the slight difference in color. These were white. The topomax has a pale yellowish color to it.
They need to make all sleeping meds red with big purple Xs on them.
There are theories that the way methylphenidate also increases serotonin is actually responsible for this, but in that case, it really doesn’t make any sense. If that was it, then why wouldn’t it take anywhere near the same length of time to kick in as the SSRI’s??
What I still don’t understand at ALL, though, is why the stimulants do work so quickly. I felt a huge difference right away, and had great results within a couple of days even though the dosage wasn’t right yet. What exactly is it that a stimulant is affecting that causes it to work so differently? I’ve asked my doctor about it, and I still don’t really think I understand this point.
It’s interesting, because I think the attitude and beliefs about stimulants can be radically different from the one of antidepressants. Stimulants seem to be so much more suspect. My doctor told me that I’d probably do very well on Desoxyn, but he admitted frankly that he didn’t want to put me through the ordeal of trying to find it and get it. Focalin is hard enough!! But it’s all worth it.