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Is there a brain chemistry boomerang effect?
September 13, 2012 5:48 PM   Subscribe

Can going off and then later back on an antidepressant "do" something to your brain chemistry or is in some other way unsafe or unwise?

Ten years ago, I had a number of quite bad things happen and I became clinically depressed. My therapist put me on a low dose of Lexapro, which did wonders. I felt "normal" and discovered that I probably had been low-grade depressed for many, many years prior to the clinical depression episode.

I was on Lexapro with very few side effects for two years, and eventually weaned off of it at the suggestion of a new general practioner (I had moved across country, did not have a therapist, felt fine without one), as life circumstances had changed as I was feeling quite good.

That was five years ago. Though I have bouts of anxiety and can feel myself getting low-grade depressed during times of great stress, I seem to be able to battle it with regular exercise and wholesome outdoor activities. I am glad to have learned what works for me.

Jump forward – several big issues hit at once (grave illness of loved one, financial distress), and I went to see this same doc to ask if he thought my going back on Lexpro would be a good idea. I felt at times as if a crushing depression was just around the corner. My doc was out, and the MD on call that day told me that to go back on an antidepressant was dangerous, as brains often don’t respond the same way to a drug after being off it, and I was, essentially playing with fire as far as my brain chemistry was concerned.

I suspect she had some axe to grind about meds. I had never met her before; when I told her as part of my history discussion that I had depression and PTSD from childhood and had been on meds, including Clonopin and Lexapro, but off of them for several years, she told me people overdiagnosed themselves, overused antidepressants in general, and that she suspected fewer people were clinically depressed than they thought. Which, okay, sometimes, sure, but she implied that I was one of those people and reiterated that going back on anything was really reckless.

I ended up walking out and not getting meds. And while I feel mostly okay, I do wonder if meds would help me get through this extremely lousy time with more resilience. However, I do not want to potentially do something to my brain chemistry that cannot be undone.

I do think she was a jerk, but she planted doubt. Has anyone heard of this? Can going off and then later back on an antidepressant "do" something to your brain chemistry or is in some other way unsafe or unwise?
posted by anonymous to Health & Fitness (16 answers total) 2 users marked this as a favorite
 
I've never, ever heard that. I went on an SSRI for a year, off of it for a couple years, and back on. My doctor at the time thought it was a good idea and didn't mention anything. Since then, 3-4 psychiatrists have heard my complete medication history, and no one has so much as blinked at fact that I went off then back on SSRIs.
posted by insectosaurus at 5:56 PM on September 13, 2012 [3 favorites]


I have been on and off of an SSRI (the same class of drug as Lexapro) a number of times, and have been told nothing of the sort. The prescribing doctor was a rather knowledgeable psychiatrist too, not just my general practitioner.
posted by Juffo-Wup at 5:58 PM on September 13, 2012 [2 favorites]


Also, if you get confirmation from others later agreeing that she was wrong, I would consider reporting the doctor - spreading false information is not an okay thing for a doctor to do. Not to mention that sharing those opinions of hers with you was not appropriate!
posted by insectosaurus at 5:59 PM on September 13, 2012 [2 favorites]


That was alarmist claptrap. Yes brain chemistries do change over time, but going back on an antidepressant is not "playing with fire" in your brain. The same one may not work again, unusual but not unheard of, but there are lots of drugs to try. I've been on and off Prozac so many times... If you were on a low dose of Lexapro for a couple of years and it worked for you, the first thing my doc would do is put you back on it if you needed an AD.

Get another opinion.
posted by monopas at 6:15 PM on September 13, 2012 [4 favorites]


Also, general practitioners are not usually up to date about psych meds and can have weird ideas about them, as you've seen. It is worth it to go to a specialist in this case.
posted by monopas at 6:19 PM on September 13, 2012 [2 favorites]


It may be true that they don't respond the same but I don't understand how that's dangerous per se.

I was on Prozac for a number of years, then I took Zoloft for quite a while, and I'm back on Prozac again. Prozac seems to be working just as well the second time around.
posted by dgeiser13 at 6:20 PM on September 13, 2012 [1 favorite]


Talk with a psychiatrist who specializes in psychopharmacology. I have never heard this from my own hugely respected pdoc* and I've cycled on and off antidepressants under her care for 20 years.

*Teaches at fancy medical school, hasn't taken new patients for like 10 years because her practice is full, when doctors see I'm in treatment with her they always say "Oh, Dr. X, I wish she took new patients because I would love to get folks in to see her" and so on.
posted by Sidhedevil at 6:58 PM on September 13, 2012 [1 favorite]


The only thing I've heard that even remotely corresponds to what your doctor told you is that there is a chance that an antidepressant that worked for you before may not work, or at least work as well, if you need to go back on it again. FWIW, this was told to me by a psychiatrist who is well published in the field and head of a depression studies unit at an ivy league medical school.
posted by kaybdc at 8:30 PM on September 13, 2012


My doc was out, and the MD on call that day told me that to go back on an antidepressant was dangerous, as brains often don’t respond the same way to a drug after being off it, and I was, essentially playing with fire as far as my brain chemistry was concerned.

I suspect she had some axe to grind about meds. I had never met her before; when I told her as part of my history discussion that I had depression and PTSD from childhood and had been on meds, including Clonopin and Lexapro, but off of them for several years, she told me people overdiagnosed themselves, overused antidepressants in general, and that she suspected fewer people were clinically depressed than they thought. Which, okay, sometimes, sure, but she implied that I was one of those people and reiterated that going back on anything was really reckless.


This so-called "doctor" wasn't in Atlanta, was she? Because this sounds nastily familiar, and if it's the same person a lot of people have had terrible experiences with her.
posted by Violet Hour at 8:42 PM on September 13, 2012


I knoew someone who was on citalopram (celexa for you?) for a few years, came off then went back on who immediately became suicidal and had to get the full mental health crisis teams involved. But I don't think they thought that was about going back on, more just about the dangers of going onto SSRIs in the first place.
posted by kadia_a at 11:10 PM on September 13, 2012


a chance that an antidepressant that worked for you before may not work, or at least work as well, if you need to go back on it again

That's what I was told by one psychiatrist— that going off and on an antidepressant increases the chance that it will lose its effect for you. (Much of her practice, I gather, was treating depressed illegal-drug-abusers; she said the mechanism wasn't unlike habituation/tolerance to other drugs.) This is the opposite of what the OP was told, though.

Perhaps there are side effects (serotonin syndrome?) which have a chance of occurring each time you start the drug even if it was OK last time? This doctor may simply not have felt comfortable taking that chance with a new patient, and expressed herself poorly?
posted by hattifattener at 12:02 AM on September 14, 2012


I'd get a second opinion from a psychiatrist.

They are the experts in brain chemistry and depression. A GP is a good first step, but based on what you've related here, I don't feel good about what you were told.
posted by Ruthless Bunny at 6:07 AM on September 14, 2012


The only thing I've heard about going back on meds that you've weaned from is that any dangerous side effects that didn't happen before are still a possibility. Not that these side effects are more likely, just that not having had them before doesn't mean you won't have them this time. I think this might explain cases where someone picks up an SSRI they've been on before and develops the suicidal ideation.

For example, I take a mood stabilizer that rarely causes a potentially fatal rash. My p.doc told me that if I were to go off the medication, I would have to do another round of slow introduction because I could still get this rash, even though I never had it before.
posted by xyzzy at 8:43 AM on September 14, 2012


See a psychiatrist. Seriously. A GP is just that, and isn't likely to know as much since it's not their specialty. It really does sound like the office has a position on anti-depressants. First one doctor convinces you to go off your meds, then another tells you that it's playing with fire to go back on them? I'd talk to someone who specializes in depression.
posted by Meep! Eek! at 9:52 AM on September 14, 2012 [1 favorite]


I, too, have been told by a doctor that the issue with going off and back on an antidepressant is that it may not work again in future. The way she put it was (misquoted from fuzzy memory) that it seems that for any particular drug, there are only N times a person can quit then resume it and still have it be effective, and the problem is that there's no way to know in advance what N is.

Never been told by a doctor (or read anywhere credible that I remember) that it could cause problems, was "playing with fire", or was reckless in any way other than "you might be giving up something that works and not be able to get it back again".
posted by Lexica at 6:52 PM on September 14, 2012


Heh-- I came in to mention the Lamictal Rash too. Same thing-- going off and then back on puts you at risk of, well, the same stuff you were at risk of when you started the first time, and is perhaps not ideal, but not any more worrisome than starting another drug with similar side-effects. I think Lexapro's are pretty comparable to other SSRI's (I was on it for a while). It is always possible that the same drug that worked before won't work this time, true. But you're not going to fry your brain by trying Lexapro again. That was pernicious and ill-informed claptrap, and I wish that person were not in charge of advising people on important health-related topics.
posted by Because at 2:14 PM on September 15, 2012


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