Discover and read the best of Twitter Threads about #SSRIs
Most recents (3)
While the "serotonin hypothesis" of depression is no longer taught, #SSRIs delay the reuptake of serotonin @ neurotransmitters. We also now know they have a host of other effects (σ1, BDNF, CREB, cytokines, on top of a slew of differences on the various subtypes of serotonin)
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The key difference, is that today, we know that the brain changes seen in depression are impairing, and we know that SSRIs work. Instead of drawing a straight line between "serotonin regulation" and efficacy, the honest psychiatrist doesn't understand the current mechanism.
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We now suspect that there are a host of effects, second, third, & even tertiary effects, and the complex way in which the brain is interconnected plays a role.
But yes, SSRIs DO block the reuptake of serotonin. It's why we have to be careful about withdrawal and tolerance.
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But yes, SSRIs DO block the reuptake of serotonin. It's why we have to be careful about withdrawal and tolerance.
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@NYTObits writes of John Gunderson: "He was adamant over the years that psychiatric drugs did not help resolve #borderline symptoms." nyti.ms/2E6UmHv This statement is narrowly true. In lectures, he specified circumstances that warrant the use of a range of medications...
6 months ago, while arguing against widespread use of lamotrigine in #BPD, Gunderson wrote, "Clinical experience has shown that medications can help build an alliance, can relieve states of distress, and can sometimes be helpful for comorbid disorders." ajp.psychiatryonline.org/doi/10.1176/ap…
He spoke of instances when mood stabilizers, #SSRIs, and even antipsychotics might be of use. He spoke out against the overuse of medication but saw a role for judicious use in clinical management. ucdenver.edu/academics/coll…
1/ Important study on #antidepressants & #heartdisease. 6 months of Rx for even minor depression in #cardiac patients offers protection against adverse events (heart attack, death, etc) seen for many (8+) years out. bit.ly/2LBZPuM @JAMA_current # of interesting points...
2/ The effects of meds on mood were the same as those in many other studies, 2-3 points difference on symptoms, NNT to remission between 5 & 6, effect size under .4 …& this difference, often dismissed as minor, was associated with marked benefits in terms of overall health...
3/ it looks as if treating about 10 patients early on prevents one heart attack, w & other benefits for heart (& overall) health. Benefits were larger in those whose mood disorder remitted & those who completed the trial. So: good news. Brief inexpensive Rx w lasting benefits...
