You may be experiencing antidepressant “poop-out,” also known as antidepressant tachyphylaxis. What may be occurring with antidepressant “poop-out” is that prolonged use of the antidepressant causes tolerance to its clinical effect, so that increasing doses are needed for the same effect. This tolerance effect in antidepressants is similar to the tolerance seen in addictive drugs, such as benzodiazepines (ie. Ativan/lorazepam, Valium/diazepam).
With prolonged use of antidepressants such as SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin Norepinephrine Reuptake Inhibitors), what occurs in the serotonin neurons in the brain is that the antidepressants eventually deplete the serotonin from the neurons. This occurs as the SSRI/SNRI causes an increase of serotonin in the somatodendritic areas and post-synaptic cleft, with the downregulation of the somatodendritic serotonin autoreceptors causing an increase in the neuronal signal, leading to the release of serotonin into the post-synaptic cleft. So with chronic use of antidepressants, the serotonin neuron just runs out of serotonin. This is postulated to be the cause for antidepressants losing their therapeutic effect, or SSRI poop-out. Even with the SSRI/SNRI present, there is no increase in serotonin as most of the serotonin in the neuron is depleted.
To remedy antidepressant poop-out, doctors can either reduce the dose or go off of the antidepressant as therapeutic options, so that the serotonin can be given a chance to re-accumulate in the serotonin neurons. Another option is to augment the antidepressant with Buspar (buspirone). Adding Buspar slows down the neuronal impulse flow in the serotonin neuron, and this gives the neuron a chance to make more serotonin. When the serotonin is repleted, then the SSRI/SNRI can act, and the therapeutic effect returns. So this combination of Buspar with antidepressants can be an option for antidepressant poop-out, and can help in both anxiety and depression.
Other causes for loss of effectiveness of antidepressants include non-adherence to the treatment regimen, and/or worsening of the underlying depressive disorder or anxiety disorder.
So if you have anxiety and/or depression, and you are taking an antidepressant, then the loss of efficacy with prolonged use may be attributed to antidepressant poop-out. And the remedy for antidepressant poop-out is to: reduce the dose; discontinue the antidepressant; or augment the antidepressant with Buspar (buspirone).
Please visit with your doctor for further assessment and recommendations.
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This is an excellent article that opens up some good conversation about alternative options for depression treatment. I have seen a great deal of success with Transcranial Magnetic Stimulation aka TMS Therapy for Depression. TMS works by sending magnetic pulses to the area of the brain where depression occurs. The sluggish chemicals, serotonin, are activated which relieves the depression symptoms. TMS was FDA cleared in 2008 and there have been over 1 million treatments since that time. I hope this additional information can help someone who has struggled with medication resistant depression. Also, TMS is covered by most insurance plans, which helps make it more accessible to more people. Source: https://aneweratms.com/antidepressants-still-depressed/
Thanks for your comment! I agree, TMS is effective for depression, and should be utilized more, given all the side effects and efficacy problems with antidepressant medications.
Dear dr. Carlo,
I have a history of 20 years paxil 20 mg usage. I indeed encountered a poop out and will try to reduces both the dose and add Buspiron to my treatment.
How much of a dose reduce do you recommend?
Also, how much are the chances an other SSRI, like Lexapro, wil have a chance to be succesful?
regards,
Edward Schrijver
You’ll have to ask your doctor for your individual case. In general, the longer you take the SSRI, the more risk you have for poop-out. That’s why I always recommend psychotherapy to treat the underlying cause of the anxiety/depression, and only take medications to relieve the symptoms while your therapy and coping skills take over for the long term, then discontinue the medications when that happens.