SSRIs: Emotional Detachment: Personality Changes & Reduction in Positive…

Paragraph two reads:  “A recent study published in the
British Journal of Psychiatry found that the majority of
patients taking SSRIs experienced emotional detachment, feelings of
indifference, personality changes,
and a reduction in

positive and negative emotions.[1]”

http://www.medscape.com/viewarticle/716929

Physicians Are Talking About: Selective Serotonin Reuptake Inhibitors and
the Choice to Numb Out

Nancy R. Terry

Authors and
Disclosures

Posted: 02/18/2010

Selective serotonin reuptake
inhibitors (SSRIs), mainstays of psychopharmacology, effectively eliminate
suicidal ideation — not to mention feelings of exhilaration, caring, and
desire.

A recent study published in the British Journal of
Psychiatry
found that the majority of patients taking SSRIs experienced

emotional detachment, feelings of indifference, personality changes, and a
reduction in positive and negative emotions.[1]

Currently,
tens of millions of patients in the United States take SSRIs daily. However,
evidence pertaining to the long-term effects of these drugs is scant. “In a few
decades, as many as 15% of the world’s population might be on SSRIs,” comments a
psychiatrist. “Although the suicide rate might decrease, I wonder what the
long-term effect will be.”

The conjecture posited on Medscape’s Physician
Connect (MPC), an all-physician discussion board, launches a discussion about
the apparent choice in SSRI use — to be crippled by depression or functional
and emotionally numb.

MPC contributors commented that their anecdotal
experience aligns with that of the British study.

In several patients on
long-term SSRIs, I have noticed some subtle personality changes,” says a
psychiatrist. “Of course, there’s no way of ascertaining cause and effect
without a good, long-term study, but this is what I’ve observed: (1) SSRIs

decrease pain (irritability, depression) but also seem to increase the threshold
for what constitutes an exciting event (a person needs more novelty than
previously for the same effect); and (2) SSRIs increase apathy and have the
potential to decrease empathy.”

“It would be unrealistic,” adds another
psychiatrist, “to think that taking a medication which significantly impacts a
major neurotransmitter would not have, in some cases if not many, a significant
effect on a person’s personality, either short- or long-term.” The psychiatrist
comments that case studies documented in Peter Kramer’s book Listening to
Prozac
indicate that SSRIs strongly impact a patient’s feeling of “caring,”
which can affect the patient’s relationships with friends and family.

An
endocrinologist suggests that his colleagues view the film Numb, which
documents filmmaker Phil Lawrence’s struggle to stop taking the popular SSRI
Paxil. In the trailer for the film, Lawrence says, “I’m flatlined. This isn’t
me. This is me on Paxil®.”[2]

“These are the
wonder drugs of psychiatry,” argues a psychiatrist. “They continue to benefit
people over the long term, even at low doses. They help with anxiety, much more
robustly than with depression, but they help in depression too. If I had my way
Prozac®, Zoloft®, and Celexa® would be sold
over the counter.” The psychiatrist comments that the life-time prevalence of
depression is between 15% and 30%,[3] and most people remain
untreated for fear of persecution and judgment formation about their need to
take antidepressant drugs. Over-the-counter distribution, he reasons, would make

SSRIs more readily available to people who need them.

“I disagree about
the OTC [over-the-counter] issue,” replies Stephen Grcevich, MD, a child and
adolescent psychiatrist. “I think there are untoward effects of SSRIs that are
still poorly understood, such as the very small but statistically significant
risk of suicidal behavior in persons aged 25 and under. We also saw a subgroup
of kids who displayed significant disinhibition and indifference to academics in
a large, open-label, federally funded study looking at SSRI safety.” He comments
that he hopes to present the study data at the 2010 annual meeting of the
American Academy of Child and Adolescent Psychiatry (AACAP).

An internist
who frequently prescribes SSRIs, reports that she repeatedly experienced
suicidal thoughts while taking an SSRI for depression. “I have been placed by my
physician on Lexapro® 3 times. In each instance, my mood lifted and
crying decreased. I could sleep. In 3 days’ time, I started having thoughts that
came out of the blue, such as ‘I want to drive off this bridge.’ Stopping the
medication stopped the thoughts.” She says that she tells her patients about
this potential side effect, but no patient has related having a similar
response.

SSRIs and then SNRIs [serotonin noradrenaline reuptake
inhibitors] nearly killed me,” says an obstetrician/gynecologist. “They caused
narcolepsy, and I fell asleep and drove off the road.” He comments that his
level of apathy while taking the drugs was so extreme as to appear parkinsonian.
In my opinion as a patient, mild to moderate depression should be treated by
cognitive behavioral therapy, not meds.”

A surgeon comments that, in many
cases, SSRIs are given to patients who are only mildly depressed. “The drugs are
given as mood elevators,” he says. “We essentially are giving out the drug for
the same reason people self-medicate or abuse alcohol.”

“I do agree we
are pushed to start meds too early on mild cases sometimes,” says a family
medicine physician. “We must ask the tough questions of patients about suicidal
thoughts to determine the severity of their illness. Then start a multipronged
approach to treatment and not just write a script and send them out the
door.”

A neurosurgeon comments that clearly there are a number of
questions about SSRIs that need to be addressed:

  • Should we treat mild depression knowing the risks?
  • Are we educating patients about the possibility that they will experience
    apathy?
  • Are we increasing the risk for substance abuse in patients who attempt to
    counterbalance induced conditions of apathy and boredom?
  • Are the artificially high levels of serotonin caused by the use of SSRIs
    chronically changing the brain and making it impossible to withdraw from these
    drugs?


“I agree that higher doses and long-term use does blunt
emotions,” says a pediatrician. “I used Effexor® for about 7 years
and tried to wean off during that time, but at very low doses would redevelop
extreme sadness that resolved when I upped the dose.” He says that working with
his psychiatrist, he switched to Wellbutrin® and now experiences a
wider range of appropriate emotions. “However, if I did not have another option,
I would prefer Effexor® side effects over the chronic anxiety and
sadness I experienced for much of my life without it.”

The authors of the
British study reported a similar finding. Many participants in the study
considered whether they should stop taking their medication, but viewed the side
effects as preferable to the illness for which they were being
treated.

“And that is the problem, isn’t it?” comments an MPC
contributor. “We just don’t have meds that treat without some side
effects.”

The full discussion can be accessed at http://boards.medscape.com/forums/.29f65335

References

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10/24/1999 – The Pain in Littleton Continues

A Message from Ann Blake-Tracy…

As if the people of Littleton have not suffered enough via the
Luvox-induced nightmare of Eric Harris and Dylan Klebold, now they must
go through their own SSRI-induced nightmares!!!! While in Littleton
last month I was told by one of the teachers at Columbine that close to
half of their students are now on something to cope with the
Luvox-induced tragedy carried out by Eric Harris and Dylan Klebold.
Oct. 21 we heard that a friend of the boys was arrested for making
threats about finishing the job for Eric and Dylan. Now we hear that
one of the mothers of a wounded student has committed one of the most
impulsive suicides I have heard of to date. The striking impulsive
compulsion to die coupled with the personality changes and loss of the
ability to cope, makes it clear to me that this is without doubt
another SSRI-induced tragedy!

How many more?

How many more?

How many more must die before the bloodshed ends? If you have been
afraid to speak out on this issue, PLEASE do not allow your silence to
contribute to these tragedies any longer!!! We must all warn all we
know that this is a clear and very present danger that MUST
end!!!!!!!!!!!!!!!!

Ann Blake-Tracy, Executive Director,
International Coalition for Drug Awareness
www.drugawareness.org

——————————————————————–
Mom of Columbine Victim Kills Self

By COLLEEN SLEVIN Associated Press Writer

DENVER (AP) — The mother of a student wounded in the Columbine High
School massacre walked into a suburban pawn shop Friday, asked to see a
handgun, loaded it and killed herself with a shot to the head.

Carla June Hochhalter’s suicide occurred about six months after her
17-year-old daughter, Anne Marie, was critically wounded in the April
20 tragedy and left partially paralyzed.

It was not immediately known what other factors might have contributed
to Ms. Hochhalter’s suicide.

Ms. Hochhalter, 48, entered the Alpha Pawn Shop in Englewood Friday
morning and asked to see a handgun.

When a clerk turned around to fill out paperwork, Ms. Hochhalter loaded
the weapon with bullets that she brought, then fired one round that hit
the wall and a second round into her head, Englewood police spokeswoman
Leticia Castillo said.

The suicide was the latest shock for students and families in the
Columbine area. Jefferson County School District officials planned to
have grief counselors available this weekend to help deal with any
trauma.

A student was arrested this week for allegedly threatening “to finish
the job” begun by two student gunmen at Columbine.

In addition, CBS-TV was criticized by some in the community for
broadcasting a snippet of the security camera videotape that was taken
in the school cafeteria as the massacre unfolded.

Eric Harris, 18, and Dylan Klebold, 17, scattered gunfire and bombs at
the school near Englewood, killing 12 students and a teacher and
wounding about 26 others. Then they committed suicide.

Miss Hochhalter suffered injuries to her spinal cord, back and chest
when the gunmen fired at her in the parking lot. She moved her legs
for the first time last week.

Now a senior, she is taking a physics class at Columbine while a tutor
teaches the rest of her courses at home.

AP-NY-10-22-99 1947EDT
___________________________

Mom of CHS victim kills herself

By David Olinger
Denver Post Staff Writer

Oct. 22, 5:15 p.m. – Carla Hochhalter, the mother of a girl paralyzed
by the Columbine High shootings, walked into an Englewood pawn shop
Friday, asked to look at a revolver, loaded it and fatally shot
herself.

She died at Swedish Medical Center, minutes after paramedics carried
her into its emergency room.

Hochhalter, 48, killed herself at a time when her family seemed to be
battling back from a tragedy that had left her daughter Anne Marie
partially paralyzed by a bullet lodged in her back.

Anne Marie, a 17-year-old Columbine High senior, told friends a week
ago that she had managed to move her legs for the first time since
April 20. She and her parents had moved into a home renovated by
volunteers to accommodate her wheelchair. Dozens of students and
teachers at Leawood Elementary, where she once went to school, took
part in a Courage Walk last week to benefit the Hochhalters. Anne
Marie had thanked them all, adding bravely, “I think we’ll all
recover.”

Seven days later her mother walked into the Alpha Pawn Shop on South
Broadway and calmly asked to look at some handguns. A clerk showed her
three. She said she wanted to buy one, a .38 special revolver, and
asked to examine it.

While the clerk turned his attention to the paperwork associated with a
gun purchase, Carla Hochhalter surreptitiously loaded the revolver
with ammunition she had brought into the shop. She fired one bullet
into a store wall. She fired the next into her right temple.

At least half a dozen pawn shop employees and customers witnessed the
shooting.

“I’m stunned,” said Richard Castaldo, another of the students partially
paralyzed by the Columbine High gunmen. “My heart goes out to that
family. To go through what they this summer, and then this.”
Castaldo’s mother, Connie Michalik, said Carla Hochhalter suffered
terribly during the six months she watched her daughter fighting to
survive, then coping with life in a wheelchair.

“When this whole thing started, she was a different person. I saw her
slide downhill,” Michalik said. “You could see it was too much for
her. At the beginning, she was upset but a normal distraught person,
like we all were. But you’d look in her eyes and see she was … lost.
It didn’t seem like she was there any more. She was sweet and loving
and kind, but it was too much for her.”

Jefferson County Sheriff John Stone, whose department investigated the
Columbine High massacre, has watched deputies call it quits in the last
six months as the enduring stresses of this tragedy took their toll.
He expressed sympathy for the Hochhalters, saying, “I’d ask people to
pray for the family to help them get through this difficult part.”

Copyright 1999 The Denver Post.
____________________________

Columbine victim’s mother kills self in pawn shop

By Karen Abbott
Denver Rocky Mountain News Staff Writer

Carla Hochhalter, whose 17-year-old daughter was gravely wounded in the
Columbine High School shootings six months ago, took her own life
Friday.

Englewood police said Mrs. Hochhalter, 48, shot herself once in the
head at about 10 a.m. inside a South Broadway pawn shop where she had
just told a clerk she wanted to buy a gun.

“She was such a loving mother,” Connie Michalik, mother of wounded
Columbine student Rich Castaldo, said Friday.

The Hochhalter family, whose daughter, Anne Marie, suffered spinal cord
injuries and has been attending Columbine in a wheelchair this fall,
declined to comment.

Michalik said she and Mrs. Hochhalter spent many hours together at the
hospital in the weeks after their children were shot. Teenage gunmen
Eric Harris and Dylan Klebold opened fire at the school, killing 12
students and a teacher and injuring more than 20 other people before
killing themselves.

“She was very sweet and loving and kind,” Michalik said. “This whole
thing just devastated her. This just destroyed her. It destroyed her.

“In my mind, I almost feel like Eric and Dylan killed her too.”

Police spokeswoman Letitia Castillo said the clerk at Alpha Pawn, 4155
S. Broadway in Englewood, handed Mrs. Hochhalter a .38 caliber handgun
at her request. While the clerk was doing the required background
check for the purchase, Castillo said, Mrs. Hochhalter apparently
loaded the gun with bullets she had brought with her.

Castillo said Mrs. Hochhalter fired one bullet into a wall of the store
before turning the gun on herself. No one else was injured.

Arapahoe County Coroner Dr. Michael Dobersen confirmed after an autopsy
Friday that Mrs. Hochhalter died of a gunshot wound to the head. The
death was classified as a suicide, he said.

Mrs. Hochhalter was pronounced dead at about 10:50 a.m. at Swedish
Medical Center, where Anne Marie underwent radical surgery and stayed
for weeks after she was shot twice as she ate lunch outside Columbine.

A Swedish spokeswoman said the hospital staff would not comment Friday.

Michalik said she had been concerned about Mrs. Hochhalter but never
imagined the depth of her depression.

“She was devastated, just like the rest of us,” Michalik said. “When it
first happened, she was just like any other parent.

October 22, 1999

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Klonopin, Paxil and Depakote prescribed for Stress and Anxiety

“…there seemed to be some kind of psychological wall in my mind, and I couldn’t get any words past it.”

 

After 2-1/2 years of severe long-term overwork, I passed out at work one day in late Fall 1993. My doctor ran tests on me and determined that I was not ill in any way, I was simply suffering from stress and overwork. I began seeing an MFCC, who in March advised that my doctor prescribe Klonopin for anxiety. I was started out at 1.5 mg per day. Despite specifically asking about side effects etc, my doctor failed to inform me either that it was addictive, or that it would interfere with my memory and attention span. I would never have gone on it if I had known. Those effects, of course, impaired my ability to do my job and made things worse instead of better.

Over the next four months, as my condition deteriorated, the dosage was increased, I deteriorated faster, and so on until I suffered a total breakdown in mid-July, by which time I was on 3.5 mg per day. At or about this time, my therapist suggested I should go on Paxil. I declined, insisting I wasn’t depressed, I was exhausted and over stressed. A week or two later she tried a different tack, and persuaded me to try it by telling me it would give me more energy. I was so utterly drained and exhausted that I was willing to try anything. The initial dosage was 20mg per day. The Klonopin dosage was maintained.

I felt even more lethargic on Paxil, and stopped taking it after a week. My therapist told me that I hadn’t given it time to start working, and persuaded me to go back on. I began to experience personality changes, and became withdrawn and verbally aggressive. At the beginning of September, I suffered my first severe dissociative episode. I took a 10-mile late-night stroll across the Santa Clara Valley, barefoot, wearing only cotton slacks and a T-shirt. After apparently walking several miles up the middle of US 101, I eventually wandered into a hotel lobby in Milpitas, where I collapsed from exposure. The hotel called paramedics, who took me to hospital, where I was sedated, treated for hypothermia, and discharged.

My therapist, in response to this, doubled my dosage to 40mg. On the higher dosage I began to display severe personality changes, and began to suffer acute paranoia, uncontrollable mood swings, severe agitation and akathisia, intermittent hysteria, asthenia, continuous tremors, and frequent agonizing “ice-pick” headaches (my former wife’s term). I began to spend more and more of my time in dissociated, depersonalized states, and had great difficulty sleeping. When I finally did get to sleep, it took me hours to muster the strength to get out of bed when I woke up. I moved into a separate room from my wife. After some rather alarming behavior on my part, we agreed to remove all of our firearms from the house and leave them with a friend for safe keeping, and we also agreed that I would not know which friend. (I was still rational some of the time.)

My mood swings continued to become more rapid, more erratic, more powerful, and more uncontrollable. I was aware at some level inside that I was on a roller-coaster ride through Hell that I didn’t have any desire to be on, but I didn’t seem able to communicate that fact or do anything to try to escape it. I also didn’t yet know that it was the drugs doing it. In mid-October I suffered a catatonic episode that lasted about eight hours; I was unable to speak for about three or four days afterward. I am sure the physiological equipment worked, but there seemed to be some kind of psychological wall in my mind, and I couldn’t get any words past it. I had to communicate by hand signs and written notes.

My therapist’s response was to conclude that I had spontaneously developed bipolar disorder. She called in a psychiatrist from Walnut Creek, who – on the basis of a 20-minute interview with me and 20 minutes with my wife – decided that she was right, and prescribed Depakote IN ADDITION to all the other medications. I don’t remember the dosage. I spent the next three weeks in a kind of haze; I can remember almost nothing about it. The mood swings didn’t stop, but now I was kind of disconnected from them. Disconnected from pretty much everything, as a matter of fact. I think if anything, things were still getting worse, only now I didn’t seem to care, because it wasn’t happening to me, it was happening to some nebulous other person who lived in my body.

On November 11, some time in the early hours of the morning, I took a massive overdose of everything I had on hand at the time, which was around 30 tablets of Depakote, 60 of Paxil, and close to 100 Klonopin. I also made several cuts in my left arm with a Samurai sword. Alerted by our cats, my wife found me and took me to O’Connor Hospital, where I was detoxed and confined for California’s mandatory 72-hour hold after any apparent suicide attempt. I was then transferred to the inpatient therapeutic community at Good Samaritan Hospital. I was given no medications at all for the first week or so, except for a sleeping pill (Dolman, I think) after I was unable to sleep for the first 3 consecutive nights and was experiencing severe symptoms of sleep deprivation. After about a week, the consulting psychiatrist in charge of my treatment recommended I resume a low dosage of Klonopin. I did so, but at this time I was beginning to finally find out some substantive information about the drugs I had been on, and at Thanksgiving I discontinued the Klonopin altogether. I was transferred to the outpatient program around the beginning of December, and discharged altogether on December 15. My behavior was still frequently irrational, and apparently emotionally abusive, though I was mostly unaware that I was acting irrationally. My wife and I sought marital counseling in January, in April, we separated, and my wife asked me to move out. I remained living in a separate room until I was able to move out of the house in July.

In the intervening 19 months, I have avoided any medications at all, except for the past few months. About two months ago I came down with a bad cold, in treatment for which I used a cough syrup and a nasal decongestant (generic Sudafed). I experienced an overdose-like reaction to the Sudafed, and immediately stopped using both the Sudafed and the cough syrup. I still experience occasional tremors, occasional brief anxiety attacks, brief attacks of akathisia, and difficulty sleeping. My circadian clock appears to be completely out of whack. My memory is very unreliable, though slowly improving. It seems that most of the actual information is still there, but many of the pointers are hopelessly scrambled, making me unable to get at the memories. I have a lot of trouble with what I call “dyslexic fingers” – my typing has slowed down considerably, because I make large numbers of errors in which my fingers type all the right letters, but in the wrong order, and occasionally I look at the screen to find I’ve typed complete gibberish and have no idea how I managed to do it. (I catch and correct almost all of my errors, but I never used to make those kinds of errors at all.) My co-ordination does not seem to be affected otherwise. I also still suffer from occasional (though thankfully, less frequent) flashbacks, which can still reduce me more or less instantly to complete hysteria. I am being treated (by a DIFFERENT therapist) for post traumatic stress disorder, though we seem to have made comparatively little, if any, progress lately. I have an agreement with both my new doctor and my new therapist that any kind of medication is out of the question.

Well, that’s the history, to date. (And I’m feeling proud of myself, because for once I managed to tell the whole story without getting hysterical.)

Years 2000 and Prior

This is Survivor Story number 83.
Total number of stories in current database is 96

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