In my last blog I explained how and why neurochemical imbalances happen, so read that first if you haven’t yet.
Over the next several blogs I will discuss each neurochemical separately, and the typical symptoms that occur when each becomes imbalanced. I will also discuss the medications available that are designed to balance each one.
The first I will discuss is Serotonin imbalance. This is the most basic one and the one that gets the most attention since it is the most heard and read about by patients and doctors. The first “modern” psychotropic medications that came out in the 1980s focused only on this neurochemical. These are the most prescribed and considered the “first-line” medications for most patients. Unfortunately, I think there is too much attention given to serotonin, and not enough on the other chemicals that can become imbalanced, but we’ll get to that later.
The symptoms associated with serotonin imbalance are worry/rumination, obsessive thinking, hormonal-related mood changes like PMS/PMDD and perimenopausal/menopausal mood changes and other general symptoms associated with depression and anxiety. Read recent blogs for more details about these symptoms. OCD is usually associated with a significant imbalance of serotonin.
The SSRI’s (selective serotonin reuptake inhibitors) act by attaching to the serotonin receptor site of the cell membrane and inhibit the abnormal reuptake of serotonin. Therefore serotonin is only allowed to move in the correct forward direction and does not allow it to move backward. The name brands of the SSRI’s are Prozac, Zoloft, Paxil, Celexa, Luvox, Lexapro and Viibryd. They are effective in many, but the effectiveness may wane over time and not be as effective (what I refer to as the “serotonin poop-out syndrome”). It also can cause flattening of the personality with decreased emotion, sexual side effects such as decreased interest and/or delayed orgasm, fatigue, agitation, weight gain or can potentially cause worsening of mood if it is not the right fit. This would be the case if serotonin is not imbalanced to begin with.
SSRI’s can be good for certain patients, such as if the person has early or mild forms of depression and anxiety, PMS/PMDD and OCD. It is not a bad first choice, however if it does not work very well, gives incomplete results or has side effects, I would try switching to a potentially better medication class, or add an augmenting agent. I will discuss norepinephrine next time, and discuss the overall best class of medications available. For more details about this subject, please refer to my book. Bye for now.