Q:  Noradrenaline & Rapid Cycling : Serotonin Reuptake Inhibitors

Dear Dr. Phelps:

This is a long due thank you for all the help I have got from your psycheducation site and, now that I can, to ask you about some things that I have noticed and have not found in it.

First, I have read elsewhere that after a long, years long, treatment with antidepressants and after a mood stabilizer is established, the usual residual depression goes away after the takeaway of the antidepressants. And my experience says  so.

Then, I have found that noradrenaline increase causes rapid cycling, actually an acceleration. It has happened to me with imipramine and, to a lesser extent, venlafaxine, but I have found no reference to it, anywhere.

Third, I suspect that increase in serotonine does have an effect that I have found, again, never noticed, actually I have found no name for it, which is that it decreases sensations: hunger, sleepiness, even boredom (it does only increase thirst ;-). May that be so?

Thank you again,


Dear G. --

Taking your thoughts in turn: 
1. Glad to hear that your experience is consistent with my working clinical impression that things can go better when antidepressant is removed.

2. Suspecting venlafaxine (Effexor) as capable of inducing rapid cycling is indeed consistent with a recent study comparing venlafaxine with two other antidepressants. Venlafaxine seemed to be associated with a much higher rate of switching into mania than the other two. One of the comparison medications was sertraline (Zoloft), an SRI. Interestingly, the other one was bupropion (Wellbutrin), which has long been suspected as less likely to induce instability -- even though it affects noradrenaline (norepinephrine). I don't think we quite know enough to know precisely which neurotransmitters do exactly what.

3. Serotonin reuptake inhibitors have been recognized to decrease appetite, perhaps particularly Prozac, sometimes others, but quite often they increase appetite after awhile and can be associated with weight gain. They can all induce insomnia, but sometimes they make people sleepy, so that reaction is also hard to predict. As for decreasing boredom, that is trickier, as boredom is a complex phenomenon and probably means quite different things to different people. Interesting to hear that you thought an SRI might decrease it.

Thank you for your questions --

Dr. Phelps