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Low-dose SSRI to reduce neuronal apoptosis in the stress pathways and amygdala

Discussion in 'General Treatment' started by hinterland, Aug 14, 2017.

  1. hinterland


    I had an appointment with a consultant immunologist recently. One of the treatments suggested was a very low dose SSRI, even though he stated I'm not depressed or anxious.

    His rational is that extremely low dose SSRI, or tricyclic, agents can have value in preserving stressed neurons in the amygdala, which, he says, are dysfunctional in patients with ME/CFS. So, he is suggesting I take 1/4 of a 10mg tablet (ie, just 2.5mg) of Citalopram as a neuroprotective agent on a long term basis. Apparently, at this low dosage it can be stopped and started as I like, without the complication of withdrawal issues.

    Has anyone else tried this protocol?

    Do you think I'd notice any therapeutic effects at all at this very low dose, or it would simply be a treatment to preserve my neurons until such time as a cure is developed?

    He told me briefly that the work relates to the jak-3 pathway and ability of SSRI and tricyclics to reduce neuronal apoptosis in the stress pathways and amygdala, and added that it may explain some of the early studies where patients who continued antidepressant therapy, even though they weren't depressed, had a greater chance of improvement.

    I wasn't aware there were positive outcome studies for antidepressent treatment in CFS - I wonder what criteria were used, were they studying 'chronic fatigue'? I thought the general consensus was that antidepressants weren't useful in treating ME/CFS, with the exception of low dose tricyclics for symptom relief. However, I'm also aware of a systematic review in which SSRi's showed immune modulating, potentially anti-inflammatory, effects.

    Neuroprotective agents are substances that are capable of preserving brain function and structure. I think overall the medical literature reports loss of grey matter in CFS, and this, one assumes, is a bad thing. One thing that slightly puzzles me though, is that practicing meditation on a regular basis is said to reduce the size of the amygdala, along with reducing stress response, (while increasing grey matter density in the hippocampus and some other areas). So, what is it? Do you want a big amygdala, or a small one? I don't know, but that might be missing the point here.
    Last edited: Aug 14, 2017
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  2. notmyself

    notmyself Senior Member

    a big amygdala suggest a hyper active stress commonly seen in people with anxiety and don't want that.
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  3. Valentijn

    Valentijn Senior Member

    I'm not aware of any support for that statement. But a lot of doctors who believe ME is psychosomatic depression are happy to claim there's a non-psychiatric reason that they want us to take it. I wouldn't believe any of them unless there's extremely good evidence to back up their claims.

    There aren't, as far as I know. Even the mainstream psychosocial proponents gave up on anti-depressants decades ago, though they don't oppose the use of them.

    Probably poor quality research. It sounds like it involves brain scans, which are notoriously open to interpretation, and usually based on very small sample sizes.
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  4. notmyself

    notmyself Senior Member

    actually there are countless reasearch about meditation..and how affect the brain..most importantly it can lower chronic inflamation, i found studies showing a decrease in interleukin 6 from before and after 8 weeks meditation course..Unlike ME ,the studies on meditation and it's beneftis replicate all the time :)..
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  5. Jenny

    Jenny Senior Member

  6. Woolie

    Woolie Senior Member

    @hinterland, your doctor deserves a medal for his efforts in rebranding antidepressant treatment as "neurological".

    I suspect his thinking goes a bit like this: he doesn't know what wrong with you. He wonders if you're a bit depressed. So he thinks it might be worth trying some antidepressants. But he doesn't want to offend your sensibilities by saying this outright, so he's offering an explanation that he thinks is more palatable to you.

    Its up to you whether to try them. I would probably give them a go. But be ready to drop them if you don't see any benefits after six weeks or if anything gets worse. And make sure your doctor knows if they don't work.

    For the moment, I would let your doctor save face by not confronting him about all this. But always, always be aware that many doctors will think you have a psychological problem, but never say so to you directly. Its important not to take everything they say at face value. If your doctor continues to offer only psychological treatments and is going to a lot of effort to present them as somehow 'medical', it might be time to find a new doctor.
  7. Snow Leopard

    Snow Leopard Hibernating

    South Australia
    This sentence baffles me.
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