Hi,

Well, I thought I would be one of the last people to extol the virtues of an SSRI; instead here I am wondering why I didn't start one sooner. We now know that in PD we lose other neurotransmitters and they are usually hit before we notice any motor deficit. Researchers are starting to report that we lose Serotonin cells very early on before dopamine is hit, which makes sense as clinically many of us experience mood changes before any thing else, or along with autonomic dysfunctions. Here is what has improved vastly (taking 20 mg a day for 6 weeks)

I am now sleeping normally 6- 8 hours a night. I was sleeping 2-4 hours a night tops for far too long.

I have far less anxiety and less ldopa hypomanic behavior. Panic attacks near gone.

I am just sharing this because I think in that Serotonin regulates our Circadian Rhythm it is worth trying just to restore normal sleep patterns. My PD has improved I am sure because I am getting proper rest again. I now wake up ready to get up and go; am less bogged down by dystonicc foot or jelly legs. The best part is its price! Celexa is $5.50 a month.

**Please note that I think SSRi's area contraindicated when using MAO inhibitors.

These are the clinical benefits or patient perks; does anyone else have a good, bad, or ugly experience with SSRIs?

Next are the surprising things that scientists are discovering on a cellular level...

Here are some really surprising finds from current research that leave me wondering again why so much effort is spent only on dopamine?

Serotonin can turn ldopa into dopamine . Some scientists think that this is basis for dyskinesia though still being hotly debated.

Serotonin actually mediates the pathologic misfolding of alpha-Synuclein! Gak.
It is now widely believed that amyloid fibrils (gunk that results from loss of dopamine aka Lewy Bodies) that are last stage of rogue protein behavior are benign. The toxic stage is intermediate level and this is where Serotonin somehow stops the misfolding and stabilizes the a-Synuclein.

Is this how we are losing other neurotransmitters? Are they jumping in to help or trying to compensate for dopa sensitivity? Anyway, as always more questions and no answers. Seems like a lot more research in this area might reveal how other neurotransmitters besides dopamine are not lost in large proportions too?

Further, even though we reportedly lose Serotonin first; why is it I had slightly elevated levels of its metabolite upon testing two years ago. In fact, research reveals that Serotonin is actually increased in the S. Nigra- maybe it is a compensatory measure?

The neurotransmitter serotonin interrupts α-synuclein amyloid maturation



Paroxetine prevents loss of nigrostriatal dopaminergic neurons by inhibiting brain inflammation and oxidative stress in an experimental model of Parkinson's disease.


Okay then, will they please explain why many people report Parkinsonism as an SSRI side effect or why in others it is harbinger to full-blown PD? Hardly seems like all this is mere coincidence?

Looks like there may be some benefit in learning more about the relationship between serotonin and dopamine. At any rate, dopamine and a-Synuclein form merely the tip pf the iceberg.

Keep in mind that SSRI drugs do NOT increase serotonin in the brain. They increase the time the serotonin you have stays in the synapse (it is not taken up back into the cell).

In fact over time the cells sense this and stop making more serotonin.

Another way to get more serotonin is to provide L-tryptophan.
This supplement can be as effective as the drugs in fact.

There can be a troubling movement disorder side effect with SSRIs over time. Typically these show up after 6months or so.
This involves dopamine which for some reason goes down in long term SSRI users. The first symptoms involve the face, mouth and neck, and resemble tardive ones. Some people get Restless Leg syndrome too. Why the brain reduces dopamine in response to SSRIs is not well understood, but serotonin may be necessary for the dopamine pump.

So the honeymoon you have now may end, later on. Watch out for it. Sometimes it is only jaw clenching, but it may be worse, involve the tic-like movements.

This is an old paper:
http://www.ncbi.nlm.nih.gov/pubmed/9640489

Thank you again! You have such a wealth of knowledge and you are so generous in sharing it with us.

I hadn't even thought of the weird tic thing, but I didn't plan to be on the SSRI long term though I am curious about the so-called neuroprotective potential though I am beginning to think that conclusion is drawn entirely too much.

I was going to ask about substituting St. John''s Wort for the Celexa, but will that also have the same effect on producing my own cells? That is pretty much true for levadopa and dopamine, isn't it?

Also, if I were going to try St. John's Wort or L-Tryptophan to help regulate sleep, what dosage to start?

Thanks again!

Laura

Is this to regulate sleep only? And not depression?

Are you taking methylcobalamin? This form of B12 is the cofactor in the brain that is used to make melatonin from serotonin.

So having a good blood level of this, may help with sleep.
That is when I started methylB12 myself. My blood levels were in the upper end of the range- at 849, but during menopause I had real sleeping problems. The methylB12 at night helped with this.

Celexa is considered a weaker SSRI....many people who get side effects from the others, can tolerate it. Some even take 5mg which is a low dose.

I use 500mg of L-tryptophan at night with good results. I have some chronic pain issues, and it seems to help. I tried amitriptyline and it didn't work, and in addition raised my blood sugars. I use Doctor's Best brand. I had some by NOW that was not as active, as the Doctor's Best. I am taking 4 of my PN supplements from Doctor's Best now. This brand also beat out Swanson's for my L-theanine.

Doctor's Best is now available on Amazon, at a good discount and with the free shipping for $25.

It is not advisable to take any L-tryptophan with an SSRI...this may cause serotonin syndrome. So you have to be off the Celexa for at least 2 weeks or more.

I use the over the counter supplement Liposomal 5-HTP spray (5-hydroxy tryptophan produced by Neuroscience).

This is a precursor to serotonin. I keep it by my bedside for those nights when I wake up at 4 a.m. and can't go back to sleep. It works to aid sleep and lessen anxiety. One spray under the tongue delivers 25 mg and puts me under within minutes. My husband loves it too. I would only take this at night, since it does make one groggy.

Last night I felt more stiffness than usual and my sleep was hampered. After the spray, I did feel my muscles relax, but I am going to keep experimenting to see if that is really true or if was more of the cascade that less anxiety = less stiffness.

Some people really like 5-htp...

For me I found it irritating rather than settling.

The theanine is what I use for anxiety. It was recommended by
Dr. Blaylock MD (neurologist) in his newsletter for nerve damage.
A member of our PN forum brought this information to our readers' attention. You have to subscribe to get his newsletter, as it is not available online free.

I was waking up at 1am or so, with pain, and low blood sugars.
Nightmares also. Since the theanine 300mg at night, I am much better. Adding the L-tryptophan was even better.
I used to work midnights when I was younger, and I think I ruined by circadian clock! I sleep well, on a cycle, of about 2 weeks, and sometimes wake up and sometimes not.
At least the theanine works for the anxiety issue nicely.
It is not habit forming and not sedating, so you can take it in the daytime too.
This is an article on theanine:
http://web-us.com/l-theanine_anxiety_reducer.htm

My son was using this last summer so I decided to try it.
It is also helping with my dawn phenomenon elevated blood sugars... a benefit I didn't expect.

I initially started it for anxiety and panic attacks; it has helped quite a bit. I am taking 20 mg at 12 hrs apart. I find that 20 mg all at once is too much. Also, doing Cognitive Behavioral Therapy to try and rewire or break that fear loop. The frustrating thing is I think the panic is from too much extracellular levodopa that is setting off my amygdala. This is just a hunch, but it does see the more levodopa my brain thinks it needs the worse my panic attacks.

Anyway, so I found that the SSRI helped with insomnia secondarily. I really need both the anti-anxiety and sleep benefit; at the same time I do not want to be dependent on another brain altering drug. It seems like L-Tryptophan should help along with exercise and re-establishing a normal sleep time/routine.

Thanks again for helping!! I normally just use Swanson as default but will try your suggestion.

Laura

My GP put me on Zoloft (50–75 mg) for depression on April 2010. It did help remarkably; however, after a year of taking it I started to feel some problems in walking, worse slowness and tremors in my low chin – syndromes very similar as mrsD described. My instinct tells me this may have something to do with Zoloft and started to taper off on June 2011. But this did not help the symptoms and the withdrawal was also tremendous. I was diagnosed PD on August 2011 by one neurologist and two movement disorder specialists. I am now on Azilect (1 mg) and small dose of Mirapex.

As SSRI use appears to be associated with the development of movement disorders, either a direct result of the drug or exacerbation of an underlying condition, my depression issues remain unaddressed. Plus I am on Azilect (MAO-b). When I saw my specialist last time, he mentioned to me to start Zoloft again at 5 mg along with Azilect. What is the right way to address the depression? I feel this may help other symptoms if do it correctly… Thanks!

WXXU,
When I was diagnosed with PD eleven years ago my neurologist started me immediately on carbidopa/levodopa. The result was that, not only my stiffness and slowness were relieved, but the depression that I had struggled with for the previous 10-15 years was lifted like it had not been by the previous years of talk therapy or the numerous antidepressants I had been prescribed.
At least in my case, I am convinced that the levodopa was key to my depression relief. I have not used either Azilect or dopamine agonists, so I do not know if they might have had the same antidepressant effect. I do, however, continue to take Welbutrin and Cymbalta.