I am often asked whether I believe antidepressants can be of any help to a floxed person. Keeping in mind that I am not a doctor, I answer that I believe that SSRI’s can be beneficial to ‘some’ after floxing, but like many medications, they can be a double edged sword, helping some and hindering others. I have had contact with floxed folks who are adamantly against their use and for good reason, and I have heard from others who have told me they could not have survived without them. Having said that, my intent is not to convince you to take or not take any medication. My intent is that whatever your choice, it is important for you to be informed and very cautious. To help achieve this, the best thing I can do is supply information on antidepressants that other floxed folks have shared with me and toss in a little of my own experience. Again, this information is not intended as medical advice just shared information. Please read my disclaimer and consult your physician for any medical advice or care.
First, it has clearly been documented that FQ’s have the ability to alter brain chemistry (1) (2). It appears they do so by a variety of factors that include damaging or interrupting certain receptors or setting the stage for imbalances of neurotransmitters. It would appear that the GABA receptors and the acetylcholine receptors have had the most involvement followed by serotonin and adenosine (3). Either way, it appears that many floxed folks become very sensitive to changes in brain chemistry post floxing .
It certainly appears that when many floxies try these drugs (SSRI’s, SNRI’s and any other drug that alters brain chemicals) they need to start in at lower doses than the ‘average’ person. This can be hard to get across to some doctors because they want to start at, and/or build up to, normal therapeutic doses relatively quickly. For example a non-floxed person may tolerate 30mg’s of Lexapro very well and yet a floxed person will get very ill from side effects at that level and should only be taking 5mg to 10mg. Many floxed folks have shared with me that they got full benefits from a lower dose than a non-floxed person received at recommended therapeutic doses.
Second, I believe the FQ’s impact the metabolic pathways in the liver of some floxies and these same pathways are also responsible for processing many other drugs. So, many drugs that use the same pathways as the FQs did for clearance can, after floxing, have problems with drug serum levels (usually building too high). A lot of the antidepressants use the same enzymatic pathways, again another reason why dosages should be given in smaller amounts under the watchful eye of a physician. This doesn’t include those who have genetic predispositions for clearance issues. Liver pathways are highly polymorphic, which means that even without throwing the FQ’s in the mix, drug clearance varies greatly from person to person. So just because you have a normal liver function tests does not mean that you will not have issues clearing or metabolizing a drug from the body.
I have compiled through my own experience and the information from others the following information on antidepressants:
Please note that ALL antidepressants below can have insomnia as a side effect, especially while adjusting, so if you are prone to insomnia, they can aggravate your existing insomnia for short time. For most, the side effect of insomnia wears off but for some it can be too aggravating to continue.
- citalopram (Celexa): Some floxies I have talked to found this one helpful. It was reported as lightly sedating, will control anxiety and night time restlessness. Effective against depression. Possibly can help with some nerve pain. Withdrawal can be moderately unpleasant. (5mg to 10mg doses)
- escitalopram (Lexapro): Some floxies I have talked to found this one helpful. It was reported as lightly sedating, will control anxiety and nighttime restlessness. Effective against depression. Withdrawal can be moderately unpleasant. (5mg to 10mg doses)
- fluoxetine (Prozac): Not recommended by the floxies I have talked to because it is too excitatory in nature and can severely aggravate insomnia and anxiety. Withdrawal is easy.
- fluvoxamine (Luvox): No information from floxies.
- paroxetine (Paxil): Some floxies have had limited success with Paxil reporting it as generally sedating, and will control anxiety and night time restlessness. Effective against depression. Withdrawal can be very unpleasant. (5mg to 10mg doses)
- sertraline (Zoloft): Info from floxies report Zoloft as too aggravating to insomnia and nerve pain in floxies.Withdrawal can be moderately unpleasant.
- zimelidine (Zelmid, Normud): No information from floxies.
- venlafaxine (Effexor) – No positive reports from floxies on this antidepressant. Most floxies report it as having the most severe withdrawals, also known as discontinuation syndrome, plus a litany of side effects while taking the medication. Some withdrawals have taken six months or longer.
- vesvenlafaxine (Pristiq) – Same reports as Effexor.
- duloxetine (Cymbalta)- Some floxies have reported limited success with Cymbalta saying it can help with nerve pain, and anxiety control. Conversely some report it has caused come joint pain and some withdrawals issues. Can be hard on liver so use should be closely monitored. Withdrawal can severe for some.
- mirtazapine (Remeron): Some floxies have report that this was very good against their depression. Some help with anxiety in some patients, while others reported an increase in anxiety. They used smaller doses 7.5 mg to 15mg. Withdrawal fairly easy.
- bupropion (Wellbutrin): Floxies have reported this as too aggravating to insomnia. I have no reports on anyone who successfully continued with this medication for a long time.
Low and Slow
‘Low and Slow’, is a motto I live by since being floxed. If you are concerned, tell you doctor that you believe (or if you know for sure) that you are a poor metabolizer of drugs. Most physicians will allow you to start slowly with a smaller amount so that you can monitor yourself for any troublesome side effects, should they occur.
This information is obviously my own opinion and is based on data that I have compiled by after talking to those damaged by flouroquinolones and have tried antidepressants for help. Obviously everyone’s physiology is different and drugs affect each person differently, so these choices may or may not apply to you. Please talk to your doctor about medication choices.