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Re: fighting anhedonia by increasing reward pathway JohnL

Posted by not exactly on January 26, 2003, at 4:39:45

In reply to Re: fighting anhedonia by increasing reward pathway, posted by JohnL on January 25, 2003, at 5:27:22

> My depression is characterized primarily by anhedonia.

Mine too. Your experiences & conclusions sound familiar & relevant.

> 20mg Prozac, 5mg Zyprexa, 300mg Adrafinil, and 150mg of the herb Rhodiola Rosea

Wow - I've heard of lots of magic cocktails, but that's a really interesting and unique mix! You say none of the components are adequate by themselves, which I can believe. But have you tried systematically eliminating single drugs from the combo to verify that you actually need all 4?

Prozac? I've tried it; couldn't stand it. Hostility the very first day, and it went downhill from there. Orgasms were impossible.

Zyprexa? I tried 2.5 mg once. When I woke up 24 hours later I can't say I felt any better.

Adrafinil? Never tried it, but I'm on modafinil (Provigil) now, and I understand they're _very_ similar (correct me if I'm wrong about this). It definitely helps with my motivation & focus, and somewhat with my mood & anhedonia. Unfortunately makes the background anxiety a bit worse. And there still seems to be something missing, but I can't remember what it is (my memory, perhaps?).

Rhodiola Rosea? Never even heard of it. I'll have to look this one up. I'd be interested in hearing about your experience with it.

It has certainly been my experience that most antidepressants and psychotheraputic drugs are useless (or worse) for me. Anything that boosts Serotonin (SSRI's, Effexor, even 5-HTP or St. John's Wort) kills my orgasms. Remeron and TCA's (tho I haven't tried desipramine) made me feel poisoned.

> It wasn't until I started getting into drugs that affect dopamine that I saw improvement.

Pramipexole was my first miracle cure. Fabulous! Unfortunately, it was for a drug study. After the trial, it was no longer available, and I returned to hell. I tried it again years later after it finally won FDA approval and was released as Mirapex, but didn't work nearly as well for some reason, and pooped out completely in a few months. Bummer.

Wellbutrin helped, but the anhedonia thing was only slightly improved, and my emotions were dulled. Adding a bit of Ritalin fixed most of the problems. This was a good combo that I would consider returning to if I continue to find nothing better.

Selegiline (l-deprenyl) was great in patch form (another drug study; FDA has since rejected) and worked almost as well in high oral dosage (but required MAOI diet). Cheese-safe levels of selegiline were of no benefit unless combined with phenylalanine and/or chocolate. Overall, disappointing.

> I've tried all the stimulants. They worked, in a way.

Ritalin by itself is helpful but not the answer. Dexedrine would probably be much better - it's been wonderful for acute effects, but I worry about taking it chronically - besides, who would prescribe it?

Amisulpride is high on my drugs-to-try list. Would have tried it already it if could be prescribed in the US. Have you tried it? Any thoughts on the best way to obtain it?

Also to be tried: Strattera, desipramine, Parnate.

So many drugs, so little time... [sigh]

- Bob




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