Posted by ed_uk on November 13, 2004, at 17:57:29
Hello everyone...
I've taken various SSRIs on and off for the last 6 years. At high doses, they effectively reduce my anxiety and OCD. Low doses have always been ineffective. At the moment, I also take lofepramine (a norepinephrine reuptake inhibitor) for depression.
On SSRIs, I find that I'm emotionless. Sometimes, I don't care about anything. Life passes me by and I hardly notice. I see a tradgedy on TV but I am not moved. I never cry. I have little motivation.
The last time I stopped the SSRI I developed OCD and became suicidal. I don't want to stop it again.
Basically, I want to restore my drive and motivation. Here is a study I found....
J Clin Psychiatry. 2002 May;63(5):391-5. Related Articles, Links
Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM.
Mood Disorders Center, Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA. laurenm@bcm.tmc.edu
BACKGROUND: We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression. METHOD: Participants were 21 men and women who met DSM-IV criteria for major depressive disorder in full remission (Montgomery-Asberg Depression Rating Scale [MADRS] score < or = 12) who had been taking an SSRI for at least 3 months. Data are presented (last observation carried forward) based on 20 enrolled participants who completed at least 1 follow-up visit. Participants had significant symptoms of apathy, defined as a Clinical Global Impressions-Severity of Illness scale (CGI-S) score > or = 3, an Apathy Evaluation Scale (AES) score > 30, and a MADRS item 8 (inability to feel) score > or = 2. Participants with a personal or family history of psychosis were excluded. Olanzapine was titrated in 2.5-mg increments at weekly intervals, until CGI-S score improved > or = 2 points from baseline or > or = 1 point with dose-limiting side effects, and participants continued in the protocol for 8 weeks at a stable dose following this improvement. RESULTS: Improvement was clinically evident and demonstrable on all symptom assessments: AES (mean +/- SD change in score = -21.3 +/- 8.7; p < .0001), CGI-S (-2.7 +/- 0.9; p < .0001), MADRS (-5.6 +/- 5.9; p = .001), and MADRS item 8 (-2.2 +/- 1.4; p < .0001). The mean dose of olanzapine was 5.4 +/- 2.8 mg/day. CONCLUSION: These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.
Olanzapine might be effective because it is a 5-HT2a antagonist. I do not want to take an AP because of previous experiences with APs. I've been thinking about nortriptyline because it's a NRI and a 5-HT2a antagonist. I would take it instead of lofepramine.I'm worried that nort could make my drowsy. I already need a lot of sleep and suffer from fatigue. Perhaps I'd need to take a stimulant as well. I've been thinking about Dexedrine or Provigil- my pdoc wouldn't prescribe either of them though. I live in England.
Does anyone have any advice or suggestions?
Ed.
poster:ed_uk
thread:415565
URL: http://www.dr-bob.org/babble/20041113/msgs/415565.html