Posted by bleauberry on January 2, 2009, at 17:48:01
In reply to re: suicidal - follow-up/ advice on deprenyl, posted by g_g_g_unit on January 2, 2009, at 0:57:03
> for you, does anhedonia break down to a loss of interest in those minute, day-to-day tasks like conversation? or is it more an overall lack of wellbeing? my GP has dismissed it as depression, which i don't really buy, since low mood for me has usually been more tumultuous and never really affected stuff like conversational fluidity. i am just trying to think of how to 'frame' the problem to my pdoc when i saw him in a week, since i think he has left medication suggestions up to me at that point. my hope is that nardil might hit all three (OCD, GAD, anhedonia(?)/depression) bases. have you ever found any useful augmenting agents for SSRI's that were specifically pro-social/anti-anhedonic? memantine sounds interesting since it's also been studied for OCD
Good questions. For me personally, anhedonia does indeed break down to loss of interest in minute day-to-day things...cooking, eating, showering, TV, music, reading, driving, walking, sunsets, flowers, everything. In addition, I find listening to conversations totally boring, and while everyone else is laughing at a joke, I have to fake a smile.
But I'm not really sad. I'm not in despair or crying. It is a weird kind of depression. I think it fits more closely the description of the negative symptoms of schizophrenia, or maybe a pre-parkinson's syndrome, or some other thing different than generic depression. Doctors talk about depression like it is one all-encompassing thing. But if you break the symptoms down in clusters, as they do on diagnostic ratings, there are different flavors of depression that are disctinct from each other.
From what I've seen in others and experienced myself, trying to match the symptom cluster to a particular neurotransmitter is often futile. I've seen people with anhedonia restore full vibrancy on something like zoloft or lexapro or prozac or paxil, where you would think those meds would make it worse. For them, it worked. Others, it is Wellbutrin or Ritalin or Modafinil. Others, it is Risperdal, Zyprexa, or Abilify added to an SSRI. Or a stimulant added to an SSRI.
The best I ever felt was on 20mg Prozac (zero depression, but flat flat flat) plus 5mg zyprexa (improved interest and sleep) plus 300mg Adrafinil (anhedonia completely gone). This lasted 8 years before it starting pooping out on me.
Anhedonia is, in my opinion, a syndrome all by itself that may or may not be related to depression, varying from person to person. It can stand alone all by itself without depression.
In recent months I have found that only one med to make a dent in my anhedonia. That is Milnacipran. The urinary and lack-of-appetite side effects were impossible though. But after just two weeks at a small subtherapeutic dose, I was actually enjoying some things for the first time in a long time. It is heavy on Norepinephrine, light on serotonin, zero on dopamine. So for me, it looks like something in the norepinephrine circuitry is the target.
No wonder. My cortisol is very low. Also no wonder, after 2 weeks at a very low dose of hydrocortisone, I experienced a miracle day of complete remission. That will be revisited soon.
Andhedonia is also a symptom that pops up at the top of the list of most people who suffer from one of these: Lead and/or mercury accumulation, even in normal tiny amounts (some people are genetically susceptible); Lyme disease (even if they don't think they have it they very well could); and Candida. With lab confirmation, I do indeed have lead/mercury issues, I have suspected Lyme which an expert will look at it in a couple weeks, and I believe I have Candida based on my gut instincts and telltale signs. So no wonder I have anhedonia! Through it all, it seems the biochemistry most effected, in my case, is norepinephrine. But Wellbutrin, Adrafinil, Modafinil, Nortriptyline, all make me much much worse. Go figure. Only Milnacipran by itself showed promise. Just goes to show how different all these drugs are, even though they work in the same biochemistry arenas.
For you, the most useful augmenting agents I can think of to add to an SSRI would either Modafinil or Ritalin, with Modafinil being the first choice. Don't rule out Zyprexa, Risperdal, or Abilify, in combination with SSRI. The choice of SSRI is critical too. That is a gut instinct thing that only you can make the call.
I believe anhedonia is one of those things that takes a combination of 3 meds to treat it. One or two probably won't do it, except for a few lucky ones.
Nardil is certainly worth a shot. No doubt. The MAOIs stand alone in their uniqueness.
poster:bleauberry
thread:871436
URL: http://www.dr-bob.org/babble/20081223/msgs/871973.html