Posted by janejane on January 5, 2010, at 5:09:54
In reply to Re: Is the treatment the same?, posted by Laney on January 5, 2010, at 1:04:17
My sense is that if you want to treat apathy and anhedonia, you probably want to target dopamine. (There is this idea that too much serotonin can lower dopamine which is why apathy would develop after long-term SSRI use.) If the problem is motivation, you want to increase norepinephrine. (Norepinephrine is converted from dopamine so increasing dopamine might also increase norepinephrine.) I'm not sure the solution is always as straightforward as that, but that's the idea I've read about. You can try a quiz like the one below to see which neurotransmitters you might be low in:
http://www.pintochiropractic.com/php/sec1a.php
Like I said before, I think your first step should be trying to reduce the paxil to see whether that helps. It might be all you need. (I know you reduced before when you tried to get off it, but maybe you need to stay at the lowest amount you need to keep the depression at bay instead of going back up to 10 mg.) If you want to confirm that the apathy is from the SSRI before you do that, you could do as the article suggests and try increasing the paxil to see if the apathy gets worse.
If the symptoms don't go away after reducing, you might try adding wellbutrin or switching to an SNRI.
I know exactly what you're going through because apathy was part of the reason I quit SSRIs last year.
poster:janejane
thread:932193
URL: http://www.dr-bob.org/babble/20100103/msgs/932547.html