![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 25 to 49 of 82. Go back in thread:
Posted by linkadge on August 9, 2010, at 7:33:44
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 8, 2010, at 22:13:32
No, I havn't taken modafinil, but I recently read a study which suggests it has occupancy at the dopamine transporter (like ritalin).
I know some people use it for refractory depression, like stimulants, with sucess.
Posted by orbital on August 9, 2010, at 13:06:59
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by linkadge on August 9, 2010, at 7:33:44
Modafinil was a very good add-on medication for me a couple of year ago. This time around, though, it just caused anxiety and discomfort. It's like I've suddenly become sensitive to medication.
I'll ask my doc about methylphenidate, nothing to lose. Thanks for the suggestion.
> No, I havn't taken modafinil, but I recently read a study which suggests it has occupancy at the dopamine transporter (like ritalin).
>
> I know some people use it for refractory depression, like stimulants, with sucess.
>
>
Posted by orbital on August 9, 2010, at 13:30:19
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 9, 2010, at 13:06:59
I reread my initial post and can't help but think it sounds pretty crazy, if not disturbing. I mean all of the drastic measures my doc and I took to combat what's probably SSRI-induced anhedonia / apathy.
I've been on one AD or another for a decade. I'm quite peeved that my doc has never bothered to do a re-evaluation to determine if maybe I don't need meds anymore. Maybe my initial condition has resolved or is in remission, thanks to pharma and regular therapy, and now my med regime offers little benefit and plenty of side effects.
That's why I've decided to stop my meds. I'll be seeing my doctor soon, hopefully she'll be supportive and offer a reasonable method to accomplish this. If my symptoms come back, I'll be back on meds in a heartbeat. Right now, though, I want out of this constant fog, lack of motivation and emotional numbness - I simply cannot keep going like this.
I appreciate your suggestions. Thank you!
Posted by ed_uk2010 on August 9, 2010, at 15:17:02
In reply to Re: Fluoxetine » ed_uk2010, posted by orbital on August 8, 2010, at 22:04:41
> Ed, I'm kicking myself for not bookmarking the page I mentioned. That early study concluded that once weekly dosing was a feasible strategy, but Lilly clearly preferred marketing Prozac as a once-daily med. I'll keep on looking for it.
Lilly do market fluoxetine as a once weekly med too, it's a 90mg capsule called 'Prozac Weekly'. It's available in the US but not in most countries. The weekly version is for maintenace treatment only, and cannot be used to initiate treatment.
>I've had enough, I think I'm going to give them all a miss for a while.
Best of luck. You might find that you feel much better without meds. That would be great.
Posted by Phillipa on August 9, 2010, at 20:00:38
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by orbital on August 8, 2010, at 22:31:28
Orbital well this get interesting as the next I took after quite a few years was paxil l0mg had to add lopressor 25mg pluse the benzos to tolerate. For three months was a zoombie and then was okay. Went back to working and took for two years then idiot doc took me off for celexa which did me in. Now I'm also sensitive or just nothing with meds. Strange isn't it? Phillipa
Posted by linkadge on August 9, 2010, at 20:08:57
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 9, 2010, at 13:06:59
If something works for your depression, you could treat the anxiety separately.
I.e. if something like modafanil, wellbutrin, desipramine etc, worked for depression, you could continue to take the clonazepam for anxiety.
Linkadge
Posted by morgan miller on August 9, 2010, at 21:56:51
In reply to Re: Off Lexapro? - apathy syndrome //Help! » linkadge, posted by orbital on August 9, 2010, at 13:06:59
I didn't do well with modanafil, it was pretty bad actually. Some people absolutely love it though.
I've considered methylphenidate. I actually think I might want to try dexmethylphenidate as it may have a "cleaner" or smoother effect and feel. I will be asking for some Focalin XR in a few months if my energy levels and brain function don't start to improve drastically.
Posted by violette on August 10, 2010, at 12:31:02
In reply to Off Lexapro? - apathy syndrome //Help!, posted by orbital on August 8, 2010, at 15:49:57
Hi Orbital,
Personally, I think apathy, amotivation, and 'post-SSRI syndrome' are more related to psychological issues that need addressed. Of course, if you don't believe in the psychodynamic concepts, you wouldn't agree. At the same time, I think people can do themselves a disservice by searching for the right med to dissolve such symptoms, which could prolong illness. I think it's positive that you are reassessing your medication search.
I just found this website, wish I found it soooner as it offers a quick reference summary of psychodynamic concepts. Hope it helps. If not, maybe it will help someone else....Good luck. :)
(Apathy can also be an indication of a neurological disorder.)
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/apathy.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/annihilation.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/defensive_reactions_d.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/corrective_emotional_experience.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/isolation_.html
http://fox.klte.hu/~keresofi/psyth/a-to-z-entries/stress.html
Posted by violette on August 10, 2010, at 12:42:58
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by violette on August 10, 2010, at 12:31:02
Well, that website wasn't as inclusive as I had initially thought...
There are representations of apathy, lack of motivation in many case studies about patients in therapy which always seem to trace back to childhood experiences. It is an expression of inner state for many mental "disorders", while attributing the symptom with specific diagnoses doesn't fully explain the concept.
Posted by morgan miller on August 10, 2010, at 18:55:59
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by violette on August 10, 2010, at 12:31:02
Violette, I totally agree with your psychodynamic views. The problem is, most people to do not want to face their deep inner pain, sadness, and anger. Most people do not want to put in 2 or 3 years of hard work to get there. Most people, as soon as they feel better, decide they don't need therapy. Most people do not want to analyze and drudge up the past. And, most people have a difficult time finding a really good empathetic and compassionate therapist that they like and feel comfortable with.
I'm all for psychodynamic therapy, I think everyone, with an illness or without, should spent some time in therapy-hardly any of us got what we needed growing up.
Morgan
Posted by violette on August 10, 2010, at 19:23:31
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 18:55:59
Yes, I agree that may be true for some (I have no idea if it's most or some). And I also think some might possibly be better off leaving that stuff unadressed.
I just resent that various psychiatrists put me on med after med for years w/o even assessing my core issues-delaying and prolonging my recovery...and making me worse off in the long run.
And hope that at least someone here will take note of the possibility and not have to go through what I did. Especially those who are younger and have more opportunities. Some of the best years of my life were wasted..not totally wasted, but you know what I mean...
:)
(Hoping for > 1 person though)
Posted by morgan miller on August 10, 2010, at 19:44:14
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by violette on August 10, 2010, at 19:23:31
I feel the same way you do in regards to being diagnose with bipolar so late after it was pretty obvious I had already experienced a few mixed episodes in my life. I understand where you are coming from, it sucks, and you only have one youth.
Morgan
Posted by violette on August 10, 2010, at 19:54:36
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 19:44:14
Yes that's sucks too...Bipolar is difficult to diagnosis as certain symptoms and patterns have to appear first in order to evaluate them..and the ave. time frame to arrive at a correct dx for bipolar is something like 10 years (if I recall correctly-would have to look it up to be exact).
However, an innacurate dx is a bit different than not addressing psychological aspects of mental health...
Posted by morgan miller on August 10, 2010, at 20:06:50
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by violette on August 10, 2010, at 19:54:36
> Yes that's sucks too...Bipolar is difficult to diagnosis as certain symptoms and patterns have to appear first in order to evaluate them..and the ave. time frame to arrive at a correct dx for bipolar is something like 10 years (if I recall correctly-would have to look it up to be exact).
>
> However, an innacurate dx is a bit different than not addressing psychological aspects of mental health...
>
I actually have to disagree. Not getting diagnose earlier had a profound impact on my life, things that I did and did not do, and how the illness progressed.I also needed psychodynamic therapy, but I needed just as much an awareness and education on the genetic aspect of my struggles in life.
There are so many things one can do to prevent episodes and further progression of an illness. Knowing that you have an illness can empower you and can have equally as great an impact as psychodynamic therapy. I do think therapy and some hard work can also help treat a genetic illness as everything that went wrong in childhood likely contributed to the development and progression of the illness.
Morgan
Posted by violette on August 10, 2010, at 20:11:45
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 20:06:50
No, I agree with you Morgan-the effect of the situation is similar. I was emphasizing lack of addressing psychological issues-and just dispensing pills rather than correct/incorrect dx.
I think the issue I was pointing out is more of a systematic problem.
Posted by morgan miller on August 10, 2010, at 21:07:15
In reply to Re: Off Lexapro? - apathy syndrome //Help! » morgan miller, posted by violette on August 10, 2010, at 20:11:45
> No, I agree with you Morgan-the effect of the situation is similar. I was emphasizing lack of addressing psychological issues-and just dispensing pills rather than correct/incorrect dx.
>
> I think the issue I was pointing out is more of a systematic problem.I see, maybe you are right. I was taking psychology courses and on my way to going to grad school to get a Master's in Social Work(I felt like I was getting too old to go for a PhD in clinical psychology), so I will be the first one to acknowledge the need for therapy and issues with lack of participation. I think medications are necessary in some circumstances, but, I agree that they are handed out like candy without any emphasis being put on the need for therapy.
Violette, people just flat out do NOT want to deal with their issues. I do believe this is the majority of people. Everyone wants to stay in denial and move forward and take a little pill that makes them feel better. And ya know what, I can't really blame them, therapy is not easy at all. You actually almost always have to go through a period of sadness and depression and anger before you start really getting better in therapy. Most people have the misconception that they are just going to go to therapy and continue to feel better and better after day one. This just is not the case. If it were, then there wouldn't be any real work being done. There wouldn't be any dealing and coping. There wouldn't be any digging deep and analyzing for a better understanding so that one can be more empathetic and compassionate for one self.
Morgan
Posted by violette on August 10, 2010, at 21:50:22
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by morgan miller on August 10, 2010, at 21:07:15
I see...My T also told me some people who enter therapy drop out because it's too painful.
Considering I spent almost a decade feeling miserable with drugs, I'd trade a few years of therapy pain to get back that time in a hearbeat. And it's not all painful-there are many good feelings that go with having someone who believes in you...the relationship..the support..in your life.
It's worth it in the long run. But it is difficult finding the right therapist, as you said.
People in my family who deny their psychological issues are the unhealthiest.
Posted by morgan miller on August 10, 2010, at 22:28:49
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 10, 2010, at 21:50:22
>And it's not all painful-there are many good feelings that go with having someone who believes in you...the relationship..the support..in your life.
This is very true also. I've had wonderful therapists and enjoyed most of my experience in therapy, even the rough times. But that's just me, psychology is a major interest of mine. Hopefully one day I will be functioning at a very high level and have grown and matured so that I will be capable of going back to school and eventually practice therapy. Right now my brain is a dysfunctional mess and I am not as mature and developed emotionally as I would need to be.
>People in my family who deny their psychological issues are the unhealthiest.
This is true for many. And, if one is in denial, but appears to be fairly happy and successful in life and career, eventually the psychological issues deep seated in their psyche will catch up with them and negatively affect their lives in one way or another-usually impacting relationships and not as much careers.
Morgan
Posted by Phillipa on August 10, 2010, at 23:43:32
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 10, 2010, at 21:50:22
I tried so many and can't find a good fit any tips? Phillipa
Posted by orbital on August 11, 2010, at 12:20:42
In reply to Re: Off Lexapro? - apathy syndrome //Help! » orbital, posted by Phillipa on August 9, 2010, at 20:00:38
Phillipa, Paxil worked great for me. Like you, I was switched to Celexa, which I dropped after a few weeks, as it turned me into a zombie. Went back to Paxil, but it had quit working.
> Orbital well this get interesting as the next I took after quite a few years was paxil l0mg had to add lopressor 25mg pluse the benzos to tolerate. For three months was a zoombie and then was okay. Went back to working and took for two years then idiot doc took me off for celexa which did me in. Now I'm also sensitive or just nothing with meds. Strange isn't it? Phillipa
Posted by orbital on August 11, 2010, at 12:45:57
In reply to Re: Off Lexapro? - apathy syndrome //Help!, posted by violette on August 10, 2010, at 21:50:22
Violette, I've been doing psychodynamic therapy for over 15 years. I also do CBT, on and off. I agree with you, the psychological component of depression is extremely important, crucial in fact, at least in my case it stopped me from going off the deep end.
It was my therapist's suggestion that I try medication, as certain symptoms were not responding to treatment. That's how I ended up seeing a psychiatrist in the first place.
I think it's important to realize the difference between apathy being caused by psych. issues such as melancholia or dysthymia, and other causes such as SSRI "overload". I feel that the latter explains my current situation more accurately. I quit taking my excitalopram five days ago, and the fog I'm in is slowly lifting.
I think I neglected to mention in my initial post that this is the precise reason I quit my first Lexapro run about two years ago. It worked extremely well for many months, then I quite suddenly slid into a state of complete apathy and despondency. My doctor at the time decided to up my dosage, which of course made matters much worse.
This time around, I was aware of the possibility that this might happen - I figured I'd ask to lower the dose if it did. That didn't work, so I'm cutting my losses before I wind up wasting an indefinite amount of time in a blurry haze.
> I see...My T also told me some people who enter therapy drop out because it's too painful.
>
> Considering I spent almost a decade feeling miserable with drugs, I'd trade a few years of therapy pain to get back that time in a hearbeat. And it's not all painful-there are many good feelings that go with having someone who believes in you...the relationship..the support..in your life.
>
> It's worth it in the long run. But it is difficult finding the right therapist, as you said.
>
> People in my family who deny their psychological issues are the unhealthiest.
Posted by violette on August 11, 2010, at 15:51:51
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by Phillipa on August 10, 2010, at 23:43:32
Hi Phillipa,
Personal preferences sometimes dictate what patients find helpful or not helpful; for anyone whose been in the mental health system for a long time...I'd first try psychodynamic therapists. For people with really walled off emotions, I think conventional psychoanalyis might be a better place to start...
I found webites that offer advice on choosing a therapist to be kind of useless, but you might want to Google that if you've never read them. Some of the lists I've seen of 'good vs. bad' traits of therapists are sometimes unrealistic or much too black and white..
This is probably most useful information I've seen in one place:
http://website.lineone.net/~ve...erapists%20Abuse.htm
That's basically what you don't want in a therapist...
I think a therapist who has been in her own therapy is important...someone who does not let herself become intertwined with your issues. You can get really stuck if the therapist 'becomes who you want them to be'. It happens all the time, but I think it becomes a major problem if it's consistent/undiscovered rather than worked out.
For me, I don't work well with Ts who are directive/give advice. Someone with dependency issues may prefer that, but that will get you nowhere and keep you stuck. Psychodynamic therapists are usually ones who do not do this-instead, they will help you arrive at your own advice through insights.
Gender can be an issue...I have 'mother issues' and found that after working with several female Ts in the past, that working with a male is much better for me.
I always recommend starting here:
http://www.apsa.org/Find_an_Analyst.aspx
Some of the best Ts in my city are a member of that org.; my T is in the database though he was referred to me... Word of mouth is best. I don't trust any of those websites where therapist advertise-though some people may find good matches that way. In my experience, choosing someone with lots of experience and who gets referrals through colleagues made a difference...Ts on the list of that link generally will refer you to a colleague if they are not the best match for you as they usually know preferences of the Ts, who they work best with,etc. I think starting there is the best way to go.
Hope that helps.
:)
Posted by violette on August 11, 2010, at 16:03:36
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by orbital on August 11, 2010, at 12:45:57
15 years is a long time in therapy. I've only been in (psychodynamic therapy) it for a year, and it's really been the most help for those symtpoms you describe. I expect to remain in it for a long time too, hopefully not that long..
The last couple times I tried ADs, it made those symptoms much, much worse..like EdUK said, the brain is not a pot of soup! Anyway, I think you're making a wise decision. If you still have problems you could consider getting neuropsychological testing done, if you already haven't, as apathy is a commen symptom of neurological disorders too.
Posted by Phillipa on August 11, 2010, at 20:29:32
In reply to Re: Off Lexapro? - apathy syndrome //Help! » Phillipa, posted by violette on August 11, 2010, at 15:51:51
Violette thank you kindly I appreciate this as google area and did pick therapists from the advertised list. Those where the ones who didn't listen, tried to tell me what to do and then the next week forgot what they had said. Will read your lists. Phillipa
Posted by emmanuel98 on August 11, 2010, at 20:57:36
In reply to Re: Off Lexapro? - apathy syndrome //Help! » violette, posted by Phillipa on August 11, 2010, at 20:29:32
lucky for me that when I was looking for a p-doc, I really liked him and asked him if he would also do therapy with me, and he agreed. This is the ideal. A p-doc who really knows you, knows the difference between when you are in a severe biological depression and when you are just unhappy or despairing over emotional stuff.
Sadly, most p-docs don't do much therapy today (though they are trained in it) because they can make more money doing 3 med consults in an hour than doing an hour of therapy (the insurance payment and my copay nets my p-doc $115 an hour, which isn't much to maintain an office, several phones, malpractice insurance and the rest). If he did 3-4 med consults he could make from 180-240 an hour.
But having your p-doc as a therapist is the ideal situation. For me it has been a "good fit." As he said once, we make a "good team." This isn't always the case, unfortunately.
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.