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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Maximus on June 2, 2005, at 19:05:28
Hi,
I'm bp II and i have a bad bipolar depression. I have absolutely no emotion. I want to get back my ability to enjoy life again, to laugh, to cry, though. I'm taking Effexor XR 150 mg, Lamictal 200 mg and Risperdal (as needed for crisis). I tried Ritalin without success.
Please, i desesperately need suggestions. What can i add (meds), remove, lower, etc?
Ah may be a clue here. When i take a 5HT2a antagonist i feel better. I feel myself *present* with the others. I'm scared to take an atypical antipsychotic on a regular basis. I can't stand the weight gain on Remeron...
Posted by linkadge on June 2, 2005, at 19:30:57
In reply to I have NO emotion. (SLS, Linkadge???), posted by Maximus on June 2, 2005, at 19:05:28
Some people have noticed that ginkgo can reverse some aspects of effexor apathy. Ginkgo reduces binding at the 5-ht2a receptor interestingly,
ie acts as a functional 5-ht2a antagonist.
I don't know how this would mix with the lamictal though.A low dose of nortryptaline might also help, since it has medium/strong 5-ht2a antagonistic activity.
Linkadge
Posted by med_empowered on June 2, 2005, at 19:43:10
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by linkadge on June 2, 2005, at 19:30:57
hi! I'm BP 1/ BP NOS, so I know what you mean. For the last couple years, my depressive cycles have mostly been characterized by the very lack of emotion you describe. Its rough, isn't it? Linkadge made a very important point: anti-depressants, especially the ssri's and effexor (possibly cymbalta as well) can cause apathy. You may want to try the gingko. Other than that...I'd lay low on the risperdal, but that's just me; although atypicals can help with depression, I find that I'm usually better off using a benzo for crisis or just waiting it out than I am taking an anti-psychotic. Lamictal is a good call for depression; adding Wellbutrin if you can might be a good idea, possibly along with a little BuSpar (which acts as a partial serotonin anatgonist) for any wellbutrin-induced anxiety. You could try provigil...some people swear by it for augmenting treatment of depression. The research to support that isn't all that solid yet, but it certainly is worth a shot. Surmontil is an old tricyclic that has some anti-psychotic properties, but doesn't seem to cause tardive dyskinesia and what not (I think this is true). A low-dose of that could be helpful...but there would be the TCA side effects to deal with (possible weight gain, heart weirdness, etc.). Therapy can be helpful, and I'm a firm believer is self-help methods as well; try to get out some, write or do something to express yourself, exercise if feasible, so on and so forth. Good luck!
Posted by Maximus on June 2, 2005, at 19:55:24
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by linkadge on June 2, 2005, at 19:30:57
> Some people have noticed that ginkgo can reverse some aspects of effexor apathy. Ginkgo reduces binding at the 5-ht2a receptor interestingly,
> ie acts as a functional 5-ht2a antagonist.Ginkgo, really? I did not know. I will try. I will bring the Norp's idea to my pdoc. But she is very conservator, but who knows...
Thanks!
Posted by Maximus on June 2, 2005, at 20:26:01
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by med_empowered on June 2, 2005, at 19:43:10
Thanks, you're kind, indeed. I'm glad that i'm not alone with this damn anhedonia. Ah too bad, i can not take Wellbutrin. I become aggressive on it. Same thing with TCA(s), in general.
I remember Buspar. Yes it might be a good add-on. I have heard about Provigil. I'm going to take a look at it. I'm also uncertain about the usage of atypical AP. And i live in Canada. So the safers AP like Geodon or Abilify are still not available here.
Well, Ginkgo and Buspar seem to be a good start.
Posted by willyee on June 2, 2005, at 20:26:29
In reply to Re: I have NO emotion. (SLS, Linkadge???) » linkadge, posted by Maximus on June 2, 2005, at 19:55:24
> > Some people have noticed that ginkgo can reverse some aspects of effexor apathy. Ginkgo reduces binding at the 5-ht2a receptor interestingly,
> > ie acts as a functional 5-ht2a antagonist.
>
> Ginkgo, really? I did not know. I will try. I will bring the Norp's idea to my pdoc. But she is very conservator, but who knows...
>
> Thanks!
God i cant stop posting someone help!!!! lol its so fast to do since the site refreshes i do it while im waiting on a down load listening to a sing lol arrrrrrrrr.Anyway max just fyi,i dont know if ur still on parnate,and this could be just me,but i rember taking source naturals ginko years ago while on parnate and it was a horrable speed rush,nothing nice at all,could have seen even a possable interaction if it was contiuned,just thought id pass it along so ud at least have a heads up regardless if it happens to u or not.
Posted by Maximus on June 2, 2005, at 20:37:54
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by willyee on June 2, 2005, at 20:26:29
> Anyway max just fyi,i dont know if ur still on parnate,and this could be just me,but i rember taking source naturals ginko years ago while on parnate and it was a horrable speed rush,nothing nice at all,could have seen even a possable interaction if it was contiuned,just thought id pass it along so ud at least have a heads up regardless if it happens to u or not.
>Thanks willyee for your input. But for just to be sure, i'm not *Maxime* who by the way is/was (?) on Parnate.
Posted by SLS on June 2, 2005, at 21:11:52
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by linkadge on June 2, 2005, at 19:30:57
> A low dose of nortryptaline might also help, since it has medium/strong 5-ht2a antagonistic activity.I think this is a great idea.
Of course, Maxine might experience lactation as a side effect of another TCA, but she wouldn't know unless she tried.
Wellbutrin?
Remeron?
- Scott
Posted by SLS on June 2, 2005, at 21:17:17
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by SLS on June 2, 2005, at 21:11:52
Sorry Maximus.
:-)
Since you are not Maxine <embarrassed>, perhaps lactation will not be an issue. lol
I like nortriptyline to brighten mood. This might help with motivation. However, Wellbutrin is often a good complement to serotonergic drugs because it can produce more mental energy and is suggested to help with apathy.
- Scott
Posted by Maxime on June 2, 2005, at 21:32:45
In reply to I have NO emotion. (SLS, Linkadge???), posted by Maximus on June 2, 2005, at 19:05:28
Allo mon cher Maximus! I just wanted to say it's good to see you again, unfortunately under bad circumstances.
Apapthy is so awful to experience. You can't even cry over it. I hope you find a solution to help you soon.
xoxo
Maxime> Hi,
>
> I'm bp II and i have a bad bipolar depression. I have absolutely no emotion. I want to get back my ability to enjoy life again, to laugh, to cry, though. I'm taking Effexor XR 150 mg, Lamictal 200 mg and Risperdal (as needed for crisis). I tried Ritalin without success.
>
> Please, i desesperately need suggestions. What can i add (meds), remove, lower, etc?
>
> Ah may be a clue here. When i take a 5HT2a antagonist i feel better. I feel myself *present* with the others. I'm scared to take an atypical antipsychotic on a regular basis. I can't stand the weight gain on Remeron...
Posted by Maxime on June 2, 2005, at 21:42:38
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by Maxime on June 2, 2005, at 21:32:45
Yes, Maximus and I are long lost French lovers from France. We met while performing in Les Miserables (that is why we are depressed ... we were miserable). We came to Quebec to hide. We probably should have chosen somewhere like Moose Jaw or Flin Flin, but we are proud of our French heritage and the only cheese you can get those cities is Cheddar. I cannot live without my Brie and Maximus, well, he needs decent bread. I wish I could tell you more, but I can't. Please don't tell anyone we are here!
Maxime
Posted by ed_uk on June 3, 2005, at 8:40:23
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by Maxime on June 2, 2005, at 21:42:38
Hi Maxi,
>Yes, Maximus and I are long lost French lovers from France. We met while performing in Les Miserables (that is why we are depressed ... we were miserable). We came to Quebec to hide.
That was good LOL :-)
Ed xxx
Posted by Chairman_MAO on June 3, 2005, at 9:47:14
In reply to I have NO emotion. (SLS, Linkadge???), posted by Maximus on June 2, 2005, at 19:05:28
The reason 5ht2 antagonists have this effect, I think, is because they increase DA release. I may very well be wrong.
I would try a TCA (desipramine)/NE reuptake inhibitor or a DA drug (DA agonist, psychostimulant, or perhaps bupropion, but I do not think that's a great drug at all).
I'm really busy now, so I am probably missing a lot here, but am just trying to help.
Posted by Maximus on June 3, 2005, at 12:25:39
In reply to Re: I have NO emotion. (SLS, Linkadge???), posted by Maxime on June 2, 2005, at 21:42:38
Yes i can't live without you. May be i should change my nick to the Last Stallion ;-) Really you have this sense of humour that teases my... intellect ;-)
Have a good day hon!
Posted by Maximus on June 3, 2005, at 12:32:05
In reply to Re: I have NO emotion. (SLS, Linkadge???) - OOPS!, posted by SLS on June 2, 2005, at 21:17:17
> Sorry Maximus.
>
> :-)
>
> Since you are not Maxine <embarrassed>, perhaps lactation will not be an issue. lolThanks Scott, but i don't see myself with an electric milk pump;-)
Thanks for your tip: (Norp). Bye.
Posted by Maxime on June 3, 2005, at 15:24:17
In reply to Re: I have NO emotion. (SLS, Linkadge???) - OOPS! » SLS, posted by Maximus on June 3, 2005, at 12:32:05
LOL! Now THERE is an image! Thanks for the laugh!
xoxo
Maxime
>
> Thanks Scott, but i don't see myself with an electric milk pump;-)
>
> Thanks for your tip: (Norp). Bye.
Posted by blueberry on June 4, 2005, at 5:44:43
In reply to I have NO emotion. (SLS, Linkadge???), posted by Maximus on June 2, 2005, at 19:05:28
If you go to www.pubmed.com, type in the search box "olanzapine AND apathy", you'll see clinical studies indicating that zyprexa is effective for apathy and ssri induced apathy.
I take zyprexa and can verify that it is indeed very helpful for the apathy, for me anyway.
Maybe just a simple switch from risperdal to zyprexa. Other APs might be worth looking at too, such as abilify or geodon. But the clinical evidence is best for zyprexa. Other options would include Wellbutrin, desipramine, ritalin, or adderall. All can be helpful for apathy.
This is the end of the thread.
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