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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 64. Go back in thread:
Posted by Elizabeth on August 15, 1999, at 18:47:09
In reply to Lithium augmentation, posted by DL on August 15, 1999, at 14:41:18
> I'm curious to hear from any posters about using lithium as above? I had heard that lithium has so many side effects and must be watched carefully.
It has a lot of side effects for some people. I don't find it too bad. Augmentation doses are very low, though; not like what is used in bipolar. For me, the side effects have been: diarrhea (went away after a few days); acne (I was just recovering from adolescence! I'm now using topical clindamycin and it seems like it might be starting to help); and having to urinate all the time (haven't figured out a way to deal with this one, except staying near a bathroom at all times!). It may or may not be causing attention problems - this is the most worrisome to me, since I'm a student!
Some other potential side effects are nausea (already mentioned; ginger is a great tx for this) and tremor (exacerbated by caffeine). Also, it should not be used during pregnancy, as there's definitely a good chance of birth defects. (Yes, I know this doesn't apply to everyone here!)
You do have to get blood tests every so often, including serum levels, TSH, electrolytes, I forget what else. Renal, thyroid, and parathyroid functioning are the main things that need to be watched. I think this should be a limiting factor only if you are afraid of needles.
> I don't hear as many people mention it with all the newer drugs out now.
I think there is less evidence supporting it as an augmenter for the newer drugs, just because it hasn't been tested as much. I'm taking it with Parnate. (What can I say? I'm an old-fashioned kind of girl.)
> Is it used in much smaller doses than when used alone for Bi Polar?
Yeah...serum levels for augmentation are supposed to be around 0.5-0.8 mmol/L, whereas for bipolar disorder (maintenance), they're supposed to be more like 0.8-1.2 (and up to 1.4 or 1.5 for acute mania). I take 600mg, which puts me at a serum level of 0.7 or so; you might need more, depending on your body size.
> Also seems to me lithium tends to cause weight gain?
I've heard this, but it hasn't been true in my case. I gained weight because I started eating again, but not more than I would have expected.
> I take Remeron and it does let me sleep finally, and also lowers anx level.
Some people find Li+ to help with insomnia and anxiety. I don't, personally. Then again, *nothing* helps with my insomnia. (My psychopharmacologist said he would set me up with a sleep doc he knows; I think it's time to take him up on this offer.)
> I cannot take the SSRI's, Effexor or Wellbutrin. They all instantly (and on low dose) make me feel plugged into an electric outlet and I can't sleep or function or even sit still.
SSRIs just don't work for me, Wellbutrin made me feel awful, and Effexor...well, it seemed to be working pretty well, but then something bad happened.
> Any ideas to deal with anhedonia? I am in therapy. But only rarely to I have minutes of what it feels like, perhaps, to be normal--to be excited,-as above to enjoy music-or really mostly anything. Life is mostly a routine.
I don't think therapy will help with this. I feel like talk therapy only became helpful to me once I started the lithium, actually.
Posted by cynthia on August 16, 1999, at 20:51:11
In reply to John and DL, posted by Cynthia on August 15, 1999, at 17:53:15
>yes, I completelyl forgot about the acne, which I didn't have before lithium. It's a pain in the ass, especially because I am 31 years old and rarely had a pimple before lithium. Now, I go to the dermatologist to have my pimples(cysts) injected. I go about once a week, and this just barely keeps it under control.
Cynthia
Posted by RG on August 18, 1999, at 9:28:04
In reply to Your vote to treat ANHEDONIA, posted by JohnL on August 14, 1999, at 17:17:25
> My previous post asking about Selegiline probably gave me away. Here's the situation. I need some ideas. I have been on Prozac for six weeks (20mg). Jumpstarted it with SAMe. St Johns 900mg a day. Remeron (7.5-15mg) as needed for sleep. Prozac is the foundation treatment, the other stuff seems to help, but not enough to write a book about. I have a 1-10 depression scale. 1 is suicidal. 10 is "It's a nice day, I think I'll take the dog for a walk." Or, a 10 might be "I feel like playing my guitar". I've been at 2 to 4 range for two years. But right now I'm about a 6 or 7. Definitely improved. More sociabe at times, more confident, less procrastination. The primary symptom remains: anhedonia. Inability to anticipate or enjoy pleasure. No joy. No spark.
>
> Anhedonia seems to stump every doc I've talked to. I've tried the SSRIs, Serzone, Wellbutrin, TCAs, Remeron. Haven't tried MAOIs. It is my guess that the dopamine system is at fault here, and that something like selegiline, amisulpride, amineptine might do the trick. Anhedonia is a primary negative symptom of schizophrenia as well, which is treated well with amisulpride. Don't know, maybe a Ritalin or something is possible. I just don't think any more serotonin approaches are going to help much, or they would have already.(Paxil, Zoloft, Celexa, now Prozac)
>
> I've played guitar professionally for 30+ years. Some enthusiastic peers said I was the best in the state. But since depression hit me, my poor guitars remain untouched in their cases. Haven't played in 1 1/2 years. What a waste. I can't play because it breaks my heart to not enjoy it. Or anything else for that matter. I want so much to sit down and pump out some serious music again. Anhedonia, what a beast. So my good friends, help me out here. Ideas to ponder? Thanks. JohnL.Wow is all I can say. I have tried those SSri's, too, but with your same results. I am going to my doc today cuz I am sick of living like this. I have little to look forward to. Would you believe I live in Aspen, CO and am miserable? I am on zoloft (100mg) now for 5 weeks after trying celexa for 7 weeks (did little). Maybe the SSRI treat the depression, but I have no joy or happiness. I go out infrequently. My job (which I know I like) performance is minimal now and I don't do anything. Nothing interests me and this isn't right. I have been sober for almost 3 years and now I don't even have alcohol and drugs to get some relief so....I look forward to any more input here on the subject.
RG
Posted by JohnL on August 19, 1999, at 3:26:13
In reply to For John or anyone RE: Anhedonia (DR. Bob??), posted by RG on August 18, 1999, at 9:28:04
RG, so sorry you're dealing with anhedonia too. I wish there was a recipe to treat it. Suggestions though? If Zoloft is OK, except for the anhedonia, try working with it. Choices are many. Add a TCA like Nortriptyline, Desiprimine, Vivactil. Buspar is so supposed to have real good synergy with Zoloft. Lithium augmentation is a standard approach. If one was to assume a dopamine connection, rather than serotonin, then there is Wellbutrin, Amisulpride. The choices really are staggering. I think it's important to have a good doc to help you understand the pros and cons of choices and set some priorities in them. Wishing you well. JohnL.
Posted by Rg on August 19, 1999, at 18:31:51
In reply to My vote for anhedonia relief, posted by andrewb on August 15, 1999, at 12:43:37
> > Thanks all for great ideas. Keep em coming if you can. My psychiatrist will write a precip for anything. No prob. He's been around a long time, worked with lots of heavy hitters, and I think he knows that often times finding the right treatment is about the same as throwing darts, throwing the dice, picking straws. He is well aware that what ends up working may or may not have any logical reason as to why. Body chemistries are just so different. No way to predict. He helps me weigh the pros and cons of choices. But he, like me, is willing to try anything that makes some sense. He did mention Ritalin once. So, getting a prescrip is no prob. Deciding what to do is. Meanwhile, the guitar does gently rust (good one Stephan!) Very grateful for your ideas and support. Thanks. JohnL.
>
> John,
> After more than a month of usage, I continue to have good results and euthymic effect from amisulpride. As you know amisulpride is specific to the D2-D3 receptors, mainly those in the limbic system. I think that pramipexole (Mirapex), though it hasn't been studied as thoroughly for depression as amisulpride, would have a similar effect with the added benefit of being available in the US. Since pramipexole acts more preferentially on the striatum D2-D3 than amisulpride it may have more of an anxiolytic effect and it has certainly been noted for that. Another good thing about these med.s is that they act quickly. You have no reason to take amisulpride longer than a week to decide whether or not it is helping you.
> It certainly seems possible that other medicines could combat anhedonia even if the key lies in the D2-D3 pathways. I've read that SSRIs and classic antidepressants increase the responsiveness of D2-D3 receptors over time, possibly by increasing receptor density.
> I've tried amineptine and it can be effective. However it seems to stimulate unnecessary parts of the dopaminergic system causing unwanted side effects like agitation or muscle tension and visual distortion. I only tried selegiline at a low dose (5-10mgs.), with and without phenylalanine. I did not experience good effect. Phenylalanine by itself I found to be unpleasantly stimulating.
> I use buprenorphine (the sublingual form that isn't available in the US) very occasionally for pain. From what I've read there are some cases where it has been effectively used to treat depression. But be warned that it seems there is some potential for habituation and even abuse. I believe its mode of action is via occupation of opiate receptors.
> By the way I hear it mentioned here and there in posts that Wellbutrin (bupropion) acts through dopaminergic mechanisms. I'm confused on this. How does bupropion’s dopaminergic effect compare in significance to the med.s effect on norepinephrine. I've also read that while it inhibits the reuptake of dopamine, bupropion also diminishes the release of dopamine. Does that make its net effect on the dopaminergic system a wash? Should bupropion’s energizing effects be attributed to norepinephrine or dopamine action?
> John glad to hear you are feeling better. Best of luck finding relief for your anhedonia. From reading your posts it seems that your approach to recovery serves you well.So, would you agree that Wellbutrin may not help, but actually limit the dopamine release??
Posted by JohnL on August 20, 1999, at 14:07:37
In reply to Re: My vote for anhedonia relief, posted by Rg on August 19, 1999, at 18:31:51
RG, Wellbutrin's mechanism seems to be a mystery. It works wonders for some. My psychiatrist says his results with it have been "spotty". I did try it once, but it caused such severe tinnitus I had to stop after just 2 weeks. I do have amisulpride on order and expect delivery in another week or two. We'll see what happens. Thanks. JohnL.
Posted by Anhed on January 4, 2009, at 19:11:59
In reply to Your vote to treat ANHEDONIA, posted by JohnL on August 14, 1999, at 17:17:25
> My previous post asking about Selegiline probably gave me away. Here's the situation. I need some ideas. I have been on Prozac for six weeks (20mg). Jumpstarted it with SAMe. St Johns 900mg a day. Remeron (7.5-15mg) as needed for sleep. Prozac is the foundation treatment, the other stuff seems to help, but not enough to write a book about. I have a 1-10 depression scale. 1 is suicidal. 10 is "It's a nice day, I think I'll take the dog for a walk." Or, a 10 might be "I feel like playing my guitar". I've been at 2 to 4 range for two years. But right now I'm about a 6 or 7. Definitely improved. More sociabe at times, more confident, less procrastination. The primary symptom remains: anhedonia. Inability to anticipate or enjoy pleasure. No joy. No spark.
>
> Anhedonia seems to stump every doc I've talked to. I've tried the SSRIs, Serzone, Wellbutrin, TCAs, Remeron. Haven't tried MAOIs. It is my guess that the dopamine system is at fault here, and that something like selegiline, amisulpride, amineptine might do the trick. Anhedonia is a primary negative symptom of schizophrenia as well, which is treated well with amisulpride. Don't know, maybe a Ritalin or something is possible. I just don't think any more serotonin approaches are going to help much, or they would have already.(Paxil, Zoloft, Celexa, now Prozac)
>
> I've played guitar professionally for 30+ years. Some enthusiastic peers said I was the best in the state. But since depression hit me, my poor guitars remain untouched in their cases. Haven't played in 1 1/2 years. What a waste. I can't play because it breaks my heart to not enjoy it. Or anything else for that matter. I want so much to sit down and pump out some serious music again. Anhedonia, what a beast. So my good friends, help me out here. Ideas to ponder? Thanks. JohnL.Dear John,
I know this reply is some 10 years after your post.
Anyway, if your're still around, for what it's worth, my oldest son Alex, 24, also a musician, suffers from what you describe.
Alex discovered a recent patent dated 02/23/2006 on the internet by a certain Dr Nathanson entitled "Treatment of Anhedonia". The link is:
http://www.freepatentsonline.com/y2006/0217394.html
Hope this helps. At least you're in the US where psychiatrists, such as Nathanson, are less conservative. Most psychiatrists just don't get it - namely that the very anti-depressants they prescribe are also responsible for causing what Nathanson calls "iatrogenic anhedeonia." Ritalin (methylphenidate)is certianly in there as the main drug to treat it.
Alex is still struggling. If you would like to correspond with him,let me know and I'll send you his email address.
To see someone who used to love music so much is to suffer with them.
You're not alone.
Kind Regards,
Paul
Australia
Posted by Sigismund on January 9, 2009, at 23:21:57
In reply to Re: Your vote to treat ANHEDONIA, posted by Anhed on January 4, 2009, at 19:11:59
>Most psychiatrists just don't get it - namely that the very anti-depressants they prescribe are also responsible for causing what Nathanson calls "iatrogenic anhedeonia."
In Australia many psychs (though less often their patients) see the iatrogenic anhedonia as therapeutic.
Posted by SLS on January 10, 2009, at 4:16:00
In reply to Re: Your vote to treat ANHEDONIA, posted by Sigismund on January 9, 2009, at 23:21:57
What about using Abilify with amphetamine? I haven't seen this combination used before, so I am afraid you would be a bit of guinea pig.
- Scott
Posted by X_ander on January 11, 2009, at 1:52:43
In reply to Re: Your vote to treat ANHEDONIA, posted by Sigismund on January 9, 2009, at 23:21:57
> >Most psychiatrists just don't get it - namely that the very anti-depressants they prescribe are also responsible for causing what Nathanson calls "iatrogenic anhedeonia."
>
> In Australia many psychs (though less often their patients) see the iatrogenic anhedonia as therapeutic.
Wow...I actually thought it was only myself who had that impression of psychs in australia...do you find it's just a general attitude to things or have they actually said something along those lines...?
Posted by Sigismund on January 11, 2009, at 14:38:04
In reply to Re: Your vote to treat ANHEDONIA, posted by X_ander on January 11, 2009, at 1:52:43
>have they actually said something along those lines...?
Well, yes.
They are aware that SSRIs promote apathy and they see that as the flip side of the therapeutic effect.
One said so to me.Anhedonia from a psychiatric point of view is no big deal..........that's the impression I get.
Posted by Cseagraves on January 14, 2009, at 11:25:28
In reply to Re: Your vote to treat ANHEDONIA, posted by Anhed on January 4, 2009, at 19:11:59
Hi John,
Sorry, but I haven't had any experience regarding anhedonia. Just wanted to welcome you here and I'm sure you will be able to get great advice from others on the board.
I wish you and your son the very best.
Courtney
Posted by Cheryl-Lynn on January 17, 2009, at 15:53:21
In reply to Re: Your vote to treat ANHEDONIA, posted by Cseagraves on January 14, 2009, at 11:25:28
I too have felt no joy for years now and have seemingly tried every combo of drugs to the point where my Dr is getting frustrated. What I haven't tried is lithium.
I'd love to hear more advice on the topic of anhedonia and how to "feel" again.
My heart goes out to all who are feeling this way - it's almost as bad as the depression.
Posted by X_ander on January 19, 2009, at 20:09:15
In reply to Re: Your vote to treat ANHEDONIA, posted by Cheryl-Lynn on January 17, 2009, at 15:53:21
Go to this weblink, read it and give it to your psychiatrist:
http://www.freepatentsonline.com/y2006/0217394.html
> I too have felt no joy for years now and have seemingly tried every combo of drugs to the point where my Dr is getting frustrated. What I haven't tried is lithium.
> I'd love to hear more advice on the topic of anhedonia and how to "feel" again.
> My heart goes out to all who are feeling this way - it's almost as bad as the depression.
Posted by Connor on January 20, 2009, at 19:46:39
In reply to Re: Your vote to treat ANHEDONIA, posted by Anhed on January 4, 2009, at 19:11:59
One of the adhd drugs such as adderall, dopamine seems to be a key component I think
Posted by psychobot5000 on January 21, 2009, at 20:09:48
In reply to Re: Your vote to treat ANHEDONIA, posted by Cheryl-Lynn on January 17, 2009, at 15:53:21
> I too have felt no joy for years now and have seemingly tried every combo of drugs to the point where my Dr is getting frustrated. What I haven't tried is lithium.
> I'd love to hear more advice on the topic of anhedonia and how to "feel" again.
> My heart goes out to all who are feeling this way - it's almost as bad as the depression.The last I heard, Pramipexole and other D2 agonists were considered possibilities to help with anhedonia.
Posted by dcruik518 on January 24, 2009, at 11:00:50
In reply to Re: Your vote to treat ANHEDONIA, posted by psychobot5000 on January 21, 2009, at 20:09:48
I've tried alot of dopaminergic drugs to help with anhedonic symptoms. I currently take Abilify and Adderall, but I believe the best drugs for this are the MAOIs, such as Nardil and Parnate. Nardil worked great for me in terms of motivation, positive affect, etc. Parnate doesn't work as well for social anxiety, but it also doesn't cause the weight gain that Nardil does.
Posted by chocoholic on January 30, 2009, at 22:52:37
In reply to Re: Your vote to treat ANHEDONIA, posted by dcruik518 on January 24, 2009, at 11:00:50
I vote for a max dose of Concerta (long-acting methylphenidate) and Provigil which have really helped me after 16 years of not feeling truly alive.I can finally "hear" music again!
I've tried scores of antidepressants that didn't help, including the MAOIs moclobemide and Marplan.
Mir
Posted by Cheryl-Lynn on February 1, 2009, at 16:06:23
In reply to Re: Your vote to treat ANHEDONIA » dcruik518, posted by chocoholic on January 30, 2009, at 22:52:37
Thank you all for your answers - I will talk to my Dr. again and see if I can try something new. I'm currently on Parnate but it's just not doing the trick.
Posted by Cheryl-Lynn on February 1, 2009, at 16:18:03
In reply to Re: Your vote to treat ANHEDONIA, posted by psychobot5000 on January 21, 2009, at 20:09:48
> > I too have felt no joy for years now and have seemingly tried every combo of drugs to the point where my Dr is getting frustrated. What I haven't tried is lithium.
> > I'd love to hear more advice on the topic of anhedonia and how to "feel" again.
> > My heart goes out to all who are feeling this way - it's almost as bad as the depression.
>
> The last I heard, Pramipexole and other D2 agonists were considered possibilities to help with anhedonia.
> Have you had luck with this?
Posted by chocoholic on February 1, 2009, at 16:39:58
In reply to Re: Your vote to treat ANHEDONIA, posted by Cheryl-Lynn on February 1, 2009, at 16:18:03
I did take pramipexole for a while about 8 years ago. I had some response to it, but nothing like the high dose Concerta and the Provigil (modafinil). Before adding them, I was SO tired all of the time I could barely drive to work, much less do basic household chores. I would go through the motions of doing things that I used to enjoy without feeling much. Now I can REALLY enjoy life, my friends and family--it is about time after 16 years! (I feel like an advertisement here for those meds!).
Please don't give up on trying--I have tried over 40 meds, supplements, etc. I finally lucked out on the right combination of meds plus the Concerta and Provigil.
Posted by Jim45 on February 3, 2009, at 15:48:13
In reply to Re: Your vote to treat ANHEDONIA, posted by X_ander on January 19, 2009, at 20:09:15
After coming off high-dose Effexor that I'd been taking for years, I went through INCREDIBLE dysphoria, anhedonia, amotivation, social phobia, and an AWFUL mental phenomena like a very vague headache, but no pain, just a feeling of misery from the first thing in the AM until I went to sleep at night. I also thought I was dying and wanted to die.
Different elements of the above lasted months. I was still suffering from others after 2 years off the Effexor.
I got tired of missing out on this short life, and seeing others, and my Dad is dying and needs help, so I went back to the medicines (less suboxone) I was on back then. I started taking LOW doses of non-time release Effexor - 37.5 mg daily dived into 1/3 and taken every 3-4 hours, and Selegiline - a 5 mg tablet daily divided into 1/4 and taken every 2 hours. Most importantly, and also the reason for the strange Effexor/Selegiline regimen, I've been taking Phenylethylamine - about 100 mg - every hour or so from around 10 or 11 AM to 6 or 7 PM. I've been on this regimen for over 2 months now and I'm still happy with it.
I have my life back now, I'm motivated, happy (most of the time) and feel like I haven't felt in YEARS.
I'm a 45 year old 200 pound male, so the dose/times are for my physiology and for the symptoms I gave above. People need to be careful with PEA and Selegiline. I've been continuously experimenting to get the doses/times right, and still do so. The Effexor further complicates this regimen because it effects blood pressure.
A warning/word of caution - overdoing it can be dangerous and possibly addictive for some people.
There's my vote if you're experiencing what I did.
Best wishes and luck finding something to help you. LIFE IS TOO SHORT to miss out on because you're miserable.
Jim
Posted by X_ander on February 8, 2009, at 4:57:36
In reply to Re: Your vote to treat ANHEDONIA, posted by Jim45 on February 3, 2009, at 15:48:13
Hi Jim, I've also been somewhat interested in the PEA + selegiline combination for anhedonia. It is a dangerous way to go if you take too much PEA..hypertensive crisis etc so be very careful. But that said I have heard it can work wonders.
May I ask what brand of PEA you use in your regimen?
Thanks, X.
Posted by jim45 on February 9, 2009, at 19:46:24
In reply to Re: Your vote to treat ANHEDONIA, posted by X_ander on February 8, 2009, at 4:57:36
Dear X_ander,
The brand I have now is Cognitive Nutrition.
They caution/discourage people about combining the PEA with selegiline. If you don't combine it with selegiline or some of the other things people "out there" have found you have to regularly take massive amounts of PEA for it to work. They sell more!
That being said, I'm glad that you're aware of the dangers if you're not VERY careful with the doses/times. Many people have problems with it and quickly give up. It worked SOOOO well for me that I decided to experiment to find a safe and effective dose/time.
I'm 200 pounds (may've already posted this) and 45 years old. My latest regimen is 1/4 of a 5 mg selegiline tablet (1/3 MAX) every 2 or 3 hours, and 100+/- mg of the PEA taken every hour or so. You'll know when to take more. If you're forgetful, write down what you take and when. A couple of times I forgot and took a dose too soon and it was scary.
I stop an hour or so before bedtime. Stopping sooner makes me too tired to be useful here, and I have a Wife and 4 kids.
I also try not to start taking the regimen daily until I have things to do. Once you start, you have to keep taking it or the fatigue sets in. Besides, it seems like there's still a positive effect the next day.
I have my life back again and have NO desire for alcohol or pot anymore either. This is one weird and wonderful combo.
One last note - Cognitive Nutritions lowest dose the last time I ordered was 250 mg. It's a pain to pour out 1/4 of a capsule. Good price though. There are other sources that sell lower and easier to use doses.
Good luck and best wishes X_ander.
Posted by X_ander on February 12, 2009, at 21:08:25
In reply to Re: Your vote to treat ANHEDONIA, posted by Jim45 on February 3, 2009, at 15:48:13
Hey Jim, cheers for replying, I'm quite interested in this cos there aren't many options for anhedonia, it really is quite sad...we have to fight for it, I'm glad you have.A few questions on your regimen...(hope you don't mind..)
1) On the breaking and pouring of the capsule.. you use a quarter of a 250mg capsule? That would make your dose around 60mg of PEA...sorry to be pedantic, but I'd like to know: do you go for as close to 100mg as you can or just approximately a quarter of the capsule...?
2) How do you store the rest once the capsule is broken?
3) How do you take the powder once it is out? Just with water or something..?
4) Have you found it absolutely necessary to take selegiline in the quarter/thirds dose as you describe? What happens if you don't?
My reason being that selegiline is an irreversible inhibitor of MAO-B, which allows for the slowing of the PEA breakdown...being irreversible, the effects of selegiline last a lot longer than after the tablet has been metabolised (up to 2 weeks, as you'll know from the warnings on antidepressant labels etc...) so I would have thought it not all that necessary to pace the dose of the selegiline so rigidly throughout the day (kind of like the principle of a drug having a really long half-life....), the effects of the previous doses are still well and truly alive...
my best wishes to you too mate.
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