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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 28 to 52 of 64. Go back in thread:
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.
Posted by Jim45 on February 13, 2009, at 14:38:53
In reply to Re: Your vote to treat ANHEDONIA, posted by X_ander on February 12, 2009, at 21:08:25
Dear X_ander.
I posted the following yesterday. Guess it didn't get through. Man I'm sorry, but I'm SO detail-oriented (doses/times) and careful with what I've been trying re the PEA/Selegiline.
After over a month of dose/time experimentation, even my "safe" regimen had problems. Following is an attempted repost that I've been putting everywhere I recommended PEA/Selegiline:
I THOUGHT that by experimenting I would find a safe PEA/Selegiline dose/time regimen.
I'm methodical and know enough about pharmacology, physiology and neurology to be dangerous .
THIS STUFF IS NOT SAFE. I HOPE I HAVEN'T HURT or will hurt anyone by what I've written about PEA/Selegiline.
Maybe....just maybe, if I can find a vasodilator and diuretic that will cancel out the vasoconstrictive and fluid retention properties of the combo, I'll write back.
Otherwise, my final word after 3 months using the combo is......
STAY AWAY FROM IT.
I don't know what in the world I'll do. Never found anything else like it.
I also kinda like life though and not having strokes from weird BP spikes or organ damage from fluid pressure. Mouth sores from the drying effect of the combo and rebound histamine spikes (PEA interferes with the enzyme that breaks down(?) histamine - NOT good for asthmatics or those with allergies.
X_ander, I can SOOOO relate to your condition, but I don't think PEA/Selegiline is the way to go. Again, if I can find countermeds for the dangerous effects, I'll post my findings.
Sorry
Jim
Posted by meltingpot on March 13, 2009, at 8:51:11
In reply to Re: Your vote to treat ANHEDONIA, posted by Cheryl-Lynn on January 17, 2009, at 15:53:21
Hi,
I was just looking at the threads on anhedonia. Did you manage to find anything to treat anhedonia as I've been suffering from this for years?
Thanks...Denise
Posted by ggggg123 on October 23, 2010, at 3:55:29
In reply to To Cheryl-Lynne Anhedonia, posted by meltingpot on March 13, 2009, at 8:51:11
I don't know if anyone still looks at this post, but what about using da agonists, benztropine, amineptine (if you can get hold of it) or any other kind of dopamine enhancing drug. What have people tried? is Tianeptine helpful for apathy? even though it enhances serotonin? thanks
Posted by Conundrum on October 26, 2010, at 9:18:04
In reply to Re: To Cheryl-Lynne Anhedonia » meltingpot, posted by ggggg123 on October 23, 2010, at 3:55:29
The more dopaminergic drugs I've tried include, ritalin, bupropion, and abilify. None helped with anhedonia.
I've also tried the supplements NADH, and mucana puriens and they didn't help either.
I think the best things to kind of help were low dose prozac, and remeron and pristiq, before they pooped out.
Never tried a direct agonist. I doubt it would be helpful.
Posted by ggggg123 on October 27, 2010, at 0:47:31
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 26, 2010, at 9:18:04
I know what you mean about going back on the ssri, that does seem to help, but its not ideal i want to be free of this stuff forever!! lol,I think most people will recover from ssri induced apathy, I have been going through it for a few months now, since discontinuing citalopram, which I had taken for 9 months. I think it takes a long time and exercise can be helpful. da agonists could be helpful in providing us with motivation, which may help get the blood and dopamine flowing in our brains again, thats my theory. The reason da agonists could be useful is the fact they can be used longterm. I think we need a boost to get fully back into life then the body may take over. We need to keep a positive attitude any negativety only inhibits recovery, although I know it is hard though. Anyways I'm gonna give very low dose Bromocriptine a good go over a long period of time along with some good lifestyle choices and see if I get anywhere. Also hopefully a very low dose of a dopamine agonist should'nt be very stimulating like amphetamines, so it may help restore interest in life without causing anxiety and restlessness.
Posted by Conundrum on October 27, 2010, at 10:04:13
In reply to Re: To Cheryl-Lynne Anhedonia » Conundrum, posted by ggggg123 on October 27, 2010, at 0:47:31
Let us know how it goes. I've found drugs that work strongly increasing dopamine to be hard edged. They didn't seem to increase motivation the way a low dose of prozac dose, or sensation and color the way pristiq weakly did, before it stopped working.
Posted by ggggg123 on October 27, 2010, at 23:30:42
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 27, 2010, at 10:04:13
I will do, I've just started the bromo, feeling a bit strange, everything's abit dark lol, but I'm gonna stick with it long term to see if this clears. I've never tried prozac, but I have taken citalopram, I hear prozac has some affinity for norep and dop, where as citalopram has non, are you still taking the low dose prozac? do you think its a good long term strategy? one other option I was considering is using benztropine, although it is an anticholinergic and will have the dry mouth side effect, it is also a dopamine reuptake inhibitor, which maybe more beneficial than a direct agonist, but unfortunately I think it may have been withdrawn in the uk, but I think its still available online.
Posted by Conundrum on October 28, 2010, at 0:07:27
In reply to Re: To Cheryl-Lynne Anhedonia » Conundrum, posted by ggggg123 on October 27, 2010, at 23:30:42
I'm not on the low dose prozac now, but if I can't find anything that works better, I would consider taking it again. Its good for motivation and drive, but it didn't totally hit anhedonia at the core. I think Pristiq was starting to hit anhedonia, but it just stopped working and felt like an SSRI. I'd consider low dose prozac with an NRI in the future. I think it could be a good longterm strategy if it works, but once you're on it for a long time, don't stop it.
I'm skeptical about DA agonists helping with anhedonia, or drugs that are mainly dopaminergic in general. I'm sure they work for some, but there is more to the brain than low dopamine = anhedonia. Unfortunately there are too many sites that say dopamine is the pleasure chemical, but its not that simple. All the other neurotransmitters carry your emotions too. For example, mice unable to synthesize norepinephrine cannot distinguish between a pleasurable drug like cocaine from an unpleasant drug Lithium cloride. So without adequate norepinephrine, no drug reward, atleast for mice. The same is probably true with serotonin and endorphins.
Also people feel flat on drugs that increase dopamine strongly, like parnate and ritalin. Don't believe me? Look it up, tons of people saying they feel less creative on ritalin or people feeling flat on parnate.
Some people, with anhedonia, do better on drugs like nardil or even dexedrine that do increase dopamine but also have stronger effects on other neurotransmitters when compared to ritalin and parnate, respectively. Some don't.
There was one person on this board with anhedonia, who was taking selegine, adderall, DLPA and maybe one other dopaminergic and had no relief from anhedonia. I'm not trying to discourage you, but there is a reason DA agonists aren't marketed as antidepressants, so if it doesn't help, you may want to consider other options. As you might be able to tell, my anhedonia has not responded well to dopaminergic drugs. Some people do. I think a DA agonist would tell you whether you are on the right path or not. I mean what can tell you whether or not you need dopamine more, than a drug that acts directly on dopamine receptors and its effects are even more potent than the natural ligand.
I really look forward to hearing how you respond to it. I think it is interesting.
Posted by ggggg123 on October 28, 2010, at 5:52:30
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 28, 2010, at 0:07:27
I agree with you that theres much more to it than dopamine, at least the dopamine that drugs provide, I think the only way is for the brain to normalize. But its very hard to succeed as drugs which increase one neurotransmitter often attenuate another, I think this is why we end up with anhedonia after taking ssri's. I agree that low dose should be the best policy in theory, still allowing the brain some natural input. Theres a new drug out here in the uk, called agomelatine, which indirectly increases norep and dop but not serotonin, also high dose venlafaxine is meant to have high affinity for norep and it is also dopaminergic (although I don't think going on a high dose ad is a great option), agomelatine might be useful though. I think norepinephrine and dopamine are very sensitive and respond to subtle changes, this is why stimulants and noradrenergic ad's don't make good ad's, as although it is well known they play a role in the aetiology of depression, these drugs can often increase dopamine and norep beyond normal levels, inducing mania and causing anxiety, basically theres a only a very thin line, between depression, feeling normal and mania. SSRI's can be beneficial as serotonin can be increased fairly substantially and the worst symptom you will experience is anhedonia,unlike dopaminergic drugs which are not ideal to dole out to the public as they could make you a threat to society or nervous wreck . There is virtually no ad's that increase dopaminergic output, just a few that have a slight disinhibiting affect and very slight reuptake inhibition.
My theory is to increase the brains dopamine very very slightly, hopefully acting as a probe to help initiate the flow of da and to also help motivate one back into an active life which inturn could prove very beneficial to the mind. I think its alot of trial and error to find something that helps, but I am positive that something will. I will keep you updated on the bromo and my progress. Cheers.
Posted by ggggg123 on October 29, 2010, at 9:45:46
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 28, 2010, at 0:07:27
day 3 of my new regime, I am taking 10/100mg carbidopa/levodopa and 1.25mg bromocriptine everyday, I am feeling slightly improved, more energy, more excited about life, it definitely affects my anhedonia, I do think for most people that dopamine is the main culprit in their anhedonia, its just many dopaminergic drugs don't pinpoint the pleasure centres, thats where exercise and being active comes in to help get some natural dopamine which is by far the best. But to beat anhedonia i do think dopaminergic medicine is the only method to speed up the process and help get back to life. I know you might say taking levodopa is'nt sustainable, but its very low dose just to give me a kick start and some people have taken it continuously for over 10 years. So basically after 3 days I am feeling alot better, I keep getting urges of excitement to go and get my life back. I hope the pattern continues and I see more improvement over the coming weeks.
Posted by Conundrum on October 29, 2010, at 11:47:37
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 9:45:46
Wow that sounds great!
Like I had said, if one thing would tell you if dopamine would help, its a direct agonist. How did you manage to get a hold of those drugs?
Right now I'm trying tianeptine, which is a serotonin reuptake enhancer. One of the results of increasing serotonin reuptake is dopamine increases. But I doubt it is as strong as taking a direct agonist or supplementing with those forms of dopa.
Posted by ggggg123 on October 29, 2010, at 23:43:30
In reply to Re: To Cheryl-Lynne Anhedonia » ggggg123, posted by Conundrum on October 29, 2010, at 11:47:37
I got hold of the drugs over the internet theyre from india, one is made by sun pharmaceuticals a generic and the other is brand gsk, its not all plain sailing I'm feeling abit nauseous, not so good today, I found this on the internet:
When only 5-HTP is used in treatment, 5-HTP depletes dopamine, norepinephrine, and epinephrine levels. When dopamine levels drop low enough, 5-HTP becomes ineffective and the side effects of dopamine depletion occur. 5-HTP and dopa must be provided in proper balance to affect optimal serotonin dopamine balance. For years doctors have depleted serotonin levels in Parkinson's Disease patient by prescribing only levodopa
with no properly balance serotonin precursors. People taking 5-HTP never realize that when the 5-HTP does not work or quits working it is because the serotonin dopamine system is not in balance.I'm not sure whether to add a very low dose ssri. Sinemet (carbidopa/levodopa) is a very cheap drug you can get it off many websites, I think its making me feel abit sick though so not sure wether to continue taking it. But i think the bromo is quite good and can be taken longterm.
But overall I think its about getting the right serotonin norep and dopamine balance, maybe by taking something that regulates all of them long term, as ssri's only regulate one, it seems that for a subgroup of people this has a negative effect on dopamine and norepinephrine so aslong as we start raising the norep and dopamine we should be on to a winner, I am thinking of adding imipramine or reboxetine.
Which meds are you taking at the moment? are you taking remeron, I found remeron really good for the first few weeks then its stopped working and only worked 20% of the time.
Posted by Conundrum on October 29, 2010, at 23:52:24
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 23:43:30
I found the same quick poopout with remeron as well. I'm probably gonna be coming off it. I just came off lamictal. I just started tianeptine today, which decreases serotonin and increases dopamine.
Posted by ggggg123 on October 29, 2010, at 23:54:10
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 23:43:30
sorry I misread your post, I see you are taking tianeptine not mirtazapine, did mirtazapine stop working? I wanted to try tianeptine,its got some good reviews, I really wanted to try amineptine, but its completely banned and the one source available is ridiculously expensive. I think I made the mistake of taking high dose ssri for a while, which seemed to cause this problem, I have heard on the tips part of this website of psychiatrists using ssri's with da agonist and having excellent results.
Posted by Conundrum on October 30, 2010, at 0:11:56
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 29, 2010, at 23:54:10
> sorry I misread your post, I see you are taking tianeptine not mirtazapine, did mirtazapine stop working? I wanted to try tianeptine,its got some good reviews, I really wanted to try amineptine, but its completely banned and the one source available is ridiculously expensive. I think I made the mistake of taking high dose ssri for a while, which seemed to cause this problem, I have heard on the tips part of this website of psychiatrists using ssri's with da agonist and having excellent results.
I'm taking mirtazapine and tianeptine right now.
My anhedonia started after stopping prozac. Go figure. I felt great on it.
Posted by ggggg123 on October 30, 2010, at 13:01:16
In reply to Re: To Cheryl-Lynne Anhedonia, posted by Conundrum on October 30, 2010, at 0:11:56
heres an extract from dr bobs tips page:
From: MKomrad@aol.com
Date: Wed, 7 Feb 1996 21:32:19 -0800
Subject: Bromocriptine for SSRI poop outI have had a very similar experience. This is now spoken about in many psychopharm conferences as "poop out." In my experience it sometimes happens as late as 3 years into an SSRI (typically Prozac, since it's been around the longest), in as many as 20% of patients.
What is to be done? There is talk among "poop out" veterans of adding bromocriptine since there is speculation that this might be a dopaminergic depletion phenomenon. People have said this helps, but I haven't used it yet myself
--------------------------------------------------did you not poop out on prozac? maybe low dose prozac with a dopaminergic could be a good strategy. I think it is worse when withdrawaing from the drug. How was the aripiprazole, that is supposed to increase dopamine, did you feel any benefit? cheers
Posted by Conundrum on October 30, 2010, at 15:19:53
In reply to Re: To Cheryl-Lynne Anhedonia, posted by ggggg123 on October 30, 2010, at 13:01:16
> did you not poop out on prozac? maybe low dose prozac with a dopaminergic could be a good strategy. I think it is worse when withdrawaing from the drug. How was the aripiprazole, that is supposed to increase dopamine, did you feel any benefit? cheersHi again,
Well what happened with me and prozac was that I had been taking it successfully for years and while studying music in boston, I stopped taking it cuz I ran out. Being me, I didn't take the time to get it filled and, I remember my pdoc, saying because it has a long half life, you don't need to ween off of it. So after taking it for 4.5 years I stopped it abruptly. Akathesia, the feeling to constantly keep moving, anhedonia, and anxiety ensued. I saw a doctor in Boston and got a new script and when I went back on it I felt like I was in another world. I just felt awful, although I think the akathesia went away, the anhedonia stayed.
So if there is a moral to the story, its that if you find something that works, don't stop it, cuz it might not work again! AND don't stop psych drugs abruptly, even if its got a 2 week half life.
Now I can take a low dose, 5mg every other day, and get some motivation. I've tried adding ritalin to it, but it did not help. I would think ritalin would be one of the more powerful dopaminergics around. (Ritalin does help me if I'm really sad, not anhedonic. It has a very artificial rescue effect.)
Given that Pristiq added some "color" to my world, I tend to think I have a norepinephrine deficiency. Pristiq does not have the DRI effects that the parent drug, Effexor has.
Aripiprazole, hmm. At 2 mg I noticed a feeling that I had a lot of energy and wanted to get things done, similar to a cup of coffee, but this feeling lasted for a couple days. I noticed another boost at 2.5 mg, and then a fade. At 5mg I felt worse, it just made my head feel weird, I went back to 2.5 and felt that boost again, and then a fade.
I'm curious about taking that low dose of prozac with desipramine, or nortriptyline.
Right now I'm on tianeptine, so I won't be taking any SRI drug while I'm on it.
Since remeron felt like a stronger prozac, I wonder what combining remeron with an SNRI would be like. I think the 5 HT2A/C antagonism of remeron works better with SRI action, this is the mechanism by which low dose prozac increases norepinephrine and dopamine in the prefrontal cortex.
Oh also abilify, only increase dopamine in the prefrontal cortex, not in the striatum or nucleus accumbens, and at higher doses it decreases dopamine in the reward regions of the brain.
The motivation from remeron and low dose prozac felt more natural than abilify which seemed, kind of hyper and robotic.
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