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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Elanor Roosevelt on January 23, 2014, at 19:16:15
I am taking cymbalta and lithium and somehow have gotten through the last few years with almost no reward system. I just don't enjoy things, I would prefer to hide in my room and I have lost my sense of taste. I've been avoiding going to my pdoc bc I keep telling him this and he seems good with it. What do I need? Some serotonin?
Posted by Christ_empowered on January 23, 2014, at 19:47:32
In reply to cymbalta+lithium+? some advice please, posted by Elanor Roosevelt on January 23, 2014, at 19:16:15
Ritalin? A new shrink? supplements? Drop the lithium and take...I dunno..lamictal or something?
Maybe Parnate instead of an SNRI? Maybe...drop the lithium, take a low dose atypical, take antioxidants, and a low dose stimulant? Provigil?
I dunno :-( I'm just throwing random ideas your way.
Posted by phidippus on January 23, 2014, at 20:21:36
In reply to cymbalta+lithium+? some advice please, posted by Elanor Roosevelt on January 23, 2014, at 19:16:15
Anhedonia is usually a symptom of depression. Anhedonia is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, music, sexual activities or social interactions.
Researchers theorize that anhedonia may result from the breakdown in the brain's reward system, involving the neurotransmitter dopamine. Studies by Paul Keedwell, MD, then of King's College, found that the brains of participants who were clinically depressed had to work harder to process rewarding experiences. While earlier research believed dopamine to be primarily involved in the subjective experience of pleasure, the last 20 years has seen a conceptual shift, such that dopamine is now believed to underlie various aspects of reward anticipation, learning, and motivation.
My best advice would be to isolate whether the Cymbalta or the lithium is causing your anhedonia. I would stop the Cymbalta and assess who you do off of it.
Eric
Posted by cadett on January 23, 2014, at 20:30:10
In reply to Re: cymbalta+lithium+? some advice please » Elanor Roosevelt, posted by phidippus on January 23, 2014, at 20:21:36
what med would increase dopamine?
Posted by phidippus on January 23, 2014, at 21:20:49
In reply to Re: cymbalta+lithium+? some advice please, posted by cadett on January 23, 2014, at 20:30:10
Wellbutrin, Mirapex and Requip all enhance dopaminergic transmission.
I'd try to figure out if the Cymbalta is screwing you over before adding something.
Eric
Posted by Phillipa on January 23, 2014, at 21:36:04
In reply to cymbalta+lithium+? some advice please, posted by Elanor Roosevelt on January 23, 2014, at 19:16:15
When you say lost taste do you mean completely as I did l0 years ago? Phillipa
Posted by bleauberry on January 24, 2014, at 7:05:06
In reply to cymbalta+lithium+? some advice please, posted by Elanor Roosevelt on January 23, 2014, at 19:16:15
Creating flat emotions is something both of those meds frequently do.
More serotonin? No. That's one of the problems...there is too much serotonin and that is what is damping down the ability to feel emotions.
What you need is different meds and a different doctor maybe. A second opinion at the very least, anyway. If you were to stay with your current meds, then to help the flat emotions would most likely require norepinephrine and dopamine assistance, such as with Ritalin or Adderall or Modafinil.
To switch out cymbalta for something similar with less emotional numbing, maybe consider prozac+nortriptyline, zoloft+nortriptyline, prozac+desipramine, zoloft+desipramine.
Docs commonly herabld Cymbalta as a SNRI which is really isn't. It is 30 parts serotonin to 1 part norepinephrine. The above combinations, in contrast, can be dosed for any desired balance of serotonin versus norepinephrine, creating a true SNRI that has the added benefit of flexible dosing.
> I am taking cymbalta and lithium and somehow have gotten through the last few years with almost no reward system. I just don't enjoy things, I would prefer to hide in my room and I have lost my sense of taste. I've been avoiding going to my pdoc bc I keep telling him this and he seems good with it. What do I need? Some serotonin?
Posted by Elanor Roosevelt on January 30, 2014, at 14:20:06
In reply to Re: cymbalta+lithium+? some advice please, posted by Christ_empowered on January 23, 2014, at 19:47:32
Thanks everyone.
Seeing the doctor today.
Will keep you postedElanor
Posted by SLS on February 1, 2014, at 22:28:17
In reply to Re: cymbalta+lithium+? some advice please, posted by Elanor Roosevelt on January 30, 2014, at 14:20:06
How did your doctor visit go?
- Scott
Posted by kavinsky99 on February 19, 2014, at 19:27:31
In reply to Re: cymbalta+lithium+? some advice please » Elanor Roosevelt, posted by Phillipa on January 23, 2014, at 21:36:04
Actually, it's more likely serotonin is the culprit. Not that serotonin increasing medications are responsible for lower dopamine (the motivation/pleasure seeking neurotransmitter), but serotonin itself, when it's high, triggers the body to lower dopamine. It's a big part of the apathy SSRIs (and SNRIs, such as Cymbalta) cause.
So I'm guessing Cymbalta is causing it. You could try to counterbalance it with another medication, one that acts on dopamine or norepinephrine alone.
Wellbutrin (bupropion) and stimulants (aka amphetamines, such as Adderall, Ritalin, Dexedrine) are the main dopamine enhancers. Beware, though, if you're an anxiety sufferer, these will cause a big increase in it. More dopamine = more anxiety.
That's why I mentioned norepinephrine targeted medication. More norpinephrine tends to "toss around" more dopamine at specific parts of the brain.
Cymbalta should be a norpinephrine reuptake inhibitor (more norepinephrine), though, at the higher doses (up to an specific dose I can't rememebr, Cymbalta only messes with serotonin. After said dose, it starts the norepinephrine increasing too). But, some say reuptake inhibition isn't as good for motivation and dopamine distribution as pure norepinephrine release.Lithium shouldn't hit the dopamine receptors that much, but it does increase serotonin in some areas of the brain. However, it can "dull" most perceptions and sensations.
Personally, I kind of expect any SSRI and SNRI to cause severe apathy and lack of enjoyment. I tend to see them as "casts" for my "broken brain" that I use when anxiety, depression and PTSD get too intense. Then I endure the awful "zombie" period for a while, knowing eventually I'll be able to "break the cast" and switch to less debilitating medication. However, I do have excelent days on these medications. Not exciting days, but days where I feel really good in a very relaxed way, and things just seem to "move" again.
This is the end of the thread.
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