![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 8 to 32 of 34. Go back in thread:
Posted by klein on April 26, 2014, at 1:49:54
In reply to Re: About SSRI-induced apathy » klein, posted by LouisianaSportsman on April 25, 2014, at 20:59:32
> What receptors? Tex will provide a paper about another subject yet provides no evidence for his pseudo-science claim.
>
> You either got better by placebo, or amelioration of the reason you were prescribed 1mg. clonazepam.
>
> I don't think it's wise to suggest to others that they they should seek an addictive benzodiazepine that causes some of the worst withdrawal syptoms of any medication.
>
> Can you please provide any sources? Or, are you spouting psueudo-science that a member wrote 12 years ago that seems to have no other case reviews related?LOL Louisiana!! Ok, you sure gave me a workout here. I'm a bit surprised by the tone of your post, you must have your reasons. Anyway, I'll try to provide sources to back up my experience.
First of all, I'm certain that it wasn't a placebo effect. I keep taking ADs because they do help me, until they poop out and dump me into numbness. I've resorted to this method several times and it always works.
FWIW my pdoc has adopted it as well with patients suffering from SSRI-induced apathy, with generally good results.
I take Klonopin as a mood stabilizer, I've been on it for 8 years and never abused it. Like Phillipa mentioned, some of us take benzos long-term in a responsible way.
OK. Let me give this a try (bear with me, pure speculation, conjecture, over-simplified, just a few pointers)
Tex's theory is rudimentary but, according to recent research, there's a chance he might be right, his method might be effective in certain cases.
Let's go:
First of all, anhedonia is not depression (Marin, R.S. Apathy: A neuropsychiatric syndrome. J. Neuropsychiatry and
Clinical Neuroscience, 3:243-254, 1991.)
Anhedonia is thought to be a "meltdown" in the brain's reward center, caused by a dopamine defficiency:
(Keedwell P A, Andrew C, Williams S C R, Brammer M J, Phillips M L (2005) The neural correlates of anhedonia in major depression. Biological Psychiatry, 58(11), 843-853.)"Romanian Journal of Psychopharmacology (2009) The role of dopamine in depression, Delia Podea et al"
A lot of us know that SSRIs may eventually cause intractable apathy. It doesn't seem to happen to most people that take SSRIs (several studies available), the lucky ones, but there's evidence that some of us do indeed suffer from this syndrome:
"J Psychiatr Pract. 2004 May;10(3):196-9. SSRI-induced apathy syndrome: a clinical review"
"J Child Adolesc Psychopharmacol. 2001 Summer;11(2):181-6.Amotivational syndrome associated with selective serotonin reuptake inhibitors in children and adolescents. Garland EJ1, Baerg EA."
Why: Probably dopamine deficit = messed up mesolimbic reward pathway:
"Chronic 5-HT Transporter Blockade Reduces DA Signaling to Elicit Basal Ganglia Dysfunction. Emanuela Morelli"
"Problems associated with long-term treatment with selective serotonin reuptake inhibitors, Chantal Moret and Mike Isaac(2007)"
The usual recommendation is to raise the dose or to augment with yet another AD. Which for some of us only worsens the apathty.
But recently:
"Psychopharmacol Bull. 2010;43(4):76-9. Antidepressant induced apathy responsive to dose reduction"
"Ann Pharmacother. 2012 Mar;46(3):e8. doi: 10.1345/aph.1Q656. Epub 2012 Feb 21. Reversal of SSRI-associated apathy syndrome by discontinuation of therapy."
There are several papers that recommend treating apathy by augmenting with bupropion, modafinil, amphetamines... dopamine boosting agents. These strategies makes sense, and they might work for some of us. Personally, modafinil didn't cut it for me during my abulic states, bupropion takes a few weeks to kick in, and I don't have access to methylphenidate. Unfortunately.Anyway, here's where it gets interesting: There's emerging evidence that, contrary to wide-spread previous assumptions, benzos do in fact disinhibit dopamine release. Indirectly, via glutamate. This was briefly mentioned in a paper back in 1990 but didn't fly.
"Like opioids and cannabinoids, diazepam and other benzodiazepines take the brakes off activity of dopamine-producing neurons. April 19, 2012"
" New insights into the role of the GABAAbenzodiazepine receptor in psychiatric disorder DAVID J. NUTT, ANDREA L. MALIZIA, MRCPsych (2013)"
" Neurobiology of addiction and implications for treatment, ANNE LINGFORD-HUGHES, MRCPsych and DAVID NUTT, The British Journal of Psychiatry (2003)"
(and more but I'm too tired, lol)
So I'm thinking that maybe taking a high dose of benzos *for a short time* can kickstart a screwey, anhedonic brain's reward center by swiftly and potently increasing dopamine levels via further abrupt glutamate inhibition . Just enough to gain some motivation, get off the couch, shower for the first time in a week and clean up the house ;)
There's one catch though, this strategy might only work for people who are already taking a regular dose of benzos due to some complicated interplay between regular benzo intake and glutmatate/NMDA, which is ultimately responsible for the dopamine boost.
Tex's might have been right about those speculated receptors too, I'm thinking about the effect of enzos on NMDA receptors. Not to mention interneurons.
Wheew, okay, enough. I doubt any of this makes much sense. Pseudo-sciene mismash I know, lol, some of the stuff I've just finished reading is way over my head so I might be flat out wrong... And I'm certainly not encouraging people to binge on benzos, BTW. Like all meds, be judicious and careful. I'm just sharing what worked for me. Bottom line is, IME Tex's old post hit the nail on the head for me, and hopefully someone might benefit from this too.
But, as always, YMMV.
Posted by klein on April 26, 2014, at 2:22:08
In reply to Re: About SSRI-induced apathy » LouisianaSportsman, posted by Phillipa on April 25, 2014, at 22:40:17
> I've started and stopped benzos throughout the years. No one ever told me about withdrawal so I never had any. So for me they are not hard to stop or were not till was told addictive. Some on this board right now have recently gone off benzos. Phillipa
Phillipa, you didn't get any withdrawal from the benzos until you were told they were addictive?
Whenever I stop taking the Klonopin, I get mild symptoms... mostly really bad tinnitus and, strangely, I also get really tired, just exhausted I need lots of sleep. No anxiety etc. Weird.
Posted by porkpiehat on April 26, 2014, at 13:17:26
In reply to Re: About SSRI-induced apathy » Phillipa, posted by klein on April 26, 2014, at 2:22:08
I find this utterly fascinating. I have been taking micro doses of klonopin for almost three years in conjunction with 20mgs of Celexa.
I would agree that SSRI's create their own kind of apathy, albeit different from the depressive apathy that came before meds.
So if that is the case, that dopaminergic suppression is to blame for anhedonia, and one has access to methylphenidate (which I do), would it make sense to take that rather than up the Klonopin? Is one more of an actual "fix" than a band aid? So far, nothing has kicked my apathy's *ss like lamictal.
Great now I have another possible brain defect to obsess about!
Posted by Louisiana Sportsman on April 26, 2014, at 18:04:22
In reply to Re: About SSRI-induced apathy » LouisianaSportsman, posted by klein on April 26, 2014, at 1:49:54
I'm sure it wasn't a placebo effect, and maybe I was grumpy.
You didn't have to cite papers defining apathy and possible dopaminergic deficit. Let's cut to the chase.
Any addicting behavior is going to be dopaminergic in some regard or it wouldn't be so addicting and basically glutamate/NMDA mediates the activity of a wide spectrum of assorted goodies and are essential part of how your brain is able to function.
This is not news.
>
There's one catch though, this strategy might only work for people who are already taking a regular dose of benzos due to some complicated interplay between regular benzo intake and glutmatate/NMDA, which is ultimately responsible for the dopamine boost.
>No, it has nothing to do with benzo intake.
>
Tex's might have been right about those speculated receptors too, I'm thinking about the effect of enzos on NMDA receptors. Not to mention interneurons.
>Which interneurons? Sounds like you're grasping for straws here.
A benzodiazepine is counterintuitive to reduce apathy. It's like getting someone too drunk to care as an extreme example, it's going to end making the situation worse. Why not methylphenidate?
Posted by klein on April 26, 2014, at 19:48:20
In reply to Re: About SSRI-induced apathy, posted by porkpiehat on April 26, 2014, at 13:17:26
> I find this utterly fascinating. I have been taking micro doses of klonopin for almost three years in conjunction with 20mgs of Celexa.
>
> I would agree that SSRI's create their own kind of apathy, albeit different from the depressive apathy that came before meds.
>
> So if that is the case, that dopaminergic suppression is to blame for anhedonia, and one has access to methylphenidate (which I do), would it make sense to take that rather than up the Klonopin? Is one more of an actual "fix" than a band aid? So far, nothing has kicked my apathy's *ss like lamictal.
>
> Great now I have another possible brain defect to obsess about!Yeah, apparently it would make sense.
I resort to a benzo because I don't have access to methylphenidate, Provigil didn't work in this regard and Wellbutrin isn't practical as it takes a while to kick in. Lowering the dose of the SSRI also helps but takes time as well. The benzo strategy takes advantage of the benzo's dopamine releasing properties.
However, if your apathy is constant and low-grade, tweaking the dosage is probably the safest way to go.
Posted by Phillipa on April 26, 2014, at 20:41:07
In reply to Re: About SSRI-induced apathy » Phillipa, posted by klein on April 26, 2014, at 2:22:08
No I was young just 24 when started benzos for sheer panic attacks. At the time miltown was also used so I also took miltown with 5mg of valium TID. Also drank three beers at night. I cold turkeyed the miltown after about a year didn't need it. The doc at the time was open mouthed as hadn't had any withdrawal. But I didn't. Had three small children and had no problem caring for them. Was a home room mother, drove kids to after school activities, also had an aerobic dance business, and started RN school. Which I ended up graduating magna c*m Laude. During school I never ever drank a drop of alcohol. Only took a 5mg valium if I was in school and the stress was extremely high. When started working I completely stopped benzos. Had no need for them as was happy. As for drinking I would drink 3-4 beers after work as worked 3-11 shift in hospital. I would sleep soundly, wake and get to exercise, run errands whatever needed to be done. Then one day the SSRI's came out and a doc suggested I try Prozac. It raised my anxiety so high that by day three I was in panic mode which hadn't happened since the years ago when started taking benzos. flushed the Prozac down the toilet and in three days was back to normal. Then someone said that you could have seizures if you stopped benzos cold turkey which I had done many times prior. Now take lower doses none during the day. My nemesis is the darned luvox. Something in that med will not allow me to sleep even if take high doses of benzos. One doc said take 8mg of Ativan. I didn't sleep for 2 weeks. So returned to 25mg of luvox and then l0mg of valium and night slept soundly . Oh by then had been off all forms of alcohol for many years. Explain this to me please. Phillipa
Posted by LouisianaSportsman on April 27, 2014, at 0:29:04
In reply to Re: About SSRI-induced apathy » porkpiehat, posted by klein on April 26, 2014, at 19:48:20
>
> I resort to a benzo because I don't have access to methylphenidate.
>I understand. :)
Posted by klein on April 27, 2014, at 6:27:26
In reply to Re: About SSRI-induced apathy, posted by Louisiana Sportsman on April 26, 2014, at 18:04:22
> I'm sure it wasn't a placebo effect, and maybe I was grumpy.
>
> You didn't have to cite papers defining apathy and possible dopaminergic deficit. Let's cut to the chase.
>
> Any addicting behavior is going to be dopaminergic in some regard or it wouldn't be so addicting and basically glutamate/NMDA mediates the activity of a wide spectrum of assorted goodies and are essential part of how your brain is able to function.
>
> This is not news.Lousiana, I've been on a benzo for years -Klonopin first, now Valrelease- because they stabilize my mood and because sometimes I get bad anxiety (the anxiety has lessened considerable since I did CBT for a few months, so I've lowered the dosage down). I'm not addicted, I'm habituated.. bumping the dose for three days to get out of those horrible slumps isn't addictive behavior either, so far nothing else has worked.
> >
> There's one catch though, this strategy might only work for people who are already taking a regular dose of benzos due to some complicated interplay between regular benzo intake and glutmatate/NMDA, which is ultimately responsible for the dopamine boost.
> >
>
> No, it has nothing to do with benzo intake.
>
> >
> Tex's might have been right about those speculated receptors too, I'm thinking about the effect of enzos on NMDA receptors. Not to mention interneurons.
> >
>
> Which interneurons? Sounds like you're grasping for straws here.Sorry, that sounded esoteric, I was referring to the balance between GABAergic and glutamate neurons :)
> A benzodiazepine is counterintuitive to reduce apathy. It's like getting someone too drunk to care as an extreme example, it's going to end making the situation worse. Why not methylphenidate?
>My doctor won't prescribe it. I'm guessing that it could be very effective (though, except for the tretracyclics at high doses, all the stimulants I've tried have made me feel drowsy). So upping my benzos is the only solution I've found so far.
Posted by klein on April 27, 2014, at 6:41:02
In reply to Re: About SSRI-induced apathy » klein, posted by Phillipa on April 26, 2014, at 20:41:07
> No I was young just 24 when started benzos for sheer panic attacks. At the time miltown was also used so I also took miltown with 5mg of valium TID. Also drank three beers at night. I cold turkeyed the miltown after about a year didn't need it. The doc at the time was open mouthed as hadn't had any withdrawal. But I didn't. Had three small children and had no problem caring for them. Was a home room mother, drove kids to after school activities, also had an aerobic dance business, and started RN school. Which I ended up graduating magna c*m Laude. During school I never ever drank a drop of alcohol. Only took a 5mg valium if I was in school and the stress was extremely high. When started working I completely stopped benzos. Had no need for them as was happy. As for drinking I would drink 3-4 beers after work as worked 3-11 shift in hospital. I would sleep soundly, wake and get to exercise, run errands whatever needed to be done. Then one day the SSRI's came out and a doc suggested I try Prozac. It raised my anxiety so high that by day three I was in panic mode which hadn't happened since the years ago when started taking benzos. flushed the Prozac down the toilet and in three days was back to normal. Then someone said that you could have seizures if you stopped benzos cold turkey which I had done many times prior. Now take lower doses none during the day. My nemesis is the darned luvox. Something in that med will not allow me to sleep even if take high doses of benzos. One doc said take 8mg of Ativan. I didn't sleep for 2 weeks. So returned to 25mg of luvox and then l0mg of valium and night slept soundly . Oh by then had been off all forms of alcohol for many years. Explain this to me please. Phillipa
Well, I have no real explanations, lol, but I can sure relate. My mental health problems started with Prozac. I 20 and feeling anxious, so my GP put me on Prozac 20mg. He never warned of of its potentially severe side effects. By day 10, I was being carted to the ER on a nightly basis (sometimes twice a day) because I felt like I was dying. I'd never even heard of panic attacks before.
Why is Luvox your nemesis if it's helping? Luvox inhibits a bunch of enzymes, even though you're only on Valium 10mg your blood levels of diazepam and whatever metabolites you're getting are probably higher than the norm.
Posted by klein on April 27, 2014, at 6:44:08
In reply to Re: About SSRI-induced apathy, posted by LouisianaSportsman on April 27, 2014, at 0:29:04
> >
> > I resort to a benzo because I don't have access to methylphenidate.
> >
>
> I understand. :)LOL, thanks:) My doc won't prescribe it. It's just as well, I'd be slightly concerned about dependence. Benzos don't worry me, I don't get a high from them or anything like that, in fact (except when I'm struggling with apathy) they make me, depressed, so I try to keep the doses as low as possible. Started Valrelease just a couple of weeks ago, much milder than Klonopin.
Posted by Phillipa on April 27, 2014, at 19:54:06
In reply to Re: About SSRI-induced apathy » Phillipa, posted by klein on April 27, 2014, at 6:41:02
My pdoc thinks I take l0mg of valium and lmg Xanax and 50mg of luvox & 2.5mg of Lexapro. Which the Lexapro take a crumb of it. This doc did some type of metabolism test to show if I was metabolizing the meds as prescribed. I do think he wanted to see if I abused them. Results can back and was exactly as they should be. So if raising the metabolites it's not much at all. Phillipa
Posted by porkpiehat on April 29, 2014, at 16:22:48
In reply to Re: About SSRI-induced apathy » klein, posted by Phillipa on April 27, 2014, at 19:54:06
OK this is bizzare:
Today, sick of the low-grade apathy and spaciness that I'm having with the Brintellix, I took .25mgs of Klonopin based upon the earlier discussions re: benzos.
My mood and energy have shot through the roof. Verging on hypomania. Dunno. But I assumed a benzo would make me groggier.
I'd be interested in anyone's theories about this. It feels to good to be true and is probably unsustainable.
Posted by klein on April 29, 2014, at 17:36:30
In reply to Re: About SSRI-induced apathy, posted by porkpiehat on April 29, 2014, at 16:22:48
> OK this is bizzare:
>
> Today, sick of the low-grade apathy and spaciness that I'm having with the Brintellix, I took .25mgs of Klonopin based upon the earlier discussions re: benzos.
>
> My mood and energy have shot through the roof. Verging on hypomania. Dunno. But I assumed a benzo would make me groggier.
>
> I'd be interested in anyone's theories about this. It feels to good to be true and is probably unsustainable.
I have no idea how or why it works. In another post I cited a few articles which claim that benzos somehow boost dopamine (?). Maybe someone will be able to find more info about this. There are a few rehab websites out there claiming that, like alcohol, benzos can be highly addictive because they increase dopamine, hitting the brain's reward pathway.Or maybe it's just disinhibition.
I find that I only need the boost for 2 or 3 days, just to get into gear, then I'm fine til the apathy hits again. I'm careful about not abusing them (I've never experience a "high" from benzos).
Maybe this isn't the place to discuss the following, but on a psychological level, unconscious anxiety is a big factor. Like the original poster postulated back in 2002, maybe apathy is a result of anxiety. Benzos could relieve it (I'm guessing that gabapentin and pregabalin could work as well).
Anyway, I'm glad this method is working for you :)
Posted by Phillipa on April 29, 2014, at 20:54:25
In reply to Re: About SSRI-induced apathy » porkpiehat, posted by klein on April 29, 2014, at 17:36:30
I feel the lifting of anxiety allows one to be relaxed so they just feel like their old selves. Phillipa
Posted by klein on April 29, 2014, at 21:59:42
In reply to Re: About SSRI-induced apathy, posted by Phillipa on April 29, 2014, at 20:54:25
> I feel the lifting of anxiety allows one to be relaxed so they just feel like their old selves. Phillipa
Exactly! The mechanism by which SSRIs and SNRIs produce an anxiolytic effect is speculative :
http://www.sciencedirect.com/science/article/pii/S0149763411001710
And there's a fine line between feeling calm and feeling numb and apathetic.
We know how benzos work, the mechanism is pretty straightforward (thought the dopamine thing remains to be seen?)
My coarse theory:
I believe SSRIs and benzos compliment each other. Maybe average doses of SSRIs (say Zoloft 50mg) are sufficient to control most people's anxiety and depression. But some of us need much higher doses and "cocktails" to control severe major depression, and the anxiolytic effect of the medication becomes overwhelming. The solution seems to be to either lower the dose of the AD (and risk relapse) or add a booster. A short course of extra benzos is what works for me.
I'm not a psychopharmacologist or anything like that, so I might be wrong. Bottom line (to me at least) is, if it works, then go for it.
Posted by Phillipa on April 30, 2014, at 20:29:47
In reply to Re: About SSRI-induced apathy » Phillipa, posted by klein on April 29, 2014, at 21:59:42
And I whole Heartedly agree with you. Phillipa
Posted by Beckett on May 3, 2014, at 1:19:41
In reply to Re: About SSRI-induced apathy » Phillipa, posted by klein on April 29, 2014, at 21:59:42
Here's my experiences. After a soul deadening bout of anhedonia, dexedrine broke the strangle hold. What brought about this anhedonia, (the depth of which I had never experienced even during extreme depression), was a nine month course of an AAP, a dopamine antagonist.
Xanax would give me energy if I took enough to surpass my tolerance. I always chalked that up to anxiety relief.
Interesting discussion.
Posted by porkpiehat on May 3, 2014, at 16:41:12
In reply to Re: About SSRI-induced apathy, posted by Beckett on May 3, 2014, at 1:19:41
YUP! I had the same thing happen when I stopped taking Abilify after six months or so. Worse depression EVER!
That being said, the benzo effect seems to have abated after three days. Now I am just as sedated and apathetic. Weird, because I felt REALLY high/hypomanic for a couple of days after dosing small amounts of Klonopin.
I was hoping that going up on Brintellix would give an energizing effect (25mgs as of today) but zip.
Time to eat a few ritalin I guess. SAD TROMBONE
Posted by klein on May 4, 2014, at 15:10:55
In reply to Re: About SSRI-induced apathy, posted by Beckett on May 3, 2014, at 1:19:41
> Here's my experiences. After a soul deadening bout of anhedonia, dexedrine broke the strangle hold. What brought about this anhedonia, (the depth of which I had never experienced even during extreme depression), was a nine month course of an AAP, a dopamine antagonist.
>
> Xanax would give me energy if I took enough to surpass my tolerance. I always chalked that up to anxiety relief.
>
> Interesting discussion.Beckett,
Anxiety relief definitely plays a role here. I Tex1's post very interesting, even if it's completely inaccurate.
I can see how dexedrine would help. My doc (who's aware of my past alcohol addiction) is very anti-stimulants, he's willing to try just about anything I mention, but if I bring up amphetamines I get a flat-out NO!! Lol.
Posted by klein on May 4, 2014, at 15:12:57
In reply to Re: About SSRI-induced apathy » Beckett, posted by porkpiehat on May 3, 2014, at 16:41:12
> YUP! I had the same thing happen when I stopped taking Abilify after six months or so. Worse depression EVER!
>
> That being said, the benzo effect seems to have abated after three days. Now I am just as sedated and apathetic. Weird, because I felt REALLY high/hypomanic for a couple of days after dosing small amounts of Klonopin.
>
> I was hoping that going up on Brintellix would give an energizing effect (25mgs as of today) but zip.
>
> Time to eat a few ritalin I guess. SAD TROMBONEHey PPH,
Too bad that the benzo effect pooped out. I only use the increased dose for a few days, just enough to get going, otherwise I'd probably just build more tolerance and feel zombified again.
Posted by Beckett on May 7, 2014, at 2:40:09
In reply to Re: About SSRI-induced apathy » Beckett, posted by klein on May 4, 2014, at 15:10:55
Amphetamines take considerable monitoring by psychiatrists, and I think that's why many will not scrip them. Have you tried Wellbutrin? It helped me focus for awhile. Maybe you have already tried it. For myself, I find it difficult to doctor shop. But maybe in your case a doctor who will treat ADHD. Dexedrine was wonderful, but I built such an awful tolerance very quickly.
Posted by klein on May 7, 2014, at 3:04:22
In reply to Re: About SSRI-induced apathy » klein, posted by Beckett on May 7, 2014, at 2:40:09
> Amphetamines take considerable monitoring by psychiatrists, and I think that's why many will not scrip them. Have you tried Wellbutrin? It helped me focus for awhile. Maybe you have already tried it. For myself, I find it difficult to doctor shop. But maybe in your case a doctor who will treat ADHD. Dexedrine was wonderful, but I built such an awful tolerance very quickly.
Well, my doc knows about my past alcohol dependence and he still prescribes me benzos liberally (and I've never abused them and he knows it). But he won't prescribe stimulants.
He does prescribe Wellbutrin, which helps (the SR version packs more of a punch than XL and Provigil . My tolerance for both has really increased though, I'm going to drop them to see if it works.
}Thanks Beckett =)
Posted by Beckett on May 7, 2014, at 19:16:48
In reply to Re: About SSRI-induced apathy » Beckett, posted by klein on May 7, 2014, at 3:04:22
Amphetamine is scheduled differently. It the highest category. (Does it share a schedule ranking with some narcotics?). Imoe, certain pharmacies refuse to dispense them. Doctorswho scrpt them can get flagged. But all this you already know. I wish you luck with your ADHD treatment. Right now I don't have any.
Posted by klein on May 7, 2014, at 19:41:52
In reply to Re: About SSRI-induced apathy » klein, posted by Beckett on May 7, 2014, at 19:16:48
> Amphetamine is scheduled differently. It the highest category. (Does it share a schedule ranking with some narcotics?). Imoe, certain pharmacies refuse to dispense them. Doctorswho scrpt them can get flagged. But all this you already know. I wish you luck with your ADHD treatment. Right now I don't have any.
Thanks... I don't think I have ADHD though. I worded my post incorrectly, I'm currently taking Provigil (which I'm going to drop) and start Wellbutrin.
I'd really like to try amphetamines but I'm not willing to challenge my doc. He's adamant about it, he claims they are too addictive and that they may induce psychotic episodes (!?). Maybe one of his patients had a bad experience on them, I dunno.
Posted by Englishman006! on January 1, 2021, at 5:00:48
In reply to About SSRI-induced apathy, posted by klein on April 24, 2014, at 23:56:30
> Sometimes SSRI apathy hits me like a rock. Or it used to.
>
> I searched Babble extensively, Pubmed, etc nothing seemed to work until I eventually struck gold. I found this here in Babble a couple of years ago:
>
> "Posted by tex1 on May 2, 2002, at 4:56:03
>
> ... Anyway, I believe that apathy syndrome has nothing to do with apathy at all, but with anxiety most. I wouldn't treat it by using stimulant, but better with benzos or buspirone. Apathy infact is a sort of hyperstimulation of certain receptors (even if it's hard to believe it). Say to your pdoc to have a try with a benzo. You'll see results..."
>
> Here's the link:
>
> http://www.dr-bob.org/babble/20020425/msgs/104728.html
>
> I don't know if Tex1 is still around, he or she posted this 12 years ago. But Tex, wherever you are, you are a genius!
>
> I have no idea where this theory came from, it sounds completely counter-intuitive, maybe someone is more in the know and can explain how it works.
>
> And it does work! Or at least it worked for me. At the time I was on Paxil and struggling with anhedonia, apathy and lack of motivation. Desperate. I could barely get out of bed. When I read Tex's post, I asked my doc if I could give it a try. I was on 1mg Klonopin at the time.
>
> So he told me to go ahead and gave me diazepam to... experiment with (yeah he really trusts me).
>
> Two days after adding the Valium (about 30mg/day), the anhedonia vanished. It was nothing short of a miracle. After a while I dropped the diazepam and felt fine. I've used this strategy several times since. Maybe it's benzo-induced disinhibition... Any ideas?
>
> OK, I don't know if this is the right place to post this but, as so many people here (including lurkers) suffer from the infamous apathy syndrome, I just wanted to put it out there, hopefully it might just help someone else.
>
> (thanks Tex!!)Hi klein if you're out there. I have long suffered with apathy. First it was induced by prozac but it was insidious and I didn't know I had it because there was no name for it in the early 90's. It has been my only complaint for a long time. The dex and memantine were amazing for about two years, then in 2005 Lamictal was added and I was well (apart from the apathy) for the next ten years until my stroke. Then I suffered until recently when I quit my blood pressure and cholesterol meds. Now I'm currently enjoying one of the best periods of my life. And I think it's down to you. There is some fine tuning to be done but it appears the diazepam theory works. So klein if your still around maybe I'll get to thank you! God knows I've tried nearly every other idea but yours seems the best one so far. So thank you again!
Shaun
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