![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by jimmygold70 on May 30, 2001, at 9:27:29
I'm so lazy. I can't motivate myself to do anything. Acually (though my physical condition can't justify that) I function like I'm 100% handicapped. Everything goes on so slowly, nothing gets done.
I have been diagnosed with Borderline Personality Disorder, rapid-cycling bipolar disorder, social phobia, whatever... My shrink says that my laziness is a part of my pseronality structure he's seen with other borderlines, and that he can do nothing about it.
What am I gonna do about that ? Any ideas ? Meds that do the job ?
Jimmy
(Thanks god I made it that far (-: )
Posted by SalArmy4me on May 30, 2001, at 10:43:03
In reply to Motivation ?!, posted by jimmygold70 on May 30, 2001, at 9:27:29
I was thinking of an antidepressant that would stimulate you, like fluoxetine, buproprion, tranylcypromine, protriptyline, or selegiline.
Posted by Jane D on May 30, 2001, at 16:04:18
In reply to Motivation ?!, posted by jimmygold70 on May 30, 2001, at 9:27:29
> I'm so lazy. I can't motivate myself to do anything. Acually (though my physical condition can't justify that) I function like I'm 100% handicapped. Everything goes on so slowly, nothing gets done.
>
> I have been diagnosed with Borderline Personality Disorder, rapid-cycling bipolar disorder, social phobia, whatever... My shrink says that my laziness is a part of my pseronality structure he's seen with other borderlines, and that he can do nothing about it.
>
Jimmy,I've never been sure just what "personality structure" means. I tend to suspect it really means "we don't know how this works yet". Once we find drugs that work on a set of symptons we stop describing the symptons as personality. SSRI's helped do this for BPD, atypical depression, OCD. Motivation may be the next to follow.
If what you've experienced is specifically low energy then Sal's list of suggestions may help. I personally think that motivation can be separate from energy. If it IS a separate problem, SSRI's like fluoxetine may not be a good choice. They may really be part of the problem.
You might want to take a look at the following from the "Tips" link at the top of the page. The first link mentions SSRI's causing motivation problems. The second discusses a mechanism. Keep in mind that both are several years old. So far as I know the ideas in them are not outdated but I'm not sure.
http://www.dr-bob.org/tips/split/SSRIs-and-apathy.html
http://www.dr-bob.org/tips/split/Reboxetine.htmlJane
Posted by JAMMER on May 30, 2001, at 16:08:52
In reply to Motivation ?!, posted by jimmygold70 on May 30, 2001, at 9:27:29
> I'm so lazy. I can't motivate myself to do anything. Acually (though my physical condition can't justify that) I function like I'm 100% handicapped. Everything goes on so slowly, nothing gets done.
>
> I have been diagnosed with Borderline Personality Disorder, rapid-cycling bipolar disorder, social phobia, whatever... My shrink says that my laziness is a part of my pseronality structure he's seen with other borderlines, and that he can do nothing about it.
>
> What am I gonna do about that ? Any ideas ? Meds that do the job ?
>
> Jimmy
> (Thanks god I made it that far (-: )I like to make "to do" lists when I feel that way. Any tasks or projects that come to mind, keeping the initial list short. I pick the easiest item and force myself to do it, something simple. Usually the feeling of accomplishment encourages me to try another simple task or project. Pick things you know you can get done, and commit yourself to doing it.
Sometimes it takes forcing ourselves a few times to get "back in the game"...and seeing and feeling progress seems to generate motivation...
Good luck,
James
Posted by Elizabeth on May 30, 2001, at 16:18:45
In reply to Motivation ?!, posted by jimmygold70 on May 30, 2001, at 9:27:29
Jimmy --
Don't take stigmatising labels from psych professionals too seriously. Psychiatrists, psychologists, et al. who say things to patients like "you're lazy" or "your personality is flawed" are making things worse, not better (even in cases when what they're saying is true).
If I were in your situation, I'd look into treatments known to be effective for ADHD. This mainly means psychostimulants like Ritalin and amphetamine, but some antidepressants such as Wellbutrin and the monoamine oxidase inhibitors are also effective in some cases.
G'luck.
-elizabeth
Posted by jimmygold70 on May 30, 2001, at 17:02:08
In reply to Re: Motivation ?! » jimmygold70, posted by Elizabeth on May 30, 2001, at 16:18:45
Elizabeth,
I have tried amphetamines for daytime fatigue a couple of years ago. They do work for motivation and drive, but they make my anxiety so bad...
Jimmy
Posted by jimmygold70 on May 30, 2001, at 17:09:48
In reply to Re: Motivation ?!, posted by SalArmy4me on May 30, 2001, at 10:43:03
I've tried fluoxetine up to 60mg with little success. I tried bupropion - it is extremely expensive for me. It was in a time when I had better motivation, so I can't say much about its efficiency.
Nardil did so many side effects, so I can't think of anything that works on MAO-A, like tranylcypromine.
How are protriptyline or selegiline tolerated ? I know the first has many CV side effects, and the second might be bad for me - I have obsessional thoughts, so they once put me on Risperdal. Won't selegiline do the opposite ?
What do you say about Effexor ? and Reboxetine ?
Jimmy
> I was thinking of an antidepressant that would stimulate you, like fluoxetine, buproprion, tranylcypromine, protriptyline, or selegiline.
Posted by Elizabeth on May 30, 2001, at 17:10:06
In reply to Re: Motivation ?! » Elizabeth, posted by jimmygold70 on May 30, 2001, at 17:02:08
> I have tried amphetamines for daytime fatigue a couple of years ago. They do work for motivation and drive, but they make my anxiety so bad...
How about MAO inhibitors?
-e
Posted by jimmygold70 on May 30, 2001, at 17:16:05
In reply to Re: Motivation ?! » jimmygold70, posted by Jane D on May 30, 2001, at 16:04:18
Jane, I agree.
I am taking Celexa and Depakote right now. I have tried fluoxetine and all the SSRIs with little results. I fear they make things worse for me, though improving my anxiety.
Jimmy
Posted by jimmygold70 on May 30, 2001, at 17:18:07
In reply to Re: Motivation ?! » jimmygold70, posted by Elizabeth on May 30, 2001, at 17:10:06
I have tried Nardil with little results and too many side effects about five years ago. I have also tried Manerix, but felt nothing (good or bad).
Jimmy
> How about MAO inhibitors?
>
> -e
Posted by Elizabeth on May 30, 2001, at 17:22:55
In reply to Re: Motivation ?! » Elizabeth, posted by jimmygold70 on May 30, 2001, at 17:18:07
> I have tried Nardil with little results and too many side effects about five years ago. I have also tried Manerix, but felt nothing (good or bad).
Parnate? Selegiline? (Deprenyl in Europe)
Do you feel like the Depakote is doing you any good? Have you tried other augmentation strategies with SSRIs? Maybe a stimulant-SSRI combination would solve the problem of stimulant-induced anxiety. Also, slow-release stimulants, and a long-acting, mild stimulant called pemoline, might be less anxiogenic.
-e
Posted by blackjack on May 30, 2001, at 17:29:47
In reply to Re: Motivation ?! » Elizabeth, posted by jimmygold70 on May 30, 2001, at 17:18:07
> I have tried Nardil with little results and too many side effects about five years ago. I have also tried Manerix, but felt nothing (good or bad).
Keep in mind that Parnate has a slightly different side-effect profile from Nardil. Parnate _usualy_ isn't sedating (tho it is for some), and is, in fact, often quite activating. It also doesn't tend to cause weight-gain. It does have the same problems with orthostatic hypotension (dizzyness when standing) and dietary restrictions.
Posted by jimmygold70 on May 30, 2001, at 17:30:27
In reply to Re: Motivation ?!, posted by Elizabeth on May 30, 2001, at 17:22:55
I don't trust Pemoline to be any better than Nardil. About Selegeline - can you please describe the popular side effects ? I think this might be an option.
> Do you feel like the Depakote is doing you any
>good? Have you tried other augmentationIt does improve my anxiety, make me talk much less. Can say much about mood swings. Also makes me gain weight. Worse, I can no longer enjoy drinking alcohol.
>strategies with SSRIs? Maybe a stimulant-SSRI
>combination would solve the problem of stimulant-
>induced anxiety. Also, slow-release stimulants,
>and a long-acting, mild stimulant called
>pemoline, might be less anxiogenic.I tried Ritalin, fenethyline (available here, sort of a short acting amphetamine), all made me anxious. The latter was stronger and better. Ritalin made me really depressed.
Cylert (pemoline) made me less anxious than the other, but still anxious. It is helpful with concentration and motivation, though...
Posted by jimmygold70 on May 30, 2001, at 17:34:48
In reply to Re: Motivation ?!, posted by blackjack on May 30, 2001, at 17:29:47
Ye, but it still causes constipation, from which I gained 20 pounds while on Nardil. I never gained so much weight from all drugs I have taken combined.
Jimmy
> Keep in mind that Parnate has a slightly different side-effect profile from Nardil. Parnate _usualy_ isn't sedating (tho it is for some), and is, in fact, often quite activating. It also doesn't tend to cause weight-gain. It does have the same problems with orthostatic hypotension (dizzyness when standing) and dietary restrictions.
Posted by Elizabeth on May 31, 2001, at 3:40:37
In reply to Re: Motivation ?! » blackjack, posted by jimmygold70 on May 30, 2001, at 17:34:48
> Ye, but it still causes constipation, from which I gained 20 pounds while on Nardil. I never gained so much weight from all drugs I have taken combined.
The weight gain on Nardil is not due primarily to constipation. Parnate doesn't cause weight gain. Metamucil is very helpful for constipation, BTW.
Have you tried any mood stabilisers besides Depakote?
Modafinil and adrafinil are nonamphetamine stimulants that might cause less anxiety.
-elizabeth
Posted by BrendaF on May 31, 2001, at 10:54:11
In reply to Motivation ?!, posted by jimmygold70 on May 30, 2001, at 9:27:29
Hey Jimmy! I know exactly what you mean about being lazy. I have the same problem! I asked my psych one day if he thought I was just lazy and he said if that were the case, I probably wouldn't be bothered by the fact. Made sense to me. And I'm DEFINITELY bothered! I've been taking AD's for about 10yrs. Tried Prozac+Ritalin, Effexor+Ritalin, and am now on Wellbutrin SR 150mg x2. Between the Effexor and Wellbutrin, I had a sleep study done and found I had something similar to sleep apnea and now sleep with a CPAP. That has made a big difference in sleepiness.......but not in motivation--and I was sooo sure it would! :( I haven't gotten back on the Ritalin because I didn't like coming down from it. I've read lots of posts about the Adrafinil and ordered some from overseas about a week ago. I'm anxiously waiting for it to arrive (I hear it takes approx 3-4 weeks). I'm praying this is the answer to my problem. I hate feeling like life is just some big obligation till we're released thru death. I'm not suicidal now (although, I do think about what a relief death would be), but gosh, I'm 35yrs old and have a long way to go. I can't stand the thought of feeling like this from now on. It's like a 24hr job that you find boring and uninspiring. I want to WANT to get up in the morning.
Of course, people try to help with very good intentions. They say to make lists, start small, get out and do something for yourself......but, if you're like me, it's beyond just "making" yourself do something. Hell, if you have to "make" yourself do something enjoyable......you can forget about the stuff that's not fun. In addition to depression (atypical, dysthymia) I have a mild case of social phobia. Hoping the Adrafinil helps with that, too. You should do a search on it and read the past posts, they're pretty good.
Good luck!
Posted by jimmygold70 on May 31, 2001, at 19:33:57
In reply to Re: Motivation ?!, posted by BrendaF on May 31, 2001, at 10:54:11
Folks, I saw my PDoc today, and he put me on Reboxetine. I feel much more motivated (after only 1 pill, maybe just a placebo effect). I also feel very irritated and angry. Lets hope that side effect will go away... I also had stomachache this evening. That should go away too.
Posted by jimmygold70 on May 31, 2001, at 19:37:13
In reply to Re: Motivation ?!, posted by BrendaF on May 31, 2001, at 10:54:11
Brenda,
Seems like we both have the same story. I had sleep apnea, I treated it with a nose surgery. Now I have no apnea, my sleep is better, but motivation is low.
I took modafinil a year ago and it did very little. It makes you more awake, not more motivated. Maybe it will affect you differently. It is so selective for the brain activating system, that I can hardly believe it has anything to do with motivation and the like.
Read my previous post on this thread about my new addition of Reboxetine.
Jimmy
Posted by Elizabeth on May 31, 2001, at 21:03:35
In reply to Re: Motivation ?! » SalArmy4me, posted by jimmygold70 on May 30, 2001, at 17:09:48
> Nardil did so many side effects, so I can't think of anything that works on MAO-A, like tranylcypromine.
Parnate has very different side effects than Nardil. I wouldn't rule it out.
-e
Posted by Kristi on June 1, 2001, at 9:15:18
In reply to Re: Motivation ?! » jimmygold70, posted by Elizabeth on May 31, 2001, at 21:03:35
Hi! I realize this is going to sound to easy. I have tried many ssri's and whatnot for motivation(chronic fatigue syndrom) but you know what has helped me the most? Vitamin B12 complex. I was so suprised. I wasnt expecting a difference.. in fact, expected it to do nothing... but it really gave me a lot of energy. I take one in the morning and one in the afternoon. I never thought this easy fix would work for me but it did. Now I'm non stop. I realize I'm probably not the norm..... but it really has worked amazingly for me.... it's inexpensive... why not give it a shot along with whatever else your taking? I realize everyone's different... but boy, was I suprised!!! Good luck to everyone with this problem, I know how frustrating it is. Take care, Kristi.
> > Nardil did so many side effects, so I can't think of anything that works on MAO-A, like tranylcypromine.
>
> Parnate has very different side effects than Nardil. I wouldn't rule it out.
>
> -e
Posted by JohnL on June 1, 2001, at 14:46:19
In reply to Motivation ?!, posted by jimmygold70 on May 30, 2001, at 9:27:29
For hypo-motivational symptoms I think the best meds are the ones that focus on norepinephrine and/or dopamine D2.
For me what has worked incredibly well is the combination of Adrafinil and Zyprexa, both at minimum doses, with a little Prozac in the background. These three meds, in my opinion, should be put at the top of the list before anything else. Any one of them, or any combo of them. I am a little biased because they have worked so well for me, but there is also plenty of evidence suggesting these are top drugs for hypo-motivational symptoms. Amisulpride is a strong contender as well instead of Zyprexa.
Posted by Elizabeth on June 3, 2001, at 21:03:53
In reply to Re: Motivation ?!, posted by JohnL on June 1, 2001, at 14:46:19
> For hypo-motivational symptoms I think the best meds are the ones that focus on norepinephrine and/or dopamine D2.
My experience has been that the opioids are the most effective drugs for this. This is pretty weird since they have the opposite reputation. It also sucks because they have very heavy side effects. I'd much rather be on stimulants or antidepressants.
> For me what has worked incredibly well is the combination of Adrafinil and Zyprexa, both at minimum doses, with a little Prozac in the background. These three meds, in my opinion, should be put at the top of the list before anything else.
That's surprising (perhaps even more surprising than my reaction to opioid agonists). Antipsychotics tend to be anti-motivational for most people. My response to Moban (which I think I've discussed elsewhere, although it's hard to describe) was an extreme example of this (I experienced the other antipsychotics I've taken as merely sedating).
Amisulpride is an exception because of its differing effects at high vs. low doses.
Also, many people suffer an amotivational syndrome after long-term use of SSRIs. I wouldn't necessarily recommend these, either.
-elizabeth
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.