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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by Margit on November 30, 2001, at 22:59:11
I thought that they are the same thing, but I read a lot of post talking about anhedonia while others talk about apathy. I am also interested which meds respond best to either. Thanks for any responses.
Posted by JohnX2 on November 30, 2001, at 23:15:07
In reply to What is the difference between anhedonia + apathy?, posted by Margit on November 30, 2001, at 22:59:11
Anhedonia is the complete inability to
experience pleasure. That may include even
experiencing pleasure from stimulants, sex,
whatever. I think this is more of a blanket
symptom of depression, so it would be more
of a crapshoot as to which direction to take.
I would assume one would start with an SSRI,
and if that failed, try Wellbutrin or Effexor,
and if that failed, try an MAOI inhibitor or
a mood stabilizer like Lamictal.One could be apathetic, (not interested in
doing anything), but still be able to experience
pleasure. For example, I may get pleasure from
alcohol and drink a lot, but do nothing else with
my life because of apathy.Generally apathy respons well to noradrenergic/dopaminergic
meds. Wellbutrin, Effexor may work of the more
prescribed meds. The more activating SSRIs Prozac
and Zoloft may help too. Stimulants like Adderall
definately help. The Maoi inhibitors Parnate or
Selegiline are other choices.These are my thoughts. Other people may have
varying viewpoints.regards,
john> I thought that they are the same thing, but I read a lot of post talking about anhedonia while others talk about apathy. I am also interested which meds respond best to either. Thanks for any responses.
Posted by ChrisK on December 1, 2001, at 4:27:35
In reply to What is the difference between anhedonia + apathy?, posted by Margit on November 30, 2001, at 22:59:11
I agree with John's definitions but would like to add that Mirapex has been a great drug for me when it comes to fighting off anhedonia/apathy. It's another med that targets dopamine that I've been taking for almost a year now. I really notice a difference in my interest in things and my ability to enjoy things that once did nothing for me.
I would reccomend it to anyone who has a problem with anhedonia.
Chris
> I thought that they are the same thing, but I read a lot of post talking about anhedonia while others talk about apathy. I am also interested which meds respond best to either. Thanks for any responses.
Posted by mist on December 1, 2001, at 11:52:40
In reply to Re: What is the difference between anhedonia + apathy?, posted by ChrisK on December 1, 2001, at 4:27:35
Chris, has Mirapex had any bothersome side effects for you? I would like something to treat apathy/anhedonia too, but don't want a drug that's going to make me feel worse than what it's supposed to treat (as has happened to me). I'm afraid among other things of gaining a lot of weight from a med,since too many of them seem to have that effect.
Also does Mirapex work best by itself, or in augmenting other meds?
Thank you. -mist
> I agree with John's definitions but would like to add that Mirapex has been a great drug for me when it comes to fighting off anhedonia/apathy. It's another med that targets dopamine that I've been taking for almost a year now. I really notice a difference in my interest in things and my ability to enjoy things that once did nothing for me.
>
> I would reccomend it to anyone who has a problem with anhedonia.
>
> Chris
>
> > I thought that they are the same thing, but I read a lot of post talking about anhedonia while others talk about apathy. I am also interested which meds respond best to either. Thanks for any responses.
Posted by Margit on December 1, 2001, at 14:41:41
In reply to What is the difference between anhedonia + apathy?, posted by Margit on November 30, 2001, at 22:59:11
According to your description I seem to have both anhedonia and apathy. I sit most of the day on the couch, not wanting to do anything and I haven't experienced pleasure and joy in a long time. I suffer from dysthymia, PD, and mild OCD. I take 30mg Celexa; we tried to up it but it makes me more apathetic and tired. My doc upped my Zyprexa from 2.5 to 5 about 3 days ago, but I feel no improvement mood wise. For the PD I take Xanax. Before I was on Pamelor, couldn't go up to a therapeutic level, because of heart racing and other side effects. Then we tried Paxil for 5 months (I had wondeful results with Paxil years ago), but this time no luck. An increase made me more apathetic and depressed. Now I am on Celexa. I feel tired all the time, have no interest in anything and just vegetate my life away. My stomach is also very sensitive when it comes to SSRIs.
Sine you seem to have some knowledge about brain chemistry , I was wondering what you think would be a good approach. Oh, the intital 2.5 Zyprexa helped me some with my depression and panic. But from what I have read, results with Zyprexa are to be noted in the first 3-4 days. I havent noticed anything yet, since we upped the dose.
I have a script for Prozac, but I am afraid to take it (acid reflux). I also take a very small amount of Ritalin, which I cannot increase, because it makes me panicky.
I was thinking about the Effexor; would that help for OCD? I have been in this relaps now for 1 1/2 years and with time passing it doesn't get any better.
Anybody, what are your med cocktails and how would you approach my problem? Thank you for any information you can give me.
Posted by ChrisK on December 1, 2001, at 15:50:01
In reply to mirapex for anhedonia/apathy - question » ChrisK, posted by mist on December 1, 2001, at 11:52:40
Hi,
First I would definitely consider Mirapex as an augmenting med rather than a stand alone. It was really developed for people with Parkinson's but was found to have good AD effects in these patients. It really hasn't been recognized widely as an AD med. (I had to tell my pdoc about it and give him the studies before he was willing to try it. Since then he has had other patients use it successfully.)
Anyway as far as side effects try this site :
http://www.rxlist.com/cgi/generic2/prampex_ad.htmIt will give you the standard med profile that lists the typical somnolence, nausea, etc.. Nausea does appear to be one of the main side effects. The usual process of starting Mirapex is a very slow titration up to theraputic levels. Most of the literature suggests starting at .125 mg 3 times per day to start and then slowly building to 3-6 mg/day total.
The one very bad side effect that gets some mention that I have is a sudden drop or sudden sleep condition. I can go right along and then sudeenly feel an overwhelming drowsiness come on. This usually happens in a place with limited air circulation or where I may get short of breath but it does happen. It can be especially scary when driving but I have always been able to fight through the urge.
I do tkae Mirapex with Nortriptyline and Zyprexa. I also take about 7 other meds for heart and liver conditions so my particular side effects are very open as to a direct link to one med.
Hope this helps a little.
I still think that Mirapex is great for anhedonia. It's worth a try - just start out slowly if you usually have nausea problems with meds.
Chris
Posted by Willow on December 1, 2001, at 18:12:46
In reply to mirapex for anhedonia/apathy - question » ChrisK, posted by mist on December 1, 2001, at 11:52:40
> I'm afraid among other things of gaining a lot of weight from a med,since too many of them seem to have that effect.
MistI've made a second attempt of using mirapex for periodic limb movements, which it helped the first time but affected my thinking severly and the second time it seemed to make my legs more painful, and this second time I gained weight quickly. Over ten pounds in one month!
It's all on my waist, I look like I'm five months pregnant. No other medication has done this to me and I have to admit that I was skeptical when I read about it happening to others. Wether it affects you this way you may need to try it to see?
BEST WISHES
Willow
Posted by Jenna S. on December 1, 2001, at 18:39:35
In reply to Re: mirapex for anhedonia/apathy - question, posted by ChrisK on December 1, 2001, at 15:50:01
> First I would definitely consider Mirapex as an augmenting med rather than a stand alone. It was really developed for people with Parkinson's but was found to have good AD effects in these patients. It really hasn't been recognized widely as an AD med. (I had to tell my pdoc about it and give him the studies before he was willing to try it. Since then he has had other patients use it successfully.)
>
I'm glad Mirapex is working for you. I have anhedonia, I've taken very many antidepressants, none of which really touch the anhedonia. I asked my pdoc about Mirapex a few weeks ago and he wasn't too keen. But I'm not going to give up that easily! So I was wondering if you would let me know which studies convinced your pdoc to let you try Mirapex?Jenna
Posted by JohnX2 on December 2, 2001, at 1:09:54
In reply to Re: To John, Chris and others - question, posted by Margit on December 1, 2001, at 14:41:41
Its hard to predict exactly how someone would
respond to meds, but here are a few thoughts:Remeron has a property that inhibits nausea.
Prozac and Zoloft of the SSRIs are probably
the most "acivating" (give more energy, drive).
But both can upset your stomach. Effexor is
another option. Prozac, Zoloft, and Effexor
can all treat OCD. You could pick one of those
meds and if nausea is a problem, add a low dose
of Remeron.My med cocktail is Lamictal 150 mg, Klonopin 6 mg,
Zyprexa 5 mg. But my issues and responses are
vastly different from yours. Paxil was a disaster
for me. Plus I don't have OCD.It seems that both Celexa and zyprexa can have
a drowsiness side effect. Maybe that is what is
making you feel down. Another thought is to
add in a dose of Wellbutrin. This can be activating
too.Your primary risk is that you probably need to
switch to a more activating med, but that may
cause anxiey/panic side effects.just my 2c.
good luck,
john> According to your description I seem to have both anhedonia and apathy. I sit most of the day on the couch, not wanting to do anything and I haven't experienced pleasure and joy in a long time. I suffer from dysthymia, PD, and mild OCD. I take 30mg Celexa; we tried to up it but it makes me more apathetic and tired. My doc upped my Zyprexa from 2.5 to 5 about 3 days ago, but I feel no improvement mood wise. For the PD I take Xanax. Before I was on Pamelor, couldn't go up to a therapeutic level, because of heart racing and other side effects. Then we tried Paxil for 5 months (I had wondeful results with Paxil years ago), but this time no luck. An increase made me more apathetic and depressed. Now I am on Celexa. I feel tired all the time, have no interest in anything and just vegetate my life away. My stomach is also very sensitive when it comes to SSRIs.
>
> Sine you seem to have some knowledge about brain chemistry , I was wondering what you think would be a good approach. Oh, the intital 2.5 Zyprexa helped me some with my depression and panic. But from what I have read, results with Zyprexa are to be noted in the first 3-4 days. I havent noticed anything yet, since we upped the dose.
>
> I have a script for Prozac, but I am afraid to take it (acid reflux). I also take a very small amount of Ritalin, which I cannot increase, because it makes me panicky.
>
> I was thinking about the Effexor; would that help for OCD? I have been in this relaps now for 1 1/2 years and with time passing it doesn't get any better.
>
> Anybody, what are your med cocktails and how would you approach my problem? Thank you for any information you can give me.
Posted by ChrisK on December 2, 2001, at 3:46:10
In reply to Re: mirapex for anhedonia/apathy - question, posted by Jenna S. on December 1, 2001, at 18:39:35
I asked my pdoc about Mirapex a few weeks ago and he wasn't too keen. But I'm not going to give up that easily! So I was wondering if you would let me know which studies convinced your pdoc to let you try Mirapex?
>
> JennaJenna, go to www.google.com and do a search on MIRAPEX and DEPRESSION. There are plenty of articles but start with these two:
http://www.parkinson.org/mxdepress.htm
http://www.psycom.net/depression.central.resistant.html
The second one you need to look about half way down the page. Both studies show good results. Personally I think that the theraputic dosage for depression augmentation is more in the range of 3-6 mg/day. The one study tried a dose of 5 mg/day but didn't get good data at that level because (I read somewhere else) too many people had problems with nausea at the higher level.
Good luck with your doctor. Mine used to get a kick out of the homework I did on my treatment. I almost always brought in a pile of papers to suggeest something different that might work. Now I feel much better and I think he misses the monthly updates and studies I would bring in.
Chris
Posted by Jenna S. on December 2, 2001, at 17:18:08
In reply to Re: mirapex for anhedonia/apathy - question » Jenna S., posted by ChrisK on December 2, 2001, at 3:46:10
> http://www.parkinson.org/mxdepress.htm
>
> http://www.psycom.net/depression.central.resistant.html
>Thanks for these Chris, hopefully he will be convinced. I am so fed up of having anhedonia.
Jenna
Posted by mist on December 2, 2001, at 23:02:49
In reply to What is the difference between anhedonia + apathy?, posted by Margit on November 30, 2001, at 22:59:11
This is the end of the thread.
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