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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 zana on March 22, 2004, at 21:51:39
Anybody else out there suffering from a complete lack of motivation on prozac? I've been on it for years and am no longer depressed but I swear if I never did anything but walk the dog, nap and watch TV I would be perfectly happy. Well, not perfectly...
Posted by zeugma on March 22, 2004, at 22:51:36
In reply to prozac and lack of motivation, posted by zana on March 22, 2004, at 21:51:39
Prozac has the longest half-life of any med. That means that if you have been taking it for years, you have an ocean of fluoxetine in your bloodstream. That is a sure recipe for motivational difficulties.
You might want to at least try lowering the dose to see what happens.
Posted by King Vultan on March 23, 2004, at 8:16:34
In reply to prozac and lack of motivation, posted by zana on March 22, 2004, at 21:51:39
> Anybody else out there suffering from a complete lack of motivation on prozac? I've been on it for years and am no longer depressed but I swear if I never did anything but walk the dog, nap and watch TV I would be perfectly happy. Well, not perfectly...
This is a common side effect of SSRIs in my experience and one of the biggest reasons that I started trying other classes of drugs. My thought is that the norepinephrine and/or dopamine system becomes atrophied under long term SSRI use.Todd
Posted by zana on March 23, 2004, at 8:21:40
In reply to Re: prozac and lack of motivation, posted by zeugma on March 22, 2004, at 22:51:36
Thanx Zeugma.
I have been trying to lower my dose (30mg) but everytime I do I start eating like a horse and craving carbohydrates. I mean I have no sense of fullness no matter how much I eat. It's terrible
! Any ideas about how to handle that. I hate to admit it but I don't want to get huge, huger.
Posted by zana on March 23, 2004, at 8:23:23
In reply to Re: prozac and lack of motivation » zana, posted by King Vultan on March 23, 2004, at 8:16:34
Todd, what did you try? How did it work?
Posted by harryp on March 23, 2004, at 11:27:36
In reply to prozac and lack of motivation, posted by zana on March 22, 2004, at 21:51:39
Just wanted to add that meds like Prozac reach a "steady state" of concentration in the blood. Prozac does have a long half-life, but you don't need to worry about having "oceans of fluroxetine" in your system. After a few weeks at a certain dose, the quantity of Prozac in your blood should not be different from year to year.
I suggest talking to your doctor about adding Welbutrin (a stimulating AD) to the Prozac. You might even want to try adding a stiumulant like Ritalin.
Posted by harryp on March 23, 2004, at 11:30:13
In reply to Re: prozac and lack of motivation ?zana, posted by King Vultan on March 23, 2004, at 8:16:34
>
> This is a common side effect of SSRIs in my experience and one of the biggest reasons that I started trying other classes of drugs. My thought is that the norepinephrine and/or dopamine system becomes atrophied under long term SSRI use.
>
> Todd
>I find that idea fascinating, Todd. Do you have any journal articles about this possibility?
Posted by King Vultan on March 23, 2004, at 17:14:03
In reply to Re: prozac and lack of motivation » King Vultan, posted by harryp on March 23, 2004, at 11:30:13
> >
> > This is a common side effect of SSRIs in my experience and one of the biggest reasons that I started trying other classes of drugs. My thought is that the norepinephrine and/or dopamine system becomes atrophied under long term SSRI use.
> >
> > Todd
> >
>
> I find that idea fascinating, Todd. Do you have any journal articles about this possibility?
>There may be some articles out there on this, but it is known that serotonin does reduce dopamine by stimulating 5-HT2A receptors (atypical psychotics blockade these receptors to counteract dopamine depletion in certain areas of the brain). As far as norepinephrine, there is a school of thought that a person is likelier to have greater long term success using a drug that blockades both serotonin and norepinephrine reuptake rather than just working on serotonin.
My own experience being on alternately Zoloft and low dosages of Effexor (which isn't a great deal different from an SSRI at lower dosages) for years was that norepinephrine...just seemed to get left behind. It seemed like there just was not enough stimulation of that particular neurotransmitter system, and I think that had something to do with the emotional numbing I experienced after being on these drugs for extended periods. This was also why I dropped each of them twice, as I got tired of not being able to feel anything. Unfortunately, I found that I ran into problems functioning without taking some kind of antidepressant. I'm hoping my current trial on the MAOI Nardil works out somewhat better, as this works on all three of the major neurotransmitter systems involved with mood. If the Nardil winds up not being effective, I plan on going to the other MAOI (Parnate)
Todd
Posted by zana on March 23, 2004, at 21:39:34
In reply to Re: prozac and lack of motivation » King Vultan » harryp, posted by King Vultan on March 23, 2004, at 17:14:03
Hey thanx so much for your answer. I've been thinking about Wellbutrin because I also need an antidepressant. I tried it before without much success... I didn't think the MAOIs were used much anymore. How did you decide to try them?
Have you tried any of the "adjunctive" agents like Lamictal or Provigil? I'm having mixed success with each at very low doses (added to Prozac.)
Posted by harryp on March 23, 2004, at 23:00:16
In reply to Re: prozac and lack of motivation » King Vultan, posted by zana on March 23, 2004, at 21:39:34
> Hey thanx so much for your answer. I've been thinking about Wellbutrin because I also need an antidepressant. I tried it before without much success... I didn't think the MAOIs were used much anymore. How did you decide to try them?
> Have you tried any of the "adjunctive" agents like Lamictal or Provigil? I'm having mixed success with each at very low doses (added to Prozac.)Hi,
I take the MAOI Parnate (50mg/day) because all the modern AD's either had horrible side effects or didn't work. I had a really dramatic response to the Parnate. Suddenly I could get out of bed in the morning, could make plans, and was able to go back to school. Amazingly, there were no significant side effects at all--I felt completely like myself.
Everyone responds differently to AD's, so it is a good thing that there are a wide variety available. Surprisingly, though, there is no evidence that any of the new antidepressants are actually more frequently effective than the old TCA's and MAOI's. Their main clinical benefit is that they have few interactions and are safer in overdose.
I get the impression that many pscyhophamacologists consider the MAOI's the most powerful and effective AD's for very severe and hard to treat depression. They aren't prescribed very often for two reasons:
1. Like the TCA's, they are old, out of patent, and are not marketed aggressively.
2. If you eat the wrong food or take the wrong medicine while on a MAOI, you can die of a stroke. A patient on MAOI's has to be smart and have good judgement. In practice, the diet and med restrictions are not very troublesome.
Hey! If you're still reading :), I have tried lamictal 25-75mg/day (no difference noted between dosages), and it does seem to have mild AD properties. It made me feel dumb, though, and didn't really do that much good, so I quit taking it. You might respond to it differently, though.Prozac+Welbutrin is a very common mix, and seems to work for a lot of people. In my experience, may you need to go to 300mg/day or more of Welbutrin to get a result.
Posted by zana on March 24, 2004, at 8:16:21
In reply to Re: prozac and lack of motivation » King Vultan, posted by zana on March 23, 2004, at 21:39:34
I have an app't with my doc in a few weeks and I'm going to talk to her about MAOIs. I don't know why she hasn't considered them. I've been seeing her for years and shes at a good academic medical center-- not that they know everything. But we have tried a lot of of things but never MAOIs. I would love to get off the SSRIs. I know you can't eat aged cheese. Can you eat Brie.... I mean some things are important.
Lamictal does seem to be a mixed bag. I can't quite figure out what it's doing but since I've been on it, even at a low dose, I haven't had any taking to bed in despair episodes. That definitely goes in the plus column.
Posted by King Vultan on March 24, 2004, at 10:57:06
In reply to Re: prozac and lack of motivation » zana, posted by zana on March 24, 2004, at 8:16:21
> I have an app't with my doc in a few weeks and I'm going to talk to her about MAOIs. I don't know why she hasn't considered them. I've been seeing her for years and shes at a good academic medical center-- not that they know everything. But we have tried a lot of of things but never MAOIs. I would love to get off the SSRIs. I know you can't eat aged cheese. Can you eat Brie.... I mean some things are important.
> Lamictal does seem to be a mixed bag. I can't quite figure out what it's doing but since I've been on it, even at a low dose, I haven't had any taking to bed in despair episodes. That definitely goes in the plus column.
In one of my references, the tyramine content of brie without rind is listed at 0.2 mg per serving, which is nothing. This is an amount similar to what's in sour cream and cheese whiz, both of which are considered safe. The cheeses to avoid are the heavily aged ones, such as real cheddar cheese. There are cheeses with higher tyramine contents, such as some of the blue cheeses, but cheddar seems to be the most common cheese with problematic tyramine levels.Todd
This is the end of the thread.
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