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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by ed_uk on November 13, 2004, at 17:57:29
Hello everyone...
I've taken various SSRIs on and off for the last 6 years. At high doses, they effectively reduce my anxiety and OCD. Low doses have always been ineffective. At the moment, I also take lofepramine (a norepinephrine reuptake inhibitor) for depression.
On SSRIs, I find that I'm emotionless. Sometimes, I don't care about anything. Life passes me by and I hardly notice. I see a tradgedy on TV but I am not moved. I never cry. I have little motivation.
The last time I stopped the SSRI I developed OCD and became suicidal. I don't want to stop it again.
Basically, I want to restore my drive and motivation. Here is a study I found....
J Clin Psychiatry. 2002 May;63(5):391-5. Related Articles, Links
Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.Marangell LB, Johnson CR, Kertz B, Zboyan HA, Martinez JM.
Mood Disorders Center, Department of Psychiatry, Baylor College of Medicine, Houston, Tex 77030, USA. laurenm@bcm.tmc.edu
BACKGROUND: We report a clinical trial of olanzapine in the treatment of prominent apathy in the absence of depression in patients on long-term treatment with selective serotonin reuptake inhibitors (SSRIs) for nonpsychotic major depression. METHOD: Participants were 21 men and women who met DSM-IV criteria for major depressive disorder in full remission (Montgomery-Asberg Depression Rating Scale [MADRS] score < or = 12) who had been taking an SSRI for at least 3 months. Data are presented (last observation carried forward) based on 20 enrolled participants who completed at least 1 follow-up visit. Participants had significant symptoms of apathy, defined as a Clinical Global Impressions-Severity of Illness scale (CGI-S) score > or = 3, an Apathy Evaluation Scale (AES) score > 30, and a MADRS item 8 (inability to feel) score > or = 2. Participants with a personal or family history of psychosis were excluded. Olanzapine was titrated in 2.5-mg increments at weekly intervals, until CGI-S score improved > or = 2 points from baseline or > or = 1 point with dose-limiting side effects, and participants continued in the protocol for 8 weeks at a stable dose following this improvement. RESULTS: Improvement was clinically evident and demonstrable on all symptom assessments: AES (mean +/- SD change in score = -21.3 +/- 8.7; p < .0001), CGI-S (-2.7 +/- 0.9; p < .0001), MADRS (-5.6 +/- 5.9; p = .001), and MADRS item 8 (-2.2 +/- 1.4; p < .0001). The mean dose of olanzapine was 5.4 +/- 2.8 mg/day. CONCLUSION: These preliminary data suggest that olanzapine may be effective in treating apathy syndrome in nonpsychotic patients taking SSRIs.
Olanzapine might be effective because it is a 5-HT2a antagonist. I do not want to take an AP because of previous experiences with APs. I've been thinking about nortriptyline because it's a NRI and a 5-HT2a antagonist. I would take it instead of lofepramine.I'm worried that nort could make my drowsy. I already need a lot of sleep and suffer from fatigue. Perhaps I'd need to take a stimulant as well. I've been thinking about Dexedrine or Provigil- my pdoc wouldn't prescribe either of them though. I live in England.
Does anyone have any advice or suggestions?
Ed.
Posted by ed_uk on November 13, 2004, at 18:05:34
In reply to SSRIs: Emotionless, posted by ed_uk on November 13, 2004, at 17:57:29
Oops, i said 5-HT2a when I meant 5-HT2c.
Posted by darkhorse on November 16, 2004, at 5:49:01
In reply to SSRIs: Emotionless, posted by ed_uk on November 13, 2004, at 17:57:29
Hi Ed,
I had the same experience with all 6 SSRIs + Efexor (like millions of people).How about trying imipramine instead of goinig into combos ?
Imipramine is a potent SSRi ,so you get rid of anxiety,obsessions like citalopram..etc + is as equal in potency as a NRI so you get emotional,activated,more focused and energetic,without sedation ,sexual dysfunction and less weight gain...
I believe that tofranil is really a very well- balanced AD (unlike Effexor),and better than other balanced TCA's (amitrip,dothiepin),because is less sedative
some people may get a little anxiuos in the begining of treatment,but since you take benzo,then no problem.
Unfortunatly even though imipramine is the gold standard of which no other AD proved better,because it is the oldest true AD on the planet,it is now considered old-fashinoed and sadly people tend to go for the latest wonder drugs...
This is my experience after taking countless ADs...
Regards,
AdamI think that
Posted by Keith Talent on November 16, 2004, at 6:31:41
In reply to Re: SSRIs: Emotionless » ed_uk, posted by darkhorse on November 16, 2004, at 5:49:01
Pardon me if I 'm wrong, but I thought that imipramine was less potent that clomipramine at blocking serotonin reuptake. Also, imipramine's metabolite desipramine is about on a par with clomipramine's metabolite desmethylclomipramine in terms of potency at blocking noradrenaline reupake.
Posted by darkhorse on November 16, 2004, at 7:45:34
In reply to Re: SSRIs: Emotionless, posted by Keith Talent on November 16, 2004, at 6:31:41
> Pardon me if I 'm wrong, but I thought that imipramine was less potent that clomipramine at blocking serotonin reuptake. Also, imipramine's metabolite desipramine is about on a par with clomipramine's metabolite desmethylclomipramine in terms of potency at blocking noradrenaline reupake.
>Yes, what you say is right, but, the important thing here is the "BALANCE" between serotonin/noradernaline:
Because clomipramine is an extremley potent SSRI,while its metabolite is a weaker NRI, the end result is that clomipramine's overall effects are more serotonergic, that is why it has similar SSRI side effects (e.g sexual dysfunction,apathy..etc) and is better for pure OCD.
However,although imipramine is less potent than clomipramine in terms of serotonin,its noradrenaline is nearly as potent as serotonin and so you do not get SSRi side effects such as sexual problems and apathy : the NE boost eleminate them.
That is why imipramine works also for ADD,while clomipramine is less effective like all SSRis.When doctors give an NE drug to an SSRI,all they are doing is actually trying to "balance" NE with 5ht to decrease apathy,sexual inhibition and increase concentration and energy, and that is exactly what imipramine does by itself.(but not like clomipramine,which is considered by some the godfather of SSRis - an SSRI with TCA structure).
Regards,
Adam.
Posted by ed_uk on November 16, 2004, at 8:06:03
In reply to Re: SSRIs: Emotionless, posted by darkhorse on November 16, 2004, at 7:45:34
Adam, thank you for your response. I certainly agree that imipramine can be a useful antidepressant.
The problem for me is........ I'm already taking the max. dose of lofepramine (a noradrenaline reuptake inhibitor) but it doesn't increase my energy or motivation very much despite the fact that it helps my depression. Unfortunately, I need the high dose citalopram (60mg)for OCD. If I tried to get the same amount of serotonin reuptake inhibition from imipramine I'd probably have to OD on it!!! As a result, I'm interested in dopaminergics such as methylphenidate.
Regards,
Ed.PS. What was your experience with Grandaxin?
Posted by darkhorse on November 17, 2004, at 5:58:45
In reply to Re: SSRIs: Emotionless, posted by ed_uk on November 16, 2004, at 8:06:03
PS. What was your experience with Grandaxin?
Hi,Grandaxin (Tofisopam) is an atypical benzodiazepine that was invented in Hungary.People who live in western europe&north america know nothing about it.
I tried it while living in Egypt :
It comes in 50mg and the usual effect lasts 5 hours.It is usually taken in 100mg 3 times daily,and is not recomended to be taken befoe bedtime because it is the only "STIMULANT BENZODIAZEPINE" on the planet.
My experience is that it gives you a relaxed feeling combined with excellent concentration,motivation and sociability,without any muscle relaxant or any sedative,amnestic proporties + NO withdrawal effects at all
Its structure is fundementaly different from any other BZ (2,3 benzo) and,from my own experience I believe that it must be affecting dopamine in a wayThe great thing about it is that you can take as needed for focus + anxiety or chronically without worrying about withdrawal.....
I know I might sound talking about a fantasy drug ,but the truth is that I only stopped it because I left Egypt and could not find it in the other countries I lived in......
It is really very sad that some excellent medications have been developed in eastern/3rd world countries get totally ignored in the western world,partially because of language,lack of cooporation but I think mostly because eastern/3rd world countries do not have the money or propaganda means to distribute their products...and unfortunatly giant companies (especially in the USA) are monopolizing the market,and letting american citizens-since I lived there for a while- believe that there is no life or option apart from SSRIs,Xanax & clonazepam....even for a country like France their inventions are being totally ignored (Amineptine,Tianeptine,Adrafinil,bromazepam..etc).
Just my thoughts...
Regards,
Adam
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Posted by ed_uk on November 17, 2004, at 8:31:33
In reply to Grandaxin (Tofisopam) experience, posted by darkhorse on November 17, 2004, at 5:58:45
Hi Adam, thanks for your response!
From pubmed.....'Tofisopam has mixed dopamine agonist and antagonist like properties.'
I agree about clonazepam. Clearly, some people find it very useful but there are plenty of other benzos, clonazepam is not particularly unique. I don't think we're missing much in the UK by using other benzos instead. The older benzos can be just as good for many, some people prefer them.
All the best,
Ed.
Posted by JackSprat on November 17, 2004, at 14:45:42
In reply to Re: Grandaxin (Tofisopam) experience, posted by ed_uk on November 17, 2004, at 8:31:33
Hi Ed
I'm also very interested in dopamine meds -
On prozac, looking for an 'anti-depressant' that raises alertness/concentration/wakefulness/motivation.I wonder if serotonin-raising SSRI anti-depressants may work primarily by reducing anxiety, while noradren/dopamine increase physical/mental alertness/motivation respectively.
But...
briefly tried dopamine-raising sinimet - no noticeable effectprovigil? - just started today after a bad night's sleep - feel 'physically wired' - same effect as noradrenaline-raising Yohimbe - but still entirely mentally exhausted - need sleep!
Be very interested to hear if you find something.
Posted by ed_uk on November 17, 2004, at 14:50:17
In reply to Noradrenaline/Dopamine, posted by JackSprat on November 17, 2004, at 14:45:42
Jack, I'll tell you if I do find anything but I don't think my pdoc will let me try any dopamine meds!
Ed
Posted by jujube on November 17, 2004, at 16:52:12
In reply to Noradrenaline/Dopamine, posted by JackSprat on November 17, 2004, at 14:45:42
Although it is not a pharmaceutical, I have recently been reading that Acetyl L-Carnitine (ALC)(100 - 250 mg daily) affects dopamine. I think that another natural supplement may be Enada NADH (2.5 - 5 mg two - three times a week), which is said to increase motivation and concentration. I am considering ordering ALC and NADH, depending on the cost, and giving them both a try before going to battle with my pdoc for Provigil or something similar.
Tamara
> Hi Ed
> I'm also very interested in dopamine meds -
> On prozac, looking for an 'anti-depressant' that raises alertness/concentration/wakefulness/motivation.
>
> I wonder if serotonin-raising SSRI anti-depressants may work primarily by reducing anxiety, while noradren/dopamine increase physical/mental alertness/motivation respectively.
>
> But...
> briefly tried dopamine-raising sinimet - no noticeable effect
>
> provigil? - just started today after a bad night's sleep - feel 'physically wired' - same effect as noradrenaline-raising Yohimbe - but still entirely mentally exhausted - need sleep!
>
> Be very interested to hear if you find something.
>
>
>
>
>
>
>
This is the end of the thread.
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