![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by iforgotmypassword on September 21, 2005, at 14:07:57
(PLEASE SHARE YOUR OPINION ON WHAT YOU THINK WORKS. IF MY EXPERIENCE BELOW IS TOO LONG TO READ, ANYTHING YOU COULD SHARE ON THE GENERAL TOPIC WOULD BE AWESOME. THANX.)
i remember desipramine helping me cry and overcome reversed vegetative symptoms (hypersomnia and ridiculous apppetite). i felt like some of my feeling was coming back, like i could be a real person again, but it always feel through. i was still never able to say or do anything meaningful. i would trade this lack of feeling for despair and i don't know if i would regret it, at least i would be a feeling individual again. i can't say that desipramine really helped for motivation/drive, but i certainly noticed the increased difficulty i would get if i negected to take it. still it was the only drug that really came close to helping.
i have my doubts about maois... they seem to be possibly dopaminergic, but don't increase the expression of dopamine receptors like other ADs do (venlafaxine, fluoxetine, desipramine)... and they hit serotonin receptors rather crudely (seems to be without decreasing expression of 5HT-2 like high dose venlafaxine is supposed to do) and i worry about anything intensely noradrenergic as im worried about my temper getting worse... ugh... i also tried parnate (40mg) and wasn't even sure if i felt anything. :(
i have tried every SSRI available. some doctor thought venlafaxine was helping but i don't know if he really knew what he was talking about. (i also started to forget to take it on a pretty regular basis) maybe if i start it with mirtazapine (Remeron) concomitantly with effexor i might get a better response. or would Zyprexa be a better idea? there seems to be so much out there suggesting that Effexor is superior, aside from it seeming to be the most relied on antidepressant these days, and all the success stories, it even seems to have effects on opiod, D3, and 5-HT2 receptors on the long term... they seems pretty important to presumed atypical depressives like me.
the main drugs my doctor keeps bringing up are nardil and nortriptyline, but i worry about both of those drugs. nardil i hear of all sorts of side effects, and seems to be predominantly serotonergic (whats so special about it?), and nortriptyline's reports of the tricyclic dumb-drug effects really worry me... and any sedation... my doctor didnt think it made much sense. but i worry.
tomorrow is my last day in the inpatient evaluation programme and we need to know what we are doing for my medication RIGHT AWAY. i am being referred back to my old pdoc with recommendations, but he is very unhelpful and doesn't seem very eager to help me. he also isn't ever very open to creative pharmacology. so i need to know what direction to go in asap. :(
Posted by linkadge on September 21, 2005, at 14:28:59
In reply to best drug(s) for anhedonia, feeling, and drive???, posted by iforgotmypassword on September 21, 2005, at 14:07:57
I am the same way. I will decide not to take a drug purely based on something I have read about it somewhere.
The funny thing is that, If I read someting bad about a drug that I am taking, it won't work, or abrubtly stop working.
I hated effexor too for those reasons. It just made me angry!! I hate being angry. Anger is more internally destructive than depression for me.
We need better happy pills.
Linkadge
Posted by Declan on September 21, 2005, at 14:42:38
In reply to Re: best drug(s) for anhedonia, feeling, and drive???, posted by linkadge on September 21, 2005, at 14:28:59
The happy pills are coca leaf and the poppy capsule. There aren't any better and there won't be any more. Not now.
Declan
Posted by Phillipa on September 21, 2005, at 18:20:30
In reply to Re: best drug(s) for anhedonia, feeling, and drive??? » linkadge, posted by Declan on September 21, 2005, at 14:42:38
Link, that's the same with me. The nortriptaline made me so tired I couldn't get out of bed. Now my regular doc is possibly suggesting lexapro even though I took it in the past. Fondly, Phillipa
Posted by Jedi on September 22, 2005, at 2:34:12
In reply to best drug(s) for anhedonia, feeling, and drive???, posted by iforgotmypassword on September 21, 2005, at 14:07:57
> (PLEASE SHARE YOUR OPINION ON WHAT YOU THINK WORKS. IF MY EXPERIENCE BELOW IS TOO LONG TO READ, ANYTHING YOU COULD SHARE ON THE GENERAL TOPIC WOULD BE AWESOME. THANX.)
>
Hi Iforgotmypassword,
If you haven't given Phenelzine a six week trial at 1mg/kg I believe you are doing yourself a disservice. This medication, though old and dirty, has no equal when it comes to treatment resistant atypical depression & social anxiety. Many people respond to this med after months and years trying newer drugs to no avail. One of the best combos I ever used was 75mg Nardil, 100mg Nortriptyline, & 1mg clonazepam.
Good Luck,
Jedi
Posted by iforgotmypassword on September 22, 2005, at 8:27:49
In reply to Re: best drug(s) for anhedonia, feeling, and drive??? » iforgotmypassword, posted by Jedi on September 22, 2005, at 2:34:12
the thing about parnate is i have some old stuff at home so if my outpatient doctor gets lazy and doesn't feel like increasing it, i will have more so i can do that on my own. he doesn't even mind when i do that. he really doesn't care about my case at all... he always just says oh well well just put this on the back burner for another 5 weeks... then another 5 weeks... .fsdadhjaszlavhbcj
the only thing that i keep reading about is POOPOUT. i'm really starting to wonder if maois work because there dirty... because theyd elevate anyone's mood at the doses we would use. like a narcotic would, then cause a tolerance. this in relation to how atypical depression looks like it may be caused by other somatic causes (like with the elevated thyroid bodies). after all, dopaminergic agents could prolly help anyone function better temporarily, but isnt the dopamine system the most prone to tolerance... i don't mean to be cynical... but its hard not to see hopelessness in all that im reading. (net, elsewhere, and lack of doctor support)
Posted by Chairman_MAO on September 22, 2005, at 10:34:27
In reply to what about parnate?, posted by iforgotmypassword on September 22, 2005, at 8:27:49
Tranylcypromine is better for some people for anhendonia, but not necessarily. Phenelzine also increases NE and DA levels, but what you are probably thinking of is that the SE-related inhibition of DA always seems to win out. You really should try to go to tranylcypromine 120mg/day. Can you take benzos? If you can, high-dose TCP+benzo would be great if you are overstimualted from it.
Alternatively, you could go with phenelzine+bupropion, phenelzine+DA agonist, phenelzine+psychostimulant.
Memantine is a powerful augmentation agent for DAergic drugs that can prevent "poop-out" and increase DA release.
Posted by Jedi on September 22, 2005, at 11:26:19
In reply to Re: what about parnate? » iforgotmypassword, posted by Chairman_MAO on September 22, 2005, at 10:34:27
Posted by Jedi on September 22, 2005, at 11:50:55
In reply to what about parnate?, posted by iforgotmypassword on September 22, 2005, at 8:27:49
> the thing about parnate is i have some old stuff at home so if my outpatient doctor gets lazy and doesn't feel like increasing it, i will have more so i can do that on my own. he doesn't even mind when i do that. he really doesn't care about my case at all... he always just says oh well well just put this on the back burner for another 5 weeks... then another 5 weeks... .fsdadhjaszlavhbcj
>
Hi iforgotmypassword,
I really wish my trial with Parnate would have worked for me. The weight gain and sexual issues on Nardil can make the med difficult to stay on. But nothing is as difficult as treatment resistant depression. All of the years I have been on Nardil, I have never experienced complete poop out. I have had partial loss of effectiveness to a level of dysthymia. The only times I have regressed to major depression is when I have come off the medication. I will stick with Nardil and try augmentation (Thanks Chairman)for the side effects & dysthymia.
Take care,
Jedi
Posted by Bill LL on September 22, 2005, at 15:30:10
In reply to best drug(s) for anhedonia, feeling, and drive???, posted by iforgotmypassword on September 21, 2005, at 14:07:57
I read an article yesterday by a pdoc discussing dysthymia. If I remember correctly, he felt that the best short term, or as needed pill, is tegretol. I think he said that it works within 3 hours.
For long term use he likes either Risperdal or Abilify.
Posted by iforgotmypassword on September 22, 2005, at 16:18:03
In reply to Re: best drug(s) for anhedonia, feeling, and drive???, posted by Bill LL on September 22, 2005, at 15:30:10
that's very interesting! do you know if you might be able to find out where the article came from for us?!?
Posted by shasling on September 22, 2005, at 21:27:53
In reply to Re: best drug(s) for anhedonia, feeling, and drive???, posted by Bill LL on September 22, 2005, at 15:30:10
> I read an article yesterday by a pdoc discussing dysthymia. If I remember correctly, he felt that the best short term, or as needed pill, is tegretol. I think he said that it works within 3 hours.
>
> For long term use he likes either Risperdal or Abilify.I second that on the Abilify. It is great if you can get it titrated correctly. I have same depressive subtype as you, tried Abilify and felt brand-new whole person life starting over, cured and everything else wonderful. Had energy, initiative, became part of the human race. Thing is, it shortly thereafter made me feel crazy -CRAZY - and I couldn't keep it up. That might have more to do with me, though cause I'm super hypersensitive to drugs so almost can't take a small enough dose sometimes. But damn when it was working it was unbelieveable. Its definitely worth a try, just have to toy with the dosage. Good luck. Suzie.
Posted by Jedi on September 23, 2005, at 1:21:27
In reply to Re: best drug(s) for anhedonia, feeling, and drive???, posted by shasling on September 22, 2005, at 21:27:53
>
> I second that on the Abilify. It is great if you can get it titrated correctly. ... Had energy, initiative, became part of the human race. Thing is, it shortly thereafter made me feel crazy -CRAZY - and I couldn't keep it up. That might have more to do with me, though cause I'm super hypersensitive to drugs so almost can't take a small enough dose sometimes. ...Hi Suzie,
It is not just you on the Abilify reaction. I am diagnosed with treatment resistant atypical depression. Abilify at 15mg gave me the worst feeling of akathisia I have ever experienced. Then again I haven't taken the older antipsychotics.
Good Luck,
Jedi
Akathisia
by Dr. Idan SharonAkathisia (from the Greek "not to sit") was first described by Haskovec in 1901.1 It has both subjective and objective symptoms. Subjective symptoms are dysphoric and include irritability, impatience, tension, and panic.2 Objective symptoms range from a need to move to foot tapping, rocking, or running. Akathisia is a common neuroleptic-induced movement disorder; some examples are neuroleptic-induced Parkinsonism, neuroleptic-induced tardive dyskinesia, and dystonia.3 The reports of the prevalence of akathisia in patients taking neuroleptics range from 9% to 35%.4 The differential diagnosis of akathisia includes restless leg syndrome, drug withdrawal, increased psychotic symptoms, and other neurologic disorders.5 Akathisia may result in nonadherence to medication regimen6, violence including suicide7,8, and an increased risk of developing tardive dyskinesia.9,10 ...
Posted by blueberry on September 23, 2005, at 20:20:11
In reply to best drug(s) for anhedonia, feeling, and drive???, posted by iforgotmypassword on September 21, 2005, at 14:07:57
The absolute best meds I ever tried for anhedonia, feeling, and drive were two that I got mailorder.
One was adrafinil, which is a so-called smart drug that works by norepinephrine alpha-1 agonism and also hits the dopamine D2 receptor. Though it provided immediate stimulation the first day, the real benefits didn't show up until about 3 weeks later. They were renewed interest in things, depression vanished, and I became more talkative and involved, more drive, yet perfectly comfortable with no side effects. Very tame med too. No withdrawals on stopping. I was on it for two years and loved it.
Modafinil is a close cousin to adrafinil and is easy to get.
The other was low dose amisulpride, which is an antipsychotic. At low doses, all it does is cause more dopamine to be released, almost kind of like a stimulant would do. I had more energy, more focus, more interest, more drive, and socially comfortable. This one can have significant sexual side effect though because it raises prolactin levels.
I tried them both together for a few weeks and it was terrific. Talk about stopping anhedonia dead in its tracks. But the sexual side effects from amisulpride were too much for me.
I used them both at various times in combination with prozac and zyprexa as well. I would love to go back to adrafinil right now, but for some reason I am already way too stimulated from either anxiety or akathisia to begin with, so until I get that figured out I have to avoid norepinephrine meds.
But since you asked, out of the several dozen meds I've tried, adrafinil and/or amisulpride were the best for anhedonia, feeling, and drive.
Posted by jerrympls on September 24, 2005, at 23:30:07
In reply to best drug(s) for anhedonia, feeling, and drive???, posted by iforgotmypassword on September 21, 2005, at 14:07:57
I agree that we need better medications. These SSRIs just blunt every emotion and make us feel stale.
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.