![[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 jerrympls on March 30, 2006, at 1:37:41
Adderall XR 20mg
Klonopin 4mg
hydrocodone 5mg 4x daily
Lexapro 20mg
Seroquel 100-300mg at nightI'm a musician and I don't enjoy listening to music. I feel bored. I haven't had a good belly laugh in years.
Even though this is the best med combo I've been on that has kept me from staying in bed- I go to school, etc - I still feel depressed or more dysthymic - with a LOT of anxiety and mutiple periods of strong dysphoria throughout each day.
I've grown a strong tolerance to all benzos - SSRIS just make me more apathetic. The opiate helps (hydrocodone - and yes my psychiatrist Rx'ed it to help augment the combo) but it's no panacea. I want/need to feel more calm and relaxed - no sedated - jsut not so tense. Yeah, the Adderall probably adds to the tension - but without it I'd be locked away in my apartment in my bed unable to get up and do ANYTHING. SERIOUSLY.
So - I want to enjoy music. I want the warm feeling I used to get when lsitening to msuic. I want the excitement of playing a new CD. I want to WANT to hang out with friends.
SOMEONE - please - suggestions???? I'm desperate. Please.
Jerry
Posted by ADDmom32 on March 30, 2006, at 1:56:01
In reply to WHy do I still have anhedonia??? DESPERATE!, posted by jerrympls on March 30, 2006, at 1:37:41
Jerry, you are not going to like this answer but ... you have got to get some exercise and get hooked up with SOME kind of personal interaction with other "beings". Folks who understand the difference between a human "being" vs human "doing".
I KNOW it's hard but YOU have to find a way to connect back to yourself. Do you have any close friends or family that can help?
Posted by yxibow on March 30, 2006, at 2:46:26
In reply to Re: WHy do I still have anhedonia??? DESPERATE!, posted by ADDmom32 on March 30, 2006, at 1:56:01
> Jerry, you are not going to like this answer but ... you have got to get some exercise and get hooked up with SOME kind of personal interaction with other "beings". Folks who understand the difference between a human "being" vs human "doing".
> I KNOW it's hard but YOU have to find a way to connect back to yourself. Do you have any close friends or family that can help?
I agree that anhedonia and disassociation, which can fall together, require more than just pharmacological intervention. (and while the hydrocodone may help in the short run, it too can create depression -- but that is for your pdoc to handle)I have a complex disorder and there are weeks where I fall towards anhedonia and weasle out of the volunteer jobs that are supposed to be the stepping stone towards finding some sort of work that can work with my problems.
I'll say it, but its one of those things that you say and don't do yourself -- you can't wait to "feel better" to embrace life. The life outdoors. The life among coworkers. Even in this brave new world we face in the 21st century. A piano could fall on you in your house (I'm just trying to inject some humour.) just as much as going out and doing something. By doing things productive, even little things, its hard, you have to force yourself, you gain strength over illness. And there will be relapses as you enter things that give you more anxiety -- I have had them. That's par for the course. No blame to yourself.
Best wishes
-- J
Posted by psychopharmacon on March 30, 2006, at 2:51:02
In reply to WHy do I still have anhedonia??? DESPERATE!, posted by jerrympls on March 30, 2006, at 1:37:41
You could try giving up the Lexapro and/or add a dopamine agonist. Some people report good results with cabergoline (Dostinex/Cabaser) for anhedonia.
Posted by deniseuk on March 30, 2006, at 10:20:22
In reply to WHy do I still have anhedonia??? DESPERATE!, posted by jerrympls on March 30, 2006, at 1:37:41
Hi Jerry,
If I remember rightly you started taking opoids about two years ago, did you have this anhedonia when you first started it or has it only been recently.
Are you sure your're not experiencing some sort of poop out?
I hate to suggest this but have you thought about coming off any of the meds for about six months to see if they might start working again after a period of being off them. Or is even the idea of doing that too painful?
I know you're a real expert when it comes to meds because I remember some of your posts from before so I'm in no way in a position to advise you it just sounds to me like you might be experiencing some sort of tolerance.
Denise
Posted by ADDmom32 on March 30, 2006, at 13:08:20
In reply to Re: WHy do I still have anhedonia??? DESPERATE!, posted by deniseuk on March 30, 2006, at 10:20:22
Jerry, are you up and about today?
I've been thinking of you.
Posted by blueberry on March 30, 2006, at 17:56:31
In reply to WHy do I still have anhedonia??? DESPERATE!, posted by jerrympls on March 30, 2006, at 1:37:41
From just a personal opinion, it looks to me like there is too much anti-dopamine stuff in the mix. Seroquel and lexapro are both working against you in terms of anhedonia. The stimulant in the long run will too. Maybe replace the seroquel and lexapro with remeron. Replace the stimulant with wellbutrin. Maybe a wellbutrin remeron combo.
I know this sounds weird, but you might consider cutting the doses of everything in half. Not all at once or suddenly though. Longer term, the whole mix might need to be majorly overhauled.
Amisulpride (deniban, solian) is awesome for symptoms like yours, especially after getting through the first 3 to 4 weeks of it. But it is not sold in USA.
Exercise. Visit a different church every weekend until you find one that seems cool for you. If you have a bike, go riding. If not, get one. Force yourself into social contact, even if it's an effort. All the drugs in the world aren't usually enough. But even so, I personally think your current mix could be majorly improved.
Posted by jerrympls on March 30, 2006, at 20:31:59
In reply to Re: WHy do I still have anhedonia??? DESPERATE!, posted by blueberry on March 30, 2006, at 17:56:31
> From just a personal opinion, it looks to me like there is too much anti-dopamine stuff in the mix. Seroquel and lexapro are both working against you in terms of anhedonia. The stimulant in the long run will too. Maybe replace the seroquel and lexapro with remeron. Replace the stimulant with wellbutrin. Maybe a wellbutrin remeron combo.
>
> I know this sounds weird, but you might consider cutting the doses of everything in half. Not all at once or suddenly though. Longer term, the whole mix might need to be majorly overhauled.
>
> Amisulpride (deniban, solian) is awesome for symptoms like yours, especially after getting through the first 3 to 4 weeks of it. But it is not sold in USA.
>
> Exercise. Visit a different church every weekend until you find one that seems cool for you. If you have a bike, go riding. If not, get one. Force yourself into social contact, even if it's an effort. All the drugs in the world aren't usually enough. But even so, I personally think your current mix could be majorly improved.I agree with you about the Lexapro & Seroquel - mainly the Seroquel. I bet a dopamine agonist would help- but which one?
As for Wellbutrin - the stuff makes me crazy = severe anxiety and insomnia. I can't tolerate the stuff. Remeron sounds like a good idea - except for the weight gain. However, I bet it would cause LESS weigh gain than the Seroquel has (gained 100 pounds in less than a year after starting it). PLus the remeron would help with sleep. Hmm.....maybe worth a try - PLUS now that I think of it, I've never been on Remeron for more than 3 weeks! This was years ago when it first came out. I'll talk to my doc about it.
Thanks for your suggestions!
Jerry
Posted by jerrympls on March 30, 2006, at 20:37:05
In reply to Re: WHy do I still have anhedonia??? DESPERATE!, posted by deniseuk on March 30, 2006, at 10:20:22
> Hi Jerry,
>
> If I remember rightly you started taking opoids about two years ago, did you have this anhedonia when you first started it or has it only been recently.
>
> Are you sure your're not experiencing some sort of poop out?
>
> I hate to suggest this but have you thought about coming off any of the meds for about six months to see if they might start working again after a period of being off them. Or is even the idea of doing that too painful?
>
> I know you're a real expert when it comes to meds because I remember some of your posts from before so I'm in no way in a position to advise you it just sounds to me like you might be experiencing some sort of tolerance.
>
> DeniseHi Denise!
Anhedonia has ALWAYS been a MAJOR symptom of my depression - from the day it started. I don't doubt that tolerance to the hydrocodone could surely cause anhedonia - however, I really don't think I've built up a tolerance to it. What I DO think is happening is that I'm not taking the hydrocodone regularily - meaning I kinda take one when I feel I need it which probably isn't the best thing to do - because right there that spells highs and lows, etc.
I have been thinking of weaning slowly off the hydrocodone to see how much of an effect - if any it's been having on my mood fluctuations/anhedonia, etc.
Anyway, thanks for your post - you've all got me thinking - which is a good thing!
Jerry
Posted by gibber on March 31, 2006, at 1:12:44
In reply to Re: WHy do I still have anhedonia??? DESPERATE! » deniseuk, posted by jerrympls on March 30, 2006, at 20:37:05
Yup, I'm a musician too and know that feeling of playing a new CD. It really has lost a lot of that spark for me, but I must say the SSRIs always contributed to the apathy. Now I'm trying MAOIs, every consider them?
Posted by jerrympls on March 31, 2006, at 1:26:19
In reply to Re: WHy do I still have anhedonia??? DESPERATE!, posted by gibber on March 31, 2006, at 1:12:44
> Yup, I'm a musician too and know that feeling of playing a new CD. It really has lost a lot of that spark for me, but I must say the SSRIs always contributed to the apathy. Now I'm trying MAOIs, every consider them?
>Yeah Nardil. It worked for a couple weeks then pooped out. I also had to be rushed to the ER and observed overnight in the ICU because of an episode of serotonin syndrome. Felt like I was going to die. Anyway, wasn't a success.
I just really wish I *wanted* to listen to music again. I can play music and enjoy it to some degree - but I've got over 700 CDs and they just sit in their cases. They're dusty because I haven't touched them in years.
I want music to touch me again......
Posted by SJW on April 1, 2006, at 17:04:11
In reply to WHy do I still have anhedonia??? DESPERATE!, posted by jerrympls on March 30, 2006, at 1:37:41
Just some thoughts based on my personal experiences;
I found the Adderall XR version to be quite a bit MORE tension/anxiety inducing than the IR version.Klonopin(benzos) can induce/increase dysphoria, anhedonia and/or depression, at least in my case. Not at first mind you, but over time they always did.
Seroquel over time can cause feelings of apathy and anhedonia.
SSRIS in a dose that is too high(for the individual) can induce amotivation and anhedonia.
One thing I've noticed with Adderall is that timing, or more specifically the sequence of medication dosing can make a big difference.
If Adderall is taken first or even at the same time as a benzo or hydrocodone, it seems to render the other med highly ineffective; at least in my experience.
So, I(me) would take the benzo or hydro first, wait to feel the effect, then take the adderall.
Good Luck,
Steve
Posted by jerrympls on April 2, 2006, at 1:00:45
In reply to Re: WHy do I still have anhedonia??? DESPERATE!, posted by SJW on April 1, 2006, at 17:04:11
I'm fallinginto a depressive phase...it's horrible..I just want to die.
Posted by linkadge on April 2, 2006, at 9:45:54
In reply to Re: WHy do I still have anhedonia??? DESPERATE!, posted by jerrympls on April 2, 2006, at 1:00:45
Are you just taking the seroquel for sleep ?
Could it be replaced by a sleep inducing antidepressant.You could try a low dose of amitryptaline, remeron, or trazodone, instead of the seroquel you might reduce some anhedonia.
Linkadge
Posted by linkadge on April 2, 2006, at 9:47:38
In reply to Re: WHy do I still have anhedonia??? DESPERATE! » jerrympls, posted by linkadge on April 2, 2006, at 9:45:54
Also, add folic acid (1mg) to your SSRI, it can boost effectiveness, (acutal clinical studies done on this augmentitive effect) You may also try augmentation with zinc and EPA.
Linkadge
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.