Psycho-Babble Medication Thread 773349

Shown: posts 1 to 18 of 18. This is the beginning of the thread.

 

Apathy from SSRIs -- any suggestions?

Posted by Racer on August 1, 2007, at 15:43:56

I'm taking Wellbutrin, Concerta, Prozac, and SAMe, which is working well enough, I guess, but I'm experiencing a good deal of SSRI-related apathy and sleep disturbance. The apathy is a problem, because it's not neutral apathy -- I'm definitely in a kind of "I'm depressed, but I don't care" sort of a state. Although, I don't know if it's really depression, rather than just a "oh, f--k it all, I just don't give a rat's behind" sort of a state.

As many of you might know, I've taken many, many different antidepressants. My dx is major depession, unipolar; anorexia nervosa; and generalized anxiety disorder. I also have {ahem} "obsessive compulsive personality traits," and am on the cusp of diagnosable OCD -- actually, it's only lately that I brought that up with my T, and haven't actually discussed it with my pdoc, so maybe it's not a "cusp" thing at all.

I'm debating dropping the Prozac entirely, although I know that the WB/stim combo isn't quite enough to fix me.

So, can anyone offer any other suggestions? Might Zoloft be a better choice for SSRI? (The other SSRIs are out -- been there, done that, they're worse. Effexor and Cymbalta, ditto.) My pdoc says that he thinks I do need a serotinergic component, and I think he's probably right. But I'm just not satisfied by where I am now. I've got that feeling as though I really want to sit here and cry, but it seems to much trouble even to finish a thought, let alone bother with having an emotion.

Thanks.

 

Re: Apathy from SSRIs -- any suggestions? » Racer

Posted by Phillipa on August 1, 2007, at 16:52:41

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

Well since luvox is doing nothing thinking of zoloft myself next week when see pdoc as fatigue has become a big issue. And I know a lot of people who either prefer zoloft or lexapro. My neice and sister love zoloft. Have you been on zoloft before? Love Phillipa

 

Re: Apathy from SSRIs -- any suggestions?

Posted by DharmaBum on August 1, 2007, at 18:58:30

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

Well, I've cut back on the Effexor and am feeling a bit spunkier. I know what you mean. Not sure if you can just drop the doee a bit it has been good so far.

 

Re: Apathy from SSRIs -- any suggestions?

Posted by med_empowered on August 1, 2007, at 22:41:46

In reply to Re: Apathy from SSRIs -- any suggestions?, posted by DharmaBum on August 1, 2007, at 18:58:30

I've heard of docs adding in BuSpar/"atypical" antipsychotics to help with apathy. Having taken both, I find that kind of move surprising, but hey--maybe it helps some people.
OCD can be helped with uppers (amphetamines..maybe ritalin, too?) and downers (benzos). Some people also report benefit from Ultram (tramadol, a weird opiate agonist with effexor-ish qualities built in). So..what is it the Prozac does for you? If its energizing, can you up the Ritalin or WB? If its anti-OCD, would your doc be willing to try a tranquilizer?

Have you ever tried an MAOI? Or Anafranil?

 

Re: Apathy from SSRIs -- any suggestions? » med_empowered

Posted by Racer on August 2, 2007, at 2:23:02

In reply to Re: Apathy from SSRIs -- any suggestions?, posted by med_empowered on August 1, 2007, at 22:41:46

> So..what is it the Prozac does for you? If its anti-OCD, would your doc be willing to try a tranquilizer?

The WB/Concerta alone don't quite fix my depression, which seems to require some sort of serotinergic agent. An SSRI or SNRI alone doesn't do it, too much apathy, so I do need a good deal of NE, but that's not ALL of it. Although, I kinda think that it might be better than this.

Then again, I also know that I never remember quite how bad it is. Periodically, I say, "The hell with all this -- I'm stopping these damn things." A few days or weeks later, though -- I'm forcibly reminded of the reason I take them.

>
> Have you ever tried an MAOI? Or Anafranil?


Unfortunately, the TCAs and MAOIs are pretty well out for me. I have trouble with hypotension, and can't handle them. Even desipramine provided me some close up views of the floor, and it's supposed to be pretty neutral for blood pressure. I'm limited because of that, although I know my doctor is ready to try me on EMSAM next. I'm just not sure I want to go that way -- after all the trouble I've had with drugs, WB and Concerta are my good and trusted friends. I don't particularly want to risk months of misery, only to end up back with them again in the end. I'd rather see how close I can come with them, first.

But, maybe it's worth trying EMSAM? I've heard it's not as sedating, and that the hypotension is less of a problem with it... And benzos, atypicals, and BuSpar are also problematic: I have had a few nightmare reactions to benzos, the paradoxical agitation? And BuSpar, the best I've ever taken for my anxiety, increased my depression. Atypicals haven't been a rousing success, either...

Thanks for your response.

Although, now that I'm reminded of the paucity of options at this point, I'm very sorry to have brought this up today...

 

Re: Apathy from SSRIs -- any suggestions?

Posted by linkadge on August 2, 2007, at 10:42:24

In reply to Re: Apathy from SSRIs -- any suggestions? » med_empowered, posted by Racer on August 2, 2007, at 2:23:02

I second anafranil if you havn't tried it. It is very effective for OCD, but I found it didn't cause apathy half as bad as SSRI's.

Linkadge

 

Nix on the Anafranil...

Posted by Racer on August 2, 2007, at 13:43:23

In reply to Re: Apathy from SSRIs -- any suggestions?, posted by linkadge on August 2, 2007, at 10:42:24

> I second anafranil if you havn't tried it. It is very effective for OCD, but I found it didn't cause apathy half as bad as SSRI's.
>
> Linkadge

TCAs are basically out for me. The hypotension is the immediate problem, because it's been pretty well insurmountable so far. But the weight gain is just not acceptable. I'm as fat as a cow, and I can't stand it, so gaining even more weight isn't something I'm willing to do.

I appreciate the responses, though. I guess I'm pretty well wedged between that rock and the other hard place.

 

Re: Nix on the Anafranil... » Racer

Posted by Dinah on August 2, 2007, at 13:57:37

In reply to Nix on the Anafranil..., posted by Racer on August 2, 2007, at 13:43:23

How about Provigil?

It doesn't make me feel anxious or revved up at all, while it seems to help keep me awake and able to concentrate. It might have some mild AD effects, although that may just be that when I'm awake and able to concentrate, I don't feel as depressed.

My only negative effect, after the first few weeks, was that my insurance company is reluctant to pay for it. They're denying it again, even though my sleep neurologist is prescribing it for that purpose.

 

Re: Nix on the Anafranil...

Posted by linkadge on August 2, 2007, at 15:14:09

In reply to Nix on the Anafranil..., posted by Racer on August 2, 2007, at 13:43:23

TCA's can also cause hypertention. I was on a high dose of clomipramine without effect on blood pressure. I had some increase in heart rate but thats all.

Also, TCA's vary in their propensity to cause weight gain. Doxapin and Amitryptaline are the most likely to do so. These two are strong antagonists at 5-ht2c.

Clomipramine isn't a 5-ht2c angatonist, and therefore probably a indirect agonist. I found it decreased appetite similar to effexor. It felt like a much more tollerable version of effexor.

Its your decision, and YMMV, but in terms of a strong antidepressant, and anti-OCD, with less apathy inducing effects clomipramine is a good option, and you never know unless you try.

I personally think that any drug which creates apathy is much more likely to lead to weight gain. On clomipramine I was very active and did a lot of hiking and running. I probably lost weight, although I don't need that.


Linkadge

 

Re: Apathy from SSRIs -- any suggestions?

Posted by cactus on August 2, 2007, at 22:36:49

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

> I'm taking Wellbutrin, Concerta, Prozac, and SAMe, which is working well enough, I guess, but I'm experiencing a good deal of SSRI-related apathy and sleep disturbance. The apathy is a problem, because it's not neutral apathy -- I'm definitely in a kind of "I'm depressed, but I don't care" sort of a state. Although, I don't know if it's really depression, rather than just a "oh, f--k it all, I just don't give a rat's behind" sort of a state.
>
> As many of you might know, I've taken many, many different antidepressants. My dx is major depession, unipolar; anorexia nervosa; and generalized anxiety disorder. I also have {ahem} "obsessive compulsive personality traits," and am on the cusp of diagnosable OCD -- actually, it's only lately that I brought that up with my T, and haven't actually discussed it with my pdoc, so maybe it's not a "cusp" thing at all.
>
> I'm debating dropping the Prozac entirely, although I know that the WB/stim combo isn't quite enough to fix me.
>
> So, can anyone offer any other suggestions? Might Zoloft be a better choice for SSRI? (The other SSRIs are out -- been there, done that, they're worse. Effexor and Cymbalta, ditto.) My pdoc says that he thinks I do need a serotinergic component, and I think he's probably right. But I'm just not satisfied by where I am now. I've got that feeling as though I really want to sit here and cry, but it seems to much trouble even to finish a thought, let alone bother with having an emotion.
>
> Thanks.

Hey there racer, hope you're ok. I recently started zoloft and it's had the least side effects of any ssri I have ever taken. It's been about 6 weeks now and the ssri apathy has returned BUT it is nowhere near as bad as any of the others I have tried, which like you has been quite a few. I only have lexapro and cymbalta left on the list. It's reportedly weight neutral and I have lost weight since starting it. Anyway it's been the best for me so far. I would recommend it hon!!

 

Re: Apathy from SSRIs -- any suggestions? » Racer

Posted by Netch on August 3, 2007, at 5:58:42

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

> I'm taking Wellbutrin, Concerta, Prozac, and SAMe, which is working well enough, I guess, but I'm experiencing a good deal of SSRI-related apathy and sleep disturbance. The apathy is a problem, because it's not neutral apathy -- I'm definitely in a kind of "I'm depressed, but I don't care" sort of a state. Although, I don't know if it's really depression, rather than just a "oh, f--k it all, I just don't give a rat's behind" sort of a state.
>
> As many of you might know, I've taken many, many different antidepressants. My dx is major depession, unipolar; anorexia nervosa; and generalized anxiety disorder. I also have {ahem} "obsessive compulsive personality traits," and am on the cusp of diagnosable OCD -- actually, it's only lately that I brought that up with my T, and haven't actually discussed it with my pdoc, so maybe it's not a "cusp" thing at all.
>
> I'm debating dropping the Prozac entirely, although I know that the WB/stim combo isn't quite enough to fix me.
>
> So, can anyone offer any other suggestions? Might Zoloft be a better choice for SSRI? (The other SSRIs are out -- been there, done that, they're worse. Effexor and Cymbalta, ditto.) My pdoc says that he thinks I do need a serotinergic component, and I think he's probably right. But I'm just not satisfied by where I am now. I've got that feeling as though I really want to sit here and cry, but it seems to much trouble even to finish a thought, let alone bother with having an emotion.
>
> Thanks.

Racer

I think all your drugs can cause insomnia by themselves. Your apathy may well be caused by your insomnia.

You might want to consider Remeron at night and drop some of the other meds.
I don't think switching to zoloft will help your situation, although zoloft is known to be better tolerated.

Netch

 

Re: Apathy from SSRIs -- any suggestions? » Racer

Posted by Sigismund on August 4, 2007, at 15:57:13

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

Rhodiola'a a thought, though I dunno about the sleep angle.
It's fairly long acting.

 

Re: Apathy from SSRIs -- any suggestions? » Racer

Posted by Quintal on August 6, 2007, at 3:00:22

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

If you've exhausted the SSRIs how about another antidepressant that acts on serotonin, but via a different mechanism - like tianeptine for example? All the other atypical serotonin meds I can think of cause substantial weight gain and I know that's something you want to avoid. Tianeptine is said to have a mild and pleasant psychostimulant effect at the higher doses, tends to enhance motivation and cognitive function whereas SSRIs tend not to. Also (and I know this is a sensitive issue) I'm reminded of the 'excess serotonin' theory of AN because although I don't have an ED I'm one of those people who feels sick and nervous after eating, and this went away while I was taking tianeptine. It didn't really alter my appetite but I enjoyed my meals so much more somehow. I was left feeling satisfied and relaxed. SSRIs were awful in this regard, as if all the muscles in my throat and stomach would rise up in objection if they sensed any food coming their way.

Q

 

Re: Apathy from SSRIs -- any suggestions?

Posted by 1000songs on August 6, 2007, at 21:07:17

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

I have hypotension and I took clomipramine and amitriptyline long ago. My bp was OK

 

Re: Apathy from SSRIs -- any suggestions? » Racer

Posted by yznhymer on August 8, 2007, at 1:08:25

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56


> So, can anyone offer any other suggestions? Might Zoloft be a better choice for SSRI?

Hey Racer,

I can't really give you an opinion about whether Zoloft is a better choice, but my son takes Zoloft for depression and pretty severe OCD - disturbing obsessive thoughts as opposed to the compulsive action variety. It works very well for him on both counts.

If you're concerned about weight gain, I should tell you he was always a skinny kid but when he started Zoloft he blew up like Elvis once he discovered carbohydrates. On the other hand he has been able to lose weight with exercise and a good diet - its not been an intractable problem.

Take care,
Y

 

Re: Apathy from SSRIs -- any suggestions?

Posted by mbluett on August 10, 2007, at 15:08:58

In reply to Re: Apathy from SSRIs -- any suggestions? » Racer, posted by Phillipa on August 1, 2007, at 16:52:41

> Well since luvox is doing nothing thinking of zoloft myself next week when see pdoc as fatigue has become a big issue. And I know a lot of people who either prefer zoloft or lexapro. My neice and sister love zoloft. Have you been on zoloft before? Love Phillipa

You're way off topic sista! I diagnoze you ADD

 

Re: Apathy from SSRIs -- any suggestions?

Posted by mbluett on August 10, 2007, at 15:15:27

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

> I'm taking Wellbutrin, Concerta, Prozac, and SAMe, which is working well enough, I guess, but I'm experiencing a good deal of SSRI-related apathy and sleep disturbance. The apathy is a problem, because it's not neutral apathy -- I'm definitely in a kind of "I'm depressed, but I don't care" sort of a state. Although, I don't know if it's really depression, rather than just a "oh, f--k it all, I just don't give a rat's behind" sort of a state.
>
> As many of you might know, I've taken many, many different antidepressants. My dx is major depession, unipolar; anorexia nervosa; and generalized anxiety disorder. I also have {ahem} "obsessive compulsive personality traits," and am on the cusp of diagnosable OCD -- actually, it's only lately that I brought that up with my T, and haven't actually discussed it with my pdoc, so maybe it's not a "cusp" thing at all.
>
> I'm debating dropping the Prozac entirely, although I know that the WB/stim combo isn't quite enough to fix me.
>
> So, can anyone offer any other suggestions? Might Zoloft be a better choice for SSRI? (The other SSRIs are out -- been there, done that, they're worse. Effexor and Cymbalta, ditto.) My pdoc says that he thinks I do need a serotinergic component, and I think he's probably right. But I'm just not satisfied by where I am now. I've got that feeling as though I really want to sit here and cry, but it seems to much trouble even to finish a thought, let alone bother with having an emotion.
>
> Thanks.

Drop the Wellbutrin, Concerta and Prozac. Get on Zoloft, Strattera, Lamictal 50mg and SAMe 200mg. Watch out for feeling of motivation and happiness, as they are side effects. Enjoy the ride.

 

Re: Apathy from SSRIs -- any suggestions?

Posted by deniseuk190466 on August 11, 2007, at 5:53:17

In reply to Apathy from SSRIs -- any suggestions?, posted by Racer on August 1, 2007, at 15:43:56

Hi Racer,

I do find Zyprexa pretty much helps with all my symptoms when added to an SSRI. Even just a small amount of it.

It may be the apathy is sort of related to anxiety that you are still feeling, I sort of think the two go hand in hand.

I am currently on lexapro and buspar, I am sleeping way too much and I still feel tiredall the time so so far I am not really rating buspar that well.

I have found that klonopin and Zyprexa (Zyprexa more so) has helped with the physical tension etc that seems to cause apathy in me. Afterall if your body is constantly tensing up it's bound to make you feel tired and weak.


Denise


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