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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by psychobot5000 on January 16, 2011, at 11:22:06
Hello, all!
Anhedonia is one of those tricky symptoms for those depressives/bipolars out there, difficult to treat with medications. What do people know that works for it? My vagus nerve stimulator is somewhat effective at relieving it, where drugs have not been, but side-effects limit how high one can profitably set my device. Are there any other ideas out there for relieving anhedonia? Is TMS (transcranial magnetic stimulation) any good at it, for example? Or has anyone had long-term success with any particular medications?
Thanks for your attention, and hope this starts a useful discussion,
Psychbot(my background: I suffer from chronic, treatment-resistant depression, reasonably well-controlled, and have had a Vagus Nerve Stimulator implanted for the last two years).
Posted by Twinleaf on January 16, 2011, at 12:09:40
In reply to Anhedonia, a tricky sympt: what works besides VNS?, posted by psychobot5000 on January 16, 2011, at 11:22:06
I developed anhedonia during six years of treatment with SSRIs. When I discontinued them and began rTMS, tianeptine and low- dose lithium, the anhedonia slowly but surely disappeared. I can't say for sure, but I think the rTMS and the tianeptine both helped. The lithium might cause anhedonia, but I take only 150 mg.
Posted by Phillipa on January 16, 2011, at 13:31:42
In reply to Re: Anhedonia, posted by Twinleaf on January 16, 2011, at 12:09:40
Time flies I remember when it was implanted. Couldn't low level ahedonia go away so to speak without an ad? Phillipa
Posted by bleauberry on January 18, 2011, at 18:07:46
In reply to Anhedonia, a tricky sympt: what works besides VNS?, posted by psychobot5000 on January 16, 2011, at 11:22:06
My personal experience is that the focus on dopamine is not completely accurate. Most dopamine strategies can be somewhat helpful, but not dramatic. For me, norepinephrine is the big guns when talking about anhedonia. We're all wired different and we all have different things wrong with the wiring, so it's hard to predict. All I know is that with me, anhedonia is more of a norepinephrine thing than a dopamine thing. From that point, it becomes a journey of trial and error to identify what KIND of norepinephrine....reuptake inhibition?...accelerated release?....more raw material to make it?....antagonism?....agonism?...removal of some other thing contaminating the system? For sure at least I have learned anhedonia, for me, is not a serotonin thing, is mildly a dopamine thing, and is strongly a norepinephrine thing.
Some of the more successful stories here over the years involved well rounded strategies hit many things at once....abilify+ssri; prozac+ritalin; ssri+tca. For sure, a pure ssri aint gonna do the job with most people.
I believe a portion of the condition needs to involve retraining the brain. Consumption of some kind of herb or medicine alone is not likely to get the complete job done. New activities need to be undertaken. Things need to be "forced" before they can be enjoyed. Eventually the brain relearns how to have fun. But it takes purposeful strategic work. It requires forcing oneself to do something that should be fun regardless that it doesn't feel fun thinking about it. Repeat, repeat, repeat....as in any kind of training. A pill by itself can help set the stage to do that, but by itself is not going to provide lifelong benefits.
Posted by linkadge on January 21, 2011, at 20:11:43
In reply to Re: Anhedonia, a tricky sympt: what works besides VNS?, posted by bleauberry on January 18, 2011, at 18:07:46
I think the big issue is trying to increase CNS norepinephrine activity without peripherial effects. I can't tollerate most NRIs or SNRIs as they produce very unpeasant cardiac effects. They are good for depression though.
Linkadge
Posted by FreeFree1133 on June 3, 2011, at 23:06:27
In reply to Re: Anhedonia, posted by Twinleaf on January 16, 2011, at 12:09:40
Hi, I'm wondering if you still check the boards, twin leaf? I'm interested in your experience with rTMS and anhedonia.
Posted by Conundrum on June 4, 2011, at 11:59:41
In reply to Re: Anhedonia, a tricky sympt: what works besides VNS?, posted by bleauberry on January 18, 2011, at 18:07:46
I haven't found anything to be helpful for more than a few days, but the norepinephrine drugs have been better than dopaminergic drugs which just make me talkative or angry. unfortunately I have yet to find a doctor comfortable with TCAs. I may be starting nardil soon which is adrenergic I wish I could delete the good drug guide for perpetuating that myth alone.
> My personal experience is that the focus on dopamine is not completely accurate. Most dopamine strategies can be somewhat helpful, but not dramatic. For me, norepinephrine is the big guns when talking about anhedonia. We're all wired different and we all have different things wrong with the wiring, so it's hard to predict. All I know is that with me, anhedonia is more of a norepinephrine thing than a dopamine thing. From that point, it becomes a journey of trial and error to identify what KIND of norepinephrine....reuptake inhibition?...accelerated release?....more raw material to make it?....antagonism?....agonism?...removal of some other thing contaminating the system? For sure at least I have learned anhedonia, for me, is not a serotonin thing, is mildly a dopamine thing, and is strongly a norepinephrine thing.
>
> Some of the more successful stories here over the years involved well rounded strategies hit many things at once....abilify+ssri; prozac+ritalin; ssri+tca. For sure, a pure ssri aint gonna do the job with most people.
>
> I believe a portion of the condition needs to involve retraining the brain. Consumption of some kind of herb or medicine alone is not likely to get the complete job done. New activities need to be undertaken. Things need to be "forced" before they can be enjoyed. Eventually the brain relearns how to have fun. But it takes purposeful strategic work. It requires forcing oneself to do something that should be fun regardless that it doesn't feel fun thinking about it. Repeat, repeat, repeat....as in any kind of training. A pill by itself can help set the stage to do that, but by itself is not going to provide lifelong benefits.
>
>
Posted by creepy on June 9, 2011, at 23:59:18
In reply to Re: Anhedonia, a tricky sympt: what works besides VNS? » bleauberry, posted by Conundrum on June 4, 2011, at 11:59:41
I did good on desipramine. Doc took me off of it shes not comfortable with polypharmacy and probably TCAs too. Need to find an old-school doc that knows how to use these drugs.
Posted by zonked on June 11, 2011, at 12:03:33
In reply to Re: Anhedonia, a tricky sympt: what works besides VNS?, posted by linkadge on January 21, 2011, at 20:11:43
I can't tollerate most NRIs or SNRIs as they produce very unpeasant cardiac effects. They are good for depression though.
>
> Linkadge
>
>Link (and others), do you know what it means clinically (if anything) if SSNRIs and other drugs (in my case, nortriptyline) which preferentially affect NE cause increased anxiety, depression, and panic attacks, rather than ameliorate them? That's what happens to me...
-z
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