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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 11 to 35 of 55. Go back in thread:
Posted by jono_in_adelaide on September 23, 2012, at 20:38:20
In reply to Re: ANHEDONIA - Questions and Answers, posted by Trevpr on September 23, 2012, at 20:22:27
There is a fair bit of infomation out there about combining a TCA with an MAOI, do a pubmed search, and use google as well.
Nortriptyline + nardil/Parnate, while not exactly common, isnt unheard of, and there is evedence to support it.
Take a look at Dr Ken Gillmans site, Psychotropical.com.au, lots of material there..... he is experienced in using MAOI's alone and in combination, and could give you a lot of help (he does online consults via Skype is you ask him)
Posted by SLS on September 24, 2012, at 0:39:33
In reply to ANHEDONIA - Questions and Answers, posted by Trevpr on September 23, 2012, at 17:47:02
> Hello everyone,
Hi.
You are one smart and well-read dude/dudette.
Your treatment alternatives are extremely well chosen, in my opinion. It makes for a good review of what many of us on Psycho-Babble have already proposed as treatments.
I hope you find this forum interesting and helpful enough to stick around for a while. I'm sure your knowledge and perspectives would help a great many people.
- Scott> possible treatments:
>
> STIMLANTS
> Ritalin (Methylphenidate), Dextroamphetamine, Adderall (mixed amphetamine salts), Focalin (Dextromethylphenidate)
>
> DOPAMINE AGONISTS
> Mirapex (Pramipexole), Requip (Ropinirole), Dostinex (Cabergoline), (Apomorphine), (Bromocriptine), (Rotigotine), (Amantadine)
>
> ANTIPSYCHOTICS
> Abilify (Aripiprazole), Amisulpride, Sulpride, Zyprexa
>
> SEROTONIN RECEPTOR ANTAGONISTS
> Buspar (Busiprone), Low dose Prozac (Fluoexitine), Remeron, Periactin (Cyproheptadine)
>
> DOPAMINE REUPTAKE INHIBITORS
> (Amineptine), To a small extent Wellbutrin (Bupropion)
>
> SELECTIVE SEROTONIN REUPTAKE ENCHANCERS
> (Tianeptine)
>
> NOREPINIPHERINE REUPTAKE INHIBITORS
> (Desipramine), (Atomoxetine), Vivactil (Nortryptaline), Wellbutrin (Bupropion)
>
> MAOIs
> Parnate, Nardil, Selegiline, Marplan
>
> MOOD STABILIZERS
> Lithium, Lamactil
>
> SUPPLEMENTS
> L-Tyrosine, L-Theanine, L-Glutamine, Saint Johns Wort, Phenylethylamine, Levodopa, SAM-E, Saffron, Fish Oil, Magnesium, Zinc, Calcium, Vitamin B Complex, Multivitamins, Vitamin D
>
> SEROTONERGICS WHICH HAVE ACTIVATING FEATURES
> Pristiq, Effexor, Various TCAs
>
> OTHER
> Nicotine, Testosterone, Exercise, ETC, rTMS
>
> Preclinical neurobiological studies of anhedonia have primarily targeted neural substrates involved in motivation and reinforcement(want-ing). Across a variety of studies, liking and wanting have been linked to a variety of brain regions, neural circuits and neurotransmitters. These include primarily the neurotransmitter dopamine, norepinepherine, and opioid neuropeptides, sub-cortical structures such as the basal ganglia and striatum (particularly the nucleus accumbens(NAcc),ventral pallidum (VP),ventral tegmental area(VTA),substantia nigra(SN), amygdala and hippocampus), as well as cortical regions such as the ventro medial prefrontal cortex(vmPFC), encompassing aspects of orbital frontal cortex(OFC), anterior cingulated cortex(ACC)and medial prefrontal cortex(mPFC). (http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&sqi=2&ved=0CFIQFjAH&url=http%3A%2F%2Fzaldlab.psy.vanderbilt.edu%2Fresources%2FPublications%2Fmtt10nbr.pdf&ei=LppeUM67DOOPiALS0YHAAw&usg=AFQjCNFYaIO2t9JVX_sHcRjpzxUsWbpnVg&sig2=vBu2VN_DFfJTI9lVWS34Ig)
>
> QUESTIONS
> 1.) Has anyone here had remission from anhedonic symptoms? If so, how? What was it like? How long did it take before remission?
> 2.) Anyone have any experience with the beforementioned treatments? Any of them help anhedonic symptoms?
> 3.) Has anyone gotten their sex drive back after having it absent for months? Did it come back fully?
> 4.) Anyone have any advice on treating anhedonia?
>
> Let's have a discussion about this!
>
Posted by Trevpr on September 24, 2012, at 0:42:56
In reply to Re: ANHEDONIA - Questions and Answers » Trevpr, posted by SLS on September 24, 2012, at 0:39:33
Also added to that list should be adrafinil, modafinil, nortiptyline, and mazindol.
Amyone have good hedonic responses to these or ones previously listed? Including libido?
Posted by jono_in_adelaide on September 24, 2012, at 1:42:46
In reply to Re: ANHEDONIA - Questions and Answers, posted by Trevpr on September 24, 2012, at 0:42:56
Ijust checked Dr Ken Gillmans site, psychotropical.com, and he specificaly suggests bupropion + tranylcypromine as a treatment for severe, resistant melancholic depression...... it might be worth a shot in your case.
Posted by alchemy on September 24, 2012, at 11:30:09
In reply to Re: ANHEDONIA - Questions and Answers » Trevpr, posted by SLS on September 24, 2012, at 0:39:33
Your post comes right when i am struggling with ritalin. I have taken it off and on for a long time, mostly for work. Sometimes it would help. But it is also the only thing that has touched my anhedonia and at times my mood. Unfortunately I dont offer any good news from my situation. I have tried quite a few meds over 30ish years.
Because i have been so treatment resistant and stimulants are the only thing that have touched mood and/or motivation, my dr recently actually suggested trying to increase my ritalin, take it consistently, and throughout the day as it only seems to last about 3-4 hrs with the long-acting for me. I crashed a couple of times pretty hard over the weekend and it is losing its effectiveness. Today i have been trying to hold back tears as i really wonder if what i am afraid of will really shortly happen.
Anti-psychotics make me more depressed and agitated. I have tried amantadine and am currently on wellbutrin. Im not sure if the wellbutrin is actually helping though.
Posted by Trevpr on September 24, 2012, at 12:22:55
In reply to Re: ANHEDONIA - Questions and Answers, posted by alchemy on September 24, 2012, at 11:30:09
Anyone find anything other than Ritalin useful? While it was useful, I didnt find that it helped all the way. It made me enjoy things a bit more and increased libido slightly while making me a bit more motivated (and chatty) but didnt really make me feel empathetic or caring or "emotional." These are all traits that have seemed to dissapear with the apathy. Before, I used to find that crying, for example, was quite refreshing, as well as laughing, orgasming (tmi I know), etc. I just dont get that "refreshing" satisfied feeling anymore. Everything feels "blah."
I hope theres something besides ritalin that works! I dont think that there would be much use in augmenting parnate with wellbutrin, as I felt no different on wellbutrin alone, and with any other norepinepherine reuptake inhibitor (desipramine and now protryptaline for example).
Maybe parnate alone would be useful, but not if its as wussy (sorry I just cant think of any other word to describe how weak/useless these other drugs have been to me) or subtle as these other drugs I've tried.
That's why I've asked if parnate is more "noticeable" or "strong" than wellbutrin, TCAs, abilify, Mirapex, effexor, etc. If it's not, I'm SOL, you see. I've never even felt discontinuation symptoms.
Does parnate allow you to experience life's "highs?" Essentially that is what I am missing. There seems to be a ceiling on how good I feel, and it's rather low. I've found most antidepressants clip life's lows, but also highs, so they arent much use to me here.
And yes, libido is important too.
Posted by AlexCanada on September 24, 2012, at 13:38:06
In reply to ANHEDONIA - Questions and Answers, posted by Trevpr on September 23, 2012, at 17:47:02
I been also dealing with severe Anhedonia. Zoloft currently is blunting the hell out of me and I may be dropping it all together in a few weeks.
I been dealing w/ strong treatment resistant Melancholic Depression for a decade. Anhedonia has been one symptom which has been especially difficult to deal with. My best experiences would have been with Ritalin/Dexedrine (astonishing improvement, could feel a bit like my old normal self but tolerance onset of course), Vivalan/Vivarint (available only in France now), Stablon (it's very pro-sexual too), Parnate (quick onset and amphetamine-like initial boost, anti-dep effect would be better than most meds I've tried, some old hobbies would return), Paxil (some old hobbies would return), Risperidal (interest in things would suddenly emerge).
L-Tyrosine may be worth a try as well. I have had such horrible days on my current trial of Zoloft but L-Tyrosine has been making it easier and I feel with 500-1000mg I am a bit more able to enjoy things at least on some marginal level.
I been on few dozen meds and a dozen+ supplements/herbals. Grasping at straws here too.
> Hello everyone,
> I am currently over 10 months into a major depressive episode triggered by chronic stress I experienced at UC Berkeley, which, needless to say, forced me to withdrawal from the university. The episode began with extreme stress due to a long term relationship breakup, academic demands, and difficulty adjusting to the new dynamics of college life and that campus. I began to have panic attacks, anhedonia, extreme anxiety, insomnia, and "dark moods," forcing me to withdrawal from my second year last January. The symtoms of insomnia, anxiety, and panic attacks quickly vanished upon returning home, and after my first hospital visit, however, I have been stuck in an anhedonic, apathetic, flat emotioned, zombielike state ever since. This has been very distressing, as I feel no empathy, cannot cry, cannot enjoy anything, and feel invariably unmoved by anything, which makes for a poor quality of living. There has been no variation in this symptom, and I do not have "good days" and "bad days," just "flat days."
>
> Due to my engineering mindset I researched everything in excruciating detail, and what I have come up with is that anhedonic symptoms are theorized to be a result of the breakdown of dopaminergic pathways, particularly the mesolimbic reward pathway, in the brain. Somehow the chronic stress caused a "meltdown" and disrupted my dopaminergic systems. The two neurotransmitters, dopamine and norepinepherine, are intimately involved in this (catecholamines). The fact that the book that we are using directly lists in a chart of neurotransmitters that dopamine, out of all the transmitters listed, has a role in "emotion," without mentioning that about any of the others only reinforces my point.
>
> There seems to be two "camps" that psychiatrists fall under, and I have dealt with both. In one camp are the psychiatrists who tend to disregard anhedonia as "just a symptom of the underlying depression/other illness" and not mainly a dopaminergic phenomenon saying "treat the underlying depression/other illness, and the symptoms go away with it like a cascade." These psychiatrists believe that SSRIs are most effective for any type of depression, regardless of symptoms, (usually calling me "obsessive" for researching or disregard science backing it up as "just theories, and that nobody knows whats actually going on in the brain" etc.) and often deny that serotonergics make anhedonia worse (I've been with two of this type). Psychiatrists falling under the second camp listen to symptoms and recognize anhedonia as mainly dopaminergic or to do with norepinepherine, and recommend medications accordingly (I have been with several of this type).
>
> Serotonergic drugs seem to be effective at lowering anxiety, helping with insomnia through metabolization to melatonin, and helps with "dark moods," but do not seem to be very effective at dealing with anhedonic symptoms such as blunted emotions, and in fact, seem to perpetuate them. It's been long known, for example, that serotonergics lower the hedonic response of libido. Now, there are two main mechanisms by which elevated serotonin levels blunt hedonic response. The first is by "tricking" dopaminergic neurons into sending serotonergic signals, and thus this competition or "outcrowding" effect attenuates dopaminergic transmission. The second mechanism is the activation of 5ht2a/c receptor sites which inhibit dopamine (some serotonergics appear to do the opposite, but this is not due to their serotonergic properties. Prozac, for example, is often cited as being "more activating" due to 5ht2a/c antagonism). Serotonin also raises prolactin levels which have been known to have an inhibitory effect on drive. Scientific studies have proven that prolonged use of serotonergics can lower levels of dopamine in the prefrontal cortex. It doesn't seem that serotonergics are the best choice for all types of depression. I have located 3 different studies published in reliable scientific journals to back up my point:
>
> http://bjp.rcpsych.org/content/195/3/211.abstract
>
> http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)01322-5/abstract
>
> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989833/
>
> Here is another interesting article. It has been found that in lab rats the SSRI Prozac blunted mesolimbic reward response:
> http://www.biopsychiatry.com/fluoxrew.htm
>
> For instance, SSRIs and antipsychotics reduce testosterone and increase prolactin activity, which in turn theoretically decreases the amount of free dopamine available for distribution to the pleasure centers. Furthermore, the reuptake inhibition of serotonin decreases the availability of dopamine through neural pathways, due to its use of the same substrate and also through inhibitory action after activation of receptors such as the 5HT-1A and 5HT2A/C receptors. SSRIs like Prozac have been proven to decrease serotonin transporters (leading to more free serotonin) and increase dopamine transporters (leading to less free dopamine). This may explain reports of persistent apathy after discontinuation of serotonergic medications. http://www.sciencedirect.com/science/article/pii/S0924977X05000349
>
> Now, there is a sort of catch-22 situation with anhedonia because serotonergics blunt hedonic response, but the administration of dopaminergic agents also can worsen the problem. Downregulation, desensitization, or tolerance may develop. In addition, many dopaminergic/norepinepheric agents have many side effects such as elevated blood pressure or heart rate (such as Ritalin). So this is where I am stuck.
>
> I initially tried taking a "natural" route at treating my depression. I tried the monoamine precursors l-tyrosine, 5HTP, l-theanine, and DLPA without any effect on my mood. I have tried vitamin D, fish oil, vitamin b complex, SAM-E, rhodiola rosea, magnesium, zinc, and calcium supplements. The only effect I noticed was extreme agitation with l-theanine.
> I was then put on the SNRI Effexor (velafaxine) which made me feel more "out of it."
> I was then placed on the NRI Wellbutrin (bupropion) 450mg and AP Abilify (aripiprazole), on which I had remission of all symptoms but the anhedonia. I stayed on this for 8 weeks with no other effect. I was first administered benzodiazepines for the insomnia, but asked to be switched to trazodone 100mg. I no longer needed either in a matter of weeks. The Wellbutrin and Abilify, no matter how long I was on them, did not seem to touch the anhedonia.
> I was then administered the stimulants Ritalin (methylphenidate) and Adderall (various amphetamine salts). Ritalin was the only drug so far that I noticed any marginal improvement, but it was short lasted, I crashed after it wore off, and I formed a tolerance quickly. Adderall only raised my heart rate.
> I was then given the tricyclic NRI Desipramine 200mg for several weeks with no noticeable effect.
> I was then given the dopamine agonist, Mirapex (pramipexole) 0.375-0.650mg daily. The rationale for this was it would hit the DRD3 and DRD2 receptors which are expressed heavily in the limbic system. This medication only made me tired, I am presuming from the alpha-2 agonism it also posesses, like Remeron.
> I am currently on the tricyclic NRI Vivactil (Protriptyline) along with Abilify and am titrating up my dose over the course of 2 weeks. So far I have not noticed any effect on my emotions. I am currently taking 15mg daily and titrating up an extra 5mg every 3 days.
>
> So far, no antidepressant has touched my anhedonic symptoms, though Ritalin was the closest to helping. I'm starting to wonder why, and am beginning to wonder if the "antidepressant effect" is too subtle. I've narrowed down possible treatments:
>
> STIMLANTS
> Ritalin (Methylphenidate), Dextroamphetamine, Adderall (mixed amphetamine salts), Focalin (Dextromethylphenidate)
>
> DOPAMINE AGONISTS
> Mirapex (Pramipexole), Requip (Ropinirole), Dostinex (Cabergoline), (Apomorphine), (Bromocriptine), (Rotigotine), (Amantadine)
>
> ANTIPSYCHOTICS
> Abilify (Aripiprazole), Amisulpride, Sulpride, Zyprexa
>
> SEROTONIN RECEPTOR ANTAGONISTS
> Buspar (Busiprone), Low dose Prozac (Fluoexitine), Remeron, Periactin (Cyproheptadine)
>
> DOPAMINE REUPTAKE INHIBITORS
> (Amineptine), To a small extent Wellbutrin (Bupropion)
>
> SELECTIVE SEROTONIN REUPTAKE ENCHANCERS
> (Tianeptine)
>
> NOREPINIPHERINE REUPTAKE INHIBITORS
> (Desipramine), (Atomoxetine), Vivactil (Nortryptaline), Wellbutrin (Bupropion)
>
> MAOIs
> Parnate, Nardil, Selegiline, Marplan
>
> MOOD STABILIZERS
> Lithium, Lamactil
>
> SUPPLEMENTS
> L-Tyrosine, L-Theanine, L-Glutamine, Saint Johns Wort, Phenylethylamine, Levodopa, SAM-E, Saffron, Fish Oil, Magnesium, Zinc, Calcium, Vitamin B Complex, Multivitamins, Vitamin D
>
> SEROTONERGICS WHICH HAVE ACTIVATING FEATURES
> Pristiq, Effexor, Various TCAs
>
> OTHER
> Nicotine, Testosterone, Exercise, ETC, rTMS
>
> Preclinical neurobiological studies of anhedonia have primarily targeted neural substrates involved in motivation and reinforcement(want-ing). Across a variety of studies, liking and wanting have been linked to a variety of brain regions, neural circuits and neurotransmitters. These include primarily the neurotransmitter dopamine, norepinepherine, and opioid neuropeptides, sub-cortical structures such as the basal ganglia and striatum (particularly the nucleus accumbens(NAcc),ventral pallidum (VP),ventral tegmental area(VTA),substantia nigra(SN), amygdala and hippocampus), as well as cortical regions such as the ventro medial prefrontal cortex(vmPFC), encompassing aspects of orbital frontal cortex(OFC), anterior cingulated cortex(ACC)and medial prefrontal cortex(mPFC). (http://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=8&cad=rja&sqi=2&ved=0CFIQFjAH&url=http%3A%2F%2Fzaldlab.psy.vanderbilt.edu%2Fresources%2FPublications%2Fmtt10nbr.pdf&ei=LppeUM67DOOPiALS0YHAAw&usg=AFQjCNFYaIO2t9JVX_sHcRjpzxUsWbpnVg&sig2=vBu2VN_DFfJTI9lVWS34Ig)
>
> QUESTIONS
> 1.) Has anyone here had remission from anhedonic symptoms? If so, how? What was it like? How long did it take before remission?
> 2.) Anyone have any experience with the beforementioned treatments? Any of them help anhedonic symptoms?
> 3.) Has anyone gotten their sex drive back after having it absent for months? Did it come back fully?
> 4.) Anyone have any advice on treating anhedonia?
>
> Let's have a discussion about this!
>
Posted by alchemy on September 24, 2012, at 13:39:35
In reply to Re: ANHEDONIA - Questions and Answers, posted by Trevpr on September 24, 2012, at 12:22:55
I wonder what it is like to have a libido. Always too much sadness and sympathy for others though.
Posted by AlexCanada on September 24, 2012, at 13:46:20
In reply to Re: ANHEDONIA - Questions and Answers, posted by Trevpr on September 24, 2012, at 0:42:56
> Also added to that list should be adrafinil, modafinil, nortiptyline, and mazindol.
>
> Amyone have good hedonic responses to these or ones previously listed? Including libido?Stablon I found exceptionally pro-sexual.
Korean Ginseng at moderate to high doses when taken with Parnate caused me to be extremely sexual. Normally my sex drive is quite low.
Gingko Biloba 300mg at a time can increase my libido moderately.
Posted by AlexCanada on September 24, 2012, at 13:48:46
In reply to Re: ANHEDONIA - Questions and Answers, posted by alchemy on September 24, 2012, at 11:30:09
I've read that Magnesium can suppossedly help prevent ritalin tolerance. Magnesium Glycinate or Chilate possibly.
> Your post comes right when i am struggling with ritalin. I have taken it off and on for a long time, mostly for work. Sometimes it would help. But it is also the only thing that has touched my anhedonia and at times my mood. Unfortunately I dont offer any good news from my situation. I have tried quite a few meds over 30ish years.
> Because i have been so treatment resistant and stimulants are the only thing that have touched mood and/or motivation, my dr recently actually suggested trying to increase my ritalin, take it consistently, and throughout the day as it only seems to last about 3-4 hrs with the long-acting for me. I crashed a couple of times pretty hard over the weekend and it is losing its effectiveness. Today i have been trying to hold back tears as i really wonder if what i am afraid of will really shortly happen.
> Anti-psychotics make me more depressed and agitated. I have tried amantadine and am currently on wellbutrin. Im not sure if the wellbutrin is actually helping though.
Posted by jono_in_adelaide on September 24, 2012, at 17:41:19
In reply to Re: ANHEDONIA - Questions and Answers » alchemy, posted by AlexCanada on September 24, 2012, at 13:48:46
You might well find that parnate plus welbutrin was usefull because of the threashold effect - each drug might only raise your neurotransmitter levels so far, but not enough to get remission, but the combo might get you over the line.
You have nothing to lose by trying, and everything to gain.
Given everything you've tried, you are running low on options, so I would encourage you to try Parnate both alone in combination.
If I can explain it like this - Excedrin is quite a potent analgesic, made up of aspirin, acetaminophen ans caffeine. The individual constituents, in the doses present, are onlyweak analgesics individualy, but in concert they provide a very usefull analgesic effect.You might find the same effect with Welbutrin + parnate (or any other logical combo) - two drugs that were mediocre along might turn out to be quite potent in combination.
Posted by jono_in_adelaide on September 24, 2012, at 17:58:02
In reply to Re: ANHEDONIA - Questions and Answers, posted by jono_in_adelaide on September 24, 2012, at 17:41:19
You might prefer the combo of emasem + welbutrin, and it might be that parnate/emasem + welbutrin + methylphenidate gets you over the line.
There are also the options of vagal stimulation, deep magnetic stimulation etc which might be worth exploring if you feel you have run out of med options
Posted by jono_in_adelaide on September 24, 2012, at 18:47:21
In reply to Re: ANHEDONIA - Questions and Answers, posted by jono_in_adelaide on September 24, 2012, at 17:58:02
Also, if you can get your hands on Stabelon through the grey market, that plus welbutrin or parnate or emasem would be well worth a try
Posted by Trevpr on September 24, 2012, at 19:29:41
In reply to Re: ANHEDONIA - Questions and Answers, posted by jono_in_adelaide on September 24, 2012, at 18:47:21
Well I cant get Stablon, but ill ask about emsam or parnate. I was going to go on parnate but for some reason the doc chose vivactil and abilify
Posted by jono_in_adelaide on September 24, 2012, at 19:44:31
In reply to Re: ANHEDONIA - Questions and Answers, posted by Trevpr on September 24, 2012, at 19:29:41
I'd seriously try Parnate, and if that doesnt get you over the line, try Parnate plus Welbutrin (for the reasons outlined above)
Dont be afraid to push the doseages either, 80mg per day of Parnate isnt unusual.
Best of luck!
Posted by Trevpr on September 24, 2012, at 20:09:11
In reply to Re: ANHEDONIA - Questions and Answers, posted by jono_in_adelaide on September 24, 2012, at 19:44:31
Thanks for the help everyone! I hope Parnate will be my next trial.
Now as far as libido/interest in women goes, how likely is it that it will come back? I mean, I'm in my prime here, and I really would love to start dating again, so it's sort of important to me, but it's been gone for 11 months without any change. Does Parnate necessarily raise sex drive? From anecdotal user reviews, it appears to be equally likely to cause problems as to fix them sexually.
Posted by schleprock on September 25, 2012, at 0:05:06
In reply to Re: ANHEDONIA - Questions and Answers, posted by jono_in_adelaide on September 24, 2012, at 19:44:31
I'm currently in some sort of remission from anhedonia and other meloncholic like symptoms (they may be technically more rooted in anxiety than depression, though.) I've suffered them off and on over the past several months. Clonazepam helped in varying degrees, though I ended up gradually increasing my dosage from .5mg to 1.5 mg. I'm still on clonazepam (and nortriptyline) and have been on Lyrica (titrated from 50 mg - 150 mg) for about a month. So far this is about the longest I've went without the meloncholic\anhedonic symptoms returning. The anhedonic symptoms I'd had were very severe (as in an uncomfortable and excruciating wait for the day to pass so I could go to sleep and pray I felt better the next day; much more dostressing than just some sort of boredom.)
I've had no real relief in mood or libido (which has steadily decreased over the past year,) but at least I'm somewhat comfortable again. Before the Lyrica I tried Risperidone, which brought about two weeks of relief before it wore off and started to make me feel worse.
I've never gotten a clear answer, but there's a chance that (neurotransmitter produced) anxiety may share many symptoms associated with melancholic depression, so an anti-anxiety med strategy might be something to look into.
Posted by Trevpr on September 25, 2012, at 1:22:00
In reply to Re: ANHEDONIA - Questions and Answers, posted by schleprock on September 25, 2012, at 0:05:06
I personally have no anxiety or panic, but I did experience this to an extreme degree the first 3 months of the depression, so I'm not worried about that, I'm just worried about feeling like a zombie still. I'm calling my psychiatrist tomorrow and ill update with what she said
Posted by jono_in_adelaide on September 25, 2012, at 3:57:59
In reply to Re: ANHEDONIA - Questions and Answers, posted by schleprock on September 25, 2012, at 0:05:06
Just came to me in a dazeling flash - have you had your testosterone levels checked?
Posted by bleauberry on September 25, 2012, at 4:57:46
In reply to ANHEDONIA - Questions and Answers, posted by Trevpr on September 23, 2012, at 17:47:02
QUESTIONS
1.) Has anyone here had remission from anhedonic symptoms? If so, how? What was it like? How long did it take before remission?Mine is about 80% gone and getting better with time. As you have already seen in your research, it's a complicated mechanism, and as such, takes time. My progress has not been noticeable on a daily or weekly basis, but rather on a monthly and yearly basis. 3 years from total anhedonia to only 20% anhedonia, for me.
2.) Anyone have any experience with the beforementioned treatments? Any of them help anhedonic symptoms?
Basically the NE and DA circuits are the ones primarily involved. But we can't predict the mechanism or drug that will do what we want, so we have to try stuff that focuses on NE and DA. For me, I have discovered NE is a much bigger player in anhedonia than is dopamine. Of all the meds you listed, there are actually only meds in my experience worth looking at....savella, parnate, amisulpride. Don't worry about the scientific reasoning stuff....savella shares similarities with ritalin for example....I'm just saying these things had a definite impact on my anhedonia when absolutely nothing else did squat.
3.) Has anyone gotten their sex drive back after having it absent for months? Did it come back fully?
Yes. For me, the sexual comeback period was maybe about 3 to 6 months. I am well versed and experienced with a bunch of herbs and plant medicines. The one I would suggest to you as a longterm friend for sex, endurance, energy, and hormonal/mood support, is Cordyceps. It can be combined with anything except perhaps an maoi.
4.) Anyone have any advice on treating anhedonia?
Do not rely on meds alone. The brain needs to be shown and taught what you want it to do. Which means purposefully going out to do fun things, even though they won't feel fun. Brain training. Church, hobby, social interaction....all good healthy stuff that helps to diminish anhedonia even without drugs or herbs, and makes drugs/herbs work better. Since sex is an issue, then of the 3 meds I mentioned I would probably put savella at the top of the list as being the least offensive to sex.All three worked for me and did so fast.
Side effects caused me to only take them short term. The most dramatic improvement was with savella. I found that especially meaningful, because prior to that I had just failed ECT and prior to that a backpack full of meds and herbs.
Posted by Trevpr on September 25, 2012, at 9:03:35
In reply to Re: ANHEDONIA - Questions and Answers, posted by jono_in_adelaide on September 25, 2012, at 3:57:59
Yes, all hormones are ok
Posted by Trevpr on September 25, 2012, at 11:19:02
In reply to Re: ANHEDONIA - Questions and Answers, posted by bleauberry on September 25, 2012, at 4:57:46
I'm thinking about compiling an anhedonia guide with all the info I'm getting. Thank you all for your helpful comments
Posted by jono_in_adelaide on September 25, 2012, at 18:37:45
In reply to Re: ANHEDONIA - Questions and Answers, posted by Trevpr on September 25, 2012, at 11:19:02
The other thing I need to add is that you cant always achive 100% remission with drug therapy, sometimes you need to be satisfied with 70% improvement or whatever - you arnt at that point yet, but keep it in mind that pills might not bring total remission of every symptom.
I'd also strongly suggest you start seeing a compotent psychologist along with exploring every avenue of drug therapy.
Posted by Trevpr on September 26, 2012, at 0:45:42
In reply to Re: ANHEDONIA - Questions and Answers, posted by jono_in_adelaide on September 25, 2012, at 18:37:45
That's exactly what I'm afraid of... I really miss the old me!!!
Sometimes I contemplate just coming off all drugs all together because none have worked.
Does anyone know anything about chronic depression? The only info I could find was about dysthymia which only usually states things like "It lasts at least two years" and "it is less severe than major depression (bullsh*t in my opinion)." Does chronic depression necessarily last a lifetime? Does it never go away fully?
I hope that something works... I just went up to 20mg daily of Vivactil and 5mg abilify daily.
Posted by AlexCanada on September 26, 2012, at 3:16:38
In reply to Re: ANHEDONIA - Questions and Answers, posted by bleauberry on September 25, 2012, at 4:57:46
Hi. I'm very curious about Savella (my doc may have to somehow import it since I can't get it in Canada) and would love to try it but can you tell me more about how Amisulpride effected you?
How would you describe your depression? Mine is strong melancholic with full blown melancholic symptoms. Especially very poor cognition and lack of interest/enjoyment.
Dopamine based meds have tended to work best for me in my 10 year history but is Amisulpride likely to cause cognitive impairment in someone whom already is very impaired or more likely to alleviate it?
I had some other questions but I can't recall right now.
> QUESTIONS
> 1.) Has anyone here had remission from anhedonic symptoms? If so, how? What was it like? How long did it take before remission?
>
> Mine is about 80% gone and getting better with time. As you have already seen in your research, it's a complicated mechanism, and as such, takes time. My progress has not been noticeable on a daily or weekly basis, but rather on a monthly and yearly basis. 3 years from total anhedonia to only 20% anhedonia, for me.
>
> 2.) Anyone have any experience with the beforementioned treatments? Any of them help anhedonic symptoms?
>
> Basically the NE and DA circuits are the ones primarily involved. But we can't predict the mechanism or drug that will do what we want, so we have to try stuff that focuses on NE and DA. For me, I have discovered NE is a much bigger player in anhedonia than is dopamine. Of all the meds you listed, there are actually only meds in my experience worth looking at....savella, parnate, amisulpride. Don't worry about the scientific reasoning stuff....savella shares similarities with ritalin for example....I'm just saying these things had a definite impact on my anhedonia when absolutely nothing else did squat.
>
> 3.) Has anyone gotten their sex drive back after having it absent for months? Did it come back fully?
>
> Yes. For me, the sexual comeback period was maybe about 3 to 6 months. I am well versed and experienced with a bunch of herbs and plant medicines. The one I would suggest to you as a longterm friend for sex, endurance, energy, and hormonal/mood support, is Cordyceps. It can be combined with anything except perhaps an maoi.
>
> 4.) Anyone have any advice on treating anhedonia?
> Do not rely on meds alone. The brain needs to be shown and taught what you want it to do. Which means purposefully going out to do fun things, even though they won't feel fun. Brain training. Church, hobby, social interaction....all good healthy stuff that helps to diminish anhedonia even without drugs or herbs, and makes drugs/herbs work better. Since sex is an issue, then of the 3 meds I mentioned I would probably put savella at the top of the list as being the least offensive to sex.
>
> All three worked for me and did so fast.
> Side effects caused me to only take them short term. The most dramatic improvement was with savella. I found that especially meaningful, because prior to that I had just failed ECT and prior to that a backpack full of meds and herbs.
>
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