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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Trevpr on July 1, 2013, at 16:07:28
I've been on many meds, and so far, none has helped with my apathy/anhedonia/low libido/emotional numbness. Ritalin helped once or twice for about 15 minutes. The MAOIs did not help. Dopamine agonists made me irritable. Supplements had no noticeable effect. SSRIs/SNRIs don't seem to help obviously (I have avoided them). NRIs have no effect besides elevating heart rate and inducing panic symptoms.
ECT has been the only thing to help. After 11 rounds of bilateral shock, I was only helped a bit for like 2-3 weeks. I did not have memory loss or cognitive issues after my treatments, however, I'm so burnt out on ECT that I really need a break from it. It isn't very fun to get shocked every other day week after week after week... It's almost as bad as the anhedonia/numbness/depression/loss of libido.
I probably should have done more ECTs, but I couldn't get myself to do any more for the time being. Maybe when I muster the courage I'll go in for another series of shocks, but for now, I just can't stand any more.
Does this apathy ever go away? I've had it for 1.5 years. I'm very young, and would really like to find a mate in life and care about my family and feel truly good and all that... Do I just have to keep getting shocked over and over and over to feel like myself again or will it go away on its own? Maybe this isn't the best place to ask, since you are all treatment resistant... But 1.5 years is a long time to be numb.
Posted by Twinleaf on July 1, 2013, at 16:20:16
In reply to Does Apathy Ever Go Away?, posted by Trevpr on July 1, 2013, at 16:07:28
Do you think psychotherapy could play a helpful role, or have you tried that already?
Posted by antennastoheaven on July 1, 2013, at 16:54:31
In reply to Does Apathy Ever Go Away?, posted by Trevpr on July 1, 2013, at 16:07:28
Besides drugs that can only be used once in a while (serotonergic psychedelics, ecstasy), marijiuana was probably the most effective drug for me in treating anhedonia in the short term, but the positive benefits didn't last long and after a while it just led to even more anhedonia (and anxiety). And it caused increased apathy from the start. GHB and analogs/prodrugs would probably work for anhedonia and apathy at the right dosage, but would cause dependence; I have never taken it on a regular basis. Given the complications, risks, and legal status, none of these are good options.
A combination of Wellbutrin and doing something other than sit in front of a computer/TV screen all day helps reduce apathy a bit for me. Therapy is useful in overcoming cognitive barriers to being more active. I also find Wellbutrin to increase libido. I find getting out more often also helps a little with anhedonia. Occasional Adderall helps me as well, but I've come to the conclusion that the combination of NRI in Wellbutrin and NE effect of levoamphetamine is too anxiogenic, so I am trying to get something dextroamphetamine-only.
There are some other medications that might help. Some report Abilify (an atypical antipsychotic that is a partial dopamine D2 agonist) to be activating; I found it to be slightly helpful at the low dose I took, but not for very long and not nearly as much as Wellbutrin. Tianeptine, an SSRE (SSR enhancer) is said to reduce anhedonia; it did nothing for me. There are a few other drugs I have not tried but have noted as interesting for anhedonia (not available in US or not indicated for any condition I have): agomelatine, memantine, amispulride, pregabalin. Mirtazapine is a unique serotonergic antidepressant I've read about before, not sure how helpful it would be for treating apathy or anhedonia.
Have you considered TMS (transcranial magnetic stimulation)? It might be an option, but a post on this site made me doubtful currently available technology would help with anhedonia or motivation. http://www.dr-bob.org/babble/20130501/msgs/1043160.html It's also not covered by all health plans, and seems to cost $6,000-12,000 for a recommended course of a month's worth of treatment five days a week. It was recommended to me, and I could pay for it, but I'm not confident enough it would be worth it (I'd try at-home tDCS first)
Posted by Phillipa on July 1, 2013, at 17:54:10
In reply to Re: Does Apathy Ever Go Away? » Trevpr, posted by antennastoheaven on July 1, 2013, at 16:54:31
Getting out and doing things does that help? Phillipa
Posted by Trevpr on July 1, 2013, at 21:42:49
In reply to Re: Does Apathy Ever Go Away? » antennastoheaven, posted by Phillipa on July 1, 2013, at 17:54:10
Thank you all so much for your replies! I really don't want to sound like I'm just being difficult, but I have tried Wellbutrin and Abilify already.
Wellbutrin did not seem to have any real effect even at a max dosage and after being on it for a very long period of time. The same goes for Abilify (besides giving me tremors). Neither seemed to affect my libido or anhedonia.
Ritalin was the most "helpful" drug so far, but I feel like that is just because its mechanism of action is so similar for cocaine (of course cocaine would make almost anyone "feel good" haha). The problem with Ritalin was that I kept getting a tolerance, so I had to keep escalating the dose for it to do anything. It also raised my heartrate. When it worked, it only worked for like 20 minutes, then I was irritable and craved my next dose for the rest of the day. It was also unreliable - in other words, sometimes it raised my mood (almost) to baseline (but not quite there), and other times it did not seem to do anything at all. In the end, I craved it so much, that I accidentally overdosed on it (because I had to keep escalating the dose and I was so irritable without it working).
Next, I tried adderall. It raised my heartrate too high with no effect on mood (probably because I already had a tolerance to Ritalin at that point).
I already am getting out and seeing friends and trying to do what I can to not sit around the house and such. It has been unbelievably hot out lately (these past 2 weeks) though (over 100 degrees) so I can't go for a run or anything, but I do what I can. I signed up to volunteer at a few places and have been applying for jobs. I sometimes go running when I can, but I guess if I push myself I could do more (of course, it's hard to motivate myself to go running every day, but I might end up doing that).
NRIs such as Desipramine and Vivactil did not seem to have any affect besides elevating my heart rate to uncomfortable levels, giving me panic attack symptoms. They did not seem to affect my libido or mood.
Parnate was sort of interesting... It was sort of like Ritalin at first, but, like with Ritalin, it's dopaminergic effects faded with time, and it did not have the same sort of accompanying mood boost. The Parnate had no effect until day 8 on it (somewhere around day 8 anyways). At that point, my libido went sky-high and I felt really motivated and chatty. I liked the feeling, but it wasn't the cuddly intimate emotional kind of libido that I had before the depression, nor were my emotions back, it was more along the lines of what I would imagine methamphetamine users might experience - the "screw anything that moves" without any sort of strings attached kind of libido XD
This was a good distraction from my emotional numbness and apathy, but it only lasted like a week, then I was back to square one. I escalated my Parnate dose, but each subsequent dose increase seemed to have less and less of an effect until increasing the dose started doing nothing at all. I reached 50mg and adding more seemed to do nothing at all.
After my 11 ECTs, my mood seemed to be finally improving, and almost hit baseline. I was so sure that I was getting better! Then it slowly began declining, and I'm not sure if I'm just going to be back at square one, because I'm starting to feel like I am... I really tried keeping up the momentum. I tried crying out my feelings (now that I was able to cry), running/exercising, having a healthy sleep cycle, socializing, eating healthy - you know, the works.
You know that refreshing feeling you get from crying or (maybe TMI) orgasm? That nice, tired yet satisfied happy feeling? After ECT that came back slowly after the 11 shocks, and now is slowly disappearing. I am beginning to fear that soon I will be unable to weep at all once again.
I really can't think of any psychological problems that are perpetuating the depression (numbing/no libido), and they have been my main and most distressing symptoms since the very beginning of the episode (which began over 1.5 years ago). I called up my Great Uncle who had electroshock back in the 60s before they used anesthesia and all that. He said that the meds are designed to "protect you from your feelings" and perhaps that is why I am feeling numb, yet I have felt this way even off of the meds. Perhaps I should come off of Parnate?
I would have more ECTs, but the whole process was so draining, and I wasn't seeing any improvements, so after 11 shocks, I stopped. It was a few days to a week after my last shock that I began to notice things beginning to improve - but I really do not want a treatment that I am so uncomfortable with that just barely works for like 2 weeks. I remember my mood just spontaneously changing. Like all the sudden I started getting rushes of euphoria and I felt really lightheaded like as if I had taken some illicit drug or something. It was a refreshing feeling. Then I noticed after crying I got the refreshing feeling too. Orgasm, not so much unfortunately (again, sorry for TMI).
I really would like to find a romantic partner in life, but how if it even possible without emotion, feelings of attraction, desire for intimacy, or libido? Do things just spontaneously come back after a certain amount of time (maybe like a year or two or three down the road?) or is it something that is usually permanent?
Thanks again for the replies @_@
Posted by Hugh on July 2, 2013, at 18:25:43
In reply to Does Apathy Ever Go Away?, posted by Trevpr on July 1, 2013, at 16:07:28
The drug that made me feel most alive was baclofen, a muscle relaxant. I was taking it for muscle spasms in my lower back, and it had the unexpected side effect of wiping out my depression and anxiety. It also increased my libido. Unfortunately, I had to stop taking it after a week because it caused terrible insomnia. But I'm hypersensitive to many drugs, so most people probably wouldn't have this problem with it. For more info about baclofen, read The End of My Addiction by Olivier Ameisen.
Posted by Trevpr on July 4, 2013, at 0:59:48
In reply to Re: Does Apathy Ever Go Away?, posted by Hugh on July 2, 2013, at 18:25:43
That is very interesting and unexpected that baclofen would have that effect
Posted by SLS on July 4, 2013, at 4:56:02
In reply to Re: Does Apathy Ever Go Away?, posted by Hugh on July 2, 2013, at 18:25:43
> The drug that made me feel most alive was baclofen, a muscle relaxant. I was taking it for muscle spasms in my lower back, and it had the unexpected side effect of wiping out my depression and anxiety. It also increased my libido. Unfortunately, I had to stop taking it after a week because it caused terrible insomnia. But I'm hypersensitive to many drugs, so most people probably wouldn't have this problem with it. For more info about baclofen, read The End of My Addiction by Olivier Ameisen.
Do you think that you would respond to baclofen were you to restart it?
- Scott
Posted by sigismund on July 4, 2013, at 8:22:50
In reply to Re: Does Apathy Ever Go Away?, posted by Hugh on July 2, 2013, at 18:25:43
Do you think you could have had less insomnia by changing the dosage?
Is dependency more of a problem than with benzos?
> The drug that made me feel most alive was baclofen, a muscle relaxant. I was taking it for muscle spasms in my lower back, and it had the unexpected side effect of wiping out my depression and anxiety. It also increased my libido. Unfortunately, I had to stop taking it after a week because it caused terrible insomnia. But I'm hypersensitive to many drugs, so most people probably wouldn't have this problem with it. For more info about baclofen, read The End of My Addiction by Olivier Ameisen.
Posted by Hugh on July 13, 2013, at 10:21:21
In reply to Re: Does Apathy Ever Go Away? » Hugh, posted by SLS on July 4, 2013, at 4:56:02
> Do you think that you would respond to baclofen were you to restart it?
The dose that had the remarkable antidepressant, anti-anxiety effect on me was 75-100 mg. But after a week on this dose, I couldn't sleep anymore. I was up for over fifty hours straight when I decided to stop taking it. After it cleared my system and I could sleep again, I started taking it again, and slowly increased my dose over the next few weeks. I got up to 37.5 mg when it started to aggravate my mitral valve prolapse. It wasn't helping my depression or anxiety at this dose, so I decided to abandon it. But I'm extremely sensitive to many drugs and supplements. I think most people could tolerate those doses of baclofen without those side effects. Baclofen increases striatal levels of dopamine. Maybe that's why it worked so well for me, for a while, and why it caused insomnia.
Posted by Hugh on July 13, 2013, at 10:27:11
In reply to Re: Does Apathy Ever Go Away? » Hugh, posted by sigismund on July 4, 2013, at 8:22:50
> Do you think you could have had less insomnia by changing the dosage?
>
> Is dependency more of a problem than with benzos?The dose that made me feel so wonderful, and gave me such terrible insomnia, was 75-100 mg. After I stopped taking it and restarted it, I got as high as 37.5 mg when it started to aggravate my mitral valve prolapse. At this dose, it didn't cause insomnia, but it wasn't helping my depression or anxiety either. I've seen some posts complaining about baclofen dependence and withdrawal. Other people are able to take it long-term with no problems.
Posted by SLS on July 14, 2013, at 5:11:30
In reply to Re: Does Apathy Ever Go Away? » SLS, posted by Hugh on July 13, 2013, at 10:21:21
> > Do you think that you would respond to baclofen were you to restart it?
>
> The dose that had the remarkable antidepressant, anti-anxiety effect on me was 75-100 mg. But after a week on this dose, I couldn't sleep anymore. I was up for over fifty hours straight when I decided to stop taking it. After it cleared my system and I could sleep again, I started taking it again, and slowly increased my dose over the next few weeks. I got up to 37.5 mg when it started to aggravate my mitral valve prolapse. It wasn't helping my depression or anxiety at this dose, so I decided to abandon it. But I'm extremely sensitive to many drugs and supplements. I think most people could tolerate those doses of baclofen without those side effects. Baclofen increases striatal levels of dopamine. Maybe that's why it worked so well for me, for a while, and why it caused insomnia.I hate hearing that someone responds well to a treatment, only to give up on it due to the appearance of insomnia. The only time I responded robustly for an extended period of time, I developed severe insomnia. Rather than discontinue treatment, the doctor had me combine two benzodiazepines: Ativan and Halcion. I slept well and maintained a remission of depression. Halcion will knock you out. Ativan will help keep you asleep. I doubt that very many doctors will prescribe Halcion anymore. Ambien might be an effective replacement to be combined with Ativan. I do not know how safe such a combination would be, though.
- Scott
Posted by Hugh on July 14, 2013, at 11:03:32
In reply to Re: Does Apathy Ever Go Away? » Hugh, posted by SLS on July 14, 2013, at 5:11:30
I took 10 mg of Ambien, which would normally knock me out, on those sleepless baclofen nights and it didn't make a dent in my insomnia. I never tried Halcion. I took lorazepam for insomnia for three years, but then started to develop tolerance and interdose withdrawal, so I had to taper off of it.
Posted by SLS on July 16, 2013, at 17:17:07
In reply to Re: Does Apathy Ever Go Away? » SLS, posted by Hugh on July 14, 2013, at 11:03:32
> I took 10 mg of Ambien, which would normally knock me out, on those sleepless baclofen nights
Baclofen gave you insomnia?
- Scott
Posted by SLS on July 16, 2013, at 17:19:10
In reply to Re: Does Apathy Ever Go Away? » SLS, posted by Hugh on July 13, 2013, at 10:21:21
> > I took 10 mg of Ambien, which would normally knock me out, on those sleepless baclofen nights
>
> Baclofen gave you insomnia?Oops. You mentioned that already. Sorry.
- Scott
Posted by Trevpr on July 19, 2013, at 0:50:25
In reply to Re: Does Apathy Ever Go Away? - Oops. » Hugh, posted by SLS on July 16, 2013, at 17:19:10
Unfortunately I can't take any more dopaminergics or norepinepherine drugs - the dopaminergics quickly form a tolerance and norepinepherine ones induce tachycardia without any mood boost.
Plus I recently found that my catecholamine levels are far too high so I must get off of Parnate :(
I guess I'm hoping that eventually my apathy will go away...
This is the end of the thread.
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