Psycho-Babble Medication Thread 1119129

Shown: posts 1 to 15 of 15. This is the beginning of the thread.

 

Meds to improve task initiation

Posted by NKP on March 26, 2022, at 10:56:21

Are there any meds that help with task initiation? I struggle to get going on tasks. I tend to feel extremely unmotivated to do anything, and I can spend hours doing pretty much nothing but lying on the couch and daydreaming and watching YouTube videos.

Might flupentixol or aripiprazole improve this?

I'm currently on:

venlafaxine 225 mg/day
lamotrigine 100 mg/day

Or am I just lazy?

My psychiatrist has referred me to an occupational therapist for assessment and possible help.

 

Re: Meds to improve task initiation

Posted by Christ_empowered on March 26, 2022, at 11:05:11

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

hi. I'm prone to procrastination. both effexor and cymbalta turned my inclination towards procrastination into straight up apathetic laziness. ugh. lamictal...helps me avoid severe depression, which is good...

because then I can avoid antidepressants. :-)

full dose aripiprazole...is necessary for me. I will say that I do better with it (fewer adverse effects, less apathy, too) than with any other "atypical" tranquilizer.

people sometimes report that low dose aripiprazole helps motivation and such. my concern would be the -serious- potential adverse effects. a former prescriber (clinic...they seem to come and go all the time...) says she sometimes prescribes mirapex to help with fatigue and motivation in the context of ongoing treatment for depression or Bipolar.

hope this helps. :-)

 

Re: Meds to improve task initiation

Posted by rjlockhart37 on March 26, 2022, at 18:11:08

In reply to Re: Meds to improve task initiation, posted by Christ_empowered on March 26, 2022, at 11:05:11

only thing i know for sure, that would incidate task activation is provigil, nuvigil, then the psychostimulants of ampehtammine and methyphenidate class

 

Re: Meds to improve task initiation » NKP

Posted by Jay2112 on March 26, 2022, at 21:22:06

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

> Are there any meds that help with task initiation? I struggle to get going on tasks. I tend to feel extremely unmotivated to do anything, and I can spend hours doing pretty much nothing but lying on the couch and daydreaming and watching YouTube videos.
>
> Might flupentixol or aripiprazole improve this?
>
> I'm currently on:
>
> venlafaxine 225 mg/day
> lamotrigine 100 mg/day
>
> Or am I just lazy?
>
> My psychiatrist has referred me to an occupational therapist for assessment and possible help.

Vyvanse or Adderall XR are awesome...for me, as we are both on similar med regiments.

Jay

 

Re: Meds to improve task initiation

Posted by Lamdage22 on March 28, 2022, at 1:33:17

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

This is not a med, but for me there are/were psychological blockades. It seems to help to work through them with an analytical therapist.

 

Re: Meds to improve task initiation

Posted by Lamdage22 on March 28, 2022, at 1:35:33

In reply to Re: Meds to improve task initiation, posted by Lamdage22 on March 28, 2022, at 1:33:17

Blockades that kept/keep me from doing things.

 

Re: Meds to improve task initiation » NKP

Posted by Roslynn on April 2, 2022, at 14:35:17

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

Hi, I have the same type of issues. I haven't heard of a doc referring someone to an OT but that sounds like a good idea. Do you know how the OT would help? Are they independent or part of an agency? Sorry for so many questions!

Thank you,
Roslynn

 

Re: Meds to improve task initiation

Posted by SLS on April 2, 2022, at 17:47:42

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

> Are there any meds that help with task initiation? I struggle to get going on tasks. I tend to feel extremely unmotivated to do anything, and I can spend hours doing pretty much nothing but lying on the couch and daydreaming and watching YouTube videos.
>
> Might flupentixol or aripiprazole improve this?
>
> I'm currently on:
>
> venlafaxine 225 mg/day
> lamotrigine 100 mg/day
>
> Or am I just lazy?
>
> My psychiatrist has referred me to an occupational therapist for assessment and possible help.

Mild-to-moderate depression feels like laziness. It is the result of the co-occurrence of amotivation and anergia. The sensation of fatigue (anergia) that comes from depression, and the lack of motivation (amotivation), gang up on you. You just don't feel like doing anything.

I guess dopamine would be the first thought as to what to target as a treatment for amotivation. Abilify has the potential to stabilize the postsynaptic membrane. If there is too much dopamine, the net effect of Abilify is to reduce the excitability of the postsynaptic neuron. When there is too little dopamine, Abilify acts to stimulate the empty receptors.

"On paper", cariprazine (Vrylar) looks better than Abilify to increase dopaminergic neurotransmission along those tracts that use D3 receptors. D3 receptors seem to be important for lifting mood and increasing energy. cariprazine favors D3 receptors more than does Abilify. Cariprazine has a higher binding ratio of D3/D2 compared to Abilify.

I wonder if lumateperone (Caplyta) would be something for you to look into. It is described as being particularly good at treating bipolar depression. It is my impression that dopamine contributes more to bipolar depression than it does to unipolar depression. That's a really simplistic explanation, though. More recently, glutamate has become a substance of study in affective disorders. Lumateperone acts to "modulate" not only glutamatergic neurotransmission, but it modulates dopamineergic and serotonergic neurotransmission as well. I don't know enough about lumateperone to dislike it.


- Scott

 

Re: Meds to improve task initiation

Posted by NKP on April 8, 2022, at 4:21:14

In reply to Re: Meds to improve task initiation » NKP, posted by Roslynn on April 2, 2022, at 14:35:17

So I had my session with the occupational therapist. I was there for over five hours. It consisted of the following:

(***) an intake interview - almost two hours - during which a detailed history was taken, and questions were asked about my present difficulties;

(***) various cognitive tasks, e.g.:

(-) planning a route on a map of a zoo according to specific restrictions, like you have to visit the lions and the bears, may only take one camel ride, etc.;
(-) repeating increasingly long sequences of letters;
(-) crossing out certain digits from a long list of digits and letters;

(***) a CBS (Cambridge Brain Sciences) test. This was done on a computer and I found it quite tricky. It consisted of cognitive tasks like finding the pattern that does not belong, recalling the position of items on a grid, and so on. It is assessed automatically by CBS who send their report to the occupational therapist. By then I was also pretty tired;

(***) Lots of questionnaires relating to depression, anxiety, and self-esteem.

She also asked permission to phone any of (i) my wife, (ii) a colleague, and (iii) a friend, to ask some questions and check certain things. I have permission that she phone my wife or a friend, but not a colleague.

They'll now write a report which they'll send to my psychiatrist.

I was hoping that they would help me, but it seems that, for now, their job was merely to assess me.

I found the experience quite exhausting as it required near constant concentration for about five hours. She warned me that I would probably also be tired the next day, which, indeed, I was.

 

Re: Meds to improve task initiation

Posted by NKP on April 24, 2022, at 18:14:41

In reply to Re: Meds to improve task initiation, posted by NKP on April 8, 2022, at 4:21:14

I feel as though I have gone as far as is reasonably possible with medication. My current regimen is (a) venlafaxine 225 mg/day and (b) lamotrigine 100 mg/day.

(*) Stimulants: I'm reluctant to use them because of concerns about addiction, tolerance, downregulation of dopamine receptors, and the "zombie"-effect that some users report. Moreover, my psychiatrist is unlikely to prescribe them since I don't have ADHD (see below about my psychiatrist).

(*) Low dose flupentixol (in the form of Fluanxol): I'm concerned about the loss of brain volume reportedly caused by typical antipsychotics (though flupentixol is sometimes called an atypical typical), tardive dyskinesia, and diabetes. I saw a post on another forum wherein a Fluanxol user got diabetes and when they went to fetch their diabetes medicine from their pharmacy, their pharmacist told them that he had noticed over the years that all Fluanxol users seem eventually to get diabetes. On the plus side, my psychiatrist has said that he is open to the possibility of prescribing Fluanxol, which I've taken in the past, but he first wants to try other things (possibly quietiapine, which I really don't want to use).

(*) Aripiprazole: Sounds like a less effective form of flupentixol with more weight gain. Plus, my psychiatrist seemed to pour cold water on this possibility when I once mentioned it.

(*) Pramipexole: I'm worried about side-effects, and highly unlikely that my psychiatrist would prescribe it (see below about my psychiatrist).

I should also mention that my psychiatrist is quite conservative and does everything "by the book". He doesn't seem to do off-label prescribing. He'll only prescribe a drug if there is an algorithm or study that supports its use.

So it feels like I've gone as far on medication as I can, and short of re-introducing Fluanxol, I'll either have to conquer my lack of motivation with therapy, or I'll just have to accept my lot and live life this way if therapy doesn't work.

My wife is worried that I'm going to lose my job.

 

Re: Meds to improve task initiation

Posted by undopaminergic on April 26, 2022, at 12:26:53

In reply to Re: Meds to improve task initiation, posted by NKP on April 24, 2022, at 18:14:41

> I feel as though I have gone as far as is reasonably possible with medication.
>

I doubt it. Look at SLS!

With regard to your concerns, it's a matter of risk vs. benefit. Maybe your condition is currently not bad enough to make it seem worth the risk. If that is so, never mind.

With regard to your psychiatrist, you might look around for another prescriber, or you might obtain your drugs through other channels.

With regard to flupenthixol, I've been on it, without problem but also without much effect. TD is hardly a concern with low doses. As for diabetes, it does not pop up out of nowhere. You can monitor your weight and blood sugar, and take action if the statistics get worrisome.

There is also exercise.

-undopaminergic

 

Re: Meds to improve task initiation » NKP

Posted by SLS on April 27, 2022, at 15:08:58

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

> Are there any meds that help with task initiation? I struggle to get going on tasks. I tend to feel extremely unmotivated to do anything, and I can spend hours doing pretty much nothing but lying on the couch and daydreaming and watching YouTube videos.

> Or am I just lazy?

With mild to moderate depression, one feels frustratingly lazy. This often includes fatigue and difficulty initiating activities. Sometimes, irritability occurs as well.


> I'm currently on:
>
> venlafaxine 225 mg/day
> lamotrigine 100 mg/day


For me, I have received the maximal benefits from venlafaxine 300 mg/day and lamotrigine 300 mg/day. Is it possible for you to increase the dosages of both drugs?

Lamotrigine usually doesn't work for depression (bipolar) unless the dosage is 200 mg/day or higher.


- Scott


 

Re: Meds to improve task initiation

Posted by NKP on May 2, 2022, at 14:19:11

In reply to Re: Meds to improve task initiation » NKP, posted by SLS on April 27, 2022, at 15:08:58

I got my report from the occupational therapist.

Basically they recommend:

(i) I continue medication under the treatment of my psychiatrist;
(ii) I consult with a psychologist twice per month;
(iii) I have eight sessions with an occupational therapist.

 

Re: Meds to improve task initiation » NKP

Posted by SLS on May 4, 2022, at 8:07:56

In reply to Re: Meds to improve task initiation, posted by NKP on May 2, 2022, at 14:19:11

> I got my report from the occupational therapist.
>
> Basically they recommend:
>
> (i) I continue medication under the treatment of my psychiatrist;
> (ii) I consult with a psychologist twice per month;
> (iii) I have eight sessions with an occupational therapist.

<Like>


- Scott

 

Re: Meds to improve task initiation » NKP

Posted by TriedEveryMedication on June 24, 2022, at 11:10:55

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

for me, low doses of desipramine (10-20mg) dramatically helped my motivation and task initiation. I took it in college and I went from failing my classes to getting As and Bs.

the side effects were kinda rough for me though (increased anxiexty and depression)


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