Posted by Clayton on November 9, 2003, at 8:10:29
In reply to motivation needed, posted by kka on November 5, 2003, at 18:03:16
Hi kka,
I hear you! Loud and clear! I have a terrible amotivational syndrome. Just, getting out of bed in the morning is [well, was...] an emotionally exhausting, rending experiecnce. I can't plan anything. I can't set goals, make plans and follow through. I can't even accomplish tasks necesary for my own subsistance. I don't pay my bills on time. I don't address tasks at work necessary to keep my job (and maybe that's gone on too long and I WILL loose it). I'm seeeing a pdoc about it and I'll say more in a moment but I want to address your issues first.
First, I am not a healthcare prefessional nor do I have any real expertise. (I'm a software engineer). Five months ago, a new medicine for depression helped me tremendously and set me free. I becane *fascinated* (obsessed!) with neurotransmitters, receptors, effects on behavior, effects of psychotropic drugs, etc. Since then I have read everthing I could get my hand on re: these topics. The internet is a wonderful and highly efficient source for learning about these things and I have spent hundreds of hours staring at a computer screen reading and chasing the links. Also, I've have my own problems and have learned a little about psychiatrists and psychotropics from personal experience. That is the full extent of my knowledge. If I give any adcvice, please remember that I'm just a guy with a new interest.
First the basic question since you complain of lack of energy? How is your physical condition? Do you exercise regularly? (Sustained, moderately strenous cardiovascular exercise is the kindest favor you can do for yourself.) Do you eat properly? Have you had your thyroid function checked lately? Sorry to ask. I realize this is probably not the fundamental problem.
I just ran a very careful check for drug interactions between Effexor and Wellbutrin. There are none of real import. Wellburton will inhibit the metabolism of Effexor (and therefore impair its efficacy) a litle bit but generally not enough to cause a problem. Your Effexor is prescribed at the standard recommended dose (75 mg/day). If your doctor considers the minor cross reaction with Wellbutron, he/she might want to increase this dose a little. The Wellburton is prescibed at a very LOW dose. In fact, 150 mg/day is the recommended dose for Zyban (it is identical to Wellbutrin) which is prescribed to help folks stop smoking. For depresion, the literature says that doses in the range of 300 - 600 mg per day are common. Your dose does seem very low given the severity of your symptoms. I recommend you ask your doctor straight out, why he/she chose the dose he/she prescribed. You should expect a clear answer in plain English. If the doctor has no answer, or obfuscates or seems resentful that you asked, that is BAD NEWS and time to consider finding a new doc. I also recommend that you ask the doctor why he/she chose those two specific antidepressants for YOU SPECIFICALLY. Again, you have a right to a clear answer in plain English, cheerfully offered. Again, if the doctor bluffs or obfuscates, that is bad news.Effexor: I have no personal experience with it but I have read a plethora of horror stories. Check the PsychoBabble threads re: Effexor for starters. The side effcts sound terrible and withdrawl sounds like a living hell - worse than an addict withdrawing from heroine cold-turkey. But you, not I, am the one with the personal experience here so you are in a position to draw yur own conclusions.
The IMPORTANT THING about your two meds is that they are NOT WORKING.
The Wellburton is probably prescribed because it is chemically related to amphetamines and may boost your dopamine levels which would reenforce you "reward system" and provide you with some spunk. Unfortunetely, its reuptake inhibition of dopamine is very weak...AND you are on a very low dose. It is also a weak blocker of seratonin and norepinephrine reuptake. It's actual mecanism of antidepressant action is unknown. Norepinehrine controls drive and motivation. By prescribing the SSNRI Effexor in conjunction with Wellburton which provides a small addition to reuptake inhibition, your doc may be conscious of and trying to support yor norepinephrine levels. But face facts. It hasn't worked.
The drug that saved my life was Remaron (used in conjunction with Paxil). Remaron is a unique antidepressant that augments both seratonin and norepinephrine levels (like Effexor), but does so by essentially increasing the amount of these neurotranmitters that you brain produces, not by inhibiting the reuptake of what is already there.
This has a different effect. It starts woking in about three days. It has no sexual side-effects.If you combine Remaron with an SSRI, you get sysnergistic support (an enhanced supply subject to inhibited reuptake) of seratonin. And you get support for norepinephrine levels through stimulated additional production. If you combine Remaron with an SNRI, you get the reverse. That is, synergistic support for Norepinephrine levels and augmentation of seratonin via increased production.
Here is where I overstep the bounds of good sense and make recomendations I am NOT QUALIFIED to make:
First, Educate yousef as thoroughly as possible on your symptoms and diagnosis (you didn't mention what that was - do you mind sharing it? That might help me with MY amotivational behavior). Learn all you can about the available methods and medicatios available to respond to your diagnosis and control your symptoms. What do the research papers and scientific journals say? What do the folks posting on PsychoBanbble say? What has worked for the greatest number of people and what has failed? (Thank God one can get to most of this stuff on the internet these days!)
Then go to you doctor and tell him/her that your current meds are not working and you want to try something new. They should respond aggressively with positive suggestions for alternate medications and they should do so in a positive and reasonably upbeat manner. If they don't, or, God forbid, can't think of any, CHANGE DOCTORS. Discuss the suggestions. Ask about the intended purpose of each of the drugs in any proposed combination. Again, you should get straight answers in plain English. Ask the doctor how he/she knows these drugs are safe to use concurrently. If you aren't getting straight, no nonsense answers, then walk. Ask what the meds synergistic effect will be as a whole and if they will work for you. If the doctor admits that he/she can't be certain of the net effect of the combination in total, or tells you he/she can't predict how they'll work for you, that is good!(Because psychiatry is still in its "dark ages", nobody can answer those questions with authority and you doctor will have to rely on education, experience and, most importantly, judgement, INTUITION - a best guess - to select a coarse of treatment. He/she must be willing to take a calculated risk. YOUR JOB is to use your best judgement about whether to accept you doctor's best judgement!)
If you decide to change doctors, use every resource at your disposal to find the best one for your condition. Go to him/her and put them through some of the little tests I've suggested above. Even innocently ask a question or two that you already know the answer to (since you've educated yourself). Don't ask trick questions or go out of your way to be devious. You want to find out if the doctor's knowledge is fully up to date on your condition and the options available to treat it. If you stay with the doctor, ask him/her to expertly wean you from the Effexor and Wellbutrin and come up with a suggestion that has a good shot at being efficacious. Accept the fact that it MIGHT not work and, if not, you'll have to try again.
Personally, I think you need to substantially increase support for your Norepinephine system. I am biased toward Remaron because it made such a huge difference in my life in such a short time. Remaron enhances seratonin ("mood") and also increases your supply of Norepinephrine (drive and motivation - it MIGHT also substantially further improve your mood). In addition, do this: synergistically boost norepinephrine supply further with the new antidepressant Strattera, an SNRI. (Investigate it first. Read through the threads on Strattera on the PsychBabble site). I truly believe that this just might get you going. Have Hope!
Final Stuff: Please don't let a doctor put you on Ritalin or Adderal. They are amphetamines - speed - and, sure, they'll get you moving for a few hours...a few hours that will be followed by a black, hyper-anxious depression. Over time, you will get addicted and NEED them to do anything at all. They will make you manic. And they can cause permanent brain damage. Want info on that that's responsible and reliable? Ask and I'll send you some links. They are only supposed to be prescribed for ADHD (attention deficit disorder). Amphetamines damage your brain, including you dopamine and "reward system", permanently.
I suffer from Social Anxiety Syndrome, mood depression, insomnia and lack of any real motivation. I was taking the SSRI Paxil for the depression and SAD but it was only about 20% effective. Five months ago, I was forced to take medical leave from work for two months because my cognitive facalties had deteriorated from the lack of mental stimulation - I had stopped reading and pursuing all my interests. I found a new pdoc. The first trick he pulled out of his black bag was Remaron. He explained that it worked synergistically with the Paxil (on the seratonin side). For the first time, I had some norepinephrine support, too. I had about given up on medicine just as I had given up on on "talk therapy" in the 1970s and 1980s (I'm 52). Boy was I surprised!!! Within three days of starting the Remaron, I could feel definite positive changes. Within two weeks (or less) the Remaron had fully kicked in. I have not had a single SAD attack since then. My depression lifted by about 95% (there is still the odd bad day). I found myself getting up earlier than I had to in the morning and doing productive things or just enjoying the day. Best of all, my cognitive facalties were back. My memory was back and just keeps improving. I could think analytically again. This was a true miracle in my life. But there was one flaw: my amotivational syndrome didn't improve all that much. So my pdoc and I are considering swapping SSRI Paxil for SNRI Strattera. I'm researching it intensily. I'll have to make this decision in a couple weeks. I am messing with [unprecidented] success. I will have to listen to my doctor (he and I both came up with this notion on our own), rely on all my knowledge and use my intuition to make the best judgement I can. I will have to accept that I am taking a calculated risk.
Sorry to ramble. I hope there was perhaps a little here that helped you.
Kindest Regards
poster:Clayton
thread:276941
URL: http://www.dr-bob.org/babble/20031105/msgs/277863.html