Posted by Ktemene on July 12, 2004, at 23:26:02
In reply to Re: Best Med for Motivation, posted by KaraS on July 11, 2004, at 2:49:49
Hi Kara,
Thanks for your suggestions. Actually, I am still taking Selegiline (3-5 mg per day) and Adderall (10-20 mg per day), along with Provigil (200-400 mg per day). I have the anergic anhedonic sort of depression + ADD, so I need all the energy, motivation and focus I can get. I started Selegiline about six weeks ago when I gave up on Strattera (because it made me sleepy), and I am still getting used to Selegiline. Even at very low doses Selegiline is amazingly activating- after my first 5 mg dose I was awake and alert and feeling fine for 48 hours straight. At the time that I started Selegiline, I was very tempted to try instead two of the meds you mention, Parnate and desipramine. (I wasn't as interested in trying reboxetine because I suspect it is very similar to Strattera, since both are strong NRI's.) Parnate in particular attracted me because it has helped so many atypical depressives with ADD who were not helped by SSRI's and Effexor (SSRI's and Effexor just put me to sleep). After a lot of thought I decided to try Selegiline before trying Parnate for two reasons. Firstly, although Parnate's effect is more on dopamine and norepinephrine than on serotonin, it does increase serotonin since it inhibits MAO-A as well as MAO-B. But at low doses Selegiline only inhibits MAO-B. I saw this as a point in favor of Selegiline because all the meds that have helped me (Adderall, Wellbutrin and Strattera) have had a direct effect only on norepinephrine and dopamine. Secondly, the Selegiline patch may be available in six or eight months, while there will apparently never be any Parnate patch. I don't mind the dietary restrictions; I would happily live on bread and water for the rest of my life if I could be rid of depression. But my ADD brain makes me liable to the sort of silly thoughtless mistakes that would eventually result in a hypertensive crisis and a trip to the ER if I took Parnate.
So far the Selegiline is working out well. After six weeks I no longer have the truly epic insomnia I had at first. And I definitely have more motivation and focus; the Selegiline is helping with the anhedonia as well. I am thinking of asking my pdoc to increase the Selegiline dose to 10 mg. I am also thinking of perhaps adding a little Wellbutrin to the mix. It seems to me that low-dose Selegiline and Wellbutrin ought to work well together. When I was taking Wellbutrin (I gave Wellbutrin up to make a trial of Strattera) I always had the feeling that it was *almost* doing what I needed. In fact my pdoc and I kept increasing the dosage of Wellbutrin all the way up to 450 mg until we finally gave up and switched to Strattera. But maybe a dopamatergic med like Selegiline would provide enough dopamine in the right parts of the brain so that Wellbutrin's weak dopamine reuptake inhibition would have a strong antidepressant effect. On the other hand maybe using low-dose Selegiline to augment Wellbutrin isn't such a good idea- I haven't been able to find anyone on Psycho-Babble who has tried this combo.
Your experience with SAM-e was just what happened to me, or rather didn't happen. I took SAM-e for months and the only difference I noticed was that I had less money. I have been very tempted to try Rhodiola Rosea, mainly because of JohnL’s wonderful posts on it. He thought it was important to use a brand that had 4% or more of Rosavin from true Russian Rhodiola Rosea and so he only bought RR from a company in Europe (from Sweden I think). Are you using a brand that has some sort of standardized Rosavin content? Have you noticed any effect yet? I hope it works for you. Please let us know. Although you may have to post on the Alternative Board…Ktemene
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> Ktemene,
> I am also searching for the best medication for motivation. So far I haven't had much success but I have a lot of different things left to try. I am now in the process of withdrawing from Effexor. It helped a bit with depression but also left me feeling lethargic and completely unmotivated. It is mostly an SSRI and they are well-known for producing that emotional blunting effect. It is not unusual for someone on any of the medications in this class to react the way that we have. My opinion is that your pdoc is way off base here!
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> If you had success with Adderall, selegiline and Wellbutrin, why did you go off of them? I would also suggest you add to the list of meds to try:
> desipramine, reboxetine (not available in the U.S. but you can order from abroad with a prescription) and Parnate. (Imipramine and nortriptyline may also be stimulating for some people.)
>
> There are also alternative supplements that are supposed to be motivating. I've just started one of them now, Rhodiola Rosea. Also, the Perika brand of St. John's Wort is reportedly very motivating - though most other forms of SJW are not. Lastly, some people have found SAM-e to be very motivating though it did nothing for me.
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> Good luck!
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>
poster:Ktemene
thread:363742
URL: http://www.dr-bob.org/babble/20040712/msgs/365523.html