Posted by Tony P on January 30, 2010, at 18:18:23
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by Laurie Beth on January 27, 2010, at 11:13:41
I've suffered from anhedonia too (on Cipralex/Lexapro & various other SRI/SSRI/moood stabilizers). My pdoc put me on Cymbalta - night & day difference. Cymbalta has had some bad press compared to Effexor -- in my experience, they are very different and Cymbalta is much easier to tolerate. YMMV. Only downside to Cymbalta IME is continuing drowsiness (nothing a couple of cups of coffee won't take care of, and also see below) -- and price!
Because Cymbalta isn't covered by my drug plan and Cipralex/Lexapro is, my pdoc had me try switching to the latter at higher doses than before. I got up to 60 mg/day Cipralex, no Cymbalta by week 4, and found (a) I was getting severe anxiety attacks (b) I was having suicidal thoughts & feeling helpless, to the point where a support group I belonged to were encouraging me to head for psych. emerg.
BTW, I also tried Effexor, and had a similar reaction -- severe anxiety attacks with a sort of agoraphobia - I was virtually housebound.
So I went back to the Cymbalta (90 mg/day) and am much better, in mood, hopefulness and ability to cope with every day tasks and some serious life issues which face me. No anhedonia, except when I get attacks of hypersomnia (sleeping for 24-36 hrs straight), and the latter appears to be mostly a vicious cycle, once I break it I'm OK.
Most important: I am also taking a couple of AD adjuvants that make a big difference in mood, activity and assertiveness/problem-solving. I am sure these would work equally well with a straight SSRI.
- Modafinil (Provigil, Alertec), 200 mg/day prn. I first started taking this to overcome the hypersomnia, and found it had a _big_ positive effect on my anhedonia, activity level and social anxiety as well. It also helps combat the slight drowsiness from the Cymbalta. BTW, although it essentially acts like a stimulant, it behaves according to the manufacturer's spec. (surprise ;-) -- it doesn't prevent sleep, I have to work with it by getting up & around, but once I'm out of bed it does its stuff.
- Buspirone (Buspar). This is another med. that has suffered from bad press: either it only works for about 1 in 5 people, or the effects are sufficiently subtle that people discount it. For me, it works well at 20-30 mg/day. Good effects are: less stress-related reactive depression, more active & assertive, better mood. Almost no side-effects, except slight "dopiness" for about an hour after taking it.
- Requip (Ropinirole). A pilot study in Can. J. Psych. a few years ago showed improvement in mood etc. among most subjects regardless of which AD or mood-stabilizer they were on. I haven't seen a follow-up study, but surely there must have been one by now. I am not taking it currently (trying to simplify my regime), but it worked well for me for several years. I was taking 1.5 mg/day, but the safe dosage range is very broad, so one could titrate up to higher doses if needed. Side-benefit: It stopped the restless-leg/akathisia that I experienced initially with Remeron, Trazadone & a couple of other meds, and that hasn't come back -- touch wood -- since I stopped the Requip.
The important common factor seems to me to take _something_ that boosts DA moderately to balance the Serotonin &/or NE. Even coffee helps!
poster:Tony P
thread:121851
URL: http://www.dr-bob.org/babble/20100122/msgs/935428.html