![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 101. Go back in thread:
Posted by fachad on February 3, 2003, at 21:27:56
In reply to ADHEDONIA QUESTIONS ?? please read , posted by LAURA777 on February 2, 2003, at 16:53:01
Laura,
That's a long post...I'll put in a few things that seem significant...
First, much clinical experience and research supports that anhedonia is best treated with MAOIs. Nardil (phendlzine) and Parnate (tranylcypromine) being the gold standard meds for effective treatment of anhedonia. You may have an easier time finding a doc to write for opiates, however. Pdocs generally hate MAOIs.
As to SSRI's - yes, I definitely think they make anhedonia and anergia much worse. I think the longer they are taken the worse it gets.
After 3 years of Zoloft, I was literally too tired to breathe. It seemed like sooooo much effort to inhale, and then I would feel a tinge of sadness that came from knowing that I would have to expend more effort to exhale.
For me, the only cure came by discontinuing the SSRIs, and adding stimulants. Ritalin, Adderall, or Dextrostat are the ones to try. I do not understand it, but it really seems like pdocs are generally pretty comfortable with prescribing stimulants - much more so than about benzodiazapines, opiates, or MAOIs.
As for the TCAs, I think they may be worth a try. They are safe if used at proper doses, although they do have nuisance side effects. The worst for me was constipation, but if you're thinking about opiates, you are ready to endure that one.
I have had extensive experience with opiates due to a herniated disk in my back. I got hundreds of Vicodin over a few months. For the first few days, it felt really good to be on Vicodin. However, after only a few days the good feeling faded. After a few weeks, I felt very down.
Vicodin definitely caused me to be depressed when taken over time. This was actually worse for me than SSRIs, which caused me to be anhedonic and anergic when taken over time. But with Vicodin, I was genuinely melancholy.
Some here have reported success with opiates. The real problem is finding a pdoc who will write for them. You will of course be suspected of being an opiate abusing drug seeker concocting a story to get dope. Here's a link to a polemic I posted a few months ago on that dilemma:
http://www.dr-bob.org/babble/20020416/msgs/103521.html
That was in response to a post from Elizabeth, who was having trouble finding a pdoc in a new town to write for Xanax and opiates.
> hi i am just curious if people who suffer from this have any commonalities ,, here are some questions for you all .. This is for people who suffer from adhedonia naturally and not a result from taking AD drug or meds
> what age did you notice it started ???
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> did SSRI make it worse ???
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> if ssri was augmented with a stimulant like dexadrine or welbutrin , were you a wide awake flat person ???
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> do you suffer from hypersomnia when non medicated or just medicated with ssri ??
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> do opiates help you fell normal ??
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> do opiates stimulate you but yet you are calm ??
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> do any of you get sleepy on opiates ???
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> sorry for all the questions but i would like to see if any of us have commonalities .. i need some info and things to back me up because i am so tired of living in this greyness .. i am 38 years old and this has paralized me long enough .. so if you can please respond .. thanks in abundance laura
Posted by bozeman on February 3, 2003, at 23:56:30
In reply to Re: ADHEDONIA QUESTIONS ?? please read to BILL L » Bill L , posted by LAURA777 on February 3, 2003, at 9:25:45
Hi Laura -- Like Bill, SSRI helped me -- I remember being happy when I was younger, but a bad car wreck, back injury, head injury, many drugs and PT later, everything was grey grey grey blah, for many years, couldn't sleep, didn't feel like doing anything but had to, you know how it is, I'm sure. SSRI Lexapro was truly like a magic bullet for me, put the color back in my life. I actually did remember being happy and I feel it again, now, even if not every minute of every day.
My point is keep trying, if I've learned anything reading this board, it's that our brains and situations are all different and everyone responds a little differently. Don't give up, and I hope you find what you need to feel better soon.
bozeman
> hi bill thanks for the response , now see , this confuses me and it just goes to show you how different we all are and how complicated this all is !!! yuk .. SSRI do make me worse , i am even more Flat.. and when they augmented me with wellbutrin i am just wide awake and bored uninteresed , unmotivated blah blah blah grey grey grey .. push push push to live ... thanks for your time it is well appreciated laura
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> > I have had anhedonia since I was 11 years old. I am now 49. A psychiatrist diagnosed me with having anhedonia. I started taking Prozac about 5 years a go. Then Celexa and now Lexapro. Prozac and Celexa worked very well. Lexapro works the best for me with the least side effects. I do not feel depressed while taking ssri's.
> >
> > As for hypersomnia, I sleep less on ssri's. Before drugs, I liked to stay in bed late since I felt depressed. On drugs, I don't mind waking up and getting out of bed.
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Posted by LAURA777 on February 4, 2003, at 6:12:21
In reply to Re: ADHEDONIA QUESTIONS ?? please read » LAURA777, posted by fachad on February 3, 2003, at 21:27:56
hey fachad , yes yes yes on everything you said about vicodin , that is why i would not want to go that route ,, but i am very encouraged about the news on tcas . as far as the stimulants do they make you anxious ?? as far as stimulants go the only expierience i ever had with them was cocaine and i absolutely HATED it , sorry for the strong words but the depression that caused was off the charts ..
vicodin does cause me to be depressed afterwards also , and it is not long acting at all , 2 pills of 5/500 will only have me feeling well for 3 hours but the stimulant effect of them seems to last longer , i won't be tired until 7.00 pm or 9.00 pm , if i had taken it at say 8.00 am ..
what are you currently on now ??? can you please let me know , thanks in advance , laura
Posted by fachad on February 4, 2003, at 8:10:11
In reply to Re: ADHEDONIA QUESTIONS ?? please read » fachad, posted by LAURA777 on February 4, 2003, at 6:12:21
Laura777 wrote: "as far as stimulants go the only experience I ever had with them was cocaine and i absolutely HATED it , sorry for the strong words but the depression that caused was off the charts ..."
Yes, I had a similar experience with cocaine. I only tried it three times, but each time it was horrific. I felt great for about 20 minutes, and then I was in hell for hours. I only tried it a second and third time because I thought my negative experiences were a fluke.
My negative experience with cocaine led me to a paradigm shift in my thinking about depression and it's treatment.
I actually started antidepressants because of my cocaine experiences. I had been very depressed for most of my life, but prior to trying cocaine I would not even consider AD medication.
I was in college at the time and had a professor who thought psych meds were worthless. He would go on an on about how they only treated symptoms, without addressing the underlying causes, which were always cognitive/behavioral/psychodynamic.
At that time, I fully believed that people who took ADs were wasting their time and money, and were only masking the symptoms that they needed to feel to be motivated to address their real problems.
My experience with cocaine totally changed that belief.
The three times I tried cocaine were enough to completely convince me of the chemical nature of affective states. I observed that on cocaine I came down much sooner and much harder than my friends.
The terrible depression that followed cocaine use for me did not arise from "psychodynamic issues" or "behavioral patterns" or "negative thinking" - it was purely a chemical/biological state. And it was not helped by any amount of insight, or rational thinking...it was just pure biological depression.
That experience gave me the insight that depression could be genuinely biologically based, and the fact that cocaine affected me differently than my friends was further evidence for me that there were neurochemical factors contributing to my lifelong depression. I don't know how long it would have taken me to figure that out, or if I would have ever even considered medication, if it had not been for those hours of hell following cocaine use.
Posted by fachad on February 4, 2003, at 9:16:36
In reply to Re: ADHEDONIA QUESTIONS ?? please read » fachad, posted by LAURA777 on February 4, 2003, at 6:12:21
> hey fachad , yes yes yes on everything you said about vicodin , that is why i would not want to go that route , but i am very encouraged about the news on tcas.
I think TCAs can help a lot of people that are not helped, or are actually harmed, by SSRIs. They really do have nuisance side effects, which is why SSRIs are so popular, but if they work, and SSRIs don't...
Nortriptyline and Desipramine are probably the ones to try. They are the mildest in terms of side effects and the most potent in terms of reuptake inhibition. Low dose doxepin or trimipramine are great for sleep.
>as far as the stimulants do they make you anxious ??
No, they don't really make me anxious, but then I'm not prone to anxiety. I've always said there is not enough energy in my nervous system to be anxious. I suppose if I took very high doses stimulants could cause me anxiety, but at normal doses they just relieve lethargy and apathy. I do get some somatic side effects from stimulants, like faster heartbeat and dry mouth, but not worry type anxiety.
>as far as stimulants go the only experience I ever had with them was cocaine and i absolutely HATED it , sorry for the strong words but the depression that caused was off the charts ..
Me too. see above post.
> vicodin does cause me to be depressed afterwards also , and it is not long acting at all , 2 pills of 5/500 will only have me feeling well for 3 hours but the stimulant effect of them seems to last longer , i won't be tired until 7.00 pm or 9.00 pm , if i had taken it at say 8.00 am ..
Vicodin only causes me to be depressed if it is used several times a day for several days in a row. Otherwise it just relieves pain and does not cause any depression when it wears off.
I was not sure how you could possibly experience stimulation from opiates. Yesterday my back was hurting quite a bit (my disk is herniated, but not ruptured, so they will not operate - I just have to live with it) and I took 1/2 of a 5/500 Vicodin about 5pm.
I was extremely exhausted from a long day at work. Curiously enough, I did feel less exhausted when the Vicodin kicked in. I wouldn’t call it stimulation, but it definitely lessened the experience of exhaustion. It could never be a long term solution for me, because as I said before, if I take it for a few days in a row I start feeling melancholy. But at least I kind of understand how someone could say it relieves anhedonia/anergia.
> what are you currently on now ???
Dextrostat 40 mg/day
Prozac 5mg/day
Ambien 10 mg at bedtimeI have tried Ritalin, Adderall, and Dextrostat and for me Dextrostat is the best. I posted my rational for preferring Dextrostat here:
http://www.dr-bob.org/babble/20020718/msgs/112993.html
About the Prozac 5mg/day. After the Vicodin fiasco, I found myself very depressed so I went back on Prozac 20mg/day out of panic and desperation. Then when I tried to quit Prozac, I had withdrawal or discontinuation or whatever they are calling the misery when you quit SSRIs. Yes, Prozac is not supposed to cause this because of long half life, active metabolites, blah blah blah. But it does.
So I've gradually tapered down to 5mg/day, and seem stuck there for awhile.
The Ambien is for the insomnia cause by the Prozac. Before my last episode of depression I was sleeping fine taking 60mg/day of Ritalin. When I started Prozac, I immediately got insomnia. Ambien is expensive, but it does work well and does not cause any side effects for me.
Posted by not exactly on February 4, 2003, at 9:49:55
In reply to Listening to Cocaine, posted by fachad on February 4, 2003, at 8:10:11
Wow. That's quite a story.
I, too, hated cocaine. Tried it a few times back in my street-drug experimentation "phase" back in the late 60's / early 70's. Couldn't understand why such a stupid drug was so popular. I didn't even like the acute "up" part of the experience. It made me feel uncomfortably "out of control". I'd act without thinking, say the wrong words, pace around, tap my fingers, and generally do things without any reason/intent. It felt "wrong" even while it was happening, not just in retrospect. Unfortunately, I never made the connection you did. My lifelong depression continued untreated for another 25 years.
My epiphany came from a different DA-enhancing drug: pramipexole. I volunteered to participate in a double-blind antidepressant evaluation trial at a local "mental" hospital, not because I thought I was depressed, but because I was curious and thought that the experience might be "fun". Of course in those days, my concept of "fun" was different from most people's - an "interesting diversion", but not something to be truly enjoyed (whatever that might mean). I figured I could "fake" enough symptoms to qualify for inclusion. But when interviewed for the study, I found that I could answer the questions honestly and still give the "impression" of being depressed (I had always been good at "quizmanship", and certainly understood what depression was - I just never thought it applied to me, since I was obviously functional and not wallowing in despair).
After the questionnaire was completed, the pdoc said "Well, you are an ideal candidate for this study, since you have suffered from Chronic Major Depression for your entire life, and have never been treated for it." Talk about a paradigm shift - this was a doozy! Maybe reality didn't suck after all. Maybe it was "all in my head"! Rather than being devastated by this information, I was actually pleasantly surprised and hopeful. Unlike "sucky reality", I believed that depression could be "cured" (at least symptomatically).
Weeks later, when the pramipexole kicked in (fortunately I didn't get the placebo), I suddenly felt like "the fog had lifted". Is this how others experience life? I started to be able to experience real happiness (not constantly - I was never manic on the stuff - just from time to time in a way that felt "appropriate" and "normal"). Coping with life's everyday hassles became so easy that I felt like I was "cheating", since I could still remember how it had always been a struggle just to exist.
When the study ended and the drug was discontinued, my depression rapidly returned. But now that I knew a better life was possible, the state became intolerable for the first time. I've often described the experience with the following metaphor:
Imagine you had been born in a cage and had lived your entire life there. You couldn't see out of the cage, and no one ever told you there was a big wonderful world outside. You didn't even realize you were in a cage because that's the only thing you'd ever experienced. One day, someone came along, opened the door, and said "OK, you can come out now." Once outside, you suddenly realized what you'd been missing, and how awful the cage had really been. Weeks later, when the memory of the cage had started to seem like just a bad dream, you are told "Sorry, it's time to go back in your cage." No! Anything but that!
At that time, pramipexole was still an unapproved experimental drug, so it couldn't be prescribed. I spent the next few years "clawing at the door of my cage", trying one unsuccessful (or worse) AD after another.
I've managed to "escape the cage" a few times since, but it never lasted very long, and the "cage" has always been nearby and threatening. But I haven't given up hope. The quest continues...
- Bob
Posted by Jack Smith on February 4, 2003, at 11:59:56
In reply to Re: Listening to Cocaine » fachad, posted by not exactly on February 4, 2003, at 9:49:55
I unlike you guys always liked cocaine. I have only done it around 10 times. . . . However, the most recent was about five months ago. I did a whole bunch of it one night and a day later I crashed back into a bad depression which I am still trying to get out of. Before that, I had been successfully treated on Celexa for around 2 years. Since the coke episode, the celexa does not seem to do much, even after doubling my dose. Now, I am on WB and Celexa but will soon be trying at least a new ssri--if not just quitting everything and moving to an maoi. So, I learned my lesson, depressed people, or at least me, should not f--- around with coke.
Just my two cents,
Jack
Posted by not exactly on February 4, 2003, at 15:39:54
In reply to More on Cocaine, posted by Jack Smith on February 4, 2003, at 11:59:56
Although cocaine has no direct effect on serotonin (it is generally understood to be a reuptake inhibitor of dopamine, and to a lesser extent NE), I suspect it's capable of dramatically altering the balance among *all* of the mood-related neurotransmitters. I offer the following anecdote (which your SSRI + cocaine experience reminded me of) as further evidence of that theory.
Back in the 70's, some of my college buddies experimented with psychoactive "recreational" drugs. One of the favorites was DMX (dextromethorphan, the active ingredient in non-Rx cough medicines). In large doses (e.g. chugging 2 full bottles of cough syrup - yuk!) it acts as a psychedelic "dissociative". The euphoriant properties are most likely related to the fact that it stimulates serotonin release and inhibits its reuptake (DMX is not a narcotic and doesn't significantly affect opioid receptors). One evening, my friend John was enjoying a blissful DMX "trip" when he announced that he was going to try adding some cocaine (unlike myself, John had always liked cocaine). "Gee, I dunno, John; that doesn't seem like a good idea," I advised, but he insisted on performing the experiment. Minutes later, he appeared stunned and extremely disappointed. "Damn! It's gone! The high just vanished! Now I want something..." he remarked. He was severely depressed for the remainder of the evening, and as I remember it took him several days to recover. The cocaine had somehow cancelled & reversed the serotonin-induced euphoria.
Decades later, John was diagnosed with Chronic Major Depression, and responded well to SSRI therapy. However, I don't think the above incident "caused", "triggered", or even significantly contributed to John's lifelong depression. He was clearly depressed beforehand, and I believe that he (like many others) was in effect "self-medicating" his depression (temporarily) by the use of recreational drugs. Sometimes, such attemps can backfire.
- Bob
Posted by jumpy on February 4, 2003, at 16:55:13
In reply to Listening to Cocaine, posted by fachad on February 4, 2003, at 8:10:11
> That experience gave me the insight that depression could be genuinely biologically based, and the fact that cocaine affected me differently than my friends was further evidence for me that there were neurochemical factors contributing to my lifelong depression. I don't know how long it would have taken me to figure that out, or if I would have ever even considered medication, if it had not been for those hours of hell following cocaine use.
Hey Fachad,
That is a fascinating story. I also believe depression is 100% biological in origin ... well, at least major depression, as opposed to "problems of everyday living". Thanks for the information.
Jumpy
Posted by missinglynxx on February 4, 2003, at 18:33:02
In reply to Re: ADHEDONIA QUESTIONS ?? please read » LAURA777, posted by fachad on February 4, 2003, at 9:16:36
Hi there Facad.. I enjoyed your post on the TCAS.. why dont you ditch the Prozac, and start of Desiprimine or Nortriptyline.. I take Nortriptyline and Abilify as a combination,,Im sick to death of being sick to death from my SSRI "trials". Man, I get crazy paranoid and physically ILL on taking a half dose of ZOloft or Paxil..So therefore, I refuse anymore . Abilify is very USER friendly!!
Im far more content with my Nortriptyline. why arent you calling him up and requesting a TCA..good luck on your healing
Posted by LAURA777 on February 4, 2003, at 19:31:48
In reply to Listening to Cocaine, posted by fachad on February 4, 2003, at 8:10:11
> Laura777 wrote: "as far as stimulants go the only experience I ever had with them was cocaine and i absolutely HATED it , sorry for the strong words but the depression that caused was off the charts ..."
>
> Yes, I had a similar experience with cocaine. I only tried it three times, but each time it was horrific. I felt great for about 20 minutes, and then I was in hell for hours.First let me begin by telling you all how interesting you all are ,, i have a problem finding interesting people ..people to me are mostly surface where i think more deeply and do not care for the surface stuff much it bores me , but then again i think having this malady has maybe caused me to be this way ???!!!! who knows , but that is niether here nor there because the damage is done .. i like profound things and i like to think , i find that most people do not , or at least the ones i run into , which is not many since i tend to isolate , and this i do because i can't relate to what is so exciting about this life ...i spend alot of time in my head.. can anyone else get this ??? let me know !!!
Bob your story is very amusing , you write very well as do all of you .. i love the metaphor about the cage it is outstanding... truly ..
Fachad that is exactly how i felt about cocaine 20 minutes of so called pleasure was not worth the greuling hours of off the charts blackness ,, tell me something.... do cold medications that contain psudoephedrine effect you in the same way but on a smaller scale ???
i can not take cold meds with that ingrediant ,, i feel like i am coming off cocaine but on a smaller scale but enough to not go near them no matter how bad a cold i have .. i wonder ????today the doctor, my primary, put me on modafinil provigil .. my psychologist called my primary and explained my situation to her , he has seen me for over 3 years once a week and knows me pretty well , he knows this is a biological thing .. there is depression and bipolor in my family and she knows this as well .. any way i went to see her and further explained myself and she is willing to try this drug with the ssri .. but she BELIEVES me NOT to be depressed !! She said that she thinks i am "discontented" get that one .. would you say that people that are depressed are discontented ???
Ya know my husband suffers from this and is totally unaware of it , he just thinks that this is what life is !!! And i love when people tell me that " It could be worse " what the hell is that ??? hey man "IT could be better " this i know .. or they say " you should be grateful you have a house everyone is healthy " so because i am not dying of cancer nor are my kids but i am miserable as hell inside i should just live with it ??? " yea right what hay wagon did you fall off of "???? or how about the people who say you do not pray or go to church enough ??? or you just need to get out there and do something !!! love that one !!!! i say one word to all these things CLUELESS!!!!!! These people have to be clueless .. And this last one being very shaming but so very untrue " if you are bored you are boring " i just don't know i can not relate to alot of people .. do any of you suffer this ??? do you spend alot of time thinking cause theres nothing else to do ?? i do read alot or used to but i tell you it has NOT helped my spelling at all , i thought it was supposed to ... it just goes to show you misconceptions abound ..
Any way ..SSris calmed me down made me less impulsive and hyper .. but before i started taking them i would never watch tv , just a select few shows mostly off the main networks as well .. i would read books all kinds of books , but ones that in my opinion were well written , both fiction non fiction as well , anyway a half a year of doing ssris i found myself watching mindless sitcoms , The only picture i can give you is someone with a lobotomy drooling in front of the television set ... "Time to take your meds cheswick !!!"
talk to you all soon and if any of you have tired provigil to augment an ssri please let me know .. and how was it ?? thanks , laura
Posted by bee happy on February 4, 2003, at 20:15:48
In reply to Re: Listening to Cocaine AND TO ALL OF YOU !!! » fachad, posted by LAURA777 on February 4, 2003, at 19:31:48
Hey Laura. You're going to think I'm stalking you. Provigil was the last drug I tried before the Buprenorphine...no I'm sorry, it was Tramadol for just a day or two. But before that, it was Provigil. I am soooo suseptible to stmulants that I could only take a tiny bite of the 200 mg pill. Any more than that and I felt a whizzing through a metalic-windtunnel out of control feeling like I felt on cocaine when I experimented with it in my 'yung yooth'.This was semi helpful in getting out of bed in the morning but really did nothing for the anhedonia.I read that you had a confab with your family doc and psychologist.... did you discuss a trial of Buprenorphine yet and if so what was their response?
Posted by bee happy on February 4, 2003, at 20:53:05
In reply to Re: Listening to Cocaine AND TO ALL OF YOU !!! » fachad, posted by LAURA777 on February 4, 2003, at 19:31:48
Oh yes, I also had a very unpleasant reaction to cold remedies and cough syrups containing that alphabet soup ingredient!!! Once years ago while riding in the back seat on a long drive to San Francisco I just absolutely froze. I thought my husband and son were speaking a forein language in the front seat. I could barely speak...but managed to get out the fact that I thought i was having a bad reaction to the cough syrup. It was awful...almost out of body experience.I thought 'this must be what it's like to be really crazy.' I have never taken anything with that stuff since. Also you mentioned hating it when people tell you your life is good. I know this feeling very well. I live half the year in the West Indies and have what most would construe as a fairy tale existence. I liked the cage metaphor also...even in this beautiful place I couldn't feel my life. I do now and wow, what took me so long. Don't believe your husband when he says this is all there is. There's more, Laura. And you will find it. Keep well
Posted by LAURA777 on February 4, 2003, at 21:04:47
In reply to Re: Listening to Cocaine AND TO ALL OF YOU !!!, posted by bee happy on February 4, 2003, at 20:53:05
hey bee , i do not believe she thinks i am depresive , despite very much thought on my end on how to articulate this condition , and i did a good job ,, but people who have never been here , it is hard for them to know .. my primary thinks i am just discontented ,, not depressed , but the more i read this board the more i know i am , there are several types and i am one type .. i am going to try the meds they gave me today and see what happens , i will not forget about the bup . i am going to try and biochemically prove in some fashion that this opiate thing is real ,, after all i do belive all though i can not prove it , we self medicate before we get the help .. and we mostly choose what we need .. although i would never condone using street drugs and such .. Addiction is intolerable and is just as bad as this place , and i know you know this too , i will keep you informed and am thankful you come back on here for the hope .. love ya , laura
Posted by not exactly on February 4, 2003, at 21:12:52
In reply to Re: Listening to Cocaine AND TO ALL OF YOU !!! » fachad, posted by LAURA777 on February 4, 2003, at 19:31:48
I've tried Provigil. Recently. Liked it a lot. It's not really an AD, and it barely touched the anhedonia thing, but it did help. Boosted mood, gave me motivation, helped me think more clearly. I needed less sleep and found it easier to get going in the morning. The first day I took it, I ended up driving around my neighborhood for hours, discovering streets, buildings, lakes, hills that I never knew existed, and found the whole experience delightful. In the next few weeks, I readily accomplished many tasks that I had been procrastinating.
But (you knew there was going to be a "but", didn't you) it didn't last. I developed a tolerance after about a month, and all the benefits slowly faded away. Boosting the dose in an effort to regain the positive effects seemed like a bad idea, so I just gave up on it. I've been slowly tapering off the dosage (for fear of a hypersomnia rebound) and should be down to 0 soon. Maybe it will work again if I wait for my neurochemistry to readjust to its absence. I might just save it for "special occasions".
If you were taking it as a narcolepsy cure (its approved use), it might remain effective indefinitely. But as a mood enhancer or AD adjunct, it appears to give only short-term benefits (others have reported similarly rapid poop-out reactions). However, YMMV. Seems worth a try.
- Bob
Posted by Stan on February 5, 2003, at 4:43:56
In reply to Re: Provigil, posted by not exactly on February 4, 2003, at 21:12:52
> I've tried Provigil. Recently. Liked it a lot. It's not really an AD, and it barely touched the anhedonia thing, but it did help. Boosted mood, gave me motivation, helped me think more clearly. I needed less sleep and found it easier to get going in the morning. The first day I took it, I ended up driving around my neighborhood for hours, discovering streets, buildings, lakes, hills that I never knew existed, and found the whole experience delightful. In the next few weeks, I readily accomplished many tasks that I had been procrastinating.
>
> But (you knew there was going to be a "but", didn't you) it didn't last. I developed a tolerance after about a month, and all the benefits slowly faded away. Boosting the dose in an effort to regain the positive effects seemed like a bad idea, so I just gave up on it. I've been slowly tapering off the dosage (for fear of a hypersomnia rebound) and should be down to 0 soon. Maybe it will work again if I wait for my neurochemistry to readjust to its absence. I might just save it for "special occasions".
>
> If you were taking it as a narcolepsy cure (its approved use), it might remain effective indefinitely. But as a mood enhancer or AD adjunct, it appears to give only short-term benefits (others have reported similarly rapid poop-out reactions). However, YMMV. Seems worth a try.
>
> - Bob
>>>>>>>>>>>>>>>>>>>>hi bob -- why were you reluctant to increase the provigil dosage in an attempt to recapture your initial good fortune with this med? was your daily dose relatively high already, and perhaps you didn't want to push it? also, you mentioned that you'd taken mirapex (with good results) during a clinical trial some years back, but you weren't specific about whether you had revisited it later on in life -- did you try it again, and if so, how did you make out the second time 'round? i'm guessing it pooped out on you since you're apparently not using it now.
thanks for any insights you might have.
Stan
Posted by mistermindmasta on February 5, 2003, at 13:00:29
In reply to Listening to Cocaine, posted by fachad on February 4, 2003, at 8:10:11
Hi, I just joined this place. Seems like quite a wealth of information! Anyway, I had similar experiences like your cocaine experiences... i might expand upon this when i get more time, but I want to say I totally agree. I've had a few experiences that have convinced me beyond a doubt that mental disorders are for the most part chemical.
Posted by IsoM on February 5, 2003, at 13:15:37
In reply to Re: Provigil, posted by not exactly on February 4, 2003, at 21:12:52
I do have narcolepsy but I found Provigil did nothing for it, even at the max dose. It was like taking water. But as an AD & mood enhancer, it's wonderful!
But the effects for me are subtle. I never noticed anything for a week or so till. And when I ran out a couple of times, the effects wore off over a couple of weeks too. You DON'T need to taper off Provigil - it's not like ADs that way.
Like I said, the effects are subtle for me. But they're very real, nonetheless. I have increased appreciation of life & an inner peace & contentment from it.
It's not my only med though. I'd been taking Celexa for a couple of years before, & when the Provigil didn't help the narcolepsy, I've also added Dexedrine. But I know what each med does & can tell the difference between their effects.
Posted by not exactly on February 5, 2003, at 13:25:19
In reply to Re: Provigil » not exactly, posted by Stan on February 5, 2003, at 4:43:56
Stan,
Good questions. I'll try to answer them as well as I can. Sorry if this turns out to be more information than you wanted. :-)
> why were you reluctant to increase the provigil dosage in an attempt to recapture your initial good fortune with this med?
If I thought that the poop-out proved that I had not been at an effective level, and expected that a *single* dosage increment would reinstate the benefits *indefinitely*, then of course I would have done so. But I don't think that was the case. It was clearly an effective level at first, and even seemed "too much" at times. The poop-out was a tolerance effect, and my understanding of this (based on my readings and personal experience) is that chasing after the lost "high" only leads to a frustrating and dangerous spiral of repeated dose escalation. I did not want to become a Provigil "junkie". I figured I had given it a fair try, and it had failed to provide an ongoing benefit. Time to move on.
> also, you mentioned that you'd taken mirapex (with good results) during a clinical trial some years back, but you weren't specific about whether you had revisited it later on in life -- did you try it again, and if so, how did you make out the second time 'round? i'm guessing it pooped out on you since you're apparently not using it now.
Since Mirapex was not an option after the trial, I began a search for an effective substitute. Almost everything I tried was useless or worse. Eventually I settled on Wellbutrin + Ritalin, which actually worked rather well for an extended period with no sign of waning benefit. But it never lived up to my glorious memory of my pramipexole experience. So I anxiously awaited the approval and release of Mirapex. Once it became available, I immediated switched over to it, with mixed and overall disappointing results.
One of the problems was determining the right dose. The trial data had not yet been "unblinded", so I could not find out what my dose had been (trial participants were randomly assigned different dosage regimens). At first I was actually taking about 8 times (!) the optimal (for me) dose. When I finally adjusted to the appropriate level, the previous "overdose" exposure may have predisposed me for reduced benefit and premature tolerance effects. I continued on it for about a year, while its effectiveness slowly and imperceptably diminished until I finally realized that I was depressed again.
I could have gone back to the Wellbutrin/Ritalin combo, but instead I volunteered for another AD drug trial: the selegiline patch. It was "deja vu all over again" - dramatically positive results, return to depression after the trial, and a new "magic bullet" that was not available. Damn.
So now I know of 3 completely different drug treatments that have helped - all dopamine boosters, but by different mechanisms. I've been trying to use this knowledge to lead me to another "cure" that hopefully will combine effectiveness, freedom from troublesome side effects, enduring benefits, convience of administration, and low maintenance cost. A tall order, to say the least. But because I know that I have some acceptable (tho not optimal) fallback options, I'm willing to risk the quest. Kinda like rock climbing - you drive in a piton and climb a little higher, reassured by the expectation that a fall won't be fatal.
I recently started desipramine - so far so good. Augmenting with Ritalin or BuSpar (the dopamine thing again) are possible strategies if monotherapy proves disappointing. I'll report on my progress once it fully kicks in.
- Bob
Posted by LAURA777 on February 5, 2003, at 15:50:49
In reply to Re: Provigil / Mirapex » Stan, posted by not exactly on February 5, 2003, at 13:25:19
Hey bob, i have been doing alot of research , and it seems to me my most basic problem is dopamine in the mesolimbic system , i have been reading and it seems some of us have a genetic error of reduction of the d2 receptors in the nucleus accumbens .. people who have this sooner or later become incapable to obtain gratification from the common pleasure of life ..
i further looked into it and found out of tests they did with the nucleus accumbens reguarding reward / punishment , and while the nucleus accumbens lit up or showed more activity when reward was anticipated it did not light up when punishment was atticipated , the medial caudate showed activity with punishment as well as reward too ..
this all meaning that positive and negitive feelings do not emulate from the same places in the brain .. because i can feel the negitive feelings like sad , boredom , ect ect. but when it comes to feeling pleasure anticipation exuberation , fun, these things are muted blunted .. have been for quite some time .. no interest and such ... people who are deficient in this area usually take up atypical and noxious pleasure .. impulsive gambling alcohol and drugs , eating excessive sweet foods , (i used to eat a ton when i was a kid ) alcoholism runs in my family as well as drug abuse...
i have taken up reading and working out my frontal lobe quite alot ... but this dampens too just like every addiction or diversion does ..
i need the other half of life !!!! the other half of emotions .. ya know .. anticipation stimulates motivation .. the menial tasks in my life are so much harder to do at times because i have nothing to temper it with .. am i explaining this right ???
i know this is responsible because of other culminating factors (this post would be too long}i know why people drink and take drugs , it is absolutly misrable in this state ..Unfortunately the path of addiction is also extremely painful and intolerable ... so what is one left to do ..
why do they not make a good dopaminergic damn it !!!!!! you see serotonin and nuroepinephrine where is the dopamine ???????? this is a real malady !!! you can pile on tons of ssris snris and whatever the hell , i know that i need dopamine .. i don't want to go supper high and i do not want to stay in the grey .. i want to cry .. anyone out there give me a hand !!!
i know the stimulants increase dopamine right where i need it .. but how does that work for a solution ??? do you build tolerance ?? what are the worse side effects ?? also from what i am reading about stimulants is that they are like MOAI's ... let me know , thanks in abundance and with gratefulness , laura
Posted by jumpy on February 5, 2003, at 17:43:36
In reply to Re: Provigil / Mirapex » Stan, posted by not exactly on February 5, 2003, at 13:25:19
Hey Bob,
Mirapex is availible in most countries for parkinson's disease ... I am surprised you are not able to find it. Also, if the selegiline patch worked for you ... why not try the standard oral preparation? Most people who responded to the patch switch to the oral tablets after the study. And if you need dopamine, go get your self some parnate at least. Lots of luck, hope your well soon.
Jumpy
Posted by PuraVida on February 5, 2003, at 17:58:46
In reply to Re: Provigil / Mirapex The Dopamine Thing » not exactly, posted by LAURA777 on February 5, 2003, at 15:50:49
Hi Laura,
I am just revisiting the boards after a long time away looking for info/ideas on my current new state of apathy. Not that I'm depressed, at least, not according to how depression usually feels for me. It is more of a numbness, a nothingness - the negativeness of my typical depression isn't present. I too find myself just bored to death, and there is so much that I really should be doing. I know somewhere in my mind that the real me should want to be doing it! Yet, unlike typical depression, the "shoulds" don't cause a bit of concern for me at all - I just sleep, procrastinate, or enjoy my favorite hobby of late, drinking to pass the evenings away. This is fairly new for me, having had all episodes of depression so far and more recently anxiety, which has caused me to go on Topomax for mood stabilization. I actually don't mind it as much as the other states, but its not right, either, as I am normnally a very active, social, enthusiastic person. Especially that I need to self-medicate with alcohol to get myself motivated about anything at all.
Good thing is that there is a bit of motivation on both our parts to be here. Your post reminded me of a book I've enjoyed called Natural Prozac by Joel Robertson - I've posted about it before. He talks about two different types of depression - arousal and satiation, and how levels of serotonin, dopamine and norepinephrine get imbalanced. He suggests Wellbutrin, amphetamines and Ritalin as potential medications for low dopamine levels, as well as a host of natural remedies including high protien diets and strenuous exercise.
Anyhow, thanks for making me think a bit more on how to get myself unstuck...and best wishes -
Posted by PuraVida on February 5, 2003, at 18:14:20
In reply to The Dopamine Thing » LAURA777, posted by PuraVida on February 5, 2003, at 17:58:46
BTW, I just switched back to 20 mgs of Prozac from Serzone, which pooped. The Prozac took me right out of my wallowing self-pity depression, but now I've got the apathy and lack of motivation. Just read a post about a new drug called Abilify? Going to check it out...
Posted by jonh kimble on February 5, 2003, at 21:02:59
In reply to Re: The Dopamine Thing, posted by PuraVida on February 5, 2003, at 18:14:20
I didnt realize how many anhedonics there were hear. Thats great! (dont take that the wrong way) Alot of interesting stuff here. Pura vida, your description is very accurate. Ive always had a tough time explaining how I feel, but that is so close to it.
Dopamine in the mesolimbic system is certainly a primo target for this sort of thing. D2 but also D3 receptors have the biggest implication in this sort of thing. Abilify sounds great as it really has multiple DA enhancing effects but it is new so you wont here all that much and it is very expensive from what I here. But I think our lives are worth it:) Tom
Posted by not exactly on February 6, 2003, at 3:50:14
In reply to Mirapex/Selegiline/Parnate » not exactly, posted by jumpy on February 5, 2003, at 17:43:36
> Mirapex is availible in most countries for parkinson's disease ... I am surprised you are not able to find it.
I couldn't get it right after the trial (about 7 years ago) because it hadn't been approved yet. I *was* able to get it a couple of years later. I explained all this in a previous post [http://www.dr-bob.org/babble/20030204/msgs/139600.html].
> Also, if the selegiline patch worked for you ... why not try the standard oral preparation?
I did. For about a year. But it never worked as well. When selegiline is taken orally, the metabolic pathways are somewhat different, and hence the plasma levels of active metabolites end up at different ratios. So the overall effect is not exactly the same. Also, you need to take such a large dose orally that the MAOI diet is mandatory (which I found to be a big disadvantage). Cheese-safe levels of oral selegiline aren't effective as an AD.
> And if you need dopamine, go get your self some parnate at least.
Parnate is near the top of my "to be tried" list, but I'm not looking forward to the MAOI diet restrictions. How can I live without pepperoni pizza? :-(
- Bob
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