![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 33. This is the beginning of the thread.
Posted by Maximus on April 16, 2010, at 11:48:18
Hi,
I have been having severe anhedonia for the last three weeks. My energy level is good and the quality of my sleep too. My dx is bp II.
Here's my meds: Lamictal 200 mg, Effexor XR 225 mg and Abilify 5 mg. Do you have any suggestion or tweak for my current meds?
Thanks in advance.
Posted by Phillipa on April 16, 2010, at 12:50:23
In reply to Severe anhedonia, posted by Maximus on April 16, 2010, at 11:48:18
Maximus there is quite a long thread dealing with this very topic. As for meds I defer to the experts. But does seem many are experiencing this now. Wonder why? Phillipa
Posted by evenintherain on April 16, 2010, at 13:34:52
In reply to Re: Severe anhedonia » Maximus, posted by Phillipa on April 16, 2010, at 12:50:23
yeah, anhedonia seems to be a hot topic at the moment.
i hope it's not the beginning of some SSRI backlash!
Maximus, I'm afraid I'm not qualified to help you, but people are talking:
http://www.dr-bob.org/cgi-bin/pb/mget.pl?post=/babble/20100318/msgs/940577.html#940577
http://www.dr-bob.org/cgi-bin/pb/mget.pl?post=/babble/20100406/msgs/942996.html#942996
Posted by SLS on April 16, 2010, at 15:01:59
In reply to Severe anhedonia, posted by Maximus on April 16, 2010, at 11:48:18
> Hi,
>
> I have been having severe anhedonia for the last three weeks. My energy level is good and the quality of my sleep too. My dx is bp II.
>
> Here's my meds: Lamictal 200 mg, Effexor XR 225 mg and Abilify 5 mg. Do you have any suggestion or tweak for my current meds?I think most doctors would increase the dosage of Effexor to 300mg before giving up on it.
- Scott
Posted by Maximus on April 16, 2010, at 19:09:42
In reply to Re: Severe anhedonia, posted by SLS on April 16, 2010, at 15:01:59
> I think most doctors would increase the dosage of Effexor to 300mg before giving up on it.
>Scott,
Do you think a higher dose of Abilify would stimulate me?
Posted by SLS on April 16, 2010, at 20:44:49
In reply to Re: Severe anhedonia » SLS, posted by Maximus on April 16, 2010, at 19:09:42
> > I think most doctors would increase the dosage of Effexor to 300mg before giving up on it.
> >
>
> Scott,
>
> Do you think a higher dose of Abilify would stimulate me?
For me, I find it necessary to take a minimum of 10mg of Abilify in order to benefit from it. It increases mental energy and motivation. I'm not sure I would call it stimulating, though. Then again, I don't experience stimulation with amphetamine or methylphenidate either.
- Scott
Posted by polarbear206 on April 17, 2010, at 8:34:03
In reply to Severe anhedonia, posted by Maximus on April 16, 2010, at 11:48:18
> Hi,
>
> I have been having severe anhedonia for the last three weeks. My energy level is good and the quality of my sleep too. My dx is bp II.
>
> Here's my meds: Lamictal 200 mg, Effexor XR 225 mg and Abilify 5 mg. Do you have any suggestion or tweak for my current meds?
>
>
>
> Thanks in advance.Hey there stranger :)
You know that it could that your clock adjusting to the change in time and season. I get like this for a couple weeks, then it lifts. Still taking effexor and lamictal. It's quite bizzare, but it happens every year.
Posted by Maximus on April 17, 2010, at 10:23:25
In reply to Re: Severe anhedonia, posted by polarbear206 on April 17, 2010, at 8:34:03
> Hey there stranger :)
>
> You know that it could that your clock adjusting to the change in time and season. I get like this for a couple weeks, then it lifts. Still taking effexor and lamictal. It's quite bizzare, but it happens every year.Hello :-)
I hope you're right, i mean the season thing. Because i have no motivation and i'm unable to appreciate something.
Posted by bleauberry on April 17, 2010, at 11:12:24
In reply to Severe anhedonia, posted by Maximus on April 16, 2010, at 11:48:18
Broadly speaking anhedonia seems to me to be a hypo-excitatory thing. Too much inhibition going on, not enough excitement going on. Inside the brain's workings that is.
Lamictal as I see it is definitely putting the brakes on excitation. I mean, that's what it is supposed to do, right? Stop seizures? Anti-excitation?
Effexor is predominantly serotonin, with a distant smidgen of norepinephrine and dopamine in there. The NE and DA increase more at the highest doses, but still is a tiny percent compared to the whopping effect on serotonin. Serotonin is inhibitory, not excitatory. Despite the weak effect on NE and DA, serotonin is likely squashing them out.
Abilify I think is harder to armchair quarterback. The way it interacts with dopamine and serotonin receptors in two different opposing directions, varying from person to person, and varying from dose-size to dose-size, means that at a certain dose it could be good for anhedonia and at another dose bad. But would vary from person to person. Generally speaking, based off of most comments of abilify users here over the last couple years, doses below 5mg were best for anhedonia. Doses at or above 5mg were too dulling and too much like a full-on antipsychotic. Just comments, not my own opinions. I don't have much personal experience with it.
It is risky to play around with doses. But from an armchair quarterback position, I would say the best way to improve the anhedonia thing would be to lessen the doses of all three meds to the bare minimum dose that keeps you well. If you aren't even at that goal on the doses you are on, then I can't even see the reasoning to keep them at all.
Take my comments with a grain of salt and please don't do anything without talking to your doctor. I just wanted to say that I see too much anti-excitatory stuff in this cocktail. Which is a good thing if control of BP is crucial. Not so good for anhedonia. It is a fine line to try to balance them out. At the current doses, the balance seems to be in favor of stability at the cost of pleasure.
Posted by Maximus on April 17, 2010, at 15:22:13
In reply to Re: Severe anhedonia, posted by bleauberry on April 17, 2010, at 11:12:24
> It is risky to play around with doses. But from an armchair quarterback position, I would say the best way to improve the anhedonia thing would be to lessen the doses of all three meds to the bare minimum dose that keeps you well. If you aren't even at that goal on the doses you are on, then I can't even see the reasoning to keep them at all.
>
> Take my comments with a grain of salt and please don't do anything without talking to your doctor. I just wanted to say that I see too much anti-excitatory stuff in this cocktail. Which is a good thing if control of BP is crucial. Not so good for anhedonia. It is a fine line to try to balance them out. At the current doses, the balance seems to be in favor of stability at the cost of pleasure.Hi,
Thank you very much for your input. I think it is a kind of trade-off. You see, when i decrease the dose of Effexor, i start again to feel and enjoy things. But within 3 or 4 days the melancholia is back with a vengeance. Sometimes i think that a TCA would be better than Effexor. But my pdoc wont take this route, not for a bp patient.
There is always my beloved Zyprexa. But then again, i'm afraid of the dreaded weight gain because i want to lose some... On the other hand my ultimate and real remission was brought by Zyprexa.
Posted by bulldog2 on April 17, 2010, at 17:21:05
In reply to Re: Severe anhedonia » bleauberry, posted by Maximus on April 17, 2010, at 15:22:13
> > It is risky to play around with doses. But from an armchair quarterback position, I would say the best way to improve the anhedonia thing would be to lessen the doses of all three meds to the bare minimum dose that keeps you well. If you aren't even at that goal on the doses you are on, then I can't even see the reasoning to keep them at all.
> >
> > Take my comments with a grain of salt and please don't do anything without talking to your doctor. I just wanted to say that I see too much anti-excitatory stuff in this cocktail. Which is a good thing if control of BP is crucial. Not so good for anhedonia. It is a fine line to try to balance them out. At the current doses, the balance seems to be in favor of stability at the cost of pleasure.
>
> Hi,
>
> Thank you very much for your input. I think it is a kind of trade-off. You see, when i decrease the dose of Effexor, i start again to feel and enjoy things. But within 3 or 4 days the melancholia is back with a vengeance. Sometimes i think that a TCA would be better than Effexor. But my pdoc wont take this route, not for a bp patient.
>
> There is always my beloved Zyprexa. But then again, i'm afraid of the dreaded weight gain because i want to lose some... On the other hand my ultimate and real remission was brought by Zyprexa.
>
>My p-doc started me on clomipramine 25 mg for depression,anhedonia with melancholia.
Posted by Economist on April 18, 2010, at 2:57:31
In reply to Re: Severe anhedonia, posted by bulldog2 on April 17, 2010, at 17:21:05
Hi bulldog,
Please update us in a few weeks if there are any changes in your anhedonia.
Posted by bulldog2 on April 18, 2010, at 8:31:33
In reply to Re: Severe anhedonia » bulldog2, posted by Economist on April 18, 2010, at 2:57:31
> Hi bulldog,
>
> Please update us in a few weeks if there are any changes in your anhedonia.I have been on 25 mg the lowest dose. It truely is powerful so hopefully I can get by on as little as 50 mg or even 25 mg. I still have no desire to seek out people but when I do encounter people I seem to be quite talkative end enjoy the encounters. I am enjoying my favorite tv shows again and found myself laughing this morning. So I would say that even at this dose there is a mood brightening effect. Hope things get even better at 50 mg..
Posted by alchemy on April 18, 2010, at 10:47:24
In reply to Re: Severe anhedonia, posted by bulldog2 on April 18, 2010, at 8:31:33
I recently added dexadrine to my mix. I am not ADD, but the depression, lack of pleasure & motivation are my main symptoms. The lack of motivation is extremely hard because I also feel "trapped" in time by not wanting to do anything.
I am also somewhat bipolar 2. W/out meds I am more agitated and there is some cycling between down & more down.
When I tried Adderall years ago I was not on a stabilizer. It caused me to have extreme swings, and mostly down-bad. But the first week was awesome. I felt like doing things and I wasn't anxious about how to get through the day. It really screwed me up.
I recently started dexadrine. This time I am on Lamictal (for me it hasn't made it worse). It is very subtle, and at first I wasn't sure if it was helping. But it has helped a little bit w/ motivation. It hasn't touched my depression, but it is nice to have my motivation helped maybe 15-20%.
Interesting how all of these mood & brain related circuits are so intertwined but can be somewhat separate. No mood change, but I can pass the time and get more things done without miserably forcing myself (like exercise).
Posted by alchemy on April 18, 2010, at 11:11:15
In reply to Severe anhedonia, posted by Maximus on April 16, 2010, at 11:48:18
I find it interesting that the trend on this bored is that SSRIs tend to create or worsen anhedonia. In many people it does the opposite, but they are probably the ones that get the initial happy response where they don't need additional help.
Posted by bulldog2 on April 18, 2010, at 11:24:41
In reply to Re: Severe anhedonia, posted by alchemy on April 18, 2010, at 11:11:15
> I find it interesting that the trend on this bored is that SSRIs tend to create or worsen anhedonia. In many people it does the opposite, but they are probably the ones that get the initial happy response where they don't need additional help.
I think that the ssris can lower dopamine which seems to be a factor in happiness,libido and interest in one's surroundings.
For some people stimulants do counter that ssri side effect.
Posted by Economist on April 18, 2010, at 13:17:18
In reply to Re: Severe anhedonia, posted by bulldog2 on April 18, 2010, at 8:31:33
bulldog,
Do you think it's the effect of the medication or perhaps a placebo effect?
Posted by bleauberry on April 18, 2010, at 13:38:14
In reply to Re: Severe anhedonia » bleauberry, posted by Maximus on April 17, 2010, at 15:22:13
Then go back to Zyprexa and make a lifelong change to eating mostly veggies and meats. Very little in the way of grains or carbs or sugars. That will provide less raw material for zyprexa to send to the fat department. And likely be a much healthier life in every other way as a benefit. Takes a couple months to get accustomed to, but well worth it. Once there, your old foods are not desired any longer. The taste buds change. I'm not saying we can totally beat back the weight gain of zyprexa in every person, but I am saying I feel it is very possible to beat back most of it or all of it in a majority of people. It isn't so much how much we eat, but what we eat. I mean, real simple, if someone's plate has mostly veggies on it and modest piece of lean meat, they aren't going to gain weight. Add in a piece of cake, slice of bread, etc, forget, the weight is going to pile on fast. Favorite foods don't have to be totally eliminated, but need to be once-a-week treats, not daily routines. "Eat for health, not for pleasure."
We're pretty lucky to have a choice actually. Think about it, back in the old days, they didn't even have a choice to eat for either health or pleasure. They had to eat whatever they could find at the time. We have a choice. For anyone taking zyprexa, nobody can choose to force fat fuel into the mouth except the person eating.
If you did that well on zyprexa, geez, you gotta get back on it. Changing the things you buy at the grocery store seems like a heck of a good deal to me to have remission. I would pay that price in a heartbeat!
Posted by bulldog2 on April 18, 2010, at 13:41:09
In reply to Re: Severe anhedonia » bulldog2, posted by Economist on April 18, 2010, at 13:17:18
> bulldog,
>
> Do you think it's the effect of the medication or perhaps a placebo effect?I'm not sure which med your talking about.
It's been documented that ssris do lower dopamine and dopamine is linked to the limbic areas of the brain which is associated with basic emotions and pleasure. If you lower dopamine too much it's will have a negative effect on your mood and also your hormones.It's ironic that an ad may cause anhedonia which is one of the prominent features of depression.
To counter the ssri effect you want meds that lower prolactin. ssris raise prolactin which lowers dopamine. So some use dopamine agonists to lower the prolactin. One recently talked about was carbergoline. Some use stimulants to stimulate the release of dopamine. I don't think any of these are placebo effect.
Sometimes I wonder if the maker of prozac knew about the dopamine effect and all the subsequent problems that would cause. If the FDA had known about this I wonder if the ssris would have been approved.
Posted by conundrum on April 18, 2010, at 15:08:28
In reply to Re: Severe anhedonia » alchemy, posted by bulldog2 on April 18, 2010, at 11:24:41
I'm not surprised about clomipramine then. It is a potent SRI but it blocks the serotonin from getting to the "bad" receptors that lower norepinephrine and dopamine.
In fact it should increase norepinephrine and dopamine release in some areas of the brain.
Its a hardcore AD so I hope its not placebo effect. Good Luck on it!
Posted by Economist on April 18, 2010, at 17:01:55
In reply to Re: Severe anhedonia, posted by bulldog2 on April 18, 2010, at 13:41:09
bulldog,
Sorry, I meant that if you thought the changes you are feeling in wanting to do things more and talk to people is a result of the clomipramine or just a placebo effect (ie, you feeling hopeful that the medication might be working even though it might not have kicked in yet).
Posted by bulldog2 on April 18, 2010, at 17:18:41
In reply to Re: Severe anhedonia » bulldog2, posted by Economist on April 18, 2010, at 17:01:55
> bulldog,
>
> Sorry, I meant that if you thought the changes you are feeling in wanting to do things more and talk to people is a result of the clomipramine or just a placebo effect (ie, you feeling hopeful that the medication might be working even though it might not have kicked in yet).That is a tough one to call. I've taken a lot of ads and generally I expect them not to work. I'll go out on a limb and say this is an early blip. I really think serotonin needs some norepinephrine for a balanced mood. Even though it is more serotonin I can feel the ne also in this med. I had been on low dose amitriptyline for a while so something may have been happening and maybe the shift to more serotonin did the trick.
Posted by meltingpot on April 19, 2010, at 7:14:41
In reply to Severe anhedonia, posted by Maximus on April 16, 2010, at 11:48:18
Hi,
When I was drug nieve in my 20s it felt as though pretty much anything I was prescribed for depression worked, I was so fortunate. First prothiaden (tricyclic) and later on Seroxat (SSRI). They both worked the same in that they increased pleasure, relaxation, motivation, sense of reward etc etc. I felt no difference between the two drugs other than I felt slightly more stimulated on the Seroxat initially (not euphoric but getting there.
Later on in my 30s when the Depression and anxiety came back for the first time ever I felt suicidal. For two years I tried so many drugs that all acted in different ways and to be honest there wasn't much difference in how I reacted to the SSRIs or the SNRIs, they all seemed to just increase the anxiety and give me more energy but it was a very anxious energy, not motivated energy.
Finally after two years a higher dose of Seroxat suddenly kicked in (after four days) and the anxiety seemed to cease and there was a return in pleasure and reward. Three years later and the Seroxat seemed to lose it's affect and what I've missed the most is the lack of reward and pleasure over the last five years.
I think another poster put it so well when they said that "everything just seems muted all of the time". I can function fairly well and I can do things, I go to work, I apply for other jobs, I work at the weekend as well as during the week, I go out and meet people, I write a lot but I feel bland all of the time, I can't even seem to get a rush from cigarettes or coffee. I don't really look forward to holidays anymore (and haven't for five years) and although I still have quite a strong libido I'm too tired and apathetic in the evening to do anything about it.
I've tried Clomipramine and I have to say that whilst it helped the depression and anxiety I still had that feeling of anhedonia, of the feeling that life is just passing by and nothing changes.
I'm not sure what to try anymore. I've been told by the NHS to try "mindfullness" in other words to just accept my condition and I'm contesting this! It seems like a cop out on their part.
I would consider ECT, in fact I would consider trying anything to just feel alive again.
Denise
Posted by bulldog2 on April 19, 2010, at 8:45:55
In reply to Re: Severe anhedonia, posted by meltingpot on April 19, 2010, at 7:14:41
> Hi,
>
> When I was drug nieve in my 20s it felt as though pretty much anything I was prescribed for depression worked, I was so fortunate. First prothiaden (tricyclic) and later on Seroxat (SSRI). They both worked the same in that they increased pleasure, relaxation, motivation, sense of reward etc etc. I felt no difference between the two drugs other than I felt slightly more stimulated on the Seroxat initially (not euphoric but getting there.
>
> Later on in my 30s when the Depression and anxiety came back for the first time ever I felt suicidal. For two years I tried so many drugs that all acted in different ways and to be honest there wasn't much difference in how I reacted to the SSRIs or the SNRIs, they all seemed to just increase the anxiety and give me more energy but it was a very anxious energy, not motivated energy.
>
> Finally after two years a higher dose of Seroxat suddenly kicked in (after four days) and the anxiety seemed to cease and there was a return in pleasure and reward. Three years later and the Seroxat seemed to lose it's affect and what I've missed the most is the lack of reward and pleasure over the last five years.
>
> I think another poster put it so well when they said that "everything just seems muted all of the time". I can function fairly well and I can do things, I go to work, I apply for other jobs, I work at the weekend as well as during the week, I go out and meet people, I write a lot but I feel bland all of the time, I can't even seem to get a rush from cigarettes or coffee. I don't really look forward to holidays anymore (and haven't for five years) and although I still have quite a strong libido I'm too tired and apathetic in the evening to do anything about it.
>
> I've tried Clomipramine and I have to say that whilst it helped the depression and anxiety I still had that feeling of anhedonia, of the feeling that life is just passing by and nothing changes.
>
> I'm not sure what to try anymore. I've been told by the NHS to try "mindfullness" in other words to just accept my condition and I'm contesting this! It seems like a cop out on their part.
>
> I would consider ECT, in fact I would consider trying anything to just feel alive again.
>
>
>
> DeniseI agree. Anhedonia is not acceptable to me. You can never convince me that this is the best life has to offer. Therefore I will continue to pursue treatment options.
Posted by meltingpot on April 19, 2010, at 9:16:53
In reply to Re: Severe anhedonia, posted by bulldog2 on April 19, 2010, at 8:45:55
Hi,
If you find anything that makes a difference then please, please let me know.
The psychiatrist has recently added Mirtazapine to the Seroxat (a combination I've already tried in the past) but it doesn't seem to be doing much.
Denise
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.