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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by johnturner77 on May 15, 2000, at 15:09:56
I was accused by my exwife of being depressed though I don't always feel that depressed. More apathetic than depressed... I saw a post recently where a lady said she was diagnosed as ADD with hypoactivity. Thats a lot closer to me. I am always doing something else...I should be studying right now! 8>) I am not particularly anxious, I think I have a sort of mental tension that keeps all the nasties at bay quite well. I sometimes describe myself as mildly dissociated. I have this buffer of some kind between me and all experience. Somewhere in my unconscious my memory does quite nicely. Anyway I have tried a number of antidepressants over the years with out finding anything that really helped. Prozac was one of the worst. I was too uptight to think. All the rest eventually or quickly caused me to have short term memory problems. A doctor friend recently persuaded me to do a trial with Effexor.(it doesn't seem to stimulate the 5HTP-H2 receptors that inhibit Dopamine activity) It has been fairly good so far but I have trouble waking up in the morning, can't come, and am under pressure from my wife to quit it. She says I am spacy and not less depressed. Except when I was very fatigued, short term memory seems unaffected. I was exasperatingly slow at figuring out what I want even before this drug. The serotonin enhancing effects of effexor seem to be more than adequate IMHO so a higher dose(75 mg of XR) doesn't seem to make sense. I have a hunch that some type of a dopamine agonist in addition may be the answer. I have seen a number of anecdotes where Dopamine agonists in conjunciton with AD's have proved helpful with atypical depression, but there seems to be quite a resistance to using this approach. I am not really eager to try a stimulant such as methylphenidate or amphetamine. I am considering asking for a trial of Bromocriptine along with the Effexor. Is there a better combination that I should try first? What are your experiences with combo's of this type? I don't have insurance at present and when I start work I won't be covered because of pre-existing condition clauses so cost and endless experiments are to be avoided if possible.
Thanks in advance,
Posted by bob on May 15, 2000, at 20:24:08
In reply to AD's and Dopamine Agonists? What to try next, posted by johnturner77 on May 15, 2000, at 15:09:56
Don't rule out the older stimulants, particularly for your situation -- generics are great for folks with no insurance. Methylphenidate (ritalin, for those who don't recognise the name) comes in a slow release formula that doesn't quite kick-start you like the regular formula does ... while it's a bit milder on the system, I agree with what Noa has said about her own experiences with it in that 20mg SR is not as effective as 20mg of the regular stuff.
Which isn't necessarily such a bad thing.
Anyway, I started it with nortriptyline and now with desipramine, and it's been working fairly well with either for me.
cheers,
bob
Posted by AndrewB on May 16, 2000, at 4:45:47
In reply to AD's and Dopamine Agonists? What to try next, posted by johnturner77 on May 15, 2000, at 15:09:56
John,
Bromocryptine has been used successfully before for SSRI side effects. Another dopamine agonist is Mirapex. I just read a case study where it helped a women with SSRI induced anorgasmia and anhedonia. I think it may be quite effective for apathy also.
I would think that a person is usually a good judge of whether he is very depressed or anxious. Sometimes though a person can be depressed or anxious without realizing it, I was. I swore that I wasn’t depressed or anxious, just mentally fatigued and irritable. I was so mentally disassociated from myself however that I couldn’t tell what my feelings were. There were ways I would (and still do) protect myself from unpleasent feelings and experiences. One way is too procrastinate. I procrastinate to avoid the anxiety producing activity I should be doing. Over the long term I had become totally numb to my feelings, comfortably numb. I hadn’t cried in years.
You mentioned apathy. Sometimes apathy is associated with dysthymia. Dysthymia is chronic low to moderate grade depression. People with it very often complain of low energy, poor concentration, poor self-esteem, and feelings of hopelessness. There is a theory that these symptoms, along with apathy, anhedonia and poor motivation are an indication of poor dopamine transmission. If you have a cluster of these symptoms, you should know that there are dopaminergic medicines that have a good track record of working if SSRIs have failed.
Posted by Cindy W on May 16, 2000, at 8:53:08
In reply to Re: AD's and Dopamine Agonists? What to try next, posted by AndrewB on May 16, 2000, at 4:45:47
>
>
> John,
>
> Bromocryptine has been used successfully before for SSRI side effects. Another dopamine agonist is Mirapex. I just read a case study where it helped a women with SSRI induced anorgasmia and anhedonia. I think it may be quite effective for apathy also.
>
> I would think that a person is usually a good judge of whether he is very depressed or anxious. Sometimes though a person can be depressed or anxious without realizing it, I was. I swore that I wasn’t depressed or anxious, just mentally fatigued and irritable. I was so mentally disassociated from myself however that I couldn’t tell what my feelings were. There were ways I would (and still do) protect myself from unpleasent feelings and experiences. One way is too procrastinate. I procrastinate to avoid the anxiety producing activity I should be doing. Over the long term I had become totally numb to my feelings, comfortably numb. I hadn’t cried in years.
>
> You mentioned apathy. Sometimes apathy is associated with dysthymia. Dysthymia is chronic low to moderate grade depression. People with it very often complain of low energy, poor concentration, poor self-esteem, and feelings of hopelessness. There is a theory that these symptoms, along with apathy, anhedonia and poor motivation are an indication of poor dopamine transmission. If you have a cluster of these symptoms, you should know that there are dopaminergic medicines that have a good track record of working if SSRIs have failed.John, I'm taking Effexor-XR 375 mg/day. Effexor effects seem dose related. At first, I couldn't climax, and now, while my response is a little slowed, I have no difficulty, so I think I habituated to the Effexor, so to speak.
You mentioned that your wife said you are depressed. From what I've read on this site and elsewhere (ask Cam), Effexor first affects serotonin, then at a higher dose, affects norepinephrine. So you might want to try a higher dose before giving it up (ask Cam at what dose it does that). At a MUCH higher dose, it reportedly affects dopamine (500-600 mg/day?). Talk to your pdoc. Best wishes and hope things get better for you!
Posted by JohnL on May 17, 2000, at 3:56:00
In reply to AD's and Dopamine Agonists? What to try next, posted by johnturner77 on May 15, 2000, at 15:09:56
I think Bromocriptine or Mirapex have potential with you.
More common ways to accomplish the same thing are to augment with psychostimulants. They are much cheaper(dirt cheap), have a huge track record, and have dopamine action. Either Adderall or Ritalin would be fine choices. You'll know for sure inside a week if one is right for you or not. If not, try the other. They are very common in treating depression, but usually as an add-on to an antidepressant medication. And they're common choices for dealing with sexual side effects too. I would think a trial of these would make sense before considering other avenues.
If you're feeling adventuresome, two overseas mailorder medications are wonderful in my experience. They are, Adrafinil and Amisulpride. But again, I think one week look-sees of a couple different stimulants is the best place to start, for a variety of reasons.
JohnL
Posted by KarenB on May 31, 2000, at 16:45:14
In reply to Re: AD's and Dopamine Agonists? What to try next, posted by JohnL on May 17, 2000, at 3:56:00
Hey John,
I'm really late responding to this, so I hope you're still around. I am the woman with ADD/hypoactivity of whom you speak in your inquiry.
Ditto everything JohnL said. If you want to try overseas meds, Adrafinil combined with Amisulpride would be my first suggestion. I used an antidepressant while I lived in the Philippines (Amineptine), along with a drug similar to Amisulpride, called Sulpiride. It was the bomb. I have never felt so good in my life, in a non-medicated sort of way. However, Amineptine, (a psychostimulant modified tricyclic) has since been discontinued worldwide. Sigh. So, I sought to find something stateside to replace this very effective combo.
I do not do well at all on SSRIs.
I am currently on Adderall (an ADD stimulant) and Buspar (an anti-anxiety med with some anti-depressant qualities). I am taking 10mg Buspar three times a day and 20mg Adderall 1/2 hour before getting out of bed in the morning, then 5-10 mg five hours later. I started the Adderall at 10 mg twice a day but have since adjusted the dosage. It takes a while to find exactly how long it lasts in your system so you can take the second dose BEFORE your mood and energy start to decline.
The Buspar doesn't work for everyone but my doc said that it is effective sometimes in low level depression like mine (Dysthymia). This time, he was right and it has worked just fine. Just the stimulant alone does not do the whole job for me - I have the energy but no desire.
BTW, I take Propranolol (Inderal - a beta blocker) to prevent migraines which are triggered by the stimulant. I don't like taking so much medication but you gotta do what you gotta do.
Karen
Posted by Johnturner77 on June 2, 2000, at 9:58:47
In reply to Re: AD's and Dopamine Agonists? johnturner:, posted by KarenB on May 31, 2000, at 16:45:14
I guess I'sve been too apathetic to acknowledge the nice responses that you all have given.. I just can't see taking stimulants. I think its mostly prejudice. Not too far from here all the moon shiners have switched to Crank. I suspect the druggies are mostly trying to Self medicate, but still the results are still appalling.
I do remember back in 69 trying some street amphetamines. It was absolutely wonderful. I took a relatively small dose, and was happy, talkative, and animated, all in a very nice way. I knew this drug had my name on it so I avoided it..I did try some pharmaceutical grade dexedrine once later and had a lot more anxiety from it.
On a few occasions I have tried tranquilizers. Mostly felt dull and stupid. I go to sleep very quickly(30 sec) without having any narcolepsy type problems so I have trouble believing anxiolytics are part of the answer. One big problem I have is talking my doctor into trying anything out of the ordinary. I would be inclined to try something like Bromocryptine as an augmentative, but don't know how I could be convincing. The science makes sense to me but I'm no salesman. In fact, I've got the SADIM touch(if its gold, it turns to shit if I touch it)
BTW, KarenB, do you have any problems with developing tolerance with the adderall?>
Hey John,
>
> I'm really late responding to this, so I hope you're still around. I am the woman with ADD/hypoactivity of whom you speak in your inquiry.
>
> Ditto everything JohnL said. If you want to try overseas meds, Adrafinil combined with Amisulpride would be my first suggestion. I used an antidepressant while I lived in the Philippines (Amineptine), along with a drug similar to Amisulpride, called Sulpiride. It was the bomb. I have never felt so good in my life, in a non-medicated sort of way. However, Amineptine, (a psychostimulant modified tricyclic) has since been discontinued worldwide. Sigh. So, I sought to find something stateside to replace this very effective combo.
>
> I do not do well at all on SSRIs.
>
> I am currently on Adderall (an ADD stimulant) and Buspar (an anti-anxiety med with some anti-depressant qualities). I am taking 10mg Buspar three times a day and 20mg Adderall 1/2 hour before getting out of bed in the morning, then 5-10 mg five hours later. I started the Adderall at 10 mg twice a day but have since adjusted the dosage. It takes a while to find exactly how long it lasts in your system so you can take the second dose BEFORE your mood and energy start to decline.
>
> The Buspar doesn't work for everyone but my doc said that it is effective sometimes in low level depression like mine (Dysthymia). This time, he was right and it has worked just fine. Just the stimulant alone does not do the whole job for me - I have the energy but no desire.
>
> BTW, I take Propranolol (Inderal - a beta blocker) to prevent migraines which are triggered by the stimulant. I don't like taking so much medication but you gotta do what you gotta do.
>
> Karen
Posted by KarenB on June 2, 2000, at 16:19:48
In reply to Too Apathetic to weigh back in.., posted by Johnturner77 on June 2, 2000, at 9:58:47
John,
I am not one who suffers from insomnia either - or real anxiety for that matter - but my doc prescribed Buspar for it's antidepressant benefits in cases of low level depression or dysthymia. Since SSRIs only make me more tired and creepy and most tricyclics make me feel "medicated," with dry mouth, etc., I didn't have many alternatives. MAOIs, I have never tried but the strict dietary restrictions scare me a little.
No, I have not found that I develop a tolerance to stimulants at all. I strongly dislike feeling wired and taking any more than the therapeutic dose makes me feel that way. I used amineptine for almost two years without ever exceeding the recommended dosage and it supposedly has "potential for abuse" as well. Reportedly, that is why it was pulled from the market.
I struggled a bit with being on "amphetamines" but without stimulants I am half a person. With them, I get to have a life. I have fought to drag myself out of bed in the morning since I was a child. I have missed much of my life because I was just too tired and apathetic to care. I have two boys, ages 2 1/2 and 5, so lying in bed all day is not an option. Thank God, it's not. These precious little guys deserve a whole mommy.
Best to you...
Karen
Posted by Noa on June 2, 2000, at 16:58:05
In reply to Too Apathetic to weigh back in.., posted by Johnturner77 on June 2, 2000, at 9:58:47
I don't get any high feeling from ritalin, and I haven't been susceptible to taking more and more of it, tho I know some folks are. I was going to say that the pharmacy version is different than street amphetamines, but then again, you report feeling anxious on dexedrine. how much did you take?
When I started ritalin, I titrated up slowly, which is my usual course for any meds. If I had started on a higher dose, I think I might have felt anxious or headachy or something.
Posted by Noa on June 2, 2000, at 17:04:54
In reply to Too Apathetic to weigh back in.., posted by Johnturner77 on June 2, 2000, at 9:58:47
John, I had never heard of bromocriptine, so I looked it up on the RxList site
http://www.rxlist.com/scripts/patient/piumore.plmononum=294&dc_category=&order=0&type=&item=
What led you to consider it for your depression, apathy?
Posted by KarenB on June 3, 2000, at 10:51:24
In reply to Re: Bromocriptine » Johnturner77, posted by Noa on June 2, 2000, at 17:04:54
Noa,
I asked Cam about this med several weeks ago, as it seemed like a possibility for me too after what I read. It said that "increased libido" was a side effect ( which I don't consider a problem - kind of like how sulpiride caused cessation of menses - boo hoo)...
Anyway, Cam said he would not recommend it. I don't remember why but you could ask him again.
Karen
Posted by Johnturner77 on June 5, 2000, at 14:14:16
In reply to Re: Bromocriptine » Johnturner77, posted by Noa on June 2, 2000, at 17:04:54
> John, I had never heard of bromocriptine, so I looked it up on the RxList site
>
>
> http://www.rxlist.com/scripts/patient/piumore.plmononum=294&dc_category=&order=0&type=&item=?? This site seems to need attention from its webmaster, I couldn't get anything useful...
>
>
> What led you to consider it for your depression, apathy?Actually I hadn't researched it that thoroughly. I was thinking in terms of a Dopaminergic agonist for augmentation to AD's with less stimulative effect than the Amphetamine class. It results partly from introspection along these lines: what exactly is depressed in my mental functions? I have concluded that what would help me would probably make a substantial % of people psychotic. I guess I am looking for something that is mildy Pro-psychotic rather than Anti-psychotic.
"A civil engineer that can't hallucinate a freeway isn't a good one"
This is the end of the thread.
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