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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Mr. Scott on February 2, 2002, at 18:45:15
It seems that after being on an SSRI for a long period of time it makes you dull. I assume that this is due to the strangling off of catecholamines (NE & DA) by the the increased serotonin (5HT).Any ideas on how to counter this effectively, or if Effexor is better at avoiding this side effect?
Scott
Posted by TSA West on February 3, 2002, at 0:11:52
In reply to Dopey, dippy and dull!, posted by Mr. Scott on February 2, 2002, at 18:45:15
Greetings Sir,
I wonder if what you are describing is actually the often-noted 'apathy' that sometimes occurs due to the supposed dopamine-depletion on SSRIs: http://www.dr-bob.org/tips/split/SSRIs-and-apathy.html
Best of Luck to you and Happy Jesus Day,
----------------- ++ TSA ++ --------------------
Posted by Mr. Scott on February 3, 2002, at 12:50:10
In reply to Re: Dopey, dippy and dull! » Mr. Scott, posted by TSA West on February 3, 2002, at 0:11:52
Posted by Elizabeth on February 7, 2002, at 16:27:55
In reply to Dopey, dippy and dull!, posted by Mr. Scott on February 2, 2002, at 18:45:15
> It seems that after being on an SSRI for a long period of time it makes you dull. I assume that this is due to the strangling off of catecholamines (NE & DA) by the the increased serotonin (5HT).
Not sure if Effexor is better. Some people use stimulants or direct dopamine agonists (bromocriptine, amantadine (Symmetrel), pramipexole (Mirapex)). My pdoc in Cambridge said that he had success switching to a different SSRI. Others add Wellbutrin. I wonder if taking Remeron or perhaps Buspar with the SSRI would work. A few people say they have had luck adding naltrexone, which I think is bizarre.
So, the survey: any success stories out there? (or failure stories)
-elizabeth
Posted by Ritch on February 8, 2002, at 0:15:37
In reply to Re: SSRI apathy syndrome (survey) » Mr. Scott, posted by Elizabeth on February 7, 2002, at 16:27:55
> > It seems that after being on an SSRI for a long period of time it makes you dull. I assume that this is due to the strangling off of catecholamines (NE & DA) by the the increased serotonin (5HT).
>
> Not sure if Effexor is better. Some people use stimulants or direct dopamine agonists (bromocriptine, amantadine (Symmetrel), pramipexole (Mirapex)). My pdoc in Cambridge said that he had success switching to a different SSRI. Others add Wellbutrin. I wonder if taking Remeron or perhaps Buspar with the SSRI would work. A few people say they have had luck adding naltrexone, which I think is bizarre.
>
> So, the survey: any success stories out there? (or failure stories)
>
> -elizabethHi everybody,
Wellbutrin addition does help! I want to try a pstim (instead of WB) with an SSRI (a first). Any SSRI+pstim recipients please report in.
Mitch
Posted by Mr. Scott on February 9, 2002, at 0:56:40
In reply to Re: SSRI apathy syndrome (survey), posted by Ritch on February 8, 2002, at 0:15:37
> > > It seems that after being on an SSRI for a long period of time it makes you dull. I assume that this is due to the strangling off of catecholamines (NE & DA) by the the increased serotonin (5HT).
> >
> > Not sure if Effexor is better. Some people use stimulants or direct dopamine agonists (bromocriptine, amantadine (Symmetrel), pramipexole (Mirapex)). My pdoc in Cambridge said that he had success switching to a different SSRI. Others add Wellbutrin. I wonder if taking Remeron or perhaps Buspar with the SSRI would work. A few people say they have had luck adding naltrexone, which I think is bizarre.
> >
> > So, the survey: any success stories out there? (or failure stories)
> >
> > -elizabeth
>
> Hi everybody,
>
> Wellbutrin addition does help! I want to try a pstim (instead of WB) with an SSRI (a first). Any SSRI+pstim recipients please report in.
>
> MitchWhy dump the WB? What's wrong with it?
Posted by Ritch on February 9, 2002, at 10:08:44
In reply to Re: SSRI apathy syndrome (survey) » Ritch, posted by Mr. Scott on February 9, 2002, at 0:56:40
> > > > It seems that after being on an SSRI for a long period of time it makes you dull. I assume that this is due to the strangling off of catecholamines (NE & DA) by the the increased serotonin (5HT).
> > >
> > > Not sure if Effexor is better. Some people use stimulants or direct dopamine agonists (bromocriptine, amantadine (Symmetrel), pramipexole (Mirapex)). My pdoc in Cambridge said that he had success switching to a different SSRI. Others add Wellbutrin. I wonder if taking Remeron or perhaps Buspar with the SSRI would work. A few people say they have had luck adding naltrexone, which I think is bizarre.
> > >
> > > So, the survey: any success stories out there? (or failure stories)
> > >
> > > -elizabeth
> >
> > Hi everybody,
> >
> > Wellbutrin addition does help! I want to try a pstim (instead of WB) with an SSRI (a first). Any SSRI+pstim recipients please report in.
> >
> > Mitch
>
> Why dump the WB? What's wrong with it?
Oh, the reason I want to switch from low-dose WB to a low-dose pstim is so it will work better on attentional problems. Wellbutrin is actually #4 on my list of meds that help with attention that (I have tried anyway). Adderall and desipramine worked far better. Even Nortripytline worked better (I am talking 5mg of Adderall, 10-20mg of desipramine or nortriptyline here). However, though the Adderall was anticyclic it made me too anxious (but didn't have the opportunities of adding an SSRI for anxiety to it-hence the question), the desipramine made me hypomanic, and both TCA's didn't help with the seasonal depressions as well as WB. Ok-I know this is complicated. As far as side effects go with WB, I am getting some itchiness (not a rash yet) when I try to push the dose up. Also, I am getting blood pressure and heartrate boosts (and sleep troubles) from it that are just as bad as TCA's. Soooo, the latest idea is to try some Provigil, but I wonder if I should simply use a standard pstim instead since they have short half-lives and Adderall didn't mess up my sleep before. The Schedule-II thing is such a drag. I know that is what the problem is with my pdoc-it hasn't been said, but I can sense it-I almost think it is just the headache of having to write scripts every month.Mitch
Posted by Mr. Scott on February 9, 2002, at 14:22:34
In reply to Re: SSRI apathy syndrome (survey) » Mr. Scott, posted by Ritch on February 9, 2002, at 10:08:44
> > > > > It seems that after being on an SSRI for a long period of time it makes you dull. I assume that this is due to the strangling off of catecholamines (NE & DA) by the the increased serotonin (5HT).
> > > >
> > > > Not sure if Effexor is better. Some people use stimulants or direct dopamine agonists (bromocriptine, amantadine (Symmetrel), pramipexole (Mirapex)). My pdoc in Cambridge said that he had success switching to a different SSRI. Others add Wellbutrin. I wonder if taking Remeron or perhaps Buspar with the SSRI would work. A few people say they have had luck adding naltrexone, which I think is bizarre.
> > > >
> > > > So, the survey: any success stories out there? (or failure stories)
> > > >
> > > > -elizabeth
> > >
> > > Hi everybody,
> > >
> > > Wellbutrin addition does help! I want to try a pstim (instead of WB) with an SSRI (a first). Any SSRI+pstim recipients please report in.
> > >
> > > Mitch
> >
> > Why dump the WB? What's wrong with it?
>
>
> Oh, the reason I want to switch from low-dose WB to a low-dose pstim is so it will work better on attentional problems. Wellbutrin is actually #4 on my list of meds that help with attention that (I have tried anyway). Adderall and desipramine worked far better. Even Nortripytline worked better (I am talking 5mg of Adderall, 10-20mg of desipramine or nortriptyline here). However, though the Adderall was anticyclic it made me too anxious (but didn't have the opportunities of adding an SSRI for anxiety to it-hence the question), the desipramine made me hypomanic, and both TCA's didn't help with the seasonal depressions as well as WB. Ok-I know this is complicated. As far as side effects go with WB, I am getting some itchiness (not a rash yet) when I try to push the dose up. Also, I am getting blood pressure and heartrate boosts (and sleep troubles) from it that are just as bad as TCA's. Soooo, the latest idea is to try some Provigil, but I wonder if I should simply use a standard pstim instead since they have short half-lives and Adderall didn't mess up my sleep before. The Schedule-II thing is such a drag. I know that is what the problem is with my pdoc-it hasn't been said, but I can sense it-I almost think it is just the headache of having to write scripts every month.
>
> Mitch
-------------
So you're takingNeurontin
Wellbutrin
SSRI of some kind
varying tricylicsFor BP II, ADD, Anxiety
How well is it working? I just ask, because it seems unlike a mainstream approach. But I guess you've probably already been there and done that.
Scott
Posted by Ritch on February 9, 2002, at 15:38:13
In reply to Re: SSRI apathy syndrome (survey) » Ritch, posted by Mr. Scott on February 9, 2002, at 14:22:34
> -------------
> So you're taking
>
> Neurontin
> Wellbutrin
> SSRI of some kind
> varying tricylics
>
> For BP II, ADD, Anxiety
>
> How well is it working? I just ask, because it seems unlike a mainstream approach. But I guess you've probably already been there and done that.
>
> ScottNeurontin 100mg tid
Klonopin .5mg hs, .25-.5mg daytime prn,
Wellbutrin 18.75-37.5mg am,
Celexa 2.5mg am, 4-5x during the week.This combo thus far *hits* most everything fairly well. I really shouldn't whine about it, but I want to find *the* combo-I think you know what I mean.
All I know is that after xxx number of mood stabilizers, Neurontin allows me to function (cognitively) and seems to help all three problems. Although a bit of Trileptal (oxcarbazepine) does help the ADHD a little, as well (mainly impulsiveness-but helps focus a little bit-I am less distracted). I am eagerly awaiting pregabalin (more potent).
The Klonopin can axe a hypomanic state fairly effectively, that is why I push it up when needed, or if I am going to be involved in a presentation or something that tends to trigger panic, and of course works the best for SP "positive" symptoms (panic, freezing, etc.).
So it is the best thing for what I call "manic-panic". Although it totally wipes out my cognitive functioning, and I rarely take it during the daytime anymore.The Celexa works the best of any AD for the SP problems, but I can't take more than just a pinch because it will shred my intestines and I also get some dystonia from SSRi's as well. SSRI's tend to work best on what I call SP "negative symptoms" (avoidance). When escitalopram comes around I will immediately flip to it because I don't take much anyhow and my problem is with tolerance not effectiveness-it really is just an anxiety med-that's how I treat it. I agree with a lot of people here that most SSRI's just don't work well for severe unipolar depression (at least not by themselves).
The WB is the *wild card* right now. We have found out that I *must* have some type of noradrenergic/dopaminergic agent for my seasonal depressions. Nothing else works. SSRI's seem to make it *worse*. In other words, I have tried just increasing SSRI when the depressions strike, but they increase the apathy and make me melancholic, and I get more emotional lability and worsened cycling. That is why I think that the depressions are just a type of depressive limbic ADD state. Why would 5mg of Adderall wipe it out so effectively otherwise? ..and without cycling..
Hey, I am really glad that I have got 3 of 4 figured out-it took a long time.
Mitch
Posted by Noa on February 11, 2002, at 11:48:07
In reply to Re: SSRI apathy syndrome (survey) » Mr. Scott, posted by Ritch on February 9, 2002, at 15:38:13
This is an intriguing concept. Can anyone point me in the direction of research (if any) on this?
Posted by Mr. Scott on February 11, 2002, at 18:50:27
In reply to Re: SSRI apathy syndrome?, posted by Noa on February 11, 2002, at 11:48:07
Check out the tips section right here on babble and also http://www4.ncbi.nlm.nih.gov/PubMed/.
The antidopamine/norepinephrine with long term administration is fairly well documented.
Scott
Posted by Ritch on February 11, 2002, at 19:31:23
In reply to Re: SSRI apathy syndrome?, posted by Noa on February 11, 2002, at 11:48:07
> This is an intriguing concept. Can anyone point me in the direction of research (if any) on this?
Noa,
Could you clarify *which* concept you are curious about?
Mitch
Posted by Noa on February 12, 2002, at 16:43:51
In reply to Re: SSRI apathy syndrome? » Noa, posted by Ritch on February 11, 2002, at 19:31:23
SSRI apathy syndrome
Posted by Ritch on February 12, 2002, at 23:40:45
In reply to Re: SSRI apathy syndrome? » Ritch, posted by Noa on February 12, 2002, at 16:43:51
Posted by noa on February 13, 2002, at 16:42:33
In reply to Re: SSRI apathy syndrome? » Noa, posted by Mr. Scott on February 11, 2002, at 18:50:27
Thanks for the links. Will check them later.
Posted by Elizabeth on February 13, 2002, at 22:12:02
In reply to The obvious should be first considered-sorry! (nm) » Noa, posted by Ritch on February 12, 2002, at 23:40:45
Most pdocs I've spoken to seem to have encountered it, and it's not hard to find information about it in the literature. It sometimes goes by the name "frontal lobe syndrome."
My survey question is, have people tried treating the SSRI apathy syndrome, and if so, with what and did it work?
-elizabeth
Posted by Ritch on February 13, 2002, at 23:08:43
In reply to Re: SSRI apathy syndrome (survey) » Ritch, posted by Elizabeth on February 13, 2002, at 22:12:02
> Most pdocs I've spoken to seem to have encountered it, and it's not hard to find information about it in the literature. It sometimes goes by the name "frontal lobe syndrome."
>
> My survey question is, have people tried treating the SSRI apathy syndrome, and if so, with what and did it work?
>
> -elizabeth
Hi Elizabeth,I find that SSRI's all cause some apathy to some extent-which can be helpful if you are using them to treat an anxiety disorder (in my case). I am not really using them as an AD. Perhaps what I can offer is simply reducing the dose or switch to a more activating SSRI (i.e. Prozac). Also, what seems to work (to alleviate depression without being apathetic and still using some SSRI)---is to combine a small dose of SSRI with a small dose of a TCA. I have tried Celexa+Nortriptyline and Zoloft+Nortiptyline with a good measure of success. What I would still like to hear out there is success with low-dose SSRI+ low-dose standard psychostimulant.
Mitch
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