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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by etoc on October 1, 2002, at 15:58:29
It is well know, especially amoung users past and present of SSRI's that they can cause a syndrome of apathy (who cares, i'm tired, lack of motivation) especially after a period of time using them. Prozac and Paxil are noted for this, with Zoloft Being a less offenender some of the time, presumably because of it's putative effect on dopamine.
I am curious how many have suffered from this and what they have done to deal with it? Currently I take Lexapro 10mgs (15 days so far) and sort of feel this way. I do take 10mgs of Adderall XR and this is helpful. I like the Lexapro, as for me it has almost 0 side-effects, save that of loss of sexual intrest and ability to orgasm.
Please tell me if this syndrome gets better, worse and what, and if anyone else here experiences it.
Much Thanks....
Posted by geno on October 1, 2002, at 18:36:00
In reply to SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 1, 2002, at 15:58:29
I feel the same way on zoloft. Dead beat, no motivation. Well id say adderal would help alot. Possibly welbutrin also.
geno
Posted by JonW on October 1, 2002, at 20:13:12
In reply to SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 1, 2002, at 15:58:29
I've taken Provigil with SSRIs in the past and this has been helpful.
Jon
Posted by samenewme on October 3, 2002, at 21:44:07
In reply to SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 1, 2002, at 15:58:29
I've had this. I got better results with maprotilene (which I couldn't continue because of side effects) and Remeron. I had moments of joy with Serzone, but it made me ravenously, compulsively hungry--quite strange. I'm currently combining Remeron and Celexa.
Posted by crepuscular on October 4, 2002, at 11:45:35
In reply to SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 1, 2002, at 15:58:29
it gets better when you stop taking the drug.
Posted by etoc on October 5, 2002, at 18:44:07
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by crepuscular on October 4, 2002, at 11:45:35
heheh that was a stupid response. but true. hahaha
Posted by ChrisK on October 6, 2002, at 4:20:02
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 5, 2002, at 18:44:07
Find out about Mirapex. It has worked great for me. It works best at higher doses if you can tolerate it. I take 3-6 mg/day and don't have a problem but it does cause nausea in others. It's main use is for Parkinson's but it is used as an AD off label.
Posted by Dr. Bob on October 6, 2002, at 12:23:55
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 5, 2002, at 18:44:07
> heheh that was a stupid response. but true. hahaha
Please don't, even if you're kidding, post anything that could lead others to feel accused or put down, thanks.
Bob
PS: Follow-ups regarding posting policies should be redirected to Psycho-Babble Administration.
Posted by Ippopo on October 6, 2002, at 16:02:09
In reply to SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 1, 2002, at 15:58:29
> It is well know, especially amoung users past and present of SSRI's that they can cause a syndrome of apathy (who cares, i'm tired, lack of motivation) especially after a period of time using them. Prozac and Paxil are noted for this, with Zoloft Being a less offenender some of the time, presumably because of it's putative effect on dopamine.
>
> I am curious how many have suffered from this and what they have done to deal with it? Currently I take Lexapro 10mgs (15 days so far) and sort of feel this way. I do take 10mgs of Adderall XR and this is helpful. I like the Lexapro, as for me it has almost 0 side-effects, save that of loss of sexual intrest and ability to orgasm.
>
> Please tell me if this syndrome gets better, worse and what, and if anyone else here experiences it.
>
> Much Thanks....Oh my,
We're almost at the same place. I am so sorry but also happy I'm not alone. The only difference is I'm not taking Adderall XR. I take the same dossage 1/2 morning 1/2 noon.
Posted by university on August 12, 2004, at 14:37:31
In reply to Re: SSRI Apathy Syndrome (Anhedonia)??? » etoc, posted by Ippopo on October 6, 2002, at 16:02:09
> > It is well know, especially amoung users past and present of SSRI's that they can cause a syndrome of apathy (who cares, i'm tired, lack of motivation) especially after a period of time using them. Prozac and Paxil are noted for this, with Zoloft Being a less offenender some of the time, presumably because of it's putative effect on dopamine.
> >
> > I am curious how many have suffered from this and what they have done to deal with it? Currently I take Lexapro 10mgs (15 days so far) and sort of feel this way. I do take 10mgs of Adderall XR and this is helpful. I like the Lexapro, as for me it has almost 0 side-effects, save that of loss of sexual intrest and ability to orgasm.
> >
> > Please tell me if this syndrome gets better, worse and what, and if anyone else here experiences it.
> >
> > Much Thanks....
>
> Oh my,
> We're almost at the same place. I am so sorry but also happy I'm not alone. The only difference is I'm not taking Adderall XR. I take the same dossage 1/2 morning 1/2 noon.
>
>
I've been on Prozac for over ten years--it saved me from the most sunless, unbearable depressions. But when I had a "breakthrough" depression after four years @20mg/day, I upped the dose, variably, to ~40-80mg/day. I've been at about 40mg/day for many years now, and have had SSRI apathy for a long time. No interest or motivation to paint anymore (used to be an artist). Don't get me wrong--I'm not vegetative or anthing, just blase about most things. I'm sure part of it derives from a certain sense of emotional invulnerability; pain isn't reall a motivator anymore.I have tried to deal with this in several ways, using Provigil and Ritalin. But those just provide a very temporary buzz that's not equivalent to how I used to be. I fear the only solution is to diminish or stop Prozac and try another AD. But I've always been terrified to do this for fear I might end up in another depression. Risking a depression is almost not worth anything to me.
One thing my lazy ass hasn't tried is, of course, a sensible--if challenging--solution: daily, rigorous exercise. I think that if i got into good physical shape (I'm average/thin, but pretty sedentary), I'd feel a lot better. :(
Any advice/comments welcome :)
Posted by caraher on August 12, 2004, at 14:56:57
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by university on August 12, 2004, at 14:37:31
Interesting. I quit Paxil after about a year because I missed an appointment, realized I didn't really care, and that scared me. It wasn't "like me."
Right now I'm in a study where I *might* be on Lexapro (I've been taking that or Cymbalta or placebo for 2 weeks now). Motivational problems were among my symptoms and I feel it's only gotten worse. Before i couldn't get going and worried about it, now I feel I can't get anything done and don't especially care. So I wonder if I'm on Lexapro and SSRIs simply do not agree with me.
No tips, sorry!
Posted by jinzora on August 12, 2004, at 21:47:04
In reply to Re: SSRI Apathy, posted by caraher on August 12, 2004, at 14:56:57
> Interesting. I quit Paxil after about a year because I missed an appointment, realized I didn't really care, and that scared me. It wasn't "like me."
>
> Right now I'm in a study where I *might* be on Lexapro (I've been taking that or Cymbalta or placebo for 2 weeks now). Motivational problems were among my symptoms and I feel it's only gotten worse. Before i couldn't get going and worried about it, now I feel I can't get anything done and don't especially care. So I wonder if I'm on Lexapro and SSRIs simply do not agree with me.
>
> No tips, sorry!
I feel the same way, I don't really care about anything. I'm on ten mg.'s of Lexapro and twenty of Ritalin. The Ritalin works for about two hours. So the way I feel is, I get to live feeling alive two hours a day. The other 22 I get to be walking and working and thinking nothing. I'm truely hoping to find the right addition to the Lexapro that will keep feeling good at least five hours.
Posted by Dr. Bob on August 12, 2004, at 23:23:52
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by university on August 12, 2004, at 14:37:31
> One thing my lazy [*]ss hasn't tried is...
Sorry to be such a prude, but please don't use language that could offend others.
Anyone who has questions about this or about posting policies in general, or who is interested in alternative ways of expressing themselves, should see the FAQ:
http://www.dr-bob.org/babble/faq.html#civil
Also, follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
Posted by MystifiedNumbess on January 22, 2010, at 15:36:47
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by university on August 12, 2004, at 14:37:31
------- I know this thread is older than dirt, but I wanted to add something as I personally just stumbled on this at this late date and others might as well.
I have been on Lexpro 20mg since WInter of 2001. I had previously been on Prozac 20 mg's where I was having the manic time of my life. However, I got really tired and "assumed" it was depression setting back in, so I went off Prozac (and found out I had mononucleosis, not depression) and onto Effexor. Now this drug gave me a hard time and incredible weight gain in less than a month. So I switched to Lexapro.
My "anhedonia" was so bad at one point, I went SKYDIVING to see if I could jar myself out of the "I don't give a hoot about anything" phase. And would you believe, I jumped out of a perfectly good airplane only to land and say calmly, "Wow, that was surreal." My husband was aghast at my lack of enthusiasm.
Here I am five years later and still numb. I have emotions, don't get me wrong. That is why I feel like anhedonia is not the right word. I feel pain, sadness, joy... but I have no desire to do anything. I feel like I have no sense of urgency. If my house were on fire, I would very nonchalantly pick up a couple things and consider heading for the door. Or if I was deeply involved on the computer, I might just wait until my hair was on fair to make the move. This to me seems more like a loss of the "fight or flight" response we are supposed to have designed within us.
Meanwhile, I lost my insurance and just ordered some from Canada in the generic form. While waiting, I knew I would run out of drugs, so I cut back immediately to only 10mg in fear of cold turkey withdrawal. Suddenly, I started feeling more clarity. Still not ready to run in the event of a fire, but I feel "aware of myself." If that makes sense. I haven't felt aware of myself in ages it seems. I didn't notice it until I cut back.
Unfortunately I am heading into a four day stint cold turkey as the order is late. When they arrive, my whole intention is to wean off entirely at my own pace. I want to see what life is like drug free. After all, its been over a decade of my life that I have been psychologically altered by the effects of medication. I also feel my husband deserves a normal sex life ... as do I.
I loved Prozac - I could feel the difference on that medication though I still had highs and lows of bipolar syndrome. With Lexpro, I never felt any mental changes - just absent symptoms. I took this as a good sign. However, the mistake was that it took me all this time to realize that not only did I not feel the effects of the medication, but I was no longer feeling alive.
Good luck to all of you out there who must take medications like this. I feel your pain and I know my stint of being drug-free will be short lived. But I also know that when I do concede to another medication - this next time I will not be looking for a quick fix, but rather a tolerable long term solution that does not have negative effects on my life, career, and family.
Blessings.
Posted by Deneb on January 23, 2010, at 22:30:44
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by MystifiedNumbess on January 22, 2010, at 15:36:47
Hello MystifiedNumbness!
Welcome to Psycho-Babble! Thanks for telling us your story. I had a lot of apathy too and I'm on two SSRI's. I think it is psychological for me though because right now I am very interested and passionate about Internet marketing.
I have next to no interest in school though.
I can't be sure though, I did decrease my Celexa, maybe that helped.
I hope you post some more, it's nice having you around!
Deneb
Posted by tubeman on January 24, 2010, at 16:00:43
In reply to Re: SSRI Apathy Syndrome (Anhedonia)??? » MystifiedNumbess, posted by Deneb on January 23, 2010, at 22:30:44
> Hello MystifiedNumbness!
>
> Welcome to Psycho-Babble! Thanks for telling us your story. I had a lot of apathy too and I'm on two SSRI's. I think it is psychological for me though because right now I am very interested and passionate about Internet marketing.
>
> I have next to no interest in school though.
>
> I can't be sure though, I did decrease my Celexa, maybe that helped.
>
> I hope you post some more, it's nice having you around!
>
> DenebI was tortured by ssri apathy, so bad that for years I took tricyclics to avoid it, desiprimine was the best , oreasiest one to take. When I developed ocd I was forced to take cylexa and had apathy again. I accidentally found the 'cure " when I took a dose of remeron for sleep, the apathy lifted immediately. I've taken it for several years now at 60mg, the only problem is weight gain. Taken with an ssri remeron didn't drug me much, by itself it totally depressed and drugged me. george
>
Posted by conundrum on January 25, 2010, at 8:35:56
In reply to Remeron for ssri apathy, posted by tubeman on January 24, 2010, at 16:00:43
interesting. I wonder if some of the drugs that help SSRI apathy would help post ssri apathy and anhedonia. Its very similar except it lasts after taking the drug.
Posted by Deneb on January 26, 2010, at 21:08:29
In reply to Remeron for ssri apathy, posted by tubeman on January 24, 2010, at 16:00:43
Hello Tubeman!
Welcome to Psycho-Babble. Thanks for that info. Right now my pdoc is just reducing my Celexa. I don't think she wants to put me on more meds. I don't want to gain weight either. I wish I could be more productive.
I'm glad it's working for you.
Deneb
Posted by Laurie Beth on January 27, 2010, at 11:13:41
In reply to SSRI Apathy Syndrome (Anhedonia)???, posted by etoc on October 1, 2002, at 15:58:29
Diminished Neural Processing of Aversive and Rewarding Stimuli During Selective Serotonin Reuptake Inhibitor Treatment
"The ability of SSRIs to decrease neural responses to reward might underlie the questioned efficacy of SSRIs in depressive conditions characterized by decreased motivation and anhedonia and could also account for the experience of emotional blunting described by some patients during SSRI treatment."
Finally!
Posted by Tony P on January 30, 2010, at 18:18:23
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by Laurie Beth on January 27, 2010, at 11:13:41
I've suffered from anhedonia too (on Cipralex/Lexapro & various other SRI/SSRI/moood stabilizers). My pdoc put me on Cymbalta - night & day difference. Cymbalta has had some bad press compared to Effexor -- in my experience, they are very different and Cymbalta is much easier to tolerate. YMMV. Only downside to Cymbalta IME is continuing drowsiness (nothing a couple of cups of coffee won't take care of, and also see below) -- and price!
Because Cymbalta isn't covered by my drug plan and Cipralex/Lexapro is, my pdoc had me try switching to the latter at higher doses than before. I got up to 60 mg/day Cipralex, no Cymbalta by week 4, and found (a) I was getting severe anxiety attacks (b) I was having suicidal thoughts & feeling helpless, to the point where a support group I belonged to were encouraging me to head for psych. emerg.
BTW, I also tried Effexor, and had a similar reaction -- severe anxiety attacks with a sort of agoraphobia - I was virtually housebound.
So I went back to the Cymbalta (90 mg/day) and am much better, in mood, hopefulness and ability to cope with every day tasks and some serious life issues which face me. No anhedonia, except when I get attacks of hypersomnia (sleeping for 24-36 hrs straight), and the latter appears to be mostly a vicious cycle, once I break it I'm OK.
Most important: I am also taking a couple of AD adjuvants that make a big difference in mood, activity and assertiveness/problem-solving. I am sure these would work equally well with a straight SSRI.
- Modafinil (Provigil, Alertec), 200 mg/day prn. I first started taking this to overcome the hypersomnia, and found it had a _big_ positive effect on my anhedonia, activity level and social anxiety as well. It also helps combat the slight drowsiness from the Cymbalta. BTW, although it essentially acts like a stimulant, it behaves according to the manufacturer's spec. (surprise ;-) -- it doesn't prevent sleep, I have to work with it by getting up & around, but once I'm out of bed it does its stuff.
- Buspirone (Buspar). This is another med. that has suffered from bad press: either it only works for about 1 in 5 people, or the effects are sufficiently subtle that people discount it. For me, it works well at 20-30 mg/day. Good effects are: less stress-related reactive depression, more active & assertive, better mood. Almost no side-effects, except slight "dopiness" for about an hour after taking it.
- Requip (Ropinirole). A pilot study in Can. J. Psych. a few years ago showed improvement in mood etc. among most subjects regardless of which AD or mood-stabilizer they were on. I haven't seen a follow-up study, but surely there must have been one by now. I am not taking it currently (trying to simplify my regime), but it worked well for me for several years. I was taking 1.5 mg/day, but the safe dosage range is very broad, so one could titrate up to higher doses if needed. Side-benefit: It stopped the restless-leg/akathisia that I experienced initially with Remeron, Trazadone & a couple of other meds, and that hasn't come back -- touch wood -- since I stopped the Requip.
The important common factor seems to me to take _something_ that boosts DA moderately to balance the Serotonin &/or NE. Even coffee helps!
Posted by Tony P on January 30, 2010, at 18:30:57
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by Tony P on January 30, 2010, at 18:18:23
Forgot to mention Wellbutrin, which boosts NE & DA to balance the SSRI. I am hypersensitive to it, but I expect an SSRI + Wellbutrin would work well for some people -- my pharmacist suggested it.
Posted by desperately seeking on April 7, 2010, at 17:52:02
In reply to Re: SSRI Apathy Syndrome (Anhedonia)??? » MystifiedNumbess, posted by Deneb on January 23, 2010, at 22:30:44
Thanks for opening up the subject again after so long and sharing your story. I was touched by what you said about jumping out of an airplane because my numbness is so bad that this is something I've fantasized about doing to see if I can jolt myself! So it's good( well not good- but you know what I mean) to know that the experience with ssri's are universal.I wonder though..is your condition so bad that it's worth staying on these drugs and feeling numb?I took prozac, luvox, effexor, lithium and recently stablon (SSRE) over 7 years and I've been drug-free for 7 months and plan to stay this way. That's basically a decade of my life gone. I have no memories from this period. It's all a fog- like I've been in a deep sleep. The problem now though is that they say this apathy can last for years after stopping. I'm at my wits end- it's been one year and a half since I stopped the SSRIs and a few months since I last took the SSREs. I'm really hoping this will clear up with time. As it is now, I'm 25,living with my parents, I've been jobless since graduating university in 2006 despite graduating from a top university, no boyfriend, never had sex,couldn't care less about anything...
This should be a warning to anyone considering going on them.
Anybody had the same experience?
Posted by desperately seeking on April 7, 2010, at 17:54:34
In reply to Re: Remeron for ssri apathy » tubeman, posted by conundrum on January 25, 2010, at 8:35:56
Just out of interest...how long has it been since you stopped taking the drugs? Has the apathy improved since your last post?
Posted by conundrum on April 11, 2010, at 21:09:25
In reply to Re: SSRI Apathy Syndrome (Anhedonia)???, posted by desperately seeking on April 7, 2010, at 17:52:02
In my experience it never goes away. welcome to the island and of misfit toys.
Posted by moligun83 on April 19, 2010, at 11:28:52
In reply to Re: SSRI Apathy Syndrome (Anhedonia)??? » desperately seeking, posted by conundrum on April 11, 2010, at 21:09:25
I am currently on an SSRI primarily for anxiety issues, and Lexapro seems to work great for me. The reason why I mention this is because I tend to be too much of a perfectionist to the point where it interferes with my life. The SSRI does make me care less, but just to the point where it takes the edge off of the over obsessiveness.
If this syndrome is to the point where it is having a negative influence on daily life, I would suggest talking to the doctor about possibly lowering the dosage.
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