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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by Whit on October 14, 2004, at 20:41:21
Anhedonia is my most persistant and most debilitating symptom. My diagnosis is bipolar 2 but I am in the depressive phase 99% of the time unless I get a drug-induced manic episode. I have tried just about every drug out there with little to no relief of the anhedonia. The only things that did work were Adderall (which is an addictive dead end) and Parnate (which pooped out). I have even done a few ECTs but the memory loss scared the hell out of me and I stopped the treatment.
Is there any hope at all? I am now taking the following: Cymbalta 60mg, Wellbutrin SR 300mg, Zyprexa 10mg, Keppra 1000mg.
All symptoms of depre4ssion are gone except anhedonia, which is still sucking me ever closer to the black hole. I am so tired of this that I would give up an appendage or a testicle to be rid of the anhedonia.
I have read a bit about amisulpride and mirapex being D2 and D3 reuptake inhibitors and providing some relief. I have not tried these two meds, so I am going to ask the doc about them next time.
Please tell me if you have found anything that works to relieve anhedonia on a long-term basis.
Posted by King Vultan on October 14, 2004, at 23:02:05
In reply to ANHEDONIA, posted by Whit on October 14, 2004, at 20:41:21
>
> I have read a bit about amisulpride and mirapex being D2 and D3 reuptake inhibitors and providing some relief. I have not tried these two meds, so I am going to ask the doc about them next time.
>
> Please tell me if you have found anything that works to relieve anhedonia on a long-term basis.
Mirapex is a dopamine agonist that might work. There are some other dopamine agonists also, such as bromocriptine and Dostinex (cabergoline). I think amisulpride is an antipsychotic, but I'm not positive and am not that familiar with it. From the little I know, I have a sense it may be worth trying. Selegiline might be worth trying also, as this med is apparently extremely dopaminergic, more so than Parnate. Perhaps Provigil also, if you haven't already tried it. It seems that dopamine is probably the key neurotransmitter involved in anhedonia, but you get a very different sense reading "Listening to Prozac".I'm afraid SSRIs never did much for my own anhedonia. Wellbutrin and Parnate have been the only two meds to show some efficacy for me in this area. I am currently doing pretty well on Parnate but have not really been on it that long.
Todd
Posted by anxiety_free on October 15, 2004, at 7:16:34
In reply to ANHEDONIA, posted by Whit on October 14, 2004, at 20:41:21
I've had my own problems in this area...have you ever tried cutting your Zyprexa, or could you? Reducing neuroleptic use helped me out a lot, but that's just my experience.
Posted by Sad Panda on October 15, 2004, at 9:32:44
In reply to anhedonia sucks, posted by anxiety_free on October 15, 2004, at 7:16:34
> I've had my own problems in this area...have you ever tried cutting your Zyprexa, or could you? Reducing neuroleptic use helped me out a lot, but that's just my experience.
>
>That's what I would suggest too. 10mg of Zyprexa would dampen down any hint of a good mood. I wouldn't expect Amisupiride to be too mood lifting either as it is antidopamine just like Zyprexa.
Cheers,
Paul.
Posted by jboud24 on October 15, 2004, at 11:43:56
In reply to Re: anhedonia sucks, posted by Sad Panda on October 15, 2004, at 9:32:44
Who else has heard that Deprenyl is more dopamiergic than Parnate. I dont understand that when Parnate is supposed to actually cause the release of dopamine as a part of its actions in addition to MAO-B inhibition. I also read somewhere that Parnate is reversible in its actions. Can anyone verify that? In the PDR it says irreversible, but I have read in other places on the net, including babble, that it is actually reversible.
These are important issues for me since I have to go see my pdoc in a little under 2 weeks and I'll be asking for an MAOI.
Thanks,
Justin
Posted by King Vultan on October 15, 2004, at 14:26:52
In reply to Re: anhedonia sucks, posted by jboud24 on October 15, 2004, at 11:43:56
> Who else has heard that Deprenyl is more dopamiergic than Parnate. I dont understand that when Parnate is supposed to actually cause the release of dopamine as a part of its actions in addition to MAO-B inhibition. I also read somewhere that Parnate is reversible in its actions. Can anyone verify that? In the PDR it says irreversible, but I have read in other places on the net, including babble, that it is actually reversible.
>
> These are important issues for me since I have to go see my pdoc in a little under 2 weeks and I'll be asking for an MAOI.
>
> Thanks,
> JustinSelegiline generates amphetamine and methamphetamine metabolites on its first pass hepatic metabolism. At lower dosages, it also selectively inhibits only MAO-B (it is irreversible, however). These abilities are why it has utility in Parkinson's Disease, which is caused by a loss of dopamine neurons, and it is classified as an anti-Parkinson med, not as an antidepressant.
Parnate OTOH has a very similar chemical formula and structure to that of amphetamine but only has a fraction of the stimulation ability on a mg by mg basis. The idea behind developing Parnate (tranylcypromine) way back when was to try to come up with a stimulant with less abuse potential than amphetamine. In this, they were successful, and the drug also revealed itself to be a very potent MAO inhibitor.
The selegiline metabolites are likely far more dopaminergic in practice; although, of these two drugs, I have only tried Parnate. I have also seen Parnate referred to as "reversible" or "partially reversible" but don't know what the basis is for referring to it in that manner. AFAIK, for all practical purposes, it is irreversible, and studies and anecdotal experience have shown that it also has the greatest tendency of any of the MAOIs to increase blood pressure when consuming foods containing tyramine.
Todd
Posted by Whit on October 15, 2004, at 17:24:39
In reply to Re: anhedonia sucks » jboud24, posted by King Vultan on October 15, 2004, at 14:26:52
That's the whole problem in a nutshell...no one really knows for sure what these drugs are doing to our brains. Our best thinkers are still only guessing at how the brain works and we are all just a bunch of guinea pigs in this painfully tragic existence called life.
On another topic...
When it comes to doing research on the internet, I have found that you can pretty much find whatever you want to find...meaning that I can do a search with certain key words and come up with several articles saying one thing as well as several articles saying just the opposite.
I wish GOD would just tell us the answers. I am so tired...so very very tired. I am not even afraid of death anymore. Can it be any worse than living without the ability to experience pleasure? I think I am already in hell paying for my sins.
Posted by earthgirl on October 16, 2004, at 12:36:43
In reply to Re: anhedonia sucks, posted by Whit on October 15, 2004, at 17:24:39
Okay, I just had to look up anhedonia in the dictionary... are you all talking about an inability to experience pleasure in general, or is this with regards to sexual pleasure? (Since I have anhedonia both generally and sexual, I guess it doesn' really matter!)
Yes, I agree, it sucks. To say it "sucks" is sort of a joke, since it is so way beyond "sucking." It does in fact lead us to the question, "why bother?"
That is a low and dark place to be, people. Not cool. That's when we need to get on this board and remember that we are not alone, and maybe even laugh a little. If you haven't tried every med on the planet yet, then there is still hope. And if you HAVE tried every med on the planet, then you get to try every combonation and cocktail (that should keep us busy and give reason to hope for several years).
This is all assuming one is not spiritual, for if you "believe," then there is always hope. But I am in danger of getting off the topic and getting a warning from the D-Bob:-)
Earthgirl
Posted by Whit on October 23, 2004, at 16:38:51
In reply to anhedonia sucks: TO ALL, posted by earthgirl on October 16, 2004, at 12:36:43
Thanks to all for your advice. I think I overreacted jast a tad in my last post, lol, please forgive me.
I will see my p-doc in about a week and I will ask about adding either Selegiline or Mirapex, as these seem to be the most common meds available for this problem.
Posted by lostforwards on October 23, 2004, at 17:51:15
In reply to anhedonia sucks: TO ALL, posted by earthgirl on October 16, 2004, at 12:36:43
I've got serious anhedonia after taking Risperidal for just 4 weeks in the morning. I was also taking Nozinan. I don't know what caused it but after coming off the medication I feel completely flat and amotivated. I used to be a very manic bipolar, a night of no sleep was enough to set me off. I'm worried my other doc won't prescribe me the antidepressant I want. I think the whole point of the other doc putting me on the Risperidal to the point of severe eps was to give me this anhedonia I have right now. I'm not sure though.
Posted by iris2 on October 25, 2004, at 19:30:42
In reply to Re: anhedonia sucks » jboud24, posted by King Vultan on October 15, 2004, at 14:26:52
After reading this thread I had a few questions of my own.
I was on Parnate for several years. It started pooping out after the first year or so I added several adjunctive meds. Then that was not enough so we increased the Parnate, then changed every few months to Marplan then Moclobimide then all pooped out. I have tried parnate several times after about two years discontinuation of it to no avail.
I am on Amisulpride now 50mg. I do better on 75 to 100mg but am not able to take more. It does not help at all with the anhedonia.
I did try Selegiline one time but do not recall at what dose or for how long, it did not work. I am currently considering Mirapex, Cymbalta. Strattera to replace the Ritalin I am taking now.
Considering my great response to Parnate for quite a while I wondered if one took that into consideration if someone could tell me which of these meds would be prudent to try?I saw here how people were talking about the Mirapex working for anhedonia. The Amisulpride is raising my prolactin and my weight which I am not thrilled about.
Thanks,
irene
Posted by sundown on November 12, 2004, at 19:04:55
In reply to Re: anhedonia sucks » jboud24, posted by King Vultan on October 15, 2004, at 14:26:52
I found this thread after doing a google search on anhedonia treatment. I am anhedonic without being terribly depressed and anti-depressents (I've tried a lot) don't seem to affect that at all.
Coincidentally, I have taken Mirapex for a long time, usually .375 a day for restless leg syndrome. I can take up to .3 a day and may experiment a little to see if there is any change in my ability to feel pleasure. But I can't say that it has made any difference. I may also ask my doctor about Parnate.
Other research that I've found seems to indicate that anhedonia is related to a deficit in mental visualization. I discovered a long time ago that I can't see pictures in my head, only black. It explained my spatial difficulties, getting easily lost, not liking highly descriptive literature, etc. Now is also seems that it my be a factor in my anhedonia.
I'm wondering of anyone else has experienced this.
Posted by iris2 on November 13, 2004, at 0:01:22
In reply to Re: anhedonia sucks, posted by sundown on November 12, 2004, at 19:04:55
I am curious about your Mirapex experience. I started taking it a little over a week ago. I have increased the dose quickly and am already on .5mg 3 times a day. Actually I had to decrease the dose to .25 again because of so many side effects. I have rhinitus (sp) nausia, constipation , stomach pain and feel like I am a space cadet. I am considering going off of it now before I ever reach an effective dose for any amount of time. So I am curious about other peoples experiences with it.
Thanks,irene
Posted by sundown on November 13, 2004, at 1:55:07
In reply to Re: anhedonia sucks » sundown, posted by iris2 on November 13, 2004, at 0:01:22
> I am curious about your Mirapex experience. I started taking it a little over a week ago. I have increased the dose quickly and am already on .5mg 3 times a day. Actually I had to decrease the dose to .25 again because of so many side effects. I have rhinitus (sp) nausia, constipation , stomach pain and feel like I am a space cadet. I am considering going off of it now before I ever reach an effective dose for any amount of time. So I am curious about other peoples experiences with it.
>
>
> Thanks,
>
> ireneIrene,
The most Mirapex I've taken is .5 and that has been spread out over the day starting in the afternoon. About all I have noticed is some sleepiness - a good thing at night. I do sometimes feel a bit disoriented spacially but I'm not sure what it is from. I also take 20Mg Lexapro and an anti-inflamatory.
What condition has your Mirapex been prescribed for? Are you getting any benefit at all from it?
Patricia
Posted by iris2 on November 13, 2004, at 12:46:39
In reply to Re: anhedonia sucks, posted by sundown on November 13, 2004, at 1:55:07
Patricia,
Thanks for responding.
I have self prescibed the Mirapex for my depression. My pdoc now freqently writes scripts for me without asking for much if any information about the medication.
I have also gotten sleepy form the Mirapex but that particular side effect seems to have been very transient for me.
What do you take it for?
I have not seen or felt any positive response from it for my depression in fact I have been told that at low doses it can have a depressant effect. I concure! The side effects have gotten so bad that even though I have not had the major effect I get of a med causing my interstitial cystitis to flare up I have decided at this time to discontinue the trial. As far as an anti depressant I had not reached a theraputic dose yet. If and when I feel better I might try it again and then I will be able to know more precisly what the medicine caused and what was just illness. It is imposssible to know that now but it is apparent that a lot of what illness I have now is from the medicine. As I type this I am feeling somewhat nausious and sweating again and my head continues to be all clogged up even as my nasal passages have cleared. I have really had as much as I am willing to take right now. I wish things were different. I am always willing to go through a lot if I am actually able to take a medication for more than a couple of days because of the bladder desease I have.
Thanks again,
irene
Posted by sundown on November 13, 2004, at 18:48:53
In reply to Re: anhedonia sucks » sundown, posted by iris2 on November 13, 2004, at 12:46:39
Hello Irene,
I am taking Mirapex for restless leg syndrome. I think it helps.
I'm sorry you are feeling so poorly and I hope your nausea and other symptoms disappear when you are off the Mirapex.
And good luck finding a anti-depressant that works. Patricia
Posted by robot on November 13, 2004, at 20:53:01
In reply to ANHEDONIA, posted by Whit on October 14, 2004, at 20:41:21
Concerning the imaging... I dont think the inability to create pictures in your mind's eye causes the anhedonia. I think they are both coeffects of whatever is going wrong. Lack of imagination, inability to absorb/grasp information, no pleasure, no memory go hand in hand. I also have noticed not being able to form or hold images in my mind very well, even when its a memory. When I had a week-long remission it all came back--images were more 'there' and real in my head, along with the return of pleasure--sexual and general.
Ive come to see it as something with an identity separate from the depression. Because after 6 months of Lexapro and 3 of Wellbutrin, its barely improved, while I dont feel quite depressed. My world isnt totally black and nihilistic anymore, I can imagine who I really am and could be if not for them. But Im being forced to be this nonperson and that is as bad.The only thing that has helped me is... meditation! And I suck at it. When I was really depressed I couldnt even begin to try, and I still relatively suck at it. But its helped and Ive only done it for a few weeks. I finally got sick of doing things and trying to enjoy, to jumpstart my reward system but it dont work. Im sure you can relate. So now I dont read politics, books, or watch movies much. For 'fun' I just sit on my bed or floor and either do focused meditation or just a half-asleep state of mind.
And its actually helped. After a few days of starting it again (focus on breath, forgetting word-thoughts) I could listen to music again (that had gone away when I had not been keeping up the meditation). Not that I am very much. Staying away from the things I need pleasure from keeps me from being stressed out. So what do I do with so much time? It FORCES me to meditate because there's nothing else to do! Its given me a little general well-being too. I feel my body, its more comfortable. Everything has just a bit more MEANING. And that pleasant light feeling I often feel when meditating just spontaneously happens (for a few seconds) as I go about my day.
If meditating seems too hard, you can throw on some decent music and meditate. Ive found it makes it easier to quiet your mind chatter.
Wellbutrin and running 30 minutes a day cant hurt either, but they dont do anything really (so far)if IM not meditating.
Posted by sundown on November 14, 2004, at 1:12:13
In reply to Re: ANHEDONIA, posted by robot on November 13, 2004, at 20:53:01
Robot,
I appreciate your comments. I too believe that the anhedonia, lack of imagery, etc. are seperate from the depression.
You seem to be saying that the drugs Lexapro and Wellbutrin make you feel not like yourself. I am only taking Lexapro and I still feel like myself, but I am considering adding something to it. My doctor likes Buspar, but I have heard that a dopaminergic drug would better address the anhedonia.
I'll try meditation on your suggestion. You are not the first person to tell me that it is truly helpful. I can identify with not wanting to pursue activities that fail to make you feel good. I'm sick of trying the things that seem to make other people happy. I have to figure something better out.
Posted by robot on November 14, 2004, at 19:16:29
In reply to Re: ANHEDONIA » robot, posted by sundown on November 14, 2004, at 1:12:13
I have spatial problems too. Im directionally challenged, I get lost easily--whether in real life or a video game.
How long have you been on Lex? Im off now. I took it for 6 months. Helped me just enough to keep me from suicidal. But it had done all it was going to do. Did you know some SSRIs actually decrease seretonin? I wouldnt recommend ANY SSRI without another med, for most people.
Neither of the meds made me feel not like myself--im already unlike myself, infact thats my main problem! Near-total lack of enjoyment if anything will make you feel that. A Darkness with a life of its own had taken me over 2 years ago and persisted; now I feel its just these things like no pleasure are keeping me feeling that pain, though, and not feeling like a Self. Things like trouble speaking clearly (started 2 years ago) and mental fuzziness contribute to zero relationships, and that does it too. In other words, I have enough awareness to seperate myself from the bad things and look at it more objectively. having that remission a month ago helped because it reinforced my faith in what I can be when normal.
And we WILL be normal. We havent damaged our brains beyond recovery. Thats what Ive realized.
Wellbutrin is supposd to help mainly dopamine, I think, and it hasnt helped me with enjoyment (or anything). I cant tell its doing anything. Ive read a good article online: Can Recovery From Depression Be Achieved? by Shelton and Tomarken thats given me some food for thought. SNRI (norepinephrine) acting meds indirectly act as dopamine reuptake inhibitors as well. But I dont want to do Effexor or Cymbalta, or Remeron. Im staying away from trycyclics for now. Id like to try Strattera. Few choces, though.
I would try Wellbutrin if you havent. (Provigil does Dopamine too.)
Its the hardest thing to believe that life can actually *gasp* include enjoyment! I bet you think about it like it was on another planet. You know desire and enjoyment exist. they are 'good', but its all so far away from your experience you dont remember how it actually feels. Everytime I have felt better, it comes like a wonderful surprise...THIS actually exists! What I kept talking about not haveing, giving it names like 'pleasure', actually can be felt and it IS good. WHen youre not feeling them they dont exist except as words.
Its freeing to let go, accept that your future self will enjoy these things, but for now let them lie. I feel much better since I decided that.
Meditation... dont let it intimidate you. Think of it as practice, an experiment. If you feel like youre not acomplishing much, or progressing, just laugh. Set aside a time and practice for that time no matter what happens. Youll progress and the next time not do as well, just keep practicing.
Watch the breathe at your nostrils.
Tell yourself that youre going to 'report' any words your mind chatters. If you find yourself trailing off, dont get mad just recognize it and go back to your breath.
> Robot,
>
> I appreciate your comments. I too believe that the anhedonia, lack of imagery, etc. are seperate from the depression.
>
> You seem to be saying that the drugs Lexapro and Wellbutrin make you feel not like yourself. I am only taking Lexapro and I still feel like myself, but I am considering adding something to it. My doctor likes Buspar, but I have heard that a dopaminergic drug would better address the anhedonia.
>
> I'll try meditation on your suggestion. You are not the first person to tell me that it is truly helpful. I can identify with not wanting to pursue activities that fail to make you feel good. I'm sick of trying the things that seem to make other people happy. I have to figure something better out.
>
>
Posted by pablo1 on November 17, 2004, at 12:21:57
In reply to ANHEDONIA, posted by Whit on October 14, 2004, at 20:41:21
Could you please explain how Adderall is an addictive dead end? Were you unable to control yourself with it?
> Anhedonia is my most persistant and most debilitating symptom. My diagnosis is bipolar 2 but I am in the depressive phase 99% of the time unless I get a drug-induced manic episode. I have tried just about every drug out there with little to no relief of the anhedonia. The only things that did work were Adderall (which is an addictive dead end) and Parnate (which pooped out). I have even done a few ECTs but the memory loss scared the hell out of me and I stopped the treatment.
>
> Is there any hope at all? I am now taking the following: Cymbalta 60mg, Wellbutrin SR 300mg, Zyprexa 10mg, Keppra 1000mg.
>
> All symptoms of depre4ssion are gone except anhedonia, which is still sucking me ever closer to the black hole. I am so tired of this that I would give up an appendage or a testicle to be rid of the anhedonia.
>
> I have read a bit about amisulpride and mirapex being D2 and D3 reuptake inhibitors and providing some relief. I have not tried these two meds, so I am going to ask the doc about them next time.
>
> Please tell me if you have found anything that works to relieve anhedonia on a long-term basis.
Posted by pablo1 on November 17, 2004, at 12:26:48
In reply to Re: anhedonia sucks, posted by Sad Panda on October 15, 2004, at 9:32:44
At lower doses amisulpride increases dopamine beautifully and sweetly.
> I wouldn't expect Amisupiride to be too mood lifting either as it is antidopamine just like Zyprexa.
Posted by Economist on May 24, 2008, at 20:34:23
In reply to ANHEDONIA, posted by Whit on October 14, 2004, at 20:41:21
Hi,
I was wondering if you've found a cure for your anhedonia?
Cammy
Posted by Sigismund on May 27, 2008, at 2:48:31
In reply to Re: ANHEDONIA, posted by Economist on May 24, 2008, at 20:34:23
There's a chap here who said that memantine helped with his 'anticipatory anhedonia'.
I haven't tried it.
Posted by undopaminergic on May 28, 2008, at 5:54:57
In reply to Re: ANHEDONIA » Economist, posted by Sigismund on May 27, 2008, at 2:48:31
> There's a chap here who said that memantine helped with his 'anticipatory anhedonia'.
>Now that I have more experience with it, I must conclude that it doesn't do enough to reduce my anticipatory anhedonia. My next step was to add buprenorphine, and that looks really promising so far.
This is the end of the thread.
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