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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 3 of 3. This is the beginning of the thread.
Posted by chiron on June 18, 2008, at 17:44:05
This sure gets old, and my dr. doesn't really know what to do anymore. Tried most everything. I think this combo helps some:
250 Lamictal
2mg Xanax
30 Celexa
200 Wellbutrin
.05 SynthroidBut not enough. I'm still depressed, lack some motivation, and have this anxious loneliness that I can't shake (even though I have lots of friends). It's almost the opposite of social anxiety, but I lack the motivation to do anything (I usually force myself to anyway). I also still lack experiencing much pleasure. I hate it when my dr. asks "what have you done that's fun lately?". I've done stuff that should be fun, but it wasn't really "fun". That's one of the ongoing conflicts - wanting to do something but not wanting to do anything.
Posted by bleauberry on June 18, 2008, at 20:30:06
In reply to Seeking Advice on Med Combo, posted by chiron on June 18, 2008, at 17:44:05
There are various terms used to describe your symptoms. Depression really is not what it is. More specifically it would be anhedonia, or apathy. Anhedonia is just one specific part of depression, but it is not depression. It is a distinct syndrome that can be experienced in the absence of depression. It can stand alone without depression, but it is always part of depression as well. Anhedonia is the inability to experience pleasure/joy in pleasurable things.
Often times doctors figure you must still be depressed if unable to experience joy. But that might not be the case. Are you depressed? If so, then maybe that's why. If not, then there is something else going on.
A common cause of anhedonia, weird as it sounds, is ssri antidepressants like yours. They often numb emotions to where you do not feel lows any more, but you do not feel highs either. Very flatline emotions.
Not sure how you would rate celexa in your treatment, but if I had to place a bet on any one med in your combo that is either causing or worsening ahedonia, that would be it.
I had decent success years ago in treating depression with paxil, later prozac, lexapro, zoloft. In all cases, depression was mostly gone but I was just so flat and emotionless there was no point in life. No joy at all. I wast quite crippled, though not majorly depressed like I was. Mileage varies, but things people have found to improve anhedonia include modafinil, adrafinil, ritalin, adderall, mirapex. Mirapex is the one I think I've seen the most literature on. The one that worked pretty good for me for a few years was adrafinil, but not the others. While antipsychotics basically numb people out, they can actually work well on the negative symptoms of schizophrenia which just happen to have anhedonia as a core symptom. I found zyprexa helped me quite a bit, but not completely.
Celexa is pretty powerful stuff and I doubt the wellbutrin has the power to overcome it. You might discuss with the doc any combination of the following possibilities:
Lower celexa
Eliminate celexa
Increase wellbutrin
Add on an anhedonia specific med, which is generally accepted as being a specific pro-dopamine med.
Posted by chiron on June 19, 2008, at 0:06:54
In reply to Re: Seeking Advice on Med Combo, posted by bleauberry on June 18, 2008, at 20:30:06
Thank you bleauberry, I have found your posts to be pretty wise & knowledgable.
A couple of years ago I tried Adderall- the intial response was great. I felt like doing things and had a positive outlook. But I then I started to cycle with it. Then I added Abilify. I don't know if it was one or the other or both, but I ended up in the hospital. I am afraid of Abilify, also because when I tried Geodon, I ended up having ect on my birthday to get out my med-induced deep misery.
But with that said, now that I am on a stabilizer, I would be interested on giving Adderall or something similar another try. On the one had I worry that a stimulating drug might worsen my anxiety, but if I could sustain the type of feeling/outlook I had initially w/ Adderall, I think it would "trump" it.
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