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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by alchemy on August 10, 2009, at 15:19:50
I tried upping my dose on both, nothing.
Current cocktail: Lamictal, Wellbutrin, Celexa, Xanax, Synthroid
This has been the best cocktail I've been on, but it I feel like I am definitely not "there".
I don't think removing the Celexa would be good because SSRIs have always helped to some degree. I wish I could take Adderall, but it makes me cycle all over the place.
Posted by floatingbridge on August 10, 2009, at 16:03:35
In reply to Provigil, Wellbutrin don't even help Motivation, posted by alchemy on August 10, 2009, at 15:19:50
Hi Alchemy,
Do you think the entire stimulant class would cause cycling? I didn't respond well to either wellbutrin or provigil for motivation (or my social anxiety). I take dexedrine for the time being. Someone here take vayanese (sp) with good result. I've heard some good results from Focalin (sp).
best,
fb
Posted by alchemy on August 10, 2009, at 16:34:08
In reply to Re: Provigil, Wellbutrin don't even help Motivati » alchemy, posted by floatingbridge on August 10, 2009, at 16:03:35
thx for the response.
do you have any type of bipolar? If so, are you ok taking the Dexadrine? Do you have a stabalizer with it?
I just have the hypomanic bipolar II type.
Posted by floatingbridge on August 10, 2009, at 16:58:58
In reply to Re: Provigil, Wellbutrin don't even help Motivati, posted by alchemy on August 10, 2009, at 16:34:08
Hi Alchemy,
I've been diagnosed a number of times with BP III nos or even cyclothymia. I think BP II is a bit different. I'm not on a mood stabilizer right now--though I have a bit of emotional lability.
The dexedrine does not set me off, EXCEPT when it wears off, and my mood can plunge, the anxiety come back. I feel what I imagine normal might feel like while on it. Still looking for a smoother ride with a steadier bass note to it. My doc started me at 5-10mg per day and I seem to be stabilizing at 40-45mgs. As long as I don't end up like Elvis--no, I do have some back-up plans if this cocktail becomes unmanageable. For now, I accept it.pristiq 100
dex 40-45
klonopin .5-1.0
xanax as neededsorry for the blab-alanche--hope it's not too much info,
good luck finding that last key,
fb
Posted by alchemy on August 10, 2009, at 17:07:44
In reply to Re: Provigil, Wellbutrin don't even help Motivati » alchemy, posted by floatingbridge on August 10, 2009, at 16:58:58
another question - does it help with resilience and/or pleasure. For example, I get burned out too easily (like at work). I also don't really enjoy things.
How bad to you plunge into depression when it wears off?
~thx again.
Posted by SLS on August 10, 2009, at 17:15:05
In reply to Re: Provigil, Wellbutrin don't even help Motivati » alchemy, posted by floatingbridge on August 10, 2009, at 16:58:58
> Hi Alchemy,
>
> I've been diagnosed a number of times with BP III nos or even cyclothymia. I think BP II is a bit different. I'm not on a mood stabilizer right now--though I have a bit of emotional lability.
> The dexedrine does not set me off, EXCEPT when it wears off, and my mood can plunge, the anxiety come back. I feel what I imagine normal might feel like while on it. Still looking for a smoother ride with a steadier bass note to it. My doc started me at 5-10mg per day and I seem to be stabilizing at 40-45mgs. As long as I don't end up like Elvis--no, I do have some back-up plans if this cocktail becomes unmanageable. For now, I accept it.
>
> pristiq 100
> dex 40-45
> klonopin .5-1.0
> xanax as needed
>
> sorry for the blab-alanche--hope it's not too much info,
>
> good luck finding that last key,
>
> fb
Is Vyvanse (lisdexamfetamine) an option? It has a smoother and more predictable delivery system. It might be less apt to allow for a interdose depression.
- Scott
Posted by floatingbridge on August 10, 2009, at 17:18:08
In reply to Re: Provigil, Wellbutrin don't even help Motivati, posted by alchemy on August 10, 2009, at 17:07:44
Alchemy,
So far, it has been the only thing to restore pleasure and relieve my social anxiety. I haven't been on as many meds as some here--only being treated for the past ten years or so--but ssri's and snri's keep me afloat, but don't touch that part (pleasure and friends). So I loathe to give it up, though to my mind, I think of it as speed. When it does wear off--in the evenings usually, I may take some xanax .25 or so. But my thoughts become fairly dark. (Not suicidal, usually.) Then I go to sleep. I've thought of dopamine agonists like mirapex, but for now, my pdoc supports this treatment. I've also thought of emsam or parnate....that could be in the future. I know the adderall wasn't good for you at all, so I thought the longer acting stims might be appropriate. Are you working with a doc that knows your history well?
fb
Posted by floatingbridge on August 10, 2009, at 17:19:42
In reply to Re: Provigil, Wellbutrin don't even help Motivati, posted by SLS on August 10, 2009, at 17:15:05
yes, Scott, that's what I was wondering....
Posted by alchemy on August 10, 2009, at 17:43:11
In reply to Re: Provigil, Wellbutrin don't even help Motivati, posted by SLS on August 10, 2009, at 17:15:05
I've never even heard of Vyvanse. Is it allowed in the US? Is it smoother?
Posted by Phillipa on August 11, 2009, at 0:43:17
In reply to Re: Provigil, Wellbutrin don't even help Motivati » SLS, posted by alchemy on August 10, 2009, at 17:43:11
An old babbler is on vyvanase and it literally saved his life. He's doing very well today. A lawyer and just expanded his business. He was suicidal when he started on his cocktail of requp .25, some desipramine, zyprexa 5mg, and vyanase. So there is hope Phillipa
Posted by Garnet71 on August 11, 2009, at 19:33:17
In reply to Provigil, Wellbutrin don't even help Motivation, posted by alchemy on August 10, 2009, at 15:19:50
Hi Alchemy,
I didn't read the responses, so I apologize in advance if I say anything repetitive....
SSRIs once worked for me too, but later zapped my motivation to Zero. It was so apparent and conclusive, that merely 2 days after stopping, my motivation would come back...after a week or two--to about 50% normal. Since long-term SSRI use, motivation has not come back 100%, where before I used these drugs, I didn't have motivational problems whatsoever (had severe depression once-and anxiety throughout the years though). I'm not saying its the fault of the drugs, but it is obvious they diminish my motivation while on them. After taking an SSRI for several weeks, I couldn't even get out of bed, but before taking an SSRI, I'd have anxeity, but would be able to complete all my day to day activities..no motivational issues.
Since my motivation dissapated, the only thing that helps me temporarily is Dextroamphetamine (the Dextrosrat version (tablet)--not the Dexedrine (capsule) version). (BTW-the brand name Dextrostrat is obsolete-but the script must be written for Dextrostrat w/o the brand necessary line signed and you will be given the generic version of this; otherwise, you will get Dexedrine-the capsule).
It is not a good solution, and certtainly not for the long-term. Yet, I'm at a crisis here because it builds up tolerance, and my dosage prescribed is small-10 mg. x 2 times a day. Thus, I have to skip a day or two to regain effectiveness-so for a day or two I accomplish little..but this drug's long-term effectiveness is even questionable at this point....
I agree with you about Adderall, and I did not like it very much. It helped more than taking nothing though.
Wellbutrin once worked for me too-but with a later trial, didn't do a thing to help.I don't know about Lamictal and/or synthroid. I do take Xanax still-it doesn't seem to make a difference, no side effects from Xanax.
There's research that indicates SSRIs raise Prolactin levels-which is the inverse of dopamine; dopamine is associated with motivation.
I have an upcoming appt. with a neurologist & psychiatrist-not like you see neurology/psychiatry certifications-but he is a consultant certified in both specialities. I'll let you know how it goes. I have no idea what my issue is-but I understand the motivaation problem. Especially when you are not 'depressed' -it is confusing. Though I've had distorted vision for over 6 months too....which prompted me to see a neurologist. I hope to get some neurological tests done, and hope to get my prolactin tested as well.
I'll let you know if it provides any clues to this motivational issue. I wonder sometimes if it is due to psychological issues from childhood more than biological. I guess I'll find out soon.
Sorry my syntax is disorganized here. I Hope you find a solution so that you reach your optimal health. I'll let you know if this new doctor finds anyting to help the motivational issue.
Overall, I'd question the Celexa. What worked for us before obviously does not always continue to help and may make things worse (if you take my experience into account). Not that your experience is anything like mine, but I wanted to let you know my story in case it helps with your situation.
Take care.
Posted by Garnet71 on August 11, 2009, at 19:40:05
In reply to Provigil, Wellbutrin don't even help Motivation, posted by alchemy on August 10, 2009, at 15:19:50
One more thing about dextro..from my expeirence, its one of the cleanest drugs I've ever taken. I get no side effects and its smooth on/smooth off for me. Lasts about 6 hrs.
Of course building a tolerance to it could be considered a side effect....When I first took it, I had to cut a 10 mg tablet into 3rds and 4ths because it was way strong...after a week or two, it leveled out and I don't 'feel' I'm on a drug (like speed). It doesn't feel as though it raises my heart or blood pressure-literally no feeling on it; makes me feel more normal, the way I used to feel.
Some at the pharmacies give you glares..some doctors refuse to prescribe it. I don't understand why, because its effective and IMO, much better than adderall or ritalin--which both have abrupt on/off feelings, in addition to rebound affects (for some of us) or feeling miserable when they wear off. Dex doesn't seem to affect me when it wears off-I don't even notice it.
Never tried the Vvyanese, but will think about that too...read some of the other posts.
Good luck
Posted by floatingbridge on August 11, 2009, at 22:08:36
In reply to Re: Provigil, Wellbutrin don't even help Motivation, posted by Garnet71 on August 11, 2009, at 19:33:17
Hi Garnet,
I'm interested in your prolactin test. I didn't know one could get one....
fb
Posted by Phillipa on August 11, 2009, at 23:23:17
In reply to Re: Provigil, Wellbutrin don't even help Motivati » Garnet71, posted by floatingbridge on August 11, 2009, at 22:08:36
I think the prolactin comes from pituitary not sure though. Phillipa
Posted by alchemy on August 12, 2009, at 0:34:38
In reply to Re: Provigil, Wellbutrin don't even help Motivation, posted by Garnet71 on August 11, 2009, at 19:33:17
Thanks Garnet. There should be more neurologist/psychiatrists.
I have read that prolactin is inverse to dopamine, but I haven't heard SSRIs might increase prolactin. Interesting. How long did you take SSRIs until your motivation was gone?
I am interested to hear of your results.
~thx
Posted by Garnet71 on August 13, 2009, at 23:39:30
In reply to Re: Provigil, Wellbutrin don't even help Motivation » Garnet71, posted by alchemy on August 12, 2009, at 0:34:38
Hey there again. I took SSRIs on/off for about 8 years...
The neuro/psych appt. was dissapointing. I mentioned the possibility of getting my prolactin tested (didn't give him reasons), and he said an endo. would be best suited to do that. Maybe he doesn't know of research that indicates SSRIs affect prolactin levels...As I have said many times before, there is little cross-disciplinary clinical practice with psych issues....
He didn't think much of my distorted vision-he noted one pupil was bigger than the other, but said the diff. (approx. one millimeter) is not enough to worry TOO much about....but it's strange he didn't investigate the bent lines I see; he shined lights in my pupils and tested for color differentials-that's it..other than talking to me.
I think I'll get a second opinion. I had told him of previous encounters with specialized eye doctors-how I'd been previously diagnosed w/occular migranes, and also that my father suffered from severe migrants--he seemed too satisfied with those assertions and was dismissive after I revealed this information and those encounters with previous docs (group think), but the (negative) MRI I had was about 5? years ago...I was suprised he did not order another, but I didn't feel too assertive with him so I didn't bother asking. I didn't feel comfortable at all with him, so I just kinda sat there and listened. He might have been one to think I'm a hypochondriac or something, since I disclosed chronic anxiety....and recent emotional manifestations.
But I had previoulsy gone to a top-notch neuropthamologist (for intense behind the eye pain) who could not pin a diagnosis after spending hours and hours with me....Then the other specialist I saw at that time was a retina specialist-the one who diagnosed me w/occular migranes-but he was arrogant, and i felt this MD just pinned the diagnosis on me for lack of explanation (only intuition); he spent just a few minutes with me, but was trained in physical eye retinal issues.... I had gone to see him partly because I have retinal tears (a protracted retinal detachment), but to get a 2nd opinion about the eye pain. These encounters were both about 5 yrs. ago.
This doc did prescribe me neuro testing-pen and paper tests (for ADD or other cognitive dysfunction). I am looking foward to taking those tests. He also suggested looking into other ADs I had not yet tried, but said I need to find a regular psychiatrist (and I told him I am in the process) as he serves mostly as a consultant. he seemed offset when I told him I take Dextro. Wondering if he was thinking I was "Dr. shopping" I did not ask him for meds. My concern was the distorted vision, and I was disappointed he seemed to dismiss the symptoms.
Oh well, will follow up and report back later :)
Posted by Garnet71 on August 13, 2009, at 23:54:47
In reply to Re: Provigil, Wellbutrin don't even help Motivation » alchemy, posted by Garnet71 on August 13, 2009, at 23:39:30
Forgot to say, the issue is, i experienced a change in mental health symptoms at the same time I experienced vision distortion. This doc seemed to dismiss it all when I mentioned what other docs had previously said--but those DX were long before I had this symptom-I'm talking like 5 years ago.... I just felt this dr. was a waste of my time. I was pleased to hear his recommendations of other ADs, since the last few I saw kept prescribing me the same meds over and over and over--despite that I told them I was worse off, and lost my capacity to function as a human being while on those meds. Those other drs. never offered an alternative to the common SSRIs. Yet, this doc, who actually had alterntive ideas, said I had to find a 'regular' psychiatrist anyway...
I just can't believe how the doctors are here. I can't understand why the last 3 psychiatrists did not consider the meds this doctor suggested trying. Then again, I can't understand why this doctor did not address my distorted vision seriously.
I know the last psychiatrists were few on the list of my insurance-insurance few doctors wanted to deal with--but I just don't understnad how doctors can be so intelligent to go through med school, yet so weak in problem solving. I can't comprehend this.
I've had some excellent doctors over the years-OBGYN, neuropthamologist, opthamologist, etc; but when it comes to psych care, they have been the absolute worst. Endocrinologists have not shown much individual thinking either, only seemingly knowing about diabetes issues.
grrrrr... :(
Posted by alchemy on August 14, 2009, at 9:34:30
In reply to Re: Provigil, Wellbutrin don't even help Motivation, posted by Garnet71 on August 13, 2009, at 23:54:47
I have also found it very frustrating that Endocrinology is so limited. If it is about the endocrine glands, why do they not know how they affect the brain and women's issues. There isn't cross-over, at least that I have seen. I went to one once, and she admitted she didn't have the knowledge to address my concerns.
It is also interesting to observe how often doctors differ, and often to a great degree.
The medical field has a long way to go, we still have so much we don't know. Doctors need to admit that just because they don't find anything wrong or there isn't a defined disease that it doesn't exist.
Ranting on, like my brother's knee. He went to a reknowed specialist- "nothing's wrong". Finally he got to a dr. that figured out he had serious OCD. He has had to have at least 3 surgeries and has had his cartilege flown across the country to be grown in a lab. So I guess sometimes the dr. search is worth it. My sister found a neuro that found a rare chiari (sp?) that explained her migraines.
For my head, no one in this age will probably figure out what is wrong or how to fix it. I try, but that's really gotten nowhere.
I wanted to become a neurologist/endocrinologist/immunologist. Imagine how long that would take :) But unfortunately I'm not sane enough :)
Thanks for letting me know how your appointment went. I'm sorry it wasn't helpful. :(
Posted by Garnet71 on August 14, 2009, at 17:45:16
In reply to Re: Provigil, Wellbutrin don't even help Motivation » Garnet71, posted by alchemy on August 14, 2009, at 9:34:30
There's so much information for specialists to learn, but you'd think with something like 10-25% of the population on antidepressants at any given time, they'd be taught more about the biological context and causes of mental heath issues.
Anyway, I was happy about one thing--this doctor mentioned Emsam and Remeron (not that I'd take the latter--eat/sleep). He also mentioned Cymbalata, though I'm afraid of that one...
After 3 years of adverse effects of SSRIs, no psychiatrist had ever mentioned alternatives to me before. But he's not really a clinical psychiatrist, so I wouldn't be getting scripts from him. He does teach at the medical uni here too, and he is so young so he wouldn't have much experience. I asked him about Savella, since it acts selectively on norepinephrine--but he did not know this.
But I am going to get a second opinion. What's strange was that the retina doctor diagnosed my occular migranes because of the white flashes I was getting-I didn't tell this doctor about them yet, but he immediately said the other dr. was right about the migranes, and I had told him my dad suffered from severe migranes. His website said his main area is: headaches, MS, etc.
At first i told him about my retinal tears, and he said that could be causing the eye pain. My experienced opthamologist who routinely checks my retinas thoroughly and does technical scans to measure the thinness, said you don't feel the tears at all. And I don't.
Now your stories about your brother and sister inspire me to go to another doctor! That's crazy.
I think I should get an MRI. He basically ignored that I had distorted vision-so did an endo I asked months ago about it. WTF? What's an MRI-$1000? Drs. don't mind if you go from specialist to specialist with no outcome--but don't like to prescribe expensive MRIs.
Oh well, there are other doctors to visit. I'll let you know if anything comes out of the exams ahead...in terms of clues for the motivational isssue.
Maybe I'll find a referral from this org:
Posted by floatingbridge on August 14, 2009, at 18:03:45
In reply to Re: Provigil, Wellbutrin don't even help Motivation » alchemy, posted by Garnet71 on August 14, 2009, at 17:45:16
Hi Garnet,
Keep us posted, would you? I'm very curious about emsam. A few babblers have recently had failed trials w/ savella. Have you seen those threads? (Not that it couldn't work for you.)
best regards,
fb
Posted by Phillipa on August 14, 2009, at 19:31:37
In reply to Re: Provigil, Wellbutrin don't even help Motivati » Garnet71, posted by floatingbridge on August 14, 2009, at 18:03:45
Garnet know from experience that most endos do focus on diabetes. But hormones are so important they run our whole bodies. Trying the bioidentiacals now but not working. Are the retinal tears from profession pror? Love Phillipa
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