![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 57. This is the beginning of the thread.
Posted by Deneb on October 17, 2009, at 14:13:54
Hello, thanks for reading my question.
I have a big problem. I have been going to uni for about 9 years now trying to get my degree in science. I have a lack of motivation and at times concentration needed to study.
At this point I am unsure whether it is biological or psychological. I suspect it is a bit of both.
I am on Celexa, Prozac, Risperdal and propranolol as needed. I am wondering if my meds are part of the cause of my lack of motivation.
I was not this way in high school. I studied and got good grades.
Since this is the meds board, what kind of med changes would you recommend? I have been on the same combo of meds for years. I am starting to wonder if I can be more functional than I am now with another combo.
Posted by bulldog2 on October 17, 2009, at 14:53:43
In reply to What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 14:13:54
> Hello, thanks for reading my question.
>
> I have a big problem. I have been going to uni for about 9 years now trying to get my degree in science. I have a lack of motivation and at times concentration needed to study.
>
> At this point I am unsure whether it is biological or psychological. I suspect it is a bit of both.
>
> I am on Celexa, Prozac, Risperdal and propranolol as needed. I am wondering if my meds are part of the cause of my lack of motivation.
>
> I was not this way in high school. I studied and got good grades.
>
> Since this is the meds board, what kind of med changes would you recommend? I have been on the same combo of meds for years. I am starting to wonder if I can be more functional than I am now with another combo.
>
>You need some norepinephrine.
Posted by Deneb on October 17, 2009, at 14:56:18
In reply to Re: What is the best med for lack of motivation?, posted by bulldog2 on October 17, 2009, at 14:53:43
How do I get more norepinephrine?
Posted by emme on October 17, 2009, at 15:31:18
In reply to What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 14:13:54
I have found that Abilify helps restore motivation in addition to helping with depression and anxiety. I wonder if you would be able to try swapping the Risperdal for Abilify. Might be worth asking your doctor about it.
Did you notice increased apathy when you started the SSRIs?
emme
Posted by Deneb on October 17, 2009, at 15:46:06
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by emme on October 17, 2009, at 15:31:18
I'm not too sure when my apathy started. I've been this way for so long now. What I do know:
In for most of high school I was unmedicated. I suffered from pretty intense anxiety and depression but I was still able to study and get good grades. Starting my last year of high school I was put on Zoloft, whereby I started having very intense mood swings. My grades slipped from excellent to very good my last year of high school.
For most of my first year of uni I was unmedicated as I had decided to go off the Zoloft myself. I had a full course load. My grades were good to average. I started getting very depressed again.
I saw a counselor for a while before being referred to my current pdoc. I restarted the Zoloft.
Now sometime in the next couple of years I stopped seeing my pdoc of my own accord. I had been kicked out of my program at uni for failing a course twice. Unmedicated I decided to switch programs and do a full course load of 5 class a semester. It ended up being my best semester ever. I got 3 A's and 2 B's. Then sometime next semester my anxiety rose to unbearable levels and my mood plumented, leading to a medically serious overdose.
I have been on medication ever since. My course load has gotten smaller and smaller and I am having a lot of trouble with motivation. My anxiety and depression seems to be in check though.
Posted by Deneb on October 17, 2009, at 15:57:33
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by emme on October 17, 2009, at 15:31:18
I hear Abilify is in Canada now. I will ask my pdoc about switching the Risperdal to Abilify.
Posted by delna on October 17, 2009, at 16:05:01
In reply to Re: What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 15:57:33
Hi,
Just my 2 cents....I found that an SNRI (instead of SSRI's) really help with motivation. They act on noradrenaline which is associated with drive and motivation.
Effexor has really helped me in the past..Good luck
TC
D
Posted by Deneb on October 17, 2009, at 16:13:27
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by delna on October 17, 2009, at 16:05:01
I've never tried an SNRI before. I wonder if it would help?
What would be the best course of action? Should I maybe get rid of one or both of my SSRI's and replace it with something like Effexor or should I swap the Risperdal for Abilify?
I am concerned about getting off the the SSRI's as I've been on them forever. What would be the easiest and safest change to make?
Posted by bulldog2 on October 17, 2009, at 16:16:07
In reply to Re: What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 14:56:18
> How do I get more norepinephrine?
You could add nortriptyline to you ssri or switch to an snri such as cymbalta or minalciprin. The good thing about adding nortriptyline to an ssri is the ratio of norepinephrine can be controlled.
Posted by Deneb on October 17, 2009, at 16:22:39
In reply to Re: What is the best med for lack of motivation?, posted by bulldog2 on October 17, 2009, at 16:16:07
> > How do I get more norepinephrine?
>
> You could add nortriptyline to you ssri or switch to an snri such as cymbalta or minalciprin. The good thing about adding nortriptyline to an ssri is the ratio of norepinephrine can be controlled.Is nortriptyline a TCA? I heard those are dangerous in overdose. I haven't OD'd in a while now though so maybe it would be OK.
What does norepinephrine do? What happens if I get too much?
Posted by Maxime on October 17, 2009, at 16:43:31
In reply to What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 14:13:54
9 years for one degree? I don't think the problem is meds. I think you need to get out of the sciences. Clearly it's not something that really interests you or you would have been done by now.
Posted by Deneb on October 17, 2009, at 16:56:49
In reply to Re: What is the best med for lack of motivation?, posted by Maxime on October 17, 2009, at 16:43:31
The sciences are the only thing that interests me. Sigh. I am 4 classes away from graduating, but maybe school isn't for me.
In fact, nothing much interests me at all. I can't seem to do anything but the easiest of tasks.
I don't seem to have much of a future. I am unemployed and have been living with my parents my whole life. I only have two classes this semester and I can't even manage that.
I spent thousands and thousands of dollars on my education, only to come out empty handed?
When I do well and study I really enjoy what I am learning. It is really interesting. The problem is that I get into those phases where I have a complete lack of motivation.
Sigh.
Posted by bulldog2 on October 17, 2009, at 17:13:54
In reply to Re: What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 16:22:39
> > > How do I get more norepinephrine?
> >
> > You could add nortriptyline to you ssri or switch to an snri such as cymbalta or minalciprin. The good thing about adding nortriptyline to an ssri is the ratio of norepinephrine can be controlled.
>
> Is nortriptyline a TCA? I heard those are dangerous in overdose. I haven't OD'd in a while now though so maybe it would be OK.
>
> What does norepinephrine do? What happens if I get too much?
>
>Nortriptyline is a tca and we're talking about low dose such as 25 mg which is very safe. Norepinephrine is more of a motivator neuro. Serotonin is more of a mood modulator. Sometimes norepinephrine is needed to establish some balance.
Posted by Deneb on October 17, 2009, at 17:19:48
In reply to Re: What is the best med for lack of motivation?, posted by bulldog2 on October 17, 2009, at 17:13:54
Thanks for that info Bulldog2. The next time I see my pdoc, I will ask about nortriptyline
Posted by Deneb on October 17, 2009, at 17:42:09
In reply to Re: What is the best med for lack of motivation? » bulldog2, posted by Deneb on October 17, 2009, at 17:19:48
It is not just lack of motivation for studying that I have. I just seem to have a lack of motivation for most things in life. My favourite thing to do is sleep. I can sleep more than 14 hours a day.
Just the other day I slept from about 3 AM to 3:30 PM, got up for a bit, grew tired again and went back to bed until 7:30 PM. I only woke up at 7:30 PM because that is when my Mom gets home from work. I don't want her knowing I spent the whole day sleeping.
I slept like that on a regular basis, especially when I don't have classes. Sometimes I wake up early for class only to go home to sleep some more.
My room and my bathroom is completely disorganized and messy. I tell myself I should clean it, but again I have a lack of motivation. It stays messy for months at a time until one day I get up enough motivation to clean it. The last time I tried to clean my room, all I could do was pick up a couple of things off the floor every two days or so. This went on for months. It's not that I have a hoarding problem either. I have no trouble tossing things in the trash. I just don't have the motivation to sort through it all.
Posted by psych chat on October 17, 2009, at 18:24:44
In reply to What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 14:13:54
I'm obviously not a doctor,but from what you described, you may have atypical depression. Usually an MAOI is indicated...after trying Wellbutrin. It may be a good idea to give Wellbutrin a trial first.
Good luck...I'm going through a similar phase in my life right now. It sucks.
Posted by Deneb on October 17, 2009, at 18:38:00
In reply to Re: What is the best med for lack of motivation?, posted by psych chat on October 17, 2009, at 18:24:44
I tried Wellbutrin a long time ago. I am notoriously bad at estimating how I am doing so I'm not sure whether it helped or not. I never noticed a huge difference. I got Wellbutrin while my pdoc was on maternity leave. She quickly took me off if because of my bulimia. I don't purge anymore though. She put me on Prozac and I think that helped my bulimia.
I've heard MAOI's are good for atypical depression, but I am worried about the side effects and restrictions that come with MAOI's.
I agree and think my depression was/is of the atypical variety since I find I am still able to have good moods sometimes and when I am depressed I have hypersomnia instead of insomnia.
Posted by metafunj on October 17, 2009, at 19:02:04
In reply to Re: What is the best med for lack of motivation? » Maxime, posted by Deneb on October 17, 2009, at 16:56:49
This is because you are low on dopamine. Dopamine gives you interest and pleasure. In the prefrontal cortex dopamine is reuptaked by norepinephrine transporters. When you block norepinephrine transporters you increase dopamine which is why people feel more motivated on SNRIs, wellbutrin, and the stimulants, and some TCAs.
I think celexa + prozac may be dampening your dopamingeric transmittion too much.
If you could get by on just prozac you may notice a difference.
Posted by metafunj on October 17, 2009, at 19:05:11
In reply to Re: What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 17:42:09
That all sounds familiar. Does anything in this thread seem familiar?
Posted by Deneb on October 17, 2009, at 19:18:54
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by metafunj on October 17, 2009, at 19:02:04
I often wonder if it is necessary to take two SSRI's at the same time. It seems like SSRI overkill to me.
Regarding the anhedonia, I'm not sure that is what I have. I do experience pleasure a lot along with my depressive bouts. I have mood regulation problems. I tend to get really excited and happy one minute and depressed and suicidal the next. It is probably my borderline personality.
I read that TCA aren't good for people with borderline personality, but I think my borderline traits have gone way down. I've made a lot of progress in that regard.
Posted by psych chat on October 17, 2009, at 19:21:58
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by metafunj on October 17, 2009, at 19:02:04
I agree with the adverse effects on dopamine from SSRIs, becuase it happened to me. I got worse from SSRIs in terms of motivation.
But I quit ssris and have been taking d- amphetamine, and it isn't doing it for me. It helps with motivation, but I still have the depression as well. It's not working as good as it used to, even for the motivation, but it never worked 100% of the time anyway. I guess it can be more complicated than just dopamine deficiency. I'm just about ready to try a MAOI.
Posted by psych chat on October 17, 2009, at 19:24:50
In reply to Re: What is the best med for lack of motivation? » metafunj, posted by psych chat on October 17, 2009, at 19:21:58
But my Tdoc wants me to try lamictal first. I'm really hesitant. Plus, has that helped anyone for motivation and/or atypical depression? He wants me to try it becaues it's something I've never taken in the past.
Posted by Deneb on October 17, 2009, at 19:33:07
In reply to Re: What is the best med for lack of motivation? » metafunj, posted by psych chat on October 17, 2009, at 19:21:58
What is d-amphetamine? Is it a stimulant?
Sorry to hear your depression is still bad. I haven't taken that many meds yet. I've been on/am on Zoloft, Celexa, Wellbutrin, Prozac, Risperdal, Trazodone (for sleep) and propranolol. It's mostly SSRI's. They seem to work for depression somewhat, but never 100%, but I think maybe my depressive bouts may be normal for borderline personality.
My main problem is the motivation issue now that I have the suicidality controlled for the most part.
Posted by Deneb on October 17, 2009, at 19:35:10
In reply to Re: What is the best med for lack of motivation?, posted by psych chat on October 17, 2009, at 19:24:50
Lamictal is an anticonvulsant right? It is supposed to be for epilepsy and bipolar right?
Why are you hesitant? Are the side effects bad?
Posted by psych chat on October 17, 2009, at 19:36:19
In reply to Re: What is the best med for lack of motivation? » psych chat, posted by Deneb on October 17, 2009, at 19:33:07
d amphetamine..it's a stimulant/ADD type of medication.
Maybe PDocs need to be more educated on the motivational issues and/or atypical depression, I'm not sure.
Do you think maybe it's self sabatoge, being your almost at the graduation point? Or an adjustment disorder? Something to talk to a T about...
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.