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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Laney on January 2, 2010, at 20:23:27
induced annedoina? I'm currently taking paxil 10 mg. and want to know if I'm just depresssed from only being on 10 mg. or do I have the SSRI induced annedonia?
Thanks,
Laney
Posted by janejane on January 2, 2010, at 22:27:57
In reply to What is the difference between depression and SSRI, posted by Laney on January 2, 2010, at 20:23:27
Here's an article that might be helpful:
http://www.redorbit.com/news/health/333128/antidepressant_apathy_syndrome/
Posted by Phillipa on January 3, 2010, at 0:47:16
In reply to Re: What is the difference between depression and » Laney, posted by janejane on January 2, 2010, at 22:27:57
Jane that was interesting to me it says get off ad's anyone else think that. Don't want to add things too many things to me not good. Thanks for article. Phillipa
Posted by orbital on January 3, 2010, at 4:36:12
In reply to What is the difference between depression and SSRI, posted by Laney on January 2, 2010, at 20:23:27
IME, it's a very subtle (yet important) difference. They look very similar from the outside, but feel different.
When I'm depressed, I usually feel hopelessness, worry, sadness that comes in waves, a lot like unresolved grief.... I also absolutely lack energy.
When I experienced SSRI-induced apathy (after 2 years on Lexapro), I didn't feel much of anything at all, I was just numb. I had energy, but didn't use it, I was sluggish and unmotivated. Lowering the med didn't work, btw, I had to get off it altogether - the apathy lasted for a few more weeks.
So imho, it's a very subjective difference. Maybe you could try to identify if there's a difference in how you felt pre-Paxil and now? If the feeling is basically the same, maybe it's still depression.
Hope this helps.
> induced annedoina? I'm currently taking paxil 10 mg. and want to know if I'm just depresssed from only being on 10 mg. or do I have the SSRI induced annedonia?
>
> Thanks,
>
> Laney
Posted by janejane on January 3, 2010, at 8:25:11
In reply to Re: What is the difference between depression and » janejane, posted by Phillipa on January 3, 2010, at 0:47:16
Phillipa, that was my thought at first (this side effect was one of the reasons I quit meds last year), but you'll notice they also suggest other strategies. I know someone who had great success relieving her SSRI-induced apathy by cutting her dose in half. The antidepressant effect stayed, but the apathy went away. She just didn't need as much any more. The addition of a drug that works on norepinephrine and/or dopamine could increase motivation and reduce anhedonia. (Wellbutrin would fall into this category.) Switching from an SSRI to an SNRI might also work. Fish or krill oil (which some say increases dopamine) could theoretically help as well. The amino acids tyrosine or phenylalanine, and the herb mucuna pruriens would be other things to consider.
Posted by janejane on January 3, 2010, at 8:49:37
In reply to Re: What is the difference between depression and » Phillipa, posted by janejane on January 3, 2010, at 8:25:11
Phillipa, I wanted to clarify... I think other drugs/supplements should be added only if the reduction of the SSRI brings back the depression. (I understand your concern about simply adding more stuff in the mix just to fix the side effects of the first drug, especially when simply reducing the first drug might eliminate the symptoms.)
Posted by Laney on January 3, 2010, at 11:42:51
In reply to Re: What is the difference between depression and, posted by janejane on January 3, 2010, at 8:49:37
Thanks everyone! That article that Janejane sent a link to was superb! I have a lot to think about now. This really sucks! Not being able to feel anything.
I will be seeing a pdoc on Thursday and hopefully WB will do the trick!
Alayna
Posted by Netch on January 4, 2010, at 9:19:20
In reply to What is the difference between depression and SSRI, posted by Laney on January 2, 2010, at 20:23:27
"Apathy at discharge appeared to be greater in elderly depressed patients who were treated with SSRI's than that found in patients were not. Further studies with prospective design are required. Patients and caregivers should be informed to be more aware of this potential adverse effect when using SSRI's. Careful monitoring for apathy, and consideration of switching antidepressant class in patients presenting with apathy, should be undertaken in all patients receiving an SSRI."
Posted by SLS on January 4, 2010, at 9:47:59
In reply to What is the difference between depression and SSRI, posted by Laney on January 2, 2010, at 20:23:27
> induced annedoina? I'm currently taking paxil 10 mg. and want to know if I'm just depresssed from only being on 10 mg. or do I have the SSRI induced annedonia?
What a great question. I don't know of a really good source of a guideline for differential diagnoses. However, these are a few things that go along with depression:
Feelings of sadness
Loss of interest in doing things
Anergia - Low energy
Appetite - Weight loss or weight gain
Tearfulness
Decreased libido
Feelings of worthlessness
Feelings of guilt
Feelings of despair
Thoughts of suicide or death
Bleak outlook - sense of doom
Anxiety
Impaired concentration
Impaired memory - especially short-term memory
Slowed thoughts
Feelings of worthlessness
Decreased self-esteem
- Scott
Posted by janejane on January 4, 2010, at 10:48:30
In reply to Re: What is the difference between depression and SSRI » Laney, posted by SLS on January 4, 2010, at 9:47:59
One interesting thing they mentioned in that article... this idea of increasing the dose to see whether the apathy gets worse. That's supposed to help distinguish whether it's a symptom of the depression or a side effect of the med. If it gets worse, then it's more likely the med.
Posted by Phillipa on January 4, 2010, at 19:14:46
In reply to Re: What is the difference between depression and » SLS, posted by janejane on January 4, 2010, at 10:48:30
I just feel that the ages of the patients limit their interest in life as doing simple things for some is no longer possible. Things they once loved doing like close up hobbies (eye deterioration or fumbly hands) or activity. Vigorous excercise being one and then looking in the mirror and wondering what happened to the person they used to me looks wise. Not vanity self esteem. I wonder if a new face and stronger body parts and knowing time was on their side might have helped. This in reference to posted article. Phillipa
Posted by Laney on January 5, 2010, at 1:04:17
In reply to Re: What is the difference between depression and SSRI » Laney, posted by SLS on January 4, 2010, at 9:47:59
Between the two? Will medications help with apathy or anhedonia?
Thanks!Laney
Posted by janejane on January 5, 2010, at 5:09:54
In reply to Re: Is the treatment the same?, posted by Laney on January 5, 2010, at 1:04:17
My sense is that if you want to treat apathy and anhedonia, you probably want to target dopamine. (There is this idea that too much serotonin can lower dopamine which is why apathy would develop after long-term SSRI use.) If the problem is motivation, you want to increase norepinephrine. (Norepinephrine is converted from dopamine so increasing dopamine might also increase norepinephrine.) I'm not sure the solution is always as straightforward as that, but that's the idea I've read about. You can try a quiz like the one below to see which neurotransmitters you might be low in:
http://www.pintochiropractic.com/php/sec1a.php
Like I said before, I think your first step should be trying to reduce the paxil to see whether that helps. It might be all you need. (I know you reduced before when you tried to get off it, but maybe you need to stay at the lowest amount you need to keep the depression at bay instead of going back up to 10 mg.) If you want to confirm that the apathy is from the SSRI before you do that, you could do as the article suggests and try increasing the paxil to see if the apathy gets worse.
If the symptoms don't go away after reducing, you might try adding wellbutrin or switching to an SNRI.
I know exactly what you're going through because apathy was part of the reason I quit SSRIs last year.
Posted by Laney on January 5, 2010, at 10:34:38
In reply to Re: Is the treatment the same? » Laney, posted by janejane on January 5, 2010, at 5:09:54
Janejane,
Thanks so much for your help! It's nice to know someone understands and is willing to help.
I will take this to my pdoc on Thursday.
Laney
Posted by Phillipa on January 5, 2010, at 19:30:59
In reply to Re: Is the treatment the same? » Laney, posted by janejane on January 5, 2010, at 5:09:54
Jane what does it mean if you end up Gaba for both? Phillipa
Posted by janejane on January 6, 2010, at 7:07:39
In reply to Re: Is the treatment the same? » janejane, posted by Phillipa on January 5, 2010, at 19:30:59
Well, the first part is supposed to be your dominant nature... I'm not sure what exactly that means since I didn't read the book. (Sorry.) But the second part is supposed to be what you're deficient in. So for you, it's GABA.
This is the end of the thread.
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