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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 13 to 37 of 37. Go back in thread:
Posted by violette on June 12, 2010, at 21:41:50
In reply to Best med for anhedonia, lack of motivation, SCT?, posted by former poster on June 12, 2010, at 4:15:35
I feel for you.
I am so damn confused right now. I don't feel a need for any meds for depression or mood, just for anxiety on occasion and to sleep...but the lack of motivation is torture. I'm starting to think any dysthmia/depression symptoms I have are a direct result from one symptom-lack of motivation. I don't know what to do anymore. Amphetamines helped somewhat and I mean just enough to get me out of bed and going, but they don't work anymore. I doubled and tripled my dose to see if I had a tolerance built, but taking more just made me sleepy. It makes little difference if I do not take any-I don't even get withdrawal symptoms. Sometimes I wasn't even motivated enough to take the amphetamine-it was like indifference-total apathy-nothing mattered.
So after giving up on meds for the most part and trying to approach this from the psychological end-but can't figure it out with my therapist. The result from medications leads me to prefer the the therapeutic approach over drugs-anything I've taken makes me worse-I either sit and stare or feel agitated. I don't normally get symptoms of agitation except when I take medications. Six psychiatrists told me I was not bipolar and I read a ton about it and agree. But what is this from?
http://en.wikipedia.org/wiki/Aboulia
There's a link to read..if anyone could figure out what's going on with the group of us who have this problem-you sure would be a hero. !
Posted by violette on June 12, 2010, at 21:57:28
In reply to Best med for anhedonia, lack of motivation, SCT?, posted by former poster on June 12, 2010, at 4:15:35
I'm sorry Former Poster, I can't identify with feeling like you do-all your life? that sounds incomprehensible...
I've only had the problem for about a year, its a new symptom for me, but I have to say its worse than anxiety or depression, for me, since for 30 some years, I was the opposite-motivated. I had one epidsode of depression, which remitted, but the was prescribed all the ADs for anxiety for 10 years afterwards. Turns out xanax as needed is much better for me than all those ADs which have made me worse. But the doctors I had before would not prescribe me anything but ADs for anxiety.
I'm about to go insane from this one symptom. I don't know how you could tolerate it-so glad to hear your most recent med trial has helped. Good for you :)
Posted by Phillipa on June 12, 2010, at 22:20:20
In reply to Re: Best med for anhedonia, lack of motivation, SCT? » former poster, posted by violette on June 12, 2010, at 21:57:28
Violette benzos only thing that semi work for me also. Taking xanax and a tiny dose of valium and weaning off baby dose of luvox. Think down to about 35 mg now. Phillipa
Posted by g_g_g_unit on June 12, 2010, at 22:59:07
In reply to Re: Parnate good for anhedonia? » Conundrum, posted by zonked on June 12, 2010, at 10:25:02
>
> In my case, yes and yes. Was great for both--don't let the fact that Parnate pooped out and required megadoses for me discourage you. I think I am unusually treatment-resistant.
>
> > Does Parnate decrease norepinephrine > levels over time?
> Not that I know.
>
> -zdid nardil have much of an effect on your ADD symptoms? also, did you have trouble sleeping on nardil/parnate?
Posted by zonked on June 12, 2010, at 23:11:41
In reply to Re: Parnate good for anhedonia? » zonked, posted by g_g_g_unit on June 12, 2010, at 22:59:07
>
> did nardil have much of an effect on your ADD symptoms? also, did you have trouble sleeping on nardil/parnate?
>Nardil didn't do much for my ADD symptoms--when I was still working, I was consuming 2-3 energy drinks a day to stay focused...especially on things I found routine or uninteresting. But it certainly made them no worse, either.
I've had trouble sleeping ever since I started psychiatric meds--it goes with the territory for me, unfortunately. Parnate was worse, tho--I had to switch to taking all of it at wake time instead of twice a day because otherwise it'd keep me awake at night.
-z
Posted by g_g_g_unit on June 13, 2010, at 0:05:38
In reply to Re: Parnate good for anhedonia? » g_g_g_unit, posted by zonked on June 12, 2010, at 23:11:41
> Nardil didn't do much for my ADD symptoms--when I was still working, I was consuming 2-3 energy drinks a day to stay focused...especially on things I found routine or uninteresting. But it certainly made them no worse, either.
Hmm, my lifestyle + work routine (when it existed) are/were constructed around stuff I find interesting, which is why that aspect of meds isn't particularly bothersome; problems arise, however, when I'm feeling anhedonic because I can't even tap into my natural reward system.
My concern is more with fogginess. I gave up on Nardil the first time after 3 months because between the short-term memory loss and sleep deprivation, I could barely think straight.
My present psych is recommending I give it another shot at a lower dose (~60mg or so).
>
> I've had trouble sleeping ever since I started psychiatric meds--it goes with the territory for me, unfortunately. Parnate was worse, tho--I had to switch to taking all of it at wake time instead of twice a day because otherwise it'd keep me awake at night.
>
> -zSo when you took Parnate in the morning, were you able to sleep unassisted?
Posted by zonked on June 13, 2010, at 9:19:32
In reply to Re: Parnate good for anhedonia? » zonked, posted by g_g_g_unit on June 13, 2010, at 0:05:38
> Hmm, my lifestyle + work routine (when it existed) are/were constructed around stuff I find interesting, which is why that aspect of meds isn't particularly bothersome; problems arise, however, when I'm feeling anhedonic because I can't even tap into my natural reward system.
You certainly phrased that well--as I've said in another post, a lot of people who've never had SERIOUS depression don't understand that anhedonia means you CAN'T experience reward for good things happening, even some (less experienced) "mental health" workers! The example I used is that I could win the lottery and not feel reward, except perhaps some anticipation that I'd be able to see the best psychopharmacologists in the world and fix this. :)
That's why I get so frustrated when people suggest walks or deep breathing or meditation when I am severe--doing things like that do not work until there is some relief--THEN they come into play.
I digress.
> My concern is more with fogginess. I gave up on Nardil the first time after 3 months because between the short-term memory loss and sleep deprivation, I could barely think straight.The sleep thing has always been an issue for me with Nardil and its cousin, Marplan. Sometimes even when I get the requisite number of hours (7-8 is my sweet spot), I don't wake up feeling refreshed... Looking for a new hypnotic to address this.
> So when you took Parnate in the morning, were you able to sleep unassisted?
>
No, in fact; I have taken benzos or Ambien to sleep for the last 10 years. But I was able to get a refreshing night's sleep on 30mg temazepam taking Parnate that way. I stay away from Ambien because it caused me to wake up in the middle of the night and do ODD things, like make strange snacks and hav e incoherent instant message conversations--lol. My roommate in college was amused but it scared the heck outta me!I also tried trazodone (too groggy and cranky at wake time) and the only time an antipsychotic has ever entered my body was when a doctor thought 1/4 of a 25mg Seroquel tab might help me sleep. I felt like a walking robot/zombie for the next TWO days. That was enough to scare me away from APs for the rest of my life.... YMMV of course, many folks on here find APs very helpful for sleep and do not have the reaction I did.
Let us know how you do...
-z
Posted by europerep on June 13, 2010, at 9:26:20
In reply to Re: Parnate good for anhedonia? » jade k, posted by Conundrum on June 12, 2010, at 21:01:53
> Seems like most pdocs are really into anticonvulsants and AAP these days and I don't wanna take an AAP. One permanent problem is enough don't need TD.
Seriously, that's exactly it.. it seems like they feel it makes them "hip" to prescribe antipsychotics for augmentation of an AD, especially the new ones as with aripiprazole in my case, of which I took two doses and then stopped because it made me feel extremely weird and uncomfortable.. as if all my perception or the processing was slowed down, someone said something and the words came in so slowly..
and I think pdocs do not at all take the perspective of tardive dyskinesia for what it is, let alone the still not accepted tardive psychosis. she even told me that the atypical AP "do not produce tardive dyskinesia anymore".. and that was a doc at a university clinic..
Posted by zonked on June 13, 2010, at 9:38:19
In reply to Re: Parnate good for anhedonia?, posted by europerep on June 13, 2010, at 9:26:20
> and I think pdocs do not at all take the perspective of tardive dyskinesia for what it is, let alone the still not accepted tardive psychosis. she even told me that the atypical AP "do not produce tardive dyskinesia anymore".. and that was a doc at a university clinic..
>
>
Some docs just believe what the drug companies tell them. I have two friends who have Bipolar I with psychotic features... One has TD and akathisia from years of Seroquel (controlled somewhat with propanonol) and the other has TD and akathisia from not-even-a-year of Abilify, controlled somewhat with cogentin.These folks need their APs for sure, and I am glad they're working for them. But it's a bunch of bull that the atypicals don't cause EPS.
If SSRIs were the trend of the 1990s, atypical APs were the trend of the 2000s. I have a feeling in another 5-20 years antidopaminergic drugs will be considered crude, especially if the NMDA agonists work out as well as people hope for psychosis.
-z
Posted by violette on June 13, 2010, at 15:11:35
In reply to Best med for anhedonia, lack of motivation, SCT?, posted by former poster on June 12, 2010, at 4:15:35
Dr. Bob,
I've seen post after post of people complaining of ahedonia, and/or lack of motivation, who can't find relief. Many don't feel "depressed"....or have felt worse after taking SSRIs...I've seen similar concerns on all the other mental health forums.
What is the opinion of mental health clinicians for this specific scenerio? Are these usually symptoms a type of depression, axis 2 traits, medical problems...all, some, none?
It seems like some people spend years going from med to med to find relief and just don't get there....as if there is a subset of people where this trait is their primary symptom who end up posting on the internet because doctors have been unable to help.
There are posts after posts on this forum, referencing lack of relief from amotivation, ahedonia, what is your general opinion?
Posted by Deneb on June 13, 2010, at 18:53:47
In reply to Dr. Bob - question, posted by violette on June 13, 2010, at 15:11:35
Hi Violette
Dr. Bob only acts as administrator here and doesn't answer questions that are not related to administration or the site.
Posted by Phillipa on June 13, 2010, at 19:21:25
In reply to Re: Dr. Bob - question » violette, posted by Deneb on June 13, 2010, at 18:53:47
It's a shame he doesn't as some sites do have a doc weight in on some issures. And this topic is a good one. Phillipa
Posted by Conundrum on June 13, 2010, at 19:51:30
In reply to Dr. Bob - question, posted by violette on June 13, 2010, at 15:11:35
I don't know I'm really interested in seeing a neuropsychiatrist and getting some brain scans and seeing whats going on in some areas. Maybe that could help direct treatment? All I know is that if pdocs don't start prescribing things that I think will help. I might just order drugs online myself. Its not like their job is hard. Give a drug they like, watch for side effects and if it doesn't work try another drug randomly.
Posted by violette on June 13, 2010, at 21:35:10
In reply to Re: Dr. Bob - question » violette, posted by Conundrum on June 13, 2010, at 19:51:30
Conundrum,
When I had insurance, I saw a neuropsychiatrist, neurologist, neuropsychologist, and neuroptomologist. MRI, cat scan, and more...The costs were well over $10k. The conclusion was that I have some neurological abnormality but no real diagnosis. Besides the neuropsychologist assessment which ruled out of some things, it was mostly a waste of time, money..but who would have known.
Of all these experts, the greatest help was from my general PDoc-due to his observations from his lifetime of experiences with patients, his caring attitude, and time spent together-seeing him for an hour a week for therapy. But he can't perform miracles.
If you go the specialist/testing route, I hope your outcome turns out better than mine has.I'm going to discuss trying 2 more drugs with my pdoc, and then I give up. I can't do this or be like this anymore.
ps - I didn't expect an answer from Dr. Bob. I'm just sick of the fact that people have to complain about the same thing over and over-and can't find adequate help. He obviously reads all these posts since he comparmentalizes/seperates the medication conversations from the psychology, so I didn't think asking his opinion was too much trouble. It doesn't matter anyway because I doubt it would be much different from anyone else's..
Posted by violette on June 13, 2010, at 22:40:18
In reply to Re: Dr. Bob - question » violette, posted by Conundrum on June 13, 2010, at 19:51:30
You go to one doc for one brain symptom (psychiatrist), another specialist for another symptom of your brain (neurologist), yet another specialist for anyother brain symptom (endocronologist or ____). Although they are all related, each has their own tests and specialties-but no one has the expertise to really see the overall big picture to figure out what's going on.
Kind of like this forum-where health is seperate from medications, psychology from neurotransmitters, and the social world and politics has absolutely nothing do with it all.
Posted by Conundrum on June 13, 2010, at 22:40:52
In reply to Re: Dr. Bob - question, posted by violette on June 13, 2010, at 21:35:10
Do the scans tell you in what region the problem is?
What exactly did you learn from it?PS
Can't wait to stop wasting my time taking lamictal.
Posted by violette on June 13, 2010, at 23:19:45
In reply to Re: Dr. Bob - question » violette, posted by Conundrum on June 13, 2010, at 22:40:52
The MRI from an ER visit, showed a highlighted area in a cranial nerve (the same as one I had years ago but was misread)-a sign of infection I was told. So they tested me for syphylis (my symptoms matched the effects of dormant syphilis when it has infiltrated the central nervous system). the test was negative and it was done twice to make sure. I wished it were syphilis because that is something treatable even if you've had it for years.
Before the syphlis outpatient test, after taking lamictal, I ended up in the ER for extreme involuntary movements in my face, mouth, eye, and myclonic jerks of my limbs. That's how I ended up at the neurologist follow up in the first place although I've had some of those symptoms in a milder form, affecting different cranial nerves, and my eye, since I started ADs years ago. The lamictal somehow caused those extreme symptoms, they were somewhat stroke-like I guess since they ended up taking me in the ER within minutes after I walked in though the place was very crowded. Turned out to have an inconclusive diagnosis anyway.
The follow up neuro after the ER visit, who gave me the syphylis test never explained what else could cause the MRI abnormality, and just gave me a prescription for anticonvuslants rather than further testing when the syphlis (and lyme) were negative. They were only interested at that point in my family history of mental health. So I went to a neuropsych's for cognitive tests, whose conclusion was my cognitive symptoms (memory, concentration, blanking out, apathy/spaceyness, sensitivity to light and sound, and confusion) were not the result of depression (my mental processing speed and working memory were excellent) and recommended a full neuro workup. My iq also decreased. They wondered why I was never given an EKG (it was because doctors only seemed concerned with mental health issues of my family and self). I have no money/insurance so I'm not going to doctors any longer. Since then, I have had altered taste-a really sour taste in my mouth for months now. It's not necesssarily a bad taste, just really sour and persistent. I have no digestive symptoms.
I've had distorted vision off and on for over a year now, but none of the doctors ever took that seriously because they don't see anything physically wrong with my eyes.
Posted by violette on June 13, 2010, at 23:29:39
In reply to Re: Dr. Bob - question » violette, posted by Conundrum on June 13, 2010, at 22:40:52
Why is ahedonia iatrogenic? Do you mean as a result of the meds you were prescribed? How do you know?
Posted by Conundrum on June 13, 2010, at 23:49:50
In reply to Re: Dr. Bob - question » Conundrum, posted by violette on June 13, 2010, at 23:19:45
Wow thats pretty crazy. almost sounds like Lupus. I hope you get insurance and are able to see some docs who are interested in finding out what this appearance of infection is.
Posted by Phillipa on June 13, 2010, at 23:50:25
In reply to iatrogenic anhedonia » Conundrum, posted by violette on June 13, 2010, at 23:29:39
Violette lost taste and smell over 7 years ago theories range from lasix surgery PRK for eyes as started to diminish during this time but at same time was taken off biaxin xl for chronic lymes disease that still tests positive. The infection control doc said biaxin could do it but the biaxin with all the listed side effects made me feel great when off it crashed could actually feel it. Just a boom when at beach one day like fell out of sky and crashed. Went to two taste and smell centers one in DC and other Wake Forrest Hospital said nerve damage from virus but never sick. My spinal taps have been negative and brain MRI's normal for age???? Go figure. Phillipa
Posted by Conundrum on June 13, 2010, at 23:51:25
In reply to Re: Dr. Bob - question » violette, posted by Conundrum on June 13, 2010, at 23:49:50
I never had anhedonia in my life until discontinuing
fluoxetine. The lack of color I can't even describe in words. Its not just a mood change but a perceptual change.
Posted by g_g_g_unit on June 14, 2010, at 3:54:46
In reply to Re: Parnate good for anhedonia? » g_g_g_unit, posted by zonked on June 13, 2010, at 9:19:32
>... except perhaps some anticipation that I'd be able to see the best psychopharmacologists in the world and fix this. :)
i've always wondered if a mood upswing in anticipation of a psych appointment counts as "mood reactivity" in reaction to a "positive event" .... at my worst, the hope instilled by medical appointments are just about all i respond to..
>
> That's why I get so frustrated when people suggest walks or deep breathing or meditation when I am severe--doing things like that do not work until there is some relief--THEN they come into play.
>
> I digress.
> > My concern is more with fogginess. I gave up on Nardil the first time after 3 months because between the short-term memory loss and sleep deprivation, I could barely think straight.
>
> The sleep thing has always been an issue for me with Nardil and its cousin, Marplan. Sometimes even when I get the requisite number of hours (7-8 is my sweet spot), I don't wake up feeling refreshed... Looking for a new hypnotic to address this.
>
> > So when you took Parnate in the morning, were you able to sleep unassisted?
> >
> No, in fact; I have taken benzos or Ambien to sleep for the last 10 years. But I was able to get a refreshing night's sleep on 30mg temazepam taking Parnate that way. I stay away from Ambien because it caused me to wake up in the middle of the night and do ODD things, like make strange snacks and hav e incoherent instant message conversations--lol. My roommate in college was amused but it scared the heck outta me!
>
> I also tried trazodone (too groggy and cranky at wake time) and the only time an antipsychotic has ever entered my body was when a doctor thought 1/4 of a 25mg Seroquel tab might help me sleep. I felt like a walking robot/zombie for the next TWO days. That was enough to scare me away from APs for the rest of my life.... YMMV of course, many folks on here find APs very helpful for sleep and do not have the reaction I did.
>
> Let us know how you do...
>
> -zthanks for your response. the insomnia issue is really the only reason i can't commit to using an MAOI, unless all other options fail me. i feel like my mind and cognition are already so fragile and sensitive to a variety of mitigating factors (like diet, drugs etc.) that disturbed sleep just compounds my problems. i'd rather not be reliant on hypnotics and, like you, found Seroquel to arrive with a host of difficulties (sinus headaches, terrible myoclonic jerks).
Posted by chujoe on June 14, 2010, at 6:25:32
In reply to Re: Dr. Bob - question » Conundrum, posted by violette on June 13, 2010, at 23:19:45
> I've had distorted vision off and on for over a year now, but none of the doctors ever took that seriously because they don't see anything physically wrong with my eyes. <
Distorted vision = silent migraine? I don't know much about this, but the perceptual problems & cranial nerve issues you describe might be related to migraines w/o the debilitating pain. Worth looking into, perhaps.
Posted by violette on June 14, 2010, at 17:49:39
In reply to Re: Dr. Bob - question, posted by chujoe on June 14, 2010, at 6:25:32
chujoe,
one of my drs actually suggested looking into just what you said. You sound like a really good natured person, thanks for replying to me.
Sorry to get this thread off track, i'm just spiraling from stress and shouldnt be doing this here anyway.
Posted by chujoe on June 14, 2010, at 18:41:12
In reply to chujoe, posted by violette on June 14, 2010, at 17:49:39
If not here, where? This _is the place_ for these sorts of discussions -- no need to apologize.
I've been really interested in your posts -- I think that the psychodynamic side of things is very important, though I've had good luck, mostly, so far with my medications.
This is the end of the thread.
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