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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by DK79 on July 13, 2012, at 8:46:39
Hello there,
What in your experience helps with social anhedonia (not social anxiety). Basically not having a lot of motivation to socialize with people, having difficult time relating to people, etc. One thing I will mention that I did experiences a relief once but could not replicate the result since. I was coming of selegiline (which was helping me with memory, focus, energy but not mood per se) and decided to try buspar. I most likely still had selegiline in the my system, and trying buspar produced very pleasant result in terms of social motivation and even improvement in mood. However, that lasted only the first day on buspar and I was never able to replicate it (being just on buspar or trying to add selegiline to it). What helps in your experience medication or supplement wise? What about Stablon and/or Picamilon, or anything else (with or w/o selegiline)? I appreciate any input.
Posted by Phillipa on July 13, 2012, at 10:06:05
In reply to What helps with social anhedonia., posted by DK79 on July 13, 2012, at 8:46:39
Are you a type person that used to enjoy socializing with others? Not all enjoy this and try to force themselves to. I don't enjoy socialization other than random conversations with neighbors and those I meet when out. Phillipa
Posted by Tomatheus on July 13, 2012, at 14:56:49
In reply to What helps with social anhedonia., posted by DK79 on July 13, 2012, at 8:46:39
DK79,
I would say that, based on your description, I probably experience at least a moderate amount of what you call social anhedonia. When my anergic/vegetative depressive symptoms are at even a moderate level, I don't particularly enjoy talking to people. And since the onset of my cognitive impairment and psychosis, I enjoy talking to people even less because I have more difficulty understanding the meaning behind what they say, especially when they talk real quickly. I've always been described as being a quiet person, though, even before the onset of my anergic/vegetative symptoms (and the cognitive impairment and psychosis that came some seven years later). So, whether one would consider it to be pathological or not, socializing has never been one of my strong points.
So, to the extent that I experience social anhedonia, the treatments that have helped to reduce the intensity of that symptom more than anything else have been the MAOIs. Unfortunately, although I had great results on one version of Nardil for a month and decent results on another version of Nardil for two months, no MAOI response that I've had has lasted longer than that. I would also say that the SSRIs Paxil and Prozac produced some short-lived reductions in what you would call social anhedonia (along with reductions in what I would consider to be my core depressive symptoms) at times before the onset of my cognitive impairment and psychosis, but that the SSRIs that I've tried since the onset of my cognitive impairment and psychosis have only worsened my symptoms. I would also say that I liked the way that I felt on the first day of my last trial with picamilon, but that the most obvious benefits of that particular substance did not last for longer than a day for me. I also did try Stablon, and though I noticed a reduction in some of my symptoms when I first took the medication, the improvements that I noticed didn't last very long. I also wouldn't say that I enjoyed social interactions any more than usual on Stablon, even when I felt that I was benefiting some from the medication.
So basically, to the extent that I suffer from what you call social anhedonia, no treatment has really alleviated this symptom for me in the long run. On my current treatment -- which consists of Abilify, folic acid, coenzyme q10, Korean ginseng, DHA, liquid vitamin B12, liquid SAM-e, and counseling -- I find social interactions to be somewhat more tolerable than I did prior to utilizing this treatment regimen, but I still tend to prefer solitary activities over social activities. As far as my social activities are concerned, I think that the kind of response that I'm getting now is probably pretty close to the best that I can realistically hope for. I wouldn't say that I'd want to be socializing so much that I'd be socializing just for the sake of socializing anyway, so I think that getting me to the point where I can tolerate social interactions and engage in more social behavior than I've been used to would be a good goal.
Tomatheus
Posted by DK79 on July 13, 2012, at 17:43:35
In reply to Re: What helps with social anhedonia. » DK79, posted by Tomatheus on July 13, 2012, at 14:56:49
I can't say that I was ever a super outgoing person. I was mostly referred to as a quiet, reserved person, who doesn't talk much but I've had my shining moments. I feel like the situation has been worse lately (a few years) due to my dysthymia with several acute depressive episodes. The best way to describe the social aspect of it is having very little curiosity about other people, and minimal motivation to interact, often times not really knowing what to say if I force my self to interact and very quickly zoning out of conversation most of the time. I think the most irritating aspect of it is that I know that I can be different, since there were precedents before. I am willing to try anything to snap out of it. I tried Wellbutrin, Remeron, Lexapro during my first acute depressive episode. None of that did any good really. Wellbutrin just gave tinnitus at higher doses, Remeron has intolerable drowsiness, and Laxapro dulled my emotions and killed my sex-drive (which I am still trying to recover years after). I went on selegiline more recently after my second depressive episode and it was helpful in terms bringing you out of a real bottom. I've only tried 10mg/day dose. I have also recently tried Lamictal for several weeks but had some skin issues from it, and i think it was messing up with my deep sleep phase. I stopped it since I wasn't feeling any improvements in the moods. Overall, I think my problem might be linked to dopamine deficiency/depletion. (btw asked the doc about Parnate and she refused to try it, suggested Effexor which I am very hesitant about).
Posted by rjlockhart04-08 on July 13, 2012, at 22:45:03
In reply to What helps with social anhedonia., posted by DK79 on July 13, 2012, at 8:46:39
one of the old remedies they used advertise for people who didnt feel like talking in social situations....back then it was called Social Inhibited...it was vary popular in the social relm before they removed it due to medical evidence that tryciclic antidepressants where effective. Also these types of medications where higher abused.
Posted by rjlockhart04-08 on July 13, 2012, at 22:48:56
In reply to Re: What helps with social anhedonia., posted by rjlockhart04-08 on July 13, 2012, at 22:45:03
but still usally social aspects the motivtion to socialize is through the dopamine systems in the mind....the anxiety part of it is dealing with lack of serotonin...some people can just easily fit right in to social relms...no anxiety or anything....it takes both psychological learning process and alteration of nuerotransmitters to achieve a social success. A good remedy is focalin, dexedrine, with lorazpeam or alprazolam aka ativan or xanax....stimulants sometimes with sedatives create a synergy effect to improve social behaviors.
rj
Posted by former poster on July 13, 2012, at 23:35:41
In reply to What helps with social anhedonia., posted by DK79 on July 13, 2012, at 8:46:39
DK79... You and I seem to have almost the same personality. I could really relate to the term "social anhedonia". I get lethargic at social gatherings, party's, wedding's, meeting's, which led to anxiety, then escalated to panic and avoidance. Savella is stimulating, seems to fall somewhere between caffeine and amphetamine, has seemed to help significantly with the lack of motivation to start or join a conversation. The words just seem to roll off of my tongue without hesitation.
Posted by Tomatheus on July 14, 2012, at 0:46:15
In reply to Re: What helps with social anhedonia., posted by DK79 on July 13, 2012, at 17:43:35
DK79,
I can relate to a lot of what you wrote pertaining to social interactions, especially not knowing what to say in conversations and having a tendency to zone out when in conversations. I would say that I too would like socializing to be something that I look forward to more so than I do now and that I'd certainly like to have more to say to others when I do get involved in conversations. I think that some of being a good conversationalist might come with practice, which is something that I admit that I haven't had a whole lot of in recent years (although I've had some). But I also think that there's probably an anhedonic aspect to it, which might have a biological basis of sorts to it.
In my case, I think that the best that I can probably do as far as treating what we would call the anhedonic aspect of socializing is concerned is to get myself back to the level that I was at before the onset of my anergic/vegetative depression. Even though I was still probably one of the quietest people that most people I knew had ever met back then and generally preferred solitary activities to social ones, I at least had the energy to follow what others were saying in conversations and to participate in conversations at some level. That's not to say that I wouldn't like to be even more sociable and an even better conversationalist than I ever have been. Ideally, I would prefer to be socially outgoing and extroverted over being quiet and introverted. And I think that striving to socialize more and to socialize better are things that introverts like me should strive to do -- at least to an extent -- because socializing is what I'd consider to be an adaptive behavior. At the same time, I realize that I can only change myself so much, and I think that I've taken enough medications to realize that if a medication or supplement is going to make me as sociable as I'd like to be, it's probably not going to do so in the long run. That's not to say that medications and supplements can never help with anhedonia, social anxiety, and/or other symptoms. I just don't think that the medications that are currently available have the power to transform our personalities to be exactly how we'd like them to be (and I'm not saying that you think that medications can do that -- instead, I was just sharing my thoughts on that topic).
If you don't mind answering this, could you tell me if you're currently taking any medications? It sounds like selegiline might be worth keeping as part of your medication regimen, although I can understand if you'd want to discontinue it to try something else that you can't take with it. Effexor might be worth trying. Even though it doesn't sound like you responded favorably to the SSRI that you tried (Lexapro), and it doesn't sound like you had much of a response to Wellbutrin, it doesn't sound like your responses to either serotonin reuptake inhibition or norepinephrine reuptake inhibition were so awful that Effexor wouldn't be worth trying. I don't know for sure if Effexor could be combined with low-dose selegiline, but that might be something worth looking into, assuming that the combo is safe. I personally think that medications can help with things such as anhedonia (social or otherwise) -- especially if it's associated with a depressive illness, which you do have -- but I think that they're less likely to help reverse a lifelong tendency to be socially inhibited.
Tomatheus
Posted by DK79 on July 14, 2012, at 10:23:11
In reply to Re: What helps with social anhedonia. » DK79, posted by Tomatheus on July 14, 2012, at 0:46:15
I am currently back on selegiline, and trying to add various supplements (right now 200mg theanine at night). I also want to try adding picamilon eventually. Moreover, I've read a few posts where supplementing selegiline with D-Phenylalanine seemed to produce good results. (Any one can relate that?) As I mentioned before selegiline helps with energy, overall motivation to do things, focus and memory, but not necessarily mood (I have a flat mood, sorta dragging through life and experiences, not feeling any excitement, pleasure, etc). However, I have never tried more than 10mg/day and right now I am on 5mg. One aspect of why I was cautious with the dosage is that is seems like I was getting a sort of buzzing in the brain - not anything I couldn't tolerate but an obvious effect you notice. Also, I thought I was losing weight, whereas I am trying to put on some weight. Also, not an intolerable side effect - I could just try eating more. So I might bump back to 10mg/day again. Is it worth going more than that, what were your experiences at higher doses?
In regards to other meds, yes none of them did much it seems. I tolerated Wellbutrin well except for higher doses (450mg) but couldnt really tell if that was doing anything, Remeron was awful, it's like being a zombie, and Lexapro obliterated my sex drive and made me emotionless, hence the reason I won't touch any medication with known negative sexual side effects, only with known pro-sexual profile. I am interested in EMSAM but its cost prohibitive under my insurance plan, and doctor brushed off Parnate - she didn't even know what it was when i mentioned it and had to look it up, and I can't get my hands on it by myself, seems like overseas pharmacies are not carrying it any more (I am in US).
Posted by Tomatheus on July 14, 2012, at 11:54:56
In reply to Re: What helps with social anhedonia., posted by DK79 on July 14, 2012, at 10:23:11
DK79,
I think that your plan to continue taking selegiline and to augment it with supplements makes sense. I do think that you ought to consider adding Effexor to your selegiline if your doctor deems the combination to be safe, but augmenting your selegiline with something like phenylalanine (or perhaps even phenylethylamine) might produce favorable results, too. I haven't tried taking phenylalanine in combination with selegiline, but I have taken both substances separately. For me, both selegiline and phenylalanine produced decent but short-lived results. I know that I've taken selegiline at least twice, and every time I've taken it, it's produced decent results for about three days before losing its effectiveness and leaving me feeling more agitated and cognitively impaired than usual. I forget if I took 5 mg or 10 mg of selegiline on the occasions when I tried it, but I never tried a dose higher than 10 mg. Anyway, I don't want to discourage you with my results of my trials with selegiline. Not everybody responds to medications in the same way, and I would say that sticking with selegiline and augmenting it would be a good approach for you to take, considering that it seems to have produced better results for you than any other medication that you've tried. I wish you luck with augmenting selegiline, and please feel free to utilize this board if you're looking for ideas and/or feedback.
Tomatheus
Posted by DK79 on July 14, 2012, at 12:40:50
In reply to Re: What helps with social anhedonia. » DK79, posted by Tomatheus on July 14, 2012, at 11:54:56
What would be the difference in taking phenylethylamine vs. dl-phenylalanine vs. d-phenylalanine (seems like the latter one is harder to find for some reason)?
Posted by Tomatheus on July 14, 2012, at 15:36:10
In reply to Re: What helps with social anhedonia., posted by DK79 on July 14, 2012, at 12:40:50
> What would be the difference in taking phenylethylamine vs. dl-phenylalanine vs. d-phenylalanine (seems like the latter one is harder to find for some reason)?
DK79,
The vast majority of what I know about phenylethylamine, dl-phenylalanine, and d-phenylalanine (and also l-phenylalanine) is based on anecdotal reports that I've read on the Web, so it might be that somebody else here could give a better response than I can, but I'll try to respond as well as I can. I know that phenylethylamine has an extremely short half-life and that one review that I've read from someone who's taken the supplement contends that its effects only last approximately 5-10 minutes. I have, however, heard good things about combining phenylethylamine with selegiline, and I've also heard from others who've taken phenylethylamine for at least several weeks with good results. My guess would be that the effects of phenylalanine (in the l, d, or dl form) probably last longer for most people than the effects of phenylethylamine do, but that is just a generalization based on anecdotal reports that I've read over the years. I myself have taken dl-phenylalanine and l-phenylalanine, but not d-phenylalanine or phenylethylamine. This will probably sound strange, but I didn't respond at all to dl-phenlyalanine when I took it (my anergic/vegetative depression was very severe at the time, and I did not have psychotic symptoms then), and when I took l-phenylalanine, I had a decent response to it that lasted about a week (my anergic/vegetative depression was more moderate at the time I tried the "l" version of phenylalanine, and I did have psychotic symptoms then). I think that in my case, the main reason why I responded better to the "l" version of phenylalanine than I did to the "dl" version of the supplement had to do with the difference in my symptoms at the times that I tried the different versions of the supplement.
Anyway, what I wrote in the previous paragraph pretty much sums up what I know about phenylethylamine and phenylalanine supplements. Maybe someone else with more extensive knowledge of these particular supplements will chime in and add to what I've written.
Tomatheus
Posted by sigismund on July 14, 2012, at 16:08:32
In reply to Re: What helps with social anhedonia. » DK79, posted by Tomatheus on July 14, 2012, at 15:36:10
When I took enough phenylethylamine to get an effect there was a sort of jazzed physical feeling one associated with entheogens without much mentally happening. The intense part lasted only 10 minutes or so. It was neither pleasant nor unpleasant. I never repeated it. I don't see how anything like that could help with social anhedonia. And you would need to be careful combing it with selegeline.
Does social anxiety come from not being able to decipher the script? But social anhedonia? Perhaps that is just boredom from the nature of things, the lack of playfulness, or just not enjoying any of it? Is it any fun anyway? Maybe.
Posted by DK79 on July 15, 2012, at 7:22:54
In reply to Re: What helps with social anhedonia., posted by sigismund on July 14, 2012, at 16:08:32
Going back to my buspar trial. Why would I have a very good positive reaction to it in terms of social inhibition but only the first day, and it was never repeated again? Just something new in the system or I tricked my brain into expecting it to help? Anything else along the lines of buspar worth trying?
Posted by Tomatheus on July 15, 2012, at 17:14:58
In reply to Re: What helps with social anhedonia., posted by DK79 on July 15, 2012, at 7:22:54
DK79,
I've never taken Buspar, but I can say that I've had several experiences with supplements in which the supplement produced a favorable initial effect and then pretty much fizzled away to nothing. In some instances, as the case was for me with licorice root and kanna, giving supplements a second try after being off of them for at least several months did not produce any therapeutic benefits. I think that I can only guess as to why these things happen, but there is some thinking that the body may compensate for the presence of a foreign substance (e.g., a drug or supplement) and that sometimes, the changes made to compensate for the presence of a substance may not reverse themselves after the substance is removed.
To respond to your question about whether anything along the lines of Buspar might be worth trying, Buspar's therapeutic benefits are believed to result from its actions as a serotonin 5HT1A partial agonist. Wikipedia (http://en.wikipedia.org/wiki/5-HT1A_receptor#Agonists) features a large list of 5HT1A agonists -- a list that includes three atypical antipsychotics that may possess antidepressant properties: Abilify (aripiprazole), Seroquel (quetiapine), and Geodon (ziprasidone). Might these medications help with social inhibition or social anhedonia? Possibly, but they may also have pharmacological properties that might be undesirable as far as social inhibition is concerned. I, for example, like the effect that Abilify has on my psychosis, energy, and hypersomnia (although the effects on the last two symptoms are quite weak at this point), but I don't like the way that my cognition and emotions seem to be blunted on the medication. Another thing worth noting is that it might be expected that if Buspar only worked temporarily that other medications with similar pharmacological properties may also only work temporarily.
This sums up my thoughts on the questions that you posed. I do hope that you can get longer-lasting results from Buspar this time around, and I wish you luck with your trial.
Tomatheus
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