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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by jcc80 on August 22, 2012, at 22:49:41
I'll try not to make this a novel here. I have been diagnosed as being dysthymic, but to me I think anhedonia is my most prominent issue. I have been on the merry go round of meds already.
I have tried:
-almost all ssri/snris
-remeron
-wellbutrin
-sjw
-deprenyl
-requip (extremely short trial, the fatigue scared me away after a couple days, though I wonder what would happen if I gave it time)Now:
-abilify (currently at 2mg)
-desipramine (currently at 100mg)
-ritalin (currently at 40mg)I feel like the depression is somewhat under control, but the anhedonia is not. In general, I am indecisive, unmotivated, and don't take much interest in anything, including my wife and kids. When I take 20mg ritalin, I get a 4 hour window of feeling halfway decent. It's not complete, but I feel a little more human.
The stimulant seems to point me in the right direction, but obviously I can't maintain that 24/7. What CAN I look into next? This seems to scream "more dopamine!" at me, if I can grossly oversimplify this.
Posted by Christ_empowered on August 23, 2012, at 0:06:33
In reply to Stimulants make me feel alive, but I need a sustainable solution, posted by jcc80 on August 22, 2012, at 22:49:41
Maybe reduce/eliminate the TCA? Those will eventually dumb you down, they have sides, and they're best reserved for severe depressions and/or psychotic+agitated depressions.
Posted by rjlockhart37 on August 23, 2012, at 0:20:23
In reply to Re: Stimulants make me feel alive, but I need a sustainable solution, posted by Christ_empowered on August 23, 2012, at 0:06:33
i know exactly what your feeling...i use methamphetamine and I definetly feel alive with it. Have you heard of Concerta? theres a dose two 54mgs in morning that would double what your taking now....it lasts all day usally you should really check it out...regular ritilin is difficult because you have to redose, its an old outdated way to do things. They have concerta and focalin XR now...
dopamine makes you feel pleasure and enjoyment of things in life, when its depeleted you lose intrests, that's why you feel not intrested in the things that should be 2nd natured intrest. It gives that reward feeling of something to look forward too....you have to train yourself to have something to look forward too and not let dopamine increase medications rule over how you feel pleasure. I've had to learn this....yanked off stimulants and went a long time in darkness...also check in to Vyvanse...
Posted by jcc80 on August 23, 2012, at 8:58:55
In reply to Stimulants make me feel alive, but I need a sustainable solution, posted by jcc80 on August 22, 2012, at 22:49:41
The tca is a new addition, about 5 weeks in. It was something completely new that I'd never tried before, so I thought I'd give it a fair trial.
As for extended release stuff, they're out of my price range. My insurance is a bit odd and won't pay for them.
Posted by Alexei on August 23, 2012, at 11:37:19
In reply to Re: Stimulants make me feel alive, but I need a sustainable solution, posted by jcc80 on August 23, 2012, at 8:58:55
I must respectfully disagree with Christ_empowered. I've found TCA's to be less numbing and stupefying than most ssri/snri. And the one you take, desipramine, was very potent and made me feel very energetic and alive. It just took longer to kick in.
Posted by jcc80 on August 23, 2012, at 12:49:50
In reply to Re: Stimulants make me feel alive, but I need a sustainable solution » jcc80, posted by Alexei on August 23, 2012, at 11:37:19
Alexei, I replied to you in my other thread. Did you find that the desipramine kicked in suddenly, or gradually?
I've been on it just over 5 weeks and I'm on the fence about continuing.
Posted by jono_in_adelaide on August 23, 2012, at 19:08:39
In reply to Re: Stimulants make me feel alive, but I need a sustainable solution » Alexei, posted by jcc80 on August 23, 2012, at 12:49:50
100mg is a pretty low dose - I'd consider pushing it to 150-200mg
Posted by jcc80 on August 23, 2012, at 19:39:37
In reply to Re: Stimulants make me feel alive, but I need a sustainable solution, posted by jono_in_adelaide on August 23, 2012, at 19:08:39
I'll try. I had to talk this doc into prescribing it in the first place; I don't think he was thrilled with the idea.
I can't help but wonder if the abilify might contribute to the anhedonia. I know it's a d2 partial agonist, but I can't imagine the d3 blocking helping the matter. My knowledge of this stuff is pretty primitive, though.
Posted by jono_in_adelaide on August 23, 2012, at 20:27:32
In reply to Re: Stimulants make me feel alive, but I need a sustainable solution » jono_in_adelaide, posted by jcc80 on August 23, 2012, at 19:39:37
The manufacturers info suggests 150-200mg per day as the theraputic dose (I think), so he shouldnt be too adverse to an increase.
Desimramine has been discontinued in Australia, otherwise I'd be taking that (instead of the reboxetine I currently use)
Posted by phidippus on August 28, 2012, at 23:33:24
In reply to Stimulants make me feel alive, but I need a sustainable solution, posted by jcc80 on August 22, 2012, at 22:49:41
> anhedonia
Is the trickiest m*th*rf*ck*r to treat. Your answer will lie in drugs that are used off-label to treat depression.
> I have tried:
> -almost all ssri/snrisProblem is, SSRIs and SNRIs can incur anhedonia. I've tried 'em all too and the only one that didn't lay me flat was Viibryd
> -wellbutrin
If your hypothesis is that you need more dopamine, well Wellbutrin throws a wrench in it. Wellbutrin is an NDRI so it inhibits the reuptake of dopamine allowing more of it in your system
> -requip
This cute little drug did enhance my mood after a couple weeks of use. It is a dopamine agonist, meaning it increases dopamine in the CNS.
> -abilify (currently at 2mg)
Helps balance dopamine in the CNS. Its also a potent 5ht1a partial agonist, which means it has a litttle kick when it comes too treatiing depression and anxiety.
> -desipramine (currently at 100mg)
Basically like an SNRI.
> -ritalin (currently at 40mg)
increases the levels of dopamine and norepinephrine in the brain through reuptake inhibition of the respective monoamine transporters
From Wikipedia:
Contraindications
Methylphenidate should not be prescribed concomitantly with tricyclic antidepressants, such as desipramine, or monoamine oxidase inhibitors, such as phenelzine or tranylcypromine, as methylphenidate may dangerously increase plasma concentrations, leading to potential toxic reactions (mainly, cardiovascular effects). Methylphenidate should not be prescribed to patients who suffer from severe arrhythmia, hypertension or liver damage. It should not be prescribed to patients who demonstrate drug-seeking behaviour, pronounced agitation or nervousness.[19] Care should be taken while prescribing methylphenidate to children with a family history of Paroxysmal Supraventricular Tachycardia (PSVT).
Be careful!
>I am indecisive, unmotivated, and don't take >much interest in anything, including my wife and >kids.
This pains me to hear your illness is robbing you of what is essentially your life. I wish I could do more than give drug addvice.
> The stimulant seems to point me in the right >direction, but obviously I can't maintain that >24/7.
There is no reason you couldn't take Concerta on a daily basis (Concerta is the ER version of Ritalin.)
>What CAN I look into next? This seems to scream >"more dopamine!" at me, if I can grossly >oversimplify this.
What I think is more likely you've come onto a combination of drugs that work well together to treat your symptoms-I don't think Ritalin on its own is making you feel better.
One drug I can think of adding to your cocktail is Memantine. It helps with depression, anxiety and is a potent D2 agonist.
Unfortunately, persistent anhedonia often takes multiple drugs to treat succesfully.
Get back to me.
Eric
This is the end of the thread.
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