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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 26. This is the beginning of the thread.
Posted by SLS on January 21, 2013, at 13:30:53
Hi All.
I have been taking lithium for about 1.5 years. My dosage has been steady at 300 mg/day. I found it somewhat helpful at first, but it may no longer be needed for depression since adding several other drugs. I have continued to take lithium in the hope that it would encourage the recovery of brain tissue and to help prevent Alzheimer's Dementia.
Overall, I have been feeling better and better. However, my motivation to engage in activities has not improved very much at all. When I have responded to treatment in the past, my motivation improved along with anergia and anhedonia. I just can't get myself to do anything right now. Something is not right. I am normally very industrious when I am feeling well.
300 mg/day is considered to be a low dosage of lithium. However, higher dosages make me feel passive and perhaps apathetic. This is why I am considering it as a possible culprit in causing my lack of motivation. However, it might be one of the other drugs I am taking. For all I know, it could be the nortriptyline or Abilify. If anyone has any insight as to what might be the culprit, I could really use some help here.
The first thing I would like to know is whether or not lithium can reduce one's motivation to initiate activities.
I am considering testing each drug one by one. Lithium would be the logical first choice to test because it is the easiest to discontinue. I would probably have an answer within days and there won't be a withdrawal syndrome to worry about. I would choose Abilify next because I don't recall having problems with motivation prior to beginning treatment with it 10 years ago. Also, it is probably responsible for the bulk of my 50 pound weight gain and high triglycerides. I also consider nortriptyline to be a possible culprit, but my concern for the return of depression is greater with its removal than with that of the other drugs. The lack of motivation existed before the addition of prazosin and minocycine.
This is what I am currently taking:
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 300 mg/day
Abilify 10 mg/day
prazosin 15 mg/day
minocycline 200 mg/dayAny and all comments are welcome.
Thanks much!
- Scott
Posted by Twinleaf on January 21, 2013, at 14:09:36
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
Scott, I 'm sorry that I don't know about the effects of lithium. But I wanted to answer anyway, as I have had the same difficulty even when the depression got much better. My pdoc thinks that too- rapid metabolism of dopamine in the pre-frontal areas is responsible for the lack of motivation. We are trying low-dose Risperdal (and keeping up the tianeptine) because both of them allow dopamine to remain longer. I honestly don't feel I have completely resolved the problem, but it is at least 50% better.
We gave Latuda a trial, as he thinks highly of it, and I had a rare paradoxical reaction with real agitation! For now, we are adjusting the dosages slightly (low always) and using l- theanine for associated anxiety ( works well!)
Posted by Phil on January 21, 2013, at 14:37:59
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
I googled for info and your post came up first.
I don't know but I can relate. I take 900mg and I go to therapy week after week for three years and I can't get going.
I'm not really depressed and I am making some progress but I'm pretty much in the same boat.
I've been trying to drag myself out to see 'Lincoln' and it's impossible. Sorry I don't have an answer.
Posted by Toph on January 21, 2013, at 15:12:19
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
Hey Scott,
I have been taking lithium so long (40 years) that I have no idea what my baseline is anymore. I take 900 mgs which keeps my serum lithium at .7 to .8. I feel persistent disthymia and slight anhedonia that I and my pdoc attribute more to my psychology than lithium or bipolar I. I can't afford to get manic so I keep taking it until something better comes along. I loved Lincoln btw.
Posted by schleprock on January 21, 2013, at 15:48:21
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
I'm certain that Lithium is a definite culprit in many of the symptoms you're suffering from. I would get rid of it altogether.
Posted by schleprock on January 21, 2013, at 16:00:41
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
I'm also willing to bet that nortriptyline IS NOT a factor.
Have you considered the possibility that you might be suffering from depression?
Posted by Phil on January 21, 2013, at 16:40:27
In reply to Re: Does lithium reduce motivation and activity level?, posted by schleprock on January 21, 2013, at 15:48:21
How are you sure?
Posted by Bob on January 21, 2013, at 16:50:47
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
> Hi All.
>
> I have been taking lithium for about 1.5 years. My dosage has been steady at 300 mg/day. I found it somewhat helpful at first, but it may no longer be needed for depression since adding several other drugs. I have continued to take lithium in the hope that it would encourage the recovery of brain tissue and to help prevent Alzheimer's Dementia.
>
> Overall, I have been feeling better and better. However, my motivation to engage in activities has not improved very much at all. When I have responded to treatment in the past, my motivation improved along with anergia and anhedonia. I just can't get myself to do anything right now. Something is not right. I am normally very industrious when I am feeling well.
>
> 300 mg/day is considered to be a low dosage of lithium. However, higher dosages make me feel passive and perhaps apathetic. This is why I am considering it as a possible culprit in causing my lack of motivation. However, it might be one of the other drugs I am taking. For all I know, it could be the nortriptyline or Abilify. If anyone has any insight as to what might be the culprit, I could really use some help here.
>
> The first thing I would like to know is whether or not lithium can reduce one's motivation to initiate activities.
>
> I am considering testing each drug one by one. Lithium would be the logical first choice to test because it is the easiest to discontinue. I would probably have an answer within days and there won't be a withdrawal syndrome to worry about. I would choose Abilify next because I don't recall having problems with motivation prior to beginning treatment with it 10 years ago. Also, it is probably responsible for the bulk of my 50 pound weight gain and high triglycerides. I also consider nortriptyline to be a possible culprit, but my concern for the return of depression is greater with its removal than with that of the other drugs. The lack of motivation existed before the addition of prazosin and minocycine.
>
> This is what I am currently taking:
>
> Parnate 80 mg/day
> nortriptyline 150 mg/day
> Lamictal 200 mg/day
> lithium 300 mg/day
> Abilify 10 mg/day
> prazosin 15 mg/day
> minocycline 200 mg/day
>
> Any and all comments are welcome.
>
> Thanks much!
>
>
> - Scott
Scott,I've always had trouble with lithium causing weight gain, lethargy and anhedonia. It always seemed to be MUCH more usefull for tamping down mania and hypomania rather than helping with anhedonia or depression.
I have been considering both prazosin and minocycline as adjuncts to my current sertaline + nortriptyline regimen. I see that you still have both of those on board and am wondering what you think they are specifically doing for you now in light of the lack of ability to get started with activities? I would be suprised if it was the Abilify unless that drug has completely pooped out. That drug has always been very activating to me.
The only drug I know that consistently and reliably provided drive and focus was Mirapex. Unfortunately it also caused an angry depressive state even while I was "accomplishing" things.
Bob
Posted by jono_in_adelaide on January 21, 2013, at 16:55:40
In reply to Re: Does lithium reduce motivation and activity level? » schleprock, posted by Phil on January 21, 2013, at 16:40:27
I think that the cutting out one med at a time thing is the way to go SLS
i doubt parnate or nortriptyline are the culprits, as they tend to increase motivation and drive by making you well.
Hopefully lithium is the culprit
Posted by Phillipa on January 21, 2013, at 18:44:22
In reply to Re: Does lithium reduce motivation and activity level?, posted by jono_in_adelaide on January 21, 2013, at 16:55:40
Never personally taken it but two relatives did and definitely "tamed" them down. So sounds like lithium especially if no side effects of with drawal first to go. And it does add weight? Phillipa
Posted by rjlockhart37 on January 21, 2013, at 19:28:28
In reply to Re: Does lithium reduce motivation and activity level? » SLS, posted by Bob on January 21, 2013, at 16:50:47
slowing effect kinda on the nuerotransmitters....that's why its used for bipolar conditions...
long time ago a poster wrote lithium was canceling out the adderall effect on her...it does that...it has a polerization effect but you don't feel the need to get going. It keeps the nueros at bay....won't really let them speed up....
i think something like trileptal would be good for you...still it can have similar lethargy effects in the thoughts.
Nuerontin? that would be a great option...really
r
Posted by tensor on January 22, 2013, at 9:00:29
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
> Hi All.
>
> I have been taking lithium for about 1.5 years. My dosage has been steady at 300 mg/day. I found it somewhat helpful at first, but it may no longer be needed for depression since adding several other drugs. I have continued to take lithium in the hope that it would encourage the recovery of brain tissue and to help prevent Alzheimer's Dementia.
>
> Overall, I have been feeling better and better. However, my motivation to engage in activities has not improved very much at all. When I have responded to treatment in the past, my motivation improved along with anergia and anhedonia. I just can't get myself to do anything right now. Something is not right. I am normally very industrious when I am feeling well.
>
> 300 mg/day is considered to be a low dosage of lithium. However, higher dosages make me feel passive and perhaps apathetic. This is why I am considering it as a possible culprit in causing my lack of motivation. However, it might be one of the other drugs I am taking. For all I know, it could be the nortriptyline or Abilify. If anyone has any insight as to what might be the culprit, I could really use some help here.
>
> The first thing I would like to know is whether or not lithium can reduce one's motivation to initiate activities.
>
> I am considering testing each drug one by one. Lithium would be the logical first choice to test because it is the easiest to discontinue. I would probably have an answer within days and there won't be a withdrawal syndrome to worry about. I would choose Abilify next because I don't recall having problems with motivation prior to beginning treatment with it 10 years ago. Also, it is probably responsible for the bulk of my 50 pound weight gain and high triglycerides. I also consider nortriptyline to be a possible culprit, but my concern for the return of depression is greater with its removal than with that of the other drugs. The lack of motivation existed before the addition of prazosin and minocycine.
>
> This is what I am currently taking:
>
> Parnate 80 mg/day
> nortriptyline 150 mg/day
> Lamictal 200 mg/day
> lithium 300 mg/day
> Abilify 10 mg/day
> prazosin 15 mg/day
> minocycline 200 mg/day
>
> Any and all comments are welcome.
>
> Thanks much!
>
>
> - ScottDo you know what your blood level is? I'm wondering if it has any therapeutic value at all. You could try and leave it out for a while. Lithium had no effect on my depression and my blood level was in the therapeutic range for depression.
Higher doses of nortriptyline made me tired and unmotivated. Could be worth a try cutting back to 75mg. It's a complex combo, I wish I could be of more help./tensor
Posted by jrbecker76 on January 22, 2013, at 13:56:37
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
>
> This is what I am currently taking:
>
> Parnate 80 mg/day
> nortriptyline 150 mg/day
> Lamictal 200 mg/day
> lithium 300 mg/day
> Abilify 10 mg/day
> prazosin 15 mg/day
> minocycline 200 mg/day
>Hi Scott,
long time since we last connected. I have more of a question than a comment. I can only relate to my experience with Minocycline, Lamictal, and Abilify. Minocycline was definitely adding to a sense of apathy and malaise for me. Abilify was tricky. I had periods of apathy at times as well as streaks of feeling more motivated. I would err on the side of it being more apathy-inducing in the end for me though.
My specific question relates more to your experience with prazosin. Given that it's an alpha-1 blocker, I'm assuming you're using it as anxiolytic. Alpha-1 blockers have had some great utility with panic and PTSD sufferers, however, there are drawbacks. As you know, alpha-1 blockade can produce tiredness, hypotension, and sometimes mood issues. There is some evidence that alpha-1 blockade reduces motivation/drive (pre-clinically at least). More anecdotally, there are reports that patients taking alpha-1 blockers for certain indications (e.g, Benign prostatic hyperplasia (BPH)) have that indicated feeling less motivation and drive in some instances.
I have taken a low dose of Nefazodone (generic Serzone) for years. It has wonderful effects as an anxiolytic, hypnotic and other properties that offset the SEs that come with taking Citalopram. The downside of Nefazodone (and Trazodone for that matter) is the mCPP metabolite that can have anxiogenic and other vexing side effects (this might include detrimental effects on motivation as well). But most of the time, the parent drug's effects override mCPP's deleterious effects. The other push-pull effect of Nefazodone is that besides it's main effect on 5-HT2 antagonisn (as well as mild SSRI and 5-HT1A modulation) is a lesser role as a alpha-1 blocker.
I'm convinced that the alpha-1 blockade adds to its effects as an anxiolytic and hypnotic. However, I think the minor trade-off might be that it could possibly add to a mild impact on drive and motivation, but certainly this mechanism of action as an "apathy-inducer" is not as blunting as serotonergic drugs. As an aside, drugs such as Provigil have strong alpha-1 agonism.
Can you describe your experience with Prazosin and what you see as the cost-benefit analysis in taking it?
Thanks,
JB
Posted by brynb on January 22, 2013, at 18:39:37
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
I was on lithium for 6 months and I think it did more harm than good. My motivation is so low to begin with, and it definitely didn't help. I stopped about a month and a half ago because I developed edema and cellulitis and I noticed that I was carrying an extra 15 pounds that quickly shed off with its cessation.
Just my two cents.
-b
Posted by Solstice on January 22, 2013, at 18:54:40
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
Lithium was not good at all with my daughter Moon. I wonder if raising the lamictal is worth considering? Your dose is not high, and lamictal is famous for its effect on lifting mood, evening out emotional state.
Solstice
Posted by SLS on January 24, 2013, at 10:26:12
In reply to Does lithium reduce motivation and activity level?, posted by SLS on January 21, 2013, at 13:30:53
I wish to thank everyone who contributed to this thread.
Well, I found the major culprit of my persistent amotivation and passivity - lithium. I am feeling remarkably more motivated to initiate activities. I am getting more done. I also feel brighter and more assertive. My personality is beginning to reappear. Big difference! Woohoo! I will need to make a decision about taking very low dosages of lithium as a prophylactic against contracting Alzheimer's Dementia. Perhaps I could tolerate 100 mg h.s. Studies show that 150 mg of lithium can serve to reduce the risk of Alzheimer's. I wonder just how low you can go. I bet no one has studied dosages as low as 50 mg/day.
The next drug that I would like to remove is Abilify. It is my guess that I will still need it, but it makes sense to try discontinuing it, anyway. The benefits of removing Abilify is to lose 50 lbs of excess body weight and reduce my blood tricyclide levels, which are currently over 400 mg/dl.
- Scott
Posted by tensor on January 24, 2013, at 11:11:53
In reply to Re: Does lithium reduce motivation and activity level? » SLS, posted by SLS on January 24, 2013, at 10:26:12
> I wish to thank everyone who contributed to this thread.
>
> Well, I found the major culprit of my persistent amotivation and passivity - lithium. I am feeling remarkably more motivated to initiate activities. I am getting more done. I also feel brighter and more assertive. My personality is beginning to reappear. Big difference! Woohoo! I will need to make a decision about taking very low dosages of lithium as a prophylactic against contracting Alzheimer's Dementia. Perhaps I could tolerate 100 mg h.s. Studies show that 150 mg of lithium can serve to reduce the risk of Alzheimer's. I wonder just how low you can go. I bet no one has studied dosages as low as 50 mg/day.
>
> The next drug that I would like to remove is Abilify. It is my guess that I will still need it, but it makes sense to try discontinuing it, anyway. The benefits of removing Abilify is to lose 50 lbs of excess body weight and reduce my blood tricyclide levels, which are currently over 400 mg/dl.
>
>
> - Scott
>
>Wonderful news! :-)
/tensor
Posted by Bob on January 24, 2013, at 14:16:06
In reply to Re: Does lithium reduce motivation and activity level? » SLS, posted by SLS on January 24, 2013, at 10:26:12
> I wish to thank everyone who contributed to this thread.
>
> Well, I found the major culprit of my persistent amotivation and passivity - lithium. I am feeling remarkably more motivated to initiate activities. I am getting more done. I also feel brighter and more assertive. My personality is beginning to reappear. Big difference! Woohoo! I will need to make a decision about taking very low dosages of lithium as a prophylactic against contracting Alzheimer's Dementia. Perhaps I could tolerate 100 mg h.s. Studies show that 150 mg of lithium can serve to reduce the risk of Alzheimer's. I wonder just how low you can go. I bet no one has studied dosages as low as 50 mg/day.
>> The next drug that I would like to remove is Abilify. It is my guess that I will still need it, but it makes sense to try discontinuing it, anyway. The benefits of removing Abilify is to lose 50 lbs of excess body weight and reduce my blood tricyclide levels, which are currently over 400 mg/dl.
>
>
> - Scott
>
>
Scott,Do you think you could direct me to some links for studies supporting lithiums association with being a prophylactic for Alzheimer's and/or dementia? I'd be interested in seeing that.
Bob
Posted by Phillipa on January 24, 2013, at 20:39:38
In reply to Re: Does lithium reduce motivation and activity level? » SLS, posted by SLS on January 24, 2013, at 10:26:12
Scott just a thought not all people have Alzheimers, nor take lithium to prevent it? I think it's a good move. Congrats!! Phillipa
Posted by SLS on January 26, 2013, at 21:07:53
In reply to Re: Does lithium reduce motivation and activity level? » SLS, posted by SLS on January 24, 2013, at 10:26:12
> Well, I found the major culprit of my persistent amotivation and passivity - lithium. I am feeling remarkably more motivated to initiate activities. I am getting more done. I also feel brighter and more assertive. My personality is beginning to reappear.
The last two days have been disappointing. Depression has crept back in. Not too bad, though. I suspect that it is a rebound effect from discontinuing the lithium so abruptly. I am not terribly concerned at this point.
- Scott
Posted by Phillipa on January 26, 2013, at 21:28:41
In reply to Re: Does lithium reduce motivation and activity level?, posted by SLS on January 26, 2013, at 21:07:53
Sorry. Will you add it back? Phillipa
Posted by SLS on January 27, 2013, at 3:34:06
In reply to Re: Does lithium reduce motivation and activity level? » SLS, posted by Phillipa on January 26, 2013, at 21:28:41
> Sorry. Will you add it back? Phillipa
Not at this point. I'll let my brain seek its own level first.
- Scott
Posted by Phillipa on January 27, 2013, at 18:51:06
In reply to Re: Does lithium reduce motivation and activity level? » Phillipa, posted by SLS on January 27, 2013, at 3:34:06
So glad you caught your mistake Phillipa
Posted by SLS on January 28, 2013, at 8:52:27
In reply to Re: Does lithium reduce motivation and activity level?, posted by SLS on January 26, 2013, at 21:07:53
> > Well, I found the major culprit of my persistent amotivation and passivity - lithium. I am feeling remarkably more motivated to initiate activities. I am getting more done. I also feel brighter and more assertive. My personality is beginning to reappear.
>
> The last two days have been disappointing. Depression has crept back in. Not too bad, though. I suspect that it is a rebound effect from discontinuing the lithium so abruptly. I am not terribly concerned at this point.I am doing better.
I am hopeful, although not convinced, that I will achieve full remission over the next 12 months. In the meantime, I should be able to return to work later this year.
- Scott
Posted by SLS on February 1, 2013, at 14:35:55
In reply to Re: Does lithium reduce motivation and activity level?, posted by SLS on January 28, 2013, at 8:52:27
I am so easily fooled.
Lithium at 300 mg/day may have been causing me to feel somewhat unmotivated, apathetic, and passive, but it was also acting as an integral component of my treatment regime to produce a more robust antidepressant response.
I have felt pretty crappy over the last 2 days. I felt particularly crappy early this morning.
Sooooo...
I restarted the lithium with a dose of 150 mg this morning and followed up with a 150 mg dose in the afternoon. I am feeling much better. Damn. Now, I must find the lowest effective dosage. Perhaps 200 mg/day? I'll need to speak to my doctor about getting 100 mg pills to work with.
Please forgive my running around in circles.
Currently:
Parnate 80 mg/day
nortriptyline 150 mg/day
Lamictal 200 mg/day
lithium 150 - 300 mg/day
Abilify 10 mg/day
prazosin 15 mg/day
minocycline 200 mg/day
- Scott
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