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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 Joakim on November 5, 2015, at 15:10:34
Once i reached 100 mg Lamictal, my depression disappeared. But there is still one symptom left i'm stuck with and it's anhedonia. Just what the heck do i do now? Do i wait it out, or add an antidepressant to the Lamictal? I've already tried Wellbutrin, but it did jacksh*t for me. So that one is out of the question.
I really could use some advice on how to deal with this.
Posted by linkadge on November 5, 2015, at 20:01:31
In reply to I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 5, 2015, at 15:10:34
Try some coffee / cocoa / green tea. These do wonders for my anhedonia.
Linkadge
Posted by former poster on November 6, 2015, at 21:29:04
In reply to I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 5, 2015, at 15:10:34
Wellbutrin can take quite awhile for a full effect. Good for motivation however can leave you feeling flat.
Posted by rjlockhart37 on November 6, 2015, at 23:17:15
In reply to I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 5, 2015, at 15:10:34
lamotragine is a stabilizer, it helps some people from mood swings and it makes me not get depressed but it won't let me get in a fun mood at the 400mg, stay in a boring calm.... i take 200 and i can tolerate itlike linkege said, caffeine or maybe adding provigil or wellbutrin
Posted by rjlockhart37 on November 6, 2015, at 23:18:36
In reply to I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 5, 2015, at 15:10:34
ask about effexor, that is a good mood enhancing med
Posted by SLS on November 7, 2015, at 7:45:49
In reply to I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 5, 2015, at 15:10:34
> Once i reached 100 mg Lamictal, my depression disappeared. But there is still one symptom left i'm stuck with and it's anhedonia. Just what the heck do i do now? Do i wait it out, or add an antidepressant to the Lamictal? I've already tried Wellbutrin, but it did jacksh*t for me. So that one is out of the question.
>
> I really could use some advice on how to deal with this.First of all, I think you should explore higher dosages of Lamictal. Second, you should be evaluated for a bipolar spectrum illness. Knowing this might help your doctor choose the most appropriate treatment for you. For instance, in order to prevent mania and enhance the action of Lamictal, Abilify might be helpful. As for antidepressants, in my experience, drugs that help with anhedonia include Nardil, nortriptyline, Effexor, and Cymbalta. You might also want to research Brintellix.
- Scott
Posted by Joakim on November 7, 2015, at 9:40:03
In reply to Re: I'm stuck with anhedonia/numbness/apathy » Joakim, posted by SLS on November 7, 2015, at 7:45:49
Thanks for the replies. I have been diagnosed as Bipolar II, and my main problem has always been depression. Hypomania was never really an issue for me for the most part.
My current cocktail is Wellbutrin 300 mg, Abilify 5 mg and Lamictal 100 mg.
I have been on Wellbutrin for 17 weeks, and only in the third week did i feel better. After that it was straight back into depression, Abilify was then added to treat my obsessive compulsive thoughts. And finally Lamictal, i worked my way up to 100 mg which put a dent in my depression. But now it's just anhedonia left, i just seem to lack emotions in general. No pleasure, sadness, empathy.
This emotional numbing happened after a panic attack i had back in August, when it was my fourth week on the Wellbutrin. Now i'm trying to recover, but the scary thing is i don't know when i will. Or if i will at all.
Posted by Horse on November 7, 2015, at 12:39:22
In reply to Re: I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 7, 2015, at 9:40:03
Have you tried intermittent use of a stimulant? Ritalin is a fairly common adjunct, and one I think most doctors are willing to dispense. That helped me out of a very severe episode of anhedonia brought on by AP use.
Very best of luck.
Posted by hello321 on November 9, 2015, at 17:39:19
In reply to Re: I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 7, 2015, at 9:40:03
> This emotional numbing happened after a panic attack i had back in August, when it was my fourth week on the Wellbutrin. Now i'm trying to recover, but the scary thing is i don't know when i will. Or if i will at all.
So, you were taking wellbutrin when you had the panic attack? Meds like Wellbutrin can cause one to be more likely to experience a panic attack. I had a panic attack when I was prescribed adderall some years ago (wellbutrin is like a mild form of adderall) and my ability to feel pleasure afterwards was greatly decreased. After trying a fair amount of meds, I ended up trying Cyproheptadine and it helped amazingly.
Posted by Joakim on November 9, 2015, at 18:44:17
In reply to Re: I'm stuck with anhedonia/numbness/apathy, posted by hello321 on November 9, 2015, at 17:39:19
>
> > This emotional numbing happened after a panic attack i had back in August, when it was my fourth week on the Wellbutrin. Now i'm trying to recover, but the scary thing is i don't know when i will. Or if i will at all.
>
>
> So, you were taking wellbutrin when you had the panic attack? Meds like Wellbutrin can cause one to be more likely to experience a panic attack. I had a panic attack when I was prescribed adderall some years ago (wellbutrin is like a mild form of adderall) and my ability to feel pleasure afterwards was greatly decreased. After trying a fair amount of meds, I ended up trying Cyproheptadine and it helped amazingly.
>Yeah, my emotions were really intense when i first started Wellbutrin. After the panic attack my emotions were decreased tremendously and went numb. But i feel even more flattened out now at 100 mg Lamictal, it got rid of my depression and stabilized my mood. But i feel no excitement, joy, empathy, guilt or love. They're just missing. I'd love to find out what i need to do with my current cocktail to sort out this issue.
Posted by hello321 on November 9, 2015, at 21:31:08
In reply to Re: I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 9, 2015, at 18:44:17
Joachim, your situation sounds so much like what I experienced when I took adderall. The first few weeks I was on adderall my emotions became very intense. Especially my good emotions. But after taking it a few weeks I had the panic attack and that was when adderall completely stopped working and I developed severe depression and anhedonia.
The reason I ended up taking cyproheptadine was to help with effexors sexual side effects. I had actually stopped the effexor but the effect on libido wasn't going away. So I asked the psychiatrist if I could try cyproheptadine and he prescribed it. I can't remember the details exactly on the dose or how long I took it. But I do remember
playing around with dose a bit. I guess I slowly raised the dose after every few days. And within a month I felt so much better. I think for you cyproheptadine might be worth a try.
Posted by Lamdage22 on November 10, 2015, at 4:49:59
In reply to Re: I'm stuck with anhedonia/numbness/apathy, posted by hello321 on November 9, 2015, at 21:31:08
Interesting.
> Joachim, your situation sounds so much like what I experienced when I took adderall. The first few weeks I was on adderall my emotions became very intense. Especially my good emotions. But after taking it a few weeks I had the panic attack and that was when adderall completely stopped working and I developed severe depression and anhedonia.
>
> The reason I ended up taking cyproheptadine was to help with effexors sexual side effects. I had actually stopped the effexor but the effect on libido wasn't going away. So I asked the psychiatrist if I could try cyproheptadine and he prescribed it. I can't remember the details exactly on the dose or how long I took it. But I do remember
> playing around with dose a bit. I guess I slowly raised the dose after every few days. And within a month I felt so much better. I think for you cyproheptadine might be worth a try.
Posted by SLS on November 10, 2015, at 5:40:53
In reply to Re: I'm stuck with anhedonia/numbness/apathy, posted by hello321 on November 9, 2015, at 21:31:08
> The reason I ended up taking cyproheptadine was to help with effexors sexual side effects. I had actually stopped the effexor but the effect on libido wasn't going away. So I asked the psychiatrist if I could try cyproheptadine and he prescribed it. I can't remember the details exactly on the dose or how long I took it. But I do remember
> playing around with dose a bit. I guess I slowly raised the dose after every few days. And within a month I felt so much better. I think for you cyproheptadine might be worth a try.Do you find cyproheptadine sedating? What time of day do you take it? Do you still take it?
Thanks.
- Scott
Posted by hello321 on November 10, 2015, at 11:45:09
In reply to Re: I'm stuck with anhedonia/numbness/apathy » hello321, posted by SLS on November 10, 2015, at 5:40:53
> Do you find cyproheptadine sedating? What time of day do you take it? Do you still take it?
>
> Thanks.
>
>
> - ScottI'm not all that sensitive to antihistamines making me drowsy. But I'd say they're about as likely to induce drowsiness as much as a dose of benadryl. Cyproheptadine eventually stopped working for me as I slowly raised my dose of it over time, because it would regain effectiveness when I raised the dose.
But yep, it worked amazingly for the anhedonia I experienced after adderall screwed me up.
Posted by SLS on November 10, 2015, at 16:41:38
In reply to Re: I'm stuck with anhedonia/numbness/apathy, posted by hello321 on November 10, 2015, at 11:45:09
> Cyproheptadine eventually stopped working for me as I slowly raised my dose of it over time, because it would regain effectiveness when I raised the dose.
>
> But yep, it worked amazingly for the anhedonia I experienced after adderall screwed me up.Have you ever tried Remeron? If not, it might be worth your time to research it. It blocks two of the three 5-HT2 serotonin receptors that cyproheptadine does. Remeron is an antagonist at 5-HT2a and 5-HT2c *, while cyproheptadine adds 5-HT2b antagonism. Of course, Remeron also increases NE release and disinhibits serotonin neurons by blocking NE alpha-2 receptors. If you already tried using Remeron to help with your anhedonia without success, that might be an indicator that the 5-HT2b receptor was critical to your improvement with cyproheptadine. It would be interesting to know.
Unfortunately, a drug called ritanserin has been relegated to lab experiments, despite being a clean 5-HT2a/b/c and 5-HT7 receptor antagonist. By itself, it is not much of an antidepressant, but it has been suggested that it would make a good augmenter of antidepressants. It was once dubbed a great drug without an indication. Since the patent expired long ago, I doubt anyone would be interested in developing it for market.
Wikipedia entries:
Cyproheptadine binding profile:
https://en.wikipedia.org/wiki/Cyproheptadine#Pharmacology
Remeron binding profile:
https://en.wikipedia.org/wiki/Cyproheptadine#Pharmacology
Ritanserin binding profile:
https://en.wikipedia.org/wiki/Ritanserin#Pharmacology
* Remeron is actually an "inverse agonist" at 5-HT2c receptors according to Wiki. An inverse agonist is sort of like a super-antagonist. It pushes the state of the receptor/neuron in a direction opposite to that which the neurotransmitter or agonist would.
- Scott
Posted by phidippus on December 3, 2015, at 23:45:04
In reply to I'm stuck with anhedonia/numbness/apathy, posted by Joakim on November 5, 2015, at 15:10:34
Mirapex is great for anhedonia...upping your lamictal may help as well.
eric
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