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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 19 of 19. This is the beginning of the thread.
Posted by B2chica on March 26, 2016, at 12:06:23
i have searched the archives for anyone experiencing severe apathy while on amitriptyline and cant seem to find anything.
so im beginning to wonder if this issue are my underlying symptoms and would need to go up on tca or if the tca is causing this?
my smptoms are:
-moderate irritability first thing am for several hours
-TOTALLY in my head, prefer not to be talked to, do not want to talk, partly because annoyance and uselessness of it but also because of effort it takes.
-was very reflective and contemplative but now i am left with contemplative with negative apathetic retort back to self
-i cant seem to express any genuine emotion, i am able to attempt to fake smiles or interest with kids, but difficult and exhasting.
-Daily, for lack of better word laziness. i dont want to do anything, EVerything including getting up to go to the bathroom is an effort and i would prefer not to do it.
-Tired basically from the moment i wake up, all throughout the day and into the night.
-i not only have no interest in anything, i see no purpose in anything. it is all useless, pointless drudge that seems to drag on in voids.
-i am thankful when each day is done as that means one more day in my life is gone and i dont have to live it again...
-i have no thoughts of death nor wish to die, paradoxically nor do i really care to live.
-the only thing that gets me through the days is biding my time (which drags on in length) to get to 7:00 when i take my Lunesta, about 8-9 i have lucidity and slight reprieve of this void. and then i anticipate taking my tca which soon puts me to sleep and i am out for many hours.the odd thing about this apathy is despite how much i really dont care about things, i am writing this to you all and that am asking for suggestions- i know logically that i am not yet well and i need a change, yet i really dont care emotionally. luckily i have always been fairly good at compartmentalizing things and i can do this now.
-and there were some precipitating thoughts that ...disturbed me enough to realize i need to alter my state of being.thank you for any insight.
b2
Posted by linkadge on March 26, 2016, at 17:31:21
In reply to amitriptyline and apathy?, posted by B2chica on March 26, 2016, at 12:06:23
What all are you taking (+ doses?)
Thanks,
Linkadge
Posted by linkadge on March 26, 2016, at 17:40:53
In reply to amitriptyline and apathy?, posted by B2chica on March 26, 2016, at 12:06:23
Amitriptyline does have sedative qualities which can reduce over time. You build some tolerance to the antihistamine effect.
I wouldn't start with anymore than 10mg for a week.
Has the apathy replaced anything else? Is sleep and/or anxiety better? I have noticed that occasionally, when an antidepressant starts working, anxiety and insomnia can be replaced by initial apathy.
I got terribly apathy once starting citalopram, but reducing the dose and giving it time led to a significant response.
I take remeron and it can cause sluggishness and apathy for the first part of the day. I take strong coffee + vitamin D + vitamin b12 to help offset this.
You may get additional sedation with amitriptyline + the sedative. You may need to reduce the sedative to some extent.
If you give it a few weeks, the TCAs are notorious for producing higher rates of remission. Depending on the dose you are taking, a higher dose may actually reduce apathy more.
Linkadge
Posted by linkadge on March 26, 2016, at 17:50:22
In reply to amitriptyline and apathy?, posted by B2chica on March 26, 2016, at 12:06:23
Also, just to add. In studies of severe depression recovery, apathy / anhedonia is typically the last symptom to improve (unfortunately).
Usually, anxiety and sleep improve first (first few weeks) then energy and appetite (next few weeks) then anhedonia (weeks or sometimes months later).
Linkadge
Posted by B2chica on March 27, 2016, at 0:52:55
In reply to Re: amitriptyline and apathy?, posted by linkadge on March 26, 2016, at 17:31:21
sure link.
pristiq 50mg am
adderall 20m amadderall 10mg noon
gabapentin 300mg noongabapentin 300mg late afternoon
evening
gabapentin 300mg
topamax 25mg
ambien 12.5mg
lunesta 25mg
Amitriptyline 25mg
*****
most of the day i tried to sleep cuz i was so 'tired' but i couldnt so i just layed down, trying to read now and again, but mostly just rested.i have noticed the 'zonk' to sleep i get from tca is waning in the eveining, i can only hope that may lessen its affects during the day. i do notice i have bits of better times in the late evening -after i take the lunesta (gaba, lunesta and topamax at 7pm, until about 8 or 9 (9:00 i take tca and ambien)
so i do think this may be a side effect that may be wearing off. i do hope the anhedonia may disappear altogether at some point? but i'm still in relief from previous symptoms, and plus apathy, i dont seem to care much. but i feel i' doing terrible at ADL's items... much as before.
oh well...
b2
Posted by B2chica on March 27, 2016, at 0:57:12
In reply to Re: amitriptyline and apathy?, posted by linkadge on March 26, 2016, at 17:40:53
insomnia has been extremely helped. although lately its creeping back a little, but i'm not taking them as early as i should lately. Anxiety was at a raging constant from minute i woke until i finally went to sleep, and since tca that has gone down to a mild anxiety that comes and goes throughout a day. something i can easily handle.
thanks for the support, i was actually thinking i may need to go up a little more but since i have never been on this class of meds before i wanted to hear some advice first.
thank you link!
b2
Posted by SLS on March 27, 2016, at 6:29:39
In reply to Re: amitriptyline and apathy? » linkadge, posted by B2chica on March 27, 2016, at 0:52:55
Hi B2C
I am curious as to why you are not using higher dosages of Pristiq and Topamax.> Pristiq 50mg am
(100 mg/day)> Topamax 25mg
(100-200 mg/day for depression)
> Amitriptyline 25mg
(50-100 mg/day - moderate depression)
(100-200 mg/day - severe depression)
(200-300 mg/day - rapid-metabolizer)
When someone responds robustly to a TCA, the improvement in depression tends to be global. Anhedonia should disappear along with with other symptoms. If it doesn't, you might do better with higher dosages of Pristiq.Is it possible that amitriptyline is producing sedation that you are interpreting as apathy? For me, amitriptyline is a crappy medication. I feel a very yucky (medical term) sedation all day long, even after being on it for several weeks. Still, one is more likely to respond to amitriptyline than nortriptyline. Some people experience no daytime sedation at all, and still sleep well.
- Scott
Posted by SLS on March 27, 2016, at 6:32:29
In reply to Re: amitriptyline and apathy?, posted by linkadge on March 26, 2016, at 17:50:22
Hi Linkadge.
Is there anywhere on the Net where I can read about amitriptyline and BDNF receptors?
Thanks.
- Scott
Posted by B2chica on March 27, 2016, at 10:07:24
In reply to Re: amitriptyline and apathy? » B2chica, posted by SLS on March 27, 2016, at 6:29:39
i strongly believe it was the pristiq that was making me cycle or 'aggitation so severe so at the same time pdoc added topomax and tca i insisted we go down on pristiq so we dropped it back down to 50mg.
and i'm beginning to think these were all 'startup' responses, as yesterday i did have a few moments a couple times during the day where the apathy was lessened.
today, this morning at least i seem to have even slightly less.i did have sedation and i'm sure that was to some degree a part of it, but the apathy was entirely cognitive. i couldnt even muster smiling, not because i was sad, or i was too tired, but because whatever the action was it evoked no emotional response from me whatsoever, i literally just did not care, it means nothing to me, nor did i have any interest. i knew this especially when it came to my kids... things they would say or do, would mean..nothing to me. their joys and sadnesses i tried to respond how i rememberd i was to respond but there was no emotion behind it. nor did it seem to concern me.
but today i've noticed that can sit and watch (at least for a little while) with some interest my kids' play.
i figured i was on a pretty low dose, but since my pdoc was out of town i think he was being cautious. think i may need to go up both on topamax and on amitriptyline, or the amitriptyline at the very least.
Posted by linkadge on March 27, 2016, at 13:04:23
In reply to Re: amitriptyline and apathy? » linkadge, posted by B2chica on March 27, 2016, at 0:52:55
Hey B2,
The gabapentin, Topamax, ambien and lunesta could be contributing to anhedonia. Are you taking the topamax and gabapentin for anxiety, pain, or mood stabilization?
Too many anticonvulsants in particular can (slowly over time) lead to apathy / depression.
Gabapentin isn't always the best mood stabilizer and can sometimes lead to depression. You may try lightening up on this a little (-300mg?). You may try splitting the amitriptyline in half (12.5mg) to titrate up a bit more slowly.
Also, how has the pristiq helped? You may find that with higher doses of amitriptyline, you need less pristiq, which *may* reduce anhedonia.
Would you have as much insomnia on less Adderall? TCAs can sometimes help ADHD (amitriptyline metabolizes into nortriptyline - which builds in the system over time, this can make amitriptyline more stimulating). It can augment the norepinephrine boost from stimulants. If getting by with less Adderall meant less nighttime sedation, then it might be a win-win.
My strategy is always to fight the medication / dosage creep whenever possible. Higher doses of multiple medications can sometimes just end up being counterproductive. Too much GABAergic medication can block the antidepressant response to certain ADs. Brain cells don't always know what to do with a thousand conflicting messages coming in.
Also, do your best to make sure your diet is stellar. It will help recovery.
Linkadge
Posted by linkadge on March 27, 2016, at 13:22:55
In reply to Re: amitriptyline and apathy?, posted by B2chica on March 27, 2016, at 10:07:24
Hi SLS,
You can google "amitriptyline + trk-b". This is the receptor that amitriptyline potently binds to (like BDNF).
Personally, I love amitriptyline, because of its multiple targets. It can be a great place to start if you want stabilization of core depression symptoms. It is still considered the gold standard in terms of response and remission rates in depression. You may be able to reduce side effects by combining the amitriptyline + pristiq at less than therapeutic doses.
However, I personally believe that mood disorders become more chronic when too many medications are used for too long in too high doses. Good food and exercise can act as medication sensitizers, enhancing the brains response to chemical messages. The medications can work better when a wholistic approach is taken.I like to trade new meds for old meds, rather than layering a new one on. I tell myself that I have to give up something if I want something new. I get to use a max of 3 drugs.
Linkadge
Posted by B2chica on March 28, 2016, at 17:18:45
In reply to Re: amitriptyline and apathy?, posted by linkadge on March 27, 2016, at 13:04:23
he just started me on topamax same time as tca, i think to help stabalize mood. i take gabapentin and have for years for anxiety, varies sometimes i only take one or two a day, and its been up to 6x a day. i am only taking it twice a day now. once mid morning when the anxiety really kicks up, and in the evening id guess about 6-ish.
one night i tried not taking the ambien but noticed i didnt get to sleep, wasnt getting tired. i didnt know if it was a fluke or not so i hurried around midnight took it.
to be honest, im curious how the pristiq is fitting in to all of this. i'm down to 50 now, which before really didnt do much. however, i'm afraid to go off it completely...kinda like a security blanket. as im not sure if i'll get better or worse by dropping it. i have always liked that it gave me a little boost of energy during the day.
Now the Adderall is a very interesting med for me. i have tried to convince my last pdoc about it and me and she never really got it until my T had to talk to her time and time again. The adderall actually works good for boosting mood, also helps with concentration. the interesting thing is, i can actually sleep better on it, than off it. while i was off work and taking naps during the day as i lost sleep at night i knew that if i didnt take my adderall i would just lay in my bed and not sleep. if i would take it, about a half hour to hour later i could sleep great.
anyway, since i only take half dose (10) in the afternoon, i really dont want to drop that one.i also do wonder about the night time combo. i take the tca, topamax, ambien, lunesta and gabapentin. i would like to drop the ambien first as when i was taking that it did nothing for me. i would then drop the gabapentin. personally, the Lunesta is also an interesting one for me. a little while after i take it i notice a sense of calm, better...a restfulness in me. not sleepy, but like its a great sedative only without the fog, my mind is clear... i wonder if anyone has ever used Lunesta as and AD??
ya, definately wondering about the counterproductive. But thats the one thing i love about this pdoc, he believes in as little medication as necessary. right now it was necessary to get me out of that horror. hard to believe its only been a week since that time.
Thanks link!
b2
Posted by linkadge on March 28, 2016, at 17:42:03
In reply to Re: amitriptyline and apathy? » linkadge, posted by B2chica on March 28, 2016, at 17:18:45
Hey there,
Its hard to say based on medications alone. I take effexor (related to pristiq) and it can help my sleep and attention at the right dose.
Some doctors like to ramp meds up quick, but this can make some patients ditch the med before it has a chance to work.
25mg of amitriptyline isn't a high dose, but because it is a strong antihistamine, some patients might ditch it too quickly. The antihistamine effect should become less prominent over time.
Linkadge
Posted by B2chica on March 29, 2016, at 14:32:05
In reply to Re: amitriptyline and apathy?, posted by linkadge on March 28, 2016, at 17:42:03
i do notice that it doesnt 'drop me' like it did the first few days. it takes a while before i get tired, and i think it has more to do with the other sleep meds that the amitrip now.
but i just cant get over this absolute dread at the thought of having to do anything during the day. go outside? forget it, get something to eat? not that hungry anyway, bathroom? how bad do i really have to go and can it wait. let alone the thought of having to do a chore around the house and its looking pretty shabby around here. its really overwhelming or maybe perplexing or confusing is a better word, overwhelming is too emotional of a word.now that i say it, i think it is actually both the action of getting up to clean, but also the brain power it takes to think of where the cleaners are, where to organize things, putting it all back..etc. that is exhausting. maybe even more the latter.
the hours go by like days. although most of me is thankful i'm no longer in that horrid state i was in just over a week ago, i dont really even feel like i'm ...living. i feel very 'removed' from everything.
i do hope this is part of depression and not an unavoidable side effect of the med...
Posted by SLS on March 30, 2016, at 7:57:16
In reply to Re: amitriptyline and apathy? » linkadge, posted by B2chica on March 29, 2016, at 14:32:05
Sometimes, people get a blip improvement withing the first 3-5 days that disappears, only to reappear after 2-3 weeks. I don't know how much better you felt during the first few days. I wouldn't worry too much about side-effects that have to do with mood, cognition, or mental energy at this point. They could very well be symptoms of residual depression that will improve over time. It is premature to be pessimistic.
Keep posting of your progress day by day if you like.
- Scott
Posted by B2chica on March 30, 2016, at 13:41:25
In reply to Re: amitriptyline and apathy? » B2chica, posted by SLS on March 30, 2016, at 7:57:16
thnx scott, i think i need a gentle reminder to be patient that it still may work well. sometimes when i write it just seems like its been forever. i wish i could understand why my days seem to draaaaaag on. at least if i could be worth something during the day, maybe that would help.
this morning i was up before 7 so i could get kids ready for school, and i went to coffee shop for a while. i actually seemed to feel.."OK" till about 10:30 or 11-ish, i mean i felt nice. now i especially feel the 'drop'. though the mid afternoon always seems to be my toughest time. i'm teary but dont cry, and not necessarily 'feel' sad. i'm tired but cant sleep. i want to keep myself busy with something productive, crochet or needlework, but i'm too...listless to do it.
i was able to get a broom and sweep the kitchen, but mostly because i spilled salt all over the floor and hated the idea of walking on it... i definitely (today) feel this is depression that is not being covered vs. a result of med. i did leave message for pdoc yesterday with update of symptoms, but didnt hear anything. so i am assuming we just wait a bit more.b2
> Sometimes, people get a blip improvement withing the first 3-5 days that disappears, only to reappear after 2-3 weeks. I don't know how much better you felt during the first few days. I wouldn't worry too much about side-effects that have to do with mood, cognition, or mental energy at this point. They could very well be symptoms of residual depression that will improve over time. It is premature to be pessimistic.
>
> Keep posting of your progress day by day if you like.
>
>
> - Scott
Posted by linkadge on March 30, 2016, at 17:52:15
In reply to Re: amitriptyline and apathy?, posted by B2chica on March 30, 2016, at 13:41:25
It sounds like symptoms of depression to me. Sometimes, mixed states can collapse into depression, when the brain cells finally decide to stop firing.
Hopefully it doesn't last too long. As long as you're sleeping well, I wouldn't make any sudden changes. Do try to eat well and get some exercise. Move medication doses slowly.
My 2 cents.Linkadge
Posted by B2chica on March 31, 2016, at 13:23:14
In reply to Re: amitriptyline and apathy?, posted by linkadge on March 30, 2016, at 17:52:15
certainly feels depressive vs. some med thing.
i must mention, after i wrote yesterday i did have a mini breakdown and cried.. i was surprised i did, it meant i had feeling again..granted sad, but at least that complete loss of any emotion had disappeared. anyway after that i had about an hour of this really nice feeling of 'just being'. wasnt sad, nor happy. i just could be outside and look at things and take it in with slow breaths and it felt good (dare i say).
anyway. its a change in the positive.
my diet i'm still working on. my appetite comes and goes and the Latuda leaves a HORRIBLE taste in my mouth, but i get what i can.
On the upside i no longer drink any kind of soda. (or anything fizzy) the taste is just too awful.exercise i'm a little better at. with the exception of a few days, even most of the rough days i've forced myself to go out for a walk. i tell myself it doesnt matter how far or how fast, just that i go...and that's helped.
i am still sleeping well. getting harder to wake in the a.m. but the feeling of being rested is good. i am very grateful for the sleep.
thank you for your 2 cents Link.
b2
Posted by Escapee on April 14, 2016, at 20:23:31
In reply to Re: amitriptyline and apathy?, posted by linkadge on March 26, 2016, at 17:40:53
> Amitriptyline does have sedative qualities which can reduce over time. You build some tolerance to the antihistamine effect.
>
> I wouldn't start with anymore than 10mg for a week.
>
REALLY??$&^$%^?? Depression doses ive always known to be 50mg/100mg/150mg.
low doses are for elderly, children with bed wetting problems and 25mg for temporary sleep disterbances. i take 150mg along with a host of other meds. It seems to be the second main med of the bunch, the MAOI being the 1st. Also i cant remember exactly how many yrs i been taking it but it still sends me to sleep.
This is the end of the thread.
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