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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by btnd on January 27, 2003, at 8:00:03
Here is my story. 25 yrs old. Self-diagnosed (thanks to the internet) as having dysthymia since 6th grade. Symptoms:
- low energy, low motivation, low drive to succeed
- constant fatigue (mostly mental fatigue)
- concentration problems (ADD?)
- social anxiety (sociability dropped down)
- anhedonia
- constant worrying
- slight depression (because of above?)I thought that this was my personality until I tried Adderall. This drug removed all problems above.It made me motivated,energetic,confident,sociable - the way I've always wanted me to be. Because of this, I've read tons of studies and figured out that my problem is dopamine related. Unfortunately after some time Adderall stopped working.
Right now I'm seeking another solution so I could switch treatments and not develop tolerance. I'm thinking of using Amisulpride for 2 weeks and then Adderall for 2 weeks. What other treatments are of value? Selegiline(Deprenyl)? Adrafinil? I'd really like to try Amineptine (Survector) but it's not obtainable.
I've also tried Klonopin just for the social anxiety and it works at 1.5-2mgs. But motivation,energy,anhedonia stays the same (low).
I appreciate your input.
Posted by lonesomeloser on January 27, 2003, at 12:51:31
In reply to Dysthymia - medication?, posted by btnd on January 27, 2003, at 8:00:03
> Here is my story. 25 yrs old. Self-diagnosed (thanks to the internet) as having dysthymia since 6th grade. Symptoms:
> - low energy, low motivation, low drive to succeed
> - constant fatigue (mostly mental fatigue)
> - concentration problems (ADD?)
> - social anxiety (sociability dropped down)
> - anhedonia
> - constant worrying
> - slight depression (because of above?)
>
> I thought that this was my personality until I tried Adderall. This drug removed all problems above.It made me motivated,energetic,confident,sociable - the way I've always wanted me to be. Because of this, I've read tons of studies and figured out that my problem is dopamine related. Unfortunately after some time Adderall stopped working.
> Right now I'm seeking another solution so I could switch treatments and not develop tolerance. I'm thinking of using Amisulpride for 2 weeks and then Adderall for 2 weeks. What other treatments are of value? Selegiline(Deprenyl)? Adrafinil? I'd really like to try Amineptine (Survector) but it's not obtainable.
> I've also tried Klonopin just for the social anxiety and it works at 1.5-2mgs. But motivation,energy,anhedonia stays the same (low).
> I appreciate your input.I would really recommend a try on a Monoamine Oxidase Inhibitor (MAOI), such as Nardil, Parnate or Moclobemide.
These medication often work when other meds fail.
Consult a doctor first however.
Posted by JohnL on January 27, 2003, at 14:49:48
In reply to Dysthymia - medication?, posted by btnd on January 27, 2003, at 8:00:03
Hello,
Your type of depression sounds a lot like mine. I've come to believe that there are different breeds of depression. Each different breed tends to respond to certain classes of medications, i.e, serotonin meds, dopamine meds, combination meds, etc. Some breeds are real similar to the negative symptoms of schizophrenia. Some breeds are are primarily reward deficit in nature, or reward deficiency syndrome.
My breed, and possibly yours, involves all of the neurotransmitter systems to some degree, since they are all tied together, but is most heavily influenced by some abnormality in the dopamine D2 system. Just a guess though.
I've tried Amisulpride. It alone did not do the job. But, combined with Adrafinil and Prozac it is miraculous. Oddly, neither Adrafinil or Prozac alone do much good either. Put them all together, and wow. Apparently Prozac and Adrafinil do have indirect effects on D2, while Amisulpride has direct effects. Somehow they all work in harmony as a team, but fail if any one ingredient is missing. Anyway, Amisulpride is a fantastic med for me. I don't take it regularly for one reason. That is, it makes me start going impotent by about day 4 or 5.
With Deprenyl, you can expect a quick great response, followed by tolerance and nonresponse, similar to Adderall. Too high of a dose too soon can cause mania or psychotic features or agitation. Possibly worth a shot though.
Adfrafinil is definitely a good candidate. I take one tab a day.
Another med to consider is Zyprexa. Anhedonia and your other symptoms are sort of similar to the negative symptoms of schizophrenia. I'm not saying you have schizophrenia. I am saying that a certain breed of depression, like mine, looks similar to certain symptoms of schizohrenia, and responds well to Zyprexa.
My anhedonia buster combination is 20mg Prozac, 5mg Zyprexa, 300mg Adrafinil, the herb Rhodiola Rosea, and Amisulpride every once in a while. I can do without the herb. I can do without Amisulpride. But if I go without any of the others, forget it, it doesn't work any more.
John
> Here is my story. 25 yrs old. Self-diagnosed (thanks to the internet) as having dysthymia since 6th grade. Symptoms:
> - low energy, low motivation, low drive to succeed
> - constant fatigue (mostly mental fatigue)
> - concentration problems (ADD?)
> - social anxiety (sociability dropped down)
> - anhedonia
> - constant worrying
> - slight depression (because of above?)
>
> I thought that this was my personality until I tried Adderall. This drug removed all problems above.It made me motivated,energetic,confident,sociable - the way I've always wanted me to be. Because of this, I've read tons of studies and figured out that my problem is dopamine related. Unfortunately after some time Adderall stopped working.
> Right now I'm seeking another solution so I could switch treatments and not develop tolerance. I'm thinking of using Amisulpride for 2 weeks and then Adderall for 2 weeks. What other treatments are of value? Selegiline(Deprenyl)? Adrafinil? I'd really like to try Amineptine (Survector) but it's not obtainable.
> I've also tried Klonopin just for the social anxiety and it works at 1.5-2mgs. But motivation,energy,anhedonia stays the same (low).
> I appreciate your input.
Posted by not exactly on January 27, 2003, at 15:50:21
In reply to Dysthymia - medication?, posted by btnd on January 27, 2003, at 8:00:03
I agree with John. There are different types of depression, and yours (and his and mine) are the "low-dopamine" type. Another med to try is Wellbutrin, possibly enhanced by the addition of a bit of Ritalin. Of all the things I've tried this worked the best (and longest) for me. But I'm still on the quest for the "magic bullet".
- Bob
Posted by Marathon Man on January 27, 2003, at 21:18:36
In reply to Re: Dysthymia - medication? » btnd, posted by not exactly on January 27, 2003, at 15:50:21
I'm another with very similar simptoms. Count yourself fortunate that you are going through this now with more options than us older folks had at your age. I have good response with Parnate, but it only lasts 3 months. Maybe it would work for you and last longer. To theorize that my condition or yours is caused by low dopamine levels is in my opinion shooting in the wind. The monominergic theory of depression is just another theory. Someday we will hopefully understand what causes depression, we are not there yet. Good luck!
Posted by btnd on January 27, 2003, at 23:41:51
In reply to Parnate?, posted by Marathon Man on January 27, 2003, at 21:18:36
> I'm another with very similar simptoms. Count yourself fortunate that you are going through this now with more options than us older folks had at your age. I have good response with Parnate, but it only lasts 3 months. Maybe it would work for you and last longer. To theorize that my condition or yours is caused by low dopamine levels is in my opinion shooting in the wind. The monominergic theory of depression is just another theory. Someday we will hopefully understand what causes depression, we are not there yet. Good luck!
The problem is Parnate/Nardil are not available in my country. The only choices I have (when it comes to dopamine-related drugs) are: Selegiline (Deprenyl), Amisulpride, Adrafinil, Wellbutrin. Which one(s) would you suggest? I'm thinking of running 1 mg of selegiline daily for the 1st week, then 2nd week amisulpride+adrafinil and for the next 2 weeks adderall. What do you think? Does it make any sense? I just don't want to get tolerance to any drug that helps (or might help) my condition :)
Posted by not exactly on January 28, 2003, at 0:36:24
In reply to Re: Parnate?, posted by btnd on January 27, 2003, at 23:41:51
> 1 mg of selegiline daily for the 1st week
I often take very low doses of drugs, but only 1 mg / day of selegiline isn't even enough to cause a placebo effect.
- Bob
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