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Re: anhedonia along with severe insomnia

Posted by Onestone on November 20, 2008, at 18:40:08

In reply to anhedonia along with severe insomnia, posted by X_ander on November 16, 2008, at 22:44:12

Hi, people, Onestone here, it's my first post. I think I'm the guy that Douglas Adams modelled Marvin on. I found this thread whilst searching for "anhedonia" and "dopamine" on Google.

> I suffer from severe anhedonia. I'm as certain as I can be that it's not the "conventional" form of depression (if there is one) that would respond to SSRIs (luvox, lexapro) and mirtazapine, cymbalta (haven't tried efexor cos I've read the horror stories...) simply because I've tried them before and they make the lack of drive/motivation/ the apathy/emotional numbness worse.

Me, too. Ten years ago, I pretty much tried everything in the sweety shop: SSRIs, a tricyclic, an MAOI (I think). Then several years of psychotherapy, which was wonderfully useful. But .... although it's made me much more sociable and realistic and relaxed, it hasn't touched the base problem.

So, I teamed up recently with a neurologist. 6 weeks of Edronax helped my motivation in weeks 2 + 3 only, did nothing for the big A, and left me feeling like I was in a horror film, about to be <this bit was censored by an administrator> :-).

> This is, I'm assuming from other posts I've read, very VERY familiar to you all... serotonin is great for anxiety relief and deep sadness, anger, crying spells, but in relieving those symptoms it tends to numb everything.

Doesn't it just.

> So I really want to get into the dopaminergic side of things... bupropion, selegiline, maybe low dose amisulpride or aripiprazole, and then some of the dopamine agonists...

Me, too. But there's something very, very strange about dopamine therapies. My neurologist, normally very open and frank, got very vague and evasive when I raised the subject. He ended up prescribing me Cymbalta, which I haven't touched yet. I don't think I really want to gothere.

> The most recent AD I've tried was cymbalta really helped me sleep..but that is ALL I wanted to do. It made apathy/anhedonia even worse if that's possible.

Ah, thanks! I _definitely_ don't want to go there.

> SO so so sick of's been going on for over a year and a half now...apathy towards everything, feeling nothing at's like feeling dead but still's worse than the more medically familiar sad, angry, negative affect (emotion) form of depresson which I have experienced 3-4 yrs ago.

Yes, I know. It gets a bit wearing. The few hours of pleasure I've had in the last 20 years started in a taxi with a splint round a smashed up knee, taking me home from a casualty department of a hospital. I was enjoying, _really_ enjoying the music on the taxi driver's radio. The world was wonderful till I got to bed about 2 in the morning. The knee healed up fully, by the way. The neurologist reckons I must have got a shot of morphine as a pain killer. I was in shock, and can't remember one way or the other.

> So..I'm just wondering what your thoughts are??

Dopamine enhancers: Dr. Bob, if you're reading, why are psychiatrists and neurologists so cagey about these? SSRIs and NoRIs are dispensed like there's no tomorrow, so why not Dopamine reuptake inhibitors? They do exist.

There used to be a French drug called amineptine, a tricyclic DoRI with only the most minimal side effects, if Wikipedia is to be believed. An archetypal "happy pill". The USA's FDA pressured the French into revoking its license, supposedly because of its "abuse potential". I guess the real motive was to protect their SSRI makers from competition from a drug that actually worked. Or maybe they decided that it was "immoral".

Cocaine is also a DoRI.

Now, it strikes me that any medication capable of relieving anhedonia has the potential to be "abused". It's obviously of far greater importance to prevent a few idiots getting stoned on happy pills than effectively to treat anhedonia. After all the crazy kids on the front page of a newspaper would trigger a social outrage, whereas us lethargic zombies just shut ourselves off waiting to die, which doesn't inconvenience anybody at all.

So my theory is that doctors are prohibited from prescribing DoRIs to us, and thus in effect, prohibited from treating anhedonia with effective drugs. I'm trying to get my neurologist to express a view about this.

> It appears that serotonin acting meds help with sleep, but only the dopamine acting meds have any real shot at alleviating anhedonia/apathy. And more than this, dopamine acting meds are liable to induce like where do I go??

I have no experience of insomnia. But I'd say, try out the dopamine drugs. You might sleep OK. Or you might sleep like a woman with a very young baby ;-(. At worst, you can always discontinue it.

> Do I have to choose between sleep and feeling any kind of emotion??

Hopefully not.

> If I took bupropion together with say sertraline (zoloft) you think they'd sort of cancel eachother out?? Or is that just way too simplistic??

If you do, please report your experience.

> Thanks again, X_ander.

Apologies if my anger comes over a bit too strongly.





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