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Re: Meds to improve task initiation

Posted by SLS on April 2, 2022, at 17:47:42

In reply to Meds to improve task initiation, posted by NKP on March 26, 2022, at 10:56:21

> Are there any meds that help with task initiation? I struggle to get going on tasks. I tend to feel extremely unmotivated to do anything, and I can spend hours doing pretty much nothing but lying on the couch and daydreaming and watching YouTube videos.
> Might flupentixol or aripiprazole improve this?
> I'm currently on:
> venlafaxine 225 mg/day
> lamotrigine 100 mg/day
> Or am I just lazy?
> My psychiatrist has referred me to an occupational therapist for assessment and possible help.

Mild-to-moderate depression feels like laziness. It is the result of the co-occurrence of amotivation and anergia. The sensation of fatigue (anergia) that comes from depression, and the lack of motivation (amotivation), gang up on you. You just don't feel like doing anything.

I guess dopamine would be the first thought as to what to target as a treatment for amotivation. Abilify has the potential to stabilize the postsynaptic membrane. If there is too much dopamine, the net effect of Abilify is to reduce the excitability of the postsynaptic neuron. When there is too little dopamine, Abilify acts to stimulate the empty receptors.

"On paper", cariprazine (Vrylar) looks better than Abilify to increase dopaminergic neurotransmission along those tracts that use D3 receptors. D3 receptors seem to be important for lifting mood and increasing energy. cariprazine favors D3 receptors more than does Abilify. Cariprazine has a higher binding ratio of D3/D2 compared to Abilify.

I wonder if lumateperone (Caplyta) would be something for you to look into. It is described as being particularly good at treating bipolar depression. It is my impression that dopamine contributes more to bipolar depression than it does to unipolar depression. That's a really simplistic explanation, though. More recently, glutamate has become a substance of study in affective disorders. Lumateperone acts to "modulate" not only glutamatergic neurotransmission, but it modulates dopamineergic and serotonergic neurotransmission as well. I don't know enough about lumateperone to dislike it.

- Scott

Some see things as they are and ask why.
I dream of things that never were and ask why not.

The only thing necessary for the triumph of evil is that good men do nothing.




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