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Apathy / Demotivation; not depression or side effect


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#31 jook

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Posted 29 December 2009 - 08:15 AM

I firmly agree with Kodos.

Talk to your doctor and tell him/her how you feel.
It's probably time to try a different med.

FWIW, I had very flat affect on Trileptal the two times I tried it.
Maybe you need a different bipolar med???

jook

Edited by jook, 29 December 2009 - 08:19 AM.

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my brain hates agonists and reuptake-inhibitors

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#32 creepy

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Posted 29 December 2009 - 08:24 AM

I had a 2am revelation that Im in the same spot as you, here. My life is passing by and I feel nothing nor have the desire to do anything. I think this is just anxiety creeping up on me but the cause is legit.
Im going down on my celexa and Im going to try to transition to something activating along with low dose lithium or lamictal.
I second the provigil. You might also look into replacing luvox with zoloft. I think even lamictal has some similar properties. It also hits sigma like those OCD meds.


I wasn't sure where to post this...

I'm bipolar and ocd. Taking 900mg trileptal and now 100mg luvox.

I'm not depressed really or having any anxiety. I just feel a horrible amount of apathy now. No motivation either anymore. Having bizzare thoughts like life doesn't matter anymore but I'm not suicidal at all. I get NO pleasure anymore. Also time seems to be passing at incredible rates. Like a weeks time goes fast and feels like a day went by. Its scary how fast the time passes. Worried I'm just gonna die and my whole life was pointless but I'm not depressed so I don't know why I'm feeling this way. Not a spritual person either anymore. I'm starting to think I just cant *connect with life* n e more and no matter what I do I can't get this feeling back. Next time I blink my eye 10 years could pass. I can't figure out where this feeling is coming from. DESENSITIZED TO EVERYTHING!

At what point do I just **accept** what mental illness has done and the meds can't help n e more??

Also I feel its pointless to tell this to my doc cause I don't think he can do anything about it.


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#33 Yuna

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Posted 29 December 2009 - 08:35 AM

I firmly agree with Kodos.

Talk to your doctor and tell him/her how you feel.
It's probably time to try a different med.

FWIW, I had very flat affect on Trileptal the two times I tried it.
Maybe you need a different bipolar med???

jook


Well I was on the 900mg trileptal for a good 2 months before the OCD med was added.
I don't remember having any problems with flat effect or unmanageable depression (though the brain fog got me but that finally wore off [or I just got used to it- scary]). So the question is the flat affect or something similar to what I'm feeling coming from the trileptal and it just takes a while for this to occur and I'm confusing it with the addition of the OCD med??
Who can answer this stuff??? :mad:
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#34 jook

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Posted 29 December 2009 - 08:47 AM

Who can answer this stuff??? :mad:


Your doctor.

I was taking 1200 mg. Trileptal both times so maybe that's why I had problems and you aren't?
Not trying to confuse matters but seems Trileptal isn't the culprit.

May be time to back down a bit on the Luvox. Say 50 mgs?

Talk to doc.

jook
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my brain hates agonists and reuptake-inhibitors

former rx= Lexapro, Wellbutrin, Effexor, Zoloft, Topamax, Lamictal, Depakote, Lithobid, Trileptal, Gabitril,
Zonegran, Seroquel, Risperdal, Invega, Zyprexa, Abilify, Geodon, Ativan, Xanax, Valium, BuSpar, Nuvigil
various combinations with all of the above

#35 Yuna

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Posted 29 December 2009 - 08:51 AM

"I think even lamictal has some similar properties. It also hits sigma like those OCD meds."
What does that mean explain that please.

I should continue this discussion over someplace else but...

These SSRIs are used for depression and anxiety too but anxiety is a motivating factor in life.
Take away too much anxiety and does the motivation go with it? Maybe thats just my imagination creating a crazy theory and I'm interpretting my situation wrong. Ever since adding the Lexapro and now switching to luvox my ass has given up.
The trileptal alone and my ass was functioning fine (although bugging a little about a certain ocd thought). I really wish I knew EXACTLY whats going on here.
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#36 Jerod Poore

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Posted 29 December 2009 - 01:51 PM

"Agents included amantadine, amphetamine, bromocriptine, bupropion, methylphenidate, and selegiline."

There aren't any good studies on this r there?


Not really.

As it is now, apathy & anhedonia are primarily thought of as either symptoms of depression or negative symptoms for conditions on the psychoses spectrum, or side effects. As a syndrome itself the neurologists have latched onto it as a precursor to Parkinson's and/or Alzheimer's. Some doctors and a few researchers consider it to be a condition in of itself that may be comorbid with affective mood disorders.

Considering that the crazy are significantly more likely to develop Parkinson's, apathy syndrome is something shrinks should be dealing with before we get too old, not after.

Increased risk of developing Parkinson's disease for patients with major affective disorder: a register study.

METHOD: By linkage of public hospital registers from 1977 to 1993, three study cohorts were identified: patients with affective disorder episodes (mania or depression) and patients with osteoarthritis or diabetes. Time to the first diagnosis of Parkinson's disease was estimated with the use of survival analysis. RESULTS: A total of 164,385 patients entered the study base. The risk of being given a diagnosis of Parkinson's disease was significantly increased for patients with affective disorder, odds ratio 2.2 (CI 95% 1.7-2.8) compared with osteoarthritis, and depressive disorders, odds ratio 2.2 (CI 95% 1.7-2.9) compared with osteoarthritis. CONCLUSION: This study supports the hypothesis of a common aetiology for major affective disorder and Parkinson's disease.


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#37 Yuna

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Posted 29 December 2009 - 07:42 PM

"Agents included amantadine, amphetamine, bromocriptine, bupropion, methylphenidate, and selegiline"
I wonder if my doctor would even know about the bupropion option or the stimulants. When people suggest this stuff to help with the above, r they saying they just found this out for them selves or the docs know this (to help with negative symptoms)?


"Considering that the crazy are significantly more likely to develop Parkinson's, apathy syndrome is something shrinks should be dealing with before we get too old, not after."

Does fixing the apathy mean they can fix the Parkinsons or vice versa then? :)

Hmmmm alot of bad things are gonna happen to the crazy by the time we old. The sidebar on that site was very inspiring. Brought my mood up 10+ points.

I was thinking about this the other day didn't most of these meds only come out in the last 10years? :mad:
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#38 Jerod Poore

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Posted 30 December 2009 - 02:05 PM

Does fixing the apathy mean they can fix the Parkinsons or vice versa then? :mellow:


It's dueling studies. Dopaminergics may or may not work, they may or may not prevent Parkinson's by preventing degeneration where it counts (are neuroprotective).

For example Potential neuroprotection mechanisms in PD [Parkinson's Disease]: focus on dopamine agonist pramipexole. In a review of twenty years worth of studies, trials, etc. on Mirapex (pramipexole) sometimes with other dopamine agonists or similar agents...

CONCLUSIONS: Although the evidence is promising, neuroprotection in PD remains an elusive goal. In whatever form it emerges, neuroprotective therapy would be a strong argument against deferring PD treatment until symptoms are a significant life impediment, and thus would add urgency to early PD identification.


Or: it looks like it works, but it's kind of hard to identify, let alone create, a control group of people showing apathy syndrome or other early signs and they aren't going to take anything for it so there's something to compare with people who are going to get early intervention with dopaminergics or other treatments.

And here's fourteen years worth of different treatments used for early-as-possible intervention. Fourteen-year final report of the randomized PDRG-UK trial comparing three initial treatments in PD. Where they found bromocriptine didn't do squat, but carbidopa, with or without selegine was good. Except for that bit about 60% of the cohort (everyone in the study) died before it was over, skewing the numbers. Long-term outcome in Parkinson disease: no advantage to initiating therapy with dopamine agonists. Oops.

Here's something I don't see too often, a review of dueling studies. When and how should treatment be started in Parkinson disease?

Ideally, neuroprotective therapy would be started at the time of diagnosis. However, no treatment has been unequivocally shown to modify disease progression, and those that have some evidence for this effect all provide confounding symptomatic benefits, which may also be important to supplement faltering compensatory mechanisms within the basal ganglia. Dopamine agonists are clearly associated with a reduction in the incidence of dyskinesias in the early years, but it is not certain that this translates into long-term benefit. In addition, a number of nonmotor side effects are more frequently associated with dopamine agonists than with levodopa.


In other words, someone got grant money to write a paper on "which sucks less?"

The calculus is complicated. For people with depressive disorders and not much else it's relatively simple. As long as something like Wellbutrin, selegiline, Mirapex or methylphenidate doesn't make things worse you may as well discuss with your doctor about adding it or replacing one or more of your meds with it.

For everything else it can be difficult. Many of those meds lower seizure thresholds, can trigger manias and/or psychotic episodes, probably aren't all that great for migraines and panic/anxiety disorders. Others can be helpful or have no effect so they're worth discussing.

I was thinking about this the other day didn't most of these meds only come out in the last 10years? :mellow:


Just some of the popular ones. Levodopa has been in use since the 1950s, bromocriptine has been around since at least the 1970s.
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#39 creepy

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Posted 30 December 2009 - 02:58 PM

"I think even lamictal has some similar properties. It also hits sigma like those OCD meds."
What does that mean explain that please.


http://www.ncbi.nlm....les/PMC2699655/

Seems like sigma receptors may have something to do with OCD, but the logic is kind of weak. Like 'if this med that works on sigma helps ocd and this one which does not, doesnt help, then it must be related to sigma receptors'
Ive read this in a couple places, that its suspected that sigma has something to do with OCD since the drugs that help it share this trait in common. But sigma seems to regulate a lot of other things like this article says. Way over my head =(
It might be something to base a med choice on in the absence of any better ideas though. since there are other meds which touch sigma and arent the usual suspects like zoloft, lexapro, clomipramine and luvox, you might give them a shot to see if they also help OCD. I found two lists of drugs that work on sigma in a couple minutes of searching. Im sure theres more info out there.
Lexapro hits me hard. feels like Im taking an antipsychotic sometimes. I dont think I want to remain drugged out and sleeping my life away anymore.

Its a PITA to learn all this stuff, but becoming a good advocate for your care can help you get the right treatment. Ive met a lot of docs (like the one I have now, Grrr...) that are so overbooked and hemmed in by the insurance industry and potential litigation that theyre pretty ineffective.

Edited by creepy, 30 December 2009 - 03:02 PM.

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#40 dymphna

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Posted 31 December 2009 - 12:27 AM

Dostinex, which is now only available as the generic Cabergoline, has "a high affinity for D2 receptors [...] (and) has low affinity for dopamine D1, α1- and α2-adrenergic, and 5-HT1- and 5-HT2-serotonin receptors." It has been approved since 1996. IVAX pharm (a division of TEVA) makes an exact copy of Pfizer's Dostinex (very nice Teva chemist on the phone kindly faxed me that one...).

Mirapex (Pramipexole), which "high relative in vitro specificity and full intrinsic activity at the D2 subfamily of dopamine receptors, binding with higher affinity to D3 than to D2 or D4 receptor subtypes." RxList

What does this mean? Well, it depends.

According to the Merck manual:

Agonists and Antagonists: Drugs that target receptors are classified as agonists or antagonists. Agonist drugs activate, or stimulate, their receptors, triggering a response that increases or decreases the cell's activity. Antagonist drugs block the access or attachment of the body's natural agonists, usually neurotransmitters, to their receptors and thereby prevent or reduce cell responses to natural agonists.


So Cabergoline stimulates the D2 receptor (dopamine #2 receptor) a LOT, but just brushes the D1 and the rest of the stuff. A person isn't likely to get any side-effects similar to those from a SSRI from a drug like Cabergoline (though, if sensitive, they may get some).

Mirapex hits the full monty of dopamine receptors. Think of it more as Wellbutrin on speed. Our dopamine receptors are our "pleasure centers" - why do you think coke is so attractive? And leaves a person so paranoid? And manic? And destructive of their life? And, and, and... Sure, there are people who can do a line and quit - they need the dopamine. There are people who do marvelously on Mirapex. Just not everyone.

This is how we end up with years of self-medication prior to diagnosis. Our brains know what they want (up, down, this amino acid, that weird chemical release), and our bodies scramble to "fill the hole", so to speak. Unless some kindly, decent, INTELLIGENT Pdoc gets ahold of us. And we listen to him.


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#41 creepy

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Posted 31 December 2009 - 12:34 AM

Id love to try some of those drugs since I had such a mixed response on wellbutrin. norepinephrine makes me anxious and doesnt do squat for my motivation. Seems to do more for my depression when I stop an NRI than starting or increasing the dose.
Dopamine is what gets me out of lexapro apathy.
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#42 jook

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Posted 31 December 2009 - 08:49 AM

Dopamine is what gets me out of lexapro apathy.


Same reason why cocaine is such a popular drug.
Too bad it's so freakin' addictive/abused.

jook
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former rx= Lexapro, Wellbutrin, Effexor, Zoloft, Topamax, Lamictal, Depakote, Lithobid, Trileptal, Gabitril,
Zonegran, Seroquel, Risperdal, Invega, Zyprexa, Abilify, Geodon, Ativan, Xanax, Valium, BuSpar, Nuvigil
various combinations with all of the above

#43 creepy

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Posted 31 December 2009 - 09:04 AM

Dopamine is what gets me out of lexapro apathy.


Same reason why cocaine is such a popular drug.
Too bad it's so freakin' addictive/abused.

jook


The addictive quality probably has to do with how the drug causes the release of more dopamine rather than just inhibiting its reuptake, like amphetamine. So the adaptation to excess dopamine is to produce less normally which causes the user to need more.
Wellbutrin seems to give a great response followed by a poop-out after a few weeks. Do patients on mirapex and other dopaminergics experience the same thing? Even though its a reuptake inhibitor I wonder if the mechanism is similar?
Ive also given consideration to MAOI-B's like selegiline but my doc would never go for that.

Ive wondered about this for awhile.. even if a drug is a reuptake inhibitor or inactivates MAO, which causes more of a neurotransmitter to hang around, wouldnt the brain just adapt to the presence of more and produce less without the drug?
It would seem like this feedback loop would make any medication useless, but we know it does work, somehow.
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#44 jook

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Posted 31 December 2009 - 10:33 AM

Ive wondered about this for awhile.. even if a drug is a reuptake inhibitor or inactivates MAO, which causes more of a neurotransmitter to hang around, wouldnt the brain just adapt to the presence of more and produce less without the drug?


In theory, the brain should produce more receptors when re-uptake is blocked.

jook
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my brain hates agonists and reuptake-inhibitors

former rx= Lexapro, Wellbutrin, Effexor, Zoloft, Topamax, Lamictal, Depakote, Lithobid, Trileptal, Gabitril,
Zonegran, Seroquel, Risperdal, Invega, Zyprexa, Abilify, Geodon, Ativan, Xanax, Valium, BuSpar, Nuvigil
various combinations with all of the above

#45 Yuna

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Posted 31 December 2009 - 02:24 PM

Dopamine is what gets me out of lexapro apathy.


Same reason why cocaine is such a popular drug.
Too bad it's so freakin' addictive/abused.

jook



Frued used to give cocaine to his patients I think intervenously..... I wish my doctor did that at therapy sessions... :mad:
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#46 jook

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Posted 31 December 2009 - 04:01 PM

Dopamine is what gets me out of lexapro apathy.


Same reason why cocaine is such a popular drug.
Too bad it's so freakin' addictive/abused.

jook



Frued used to give cocaine to his patients I think intervenously..... I wish my doctor did that at therapy sessions... :mad:


Siggy was actually a big user himself and he applauded it's delights to the masses.
That is, until he got hooked and got psychotic on it.
Then he changed his tune.

jook
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my brain hates agonists and reuptake-inhibitors

former rx= Lexapro, Wellbutrin, Effexor, Zoloft, Topamax, Lamictal, Depakote, Lithobid, Trileptal, Gabitril,
Zonegran, Seroquel, Risperdal, Invega, Zyprexa, Abilify, Geodon, Ativan, Xanax, Valium, BuSpar, Nuvigil
various combinations with all of the above

#47 Jerod Poore

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Posted 02 January 2010 - 02:35 PM


Same reason why cocaine is such a popular drug.
Too bad it's so freakin' addictive/abused.

Frued used to give cocaine to his patients I think intervenously..... I wish my doctor did that at therapy sessions... :)

Siggy was actually a big user himself and he applauded it's delights to the masses.
That is, until he got hooked and got psychotic on it.
Then he changed his tune.


One major reason why Freud thought cocaine was God's gift to psychopharmacology: it helped people break their addiction to morphine.

Ooops.

The addictive quality probably has to do with how the drug causes the release of more dopamine rather than just inhibiting its reuptake, like amphetamine.


Pharmacokinetics play a big part in that. The peak plasma for snorted, smoked or injected coke is two to six minutes, half that of abusing amphetamines in a similar manner. Even if you try to do it slowly cocaine reaches peak plasma in only 20 minutes. Adderall XR doesn't reach peak plasma for eight hours. Cocaine's half-life is under an hour, the half-life for amphetamines is 12 hours. Chewing coco leaves, like they do in parts of South America, isn't all that healthy, but the different pharmacokinetics, in addition to the lesser potency, make that habit somewhat easier to quit.

Another reason is hormones. Cocaine and nicotine stimulate the release of hypothalamic-pituitary-adrenal hormones. Amphetamines have little, if anything to do with those. That's where the "cigarettes are as hard/harder to quit than cocaine/heroin" comes from.

Concurrent Pharmacokinetic Analysis of Plasma Cocaine and Adrenocorticotropic Hormone in Men

Hormones, nicotine, and cocaine: Clinical studies.

One of the big names in pharmocology said something along the lines of cocaine would make a great ADHD medication if it didn't peak so soon and had a longer half-life. I'm sure Freud would be recommending it for Apathy Syndrome as well.
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
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#48 In_Remission_conundrum

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Posted 30 August 2010 - 10:12 AM

I'm reopening this thread, since it looks like it deals with some issues I have with anhedonia and lack of motivation.

From my experience I've found that I need a combination of dopamine AND norepinephrine, and for me, I need it for more than a 24 hour period to work. I've tried all kinds of dopaminergic supplements that did nothing. I tried wellbutrin which did nothing except give me side effects so I couldn't go up to 450 mgs. I tried ritalin, which surprisingly did nothing. I've found a low dose of prozac, 5 mg every other day(it has a long half life), increases motivation and some interest but still not much emotional depth. Prozac blocks 5 HT2C receptor which is probably why this is effective in small doses but not in higher doses. But blocking this receptor increase norepinephrine and dopamine in the Prefrontal Cortex (PFC) and increase norepinephrine in this area more than dopamine. I think that norepinephrine is key to concentrating and motivation along with dopamine.

There are rat studies that show that norepinephrine depleted mice do not show a place preference to cocaine and morphine over food unlike regular mice. This indicates that that norepinephrine is some how tied to enjoying, motivation and perhaps anhedonia.

Recently I've experienced this myself. I have been taking mirtazapine for awhile with no benefit. At first there was some motivation but it kind of pooped out in less than two weeks. Going up 15mg didn't help. Then my pdoc added abilify. After getting to 2.5 mg I started feeling more interested in things, similar to how low dose prozac effects me. We thought the abilify was helping but not the mirtazapine, so we started to decrease mirtazapine. After awhile I noticed I had no interest in doing things anymore.

So two things could have happened. Everything pooped out or the increase in dopamine in the PFC needs the increase in norepinephrine from mirtazapine as well.

Unfortunately these two drugs and prozac only increase dopamine and norepinephrine in the PFC. They don't get into the mesolimbic areas or the striatum. Well higher doses of abilify do block dopamine in the nucleus accumbens.

Here are some studies showing I'm not shoveling you bullsh*t



http://www.sciencedi...62&searchtype=a

Aripiprazole increases dopamine but not noradrenaline and serotonin levels in the mouse prefrontal cortex


http://onlinelibrary....00982.x/abstra


Mirtazapine enhances frontocortical dopaminergic and corticolimbic adrenergic, but not serotonergic, transmission by blockade of α2-adrenergic and serotonin2C receptors: a comparison with citalopram

There are plenty of studies showing that NE depleted mice don't show a preference to drugs like cocaine or amphetamine. Just google conditioned place preference, norepinephrine followed by cocaine, morphine, or amphetamine.

Just something to consider for the folks who have had limited success with DA selective drugs or shorter acting stimulants. TCAs and 5 HT2C antagonistist might help. Pristiq even added some emotional depth until it began to feel like an normal SSRI.

Edited by conundrum, 30 August 2010 - 10:37 AM.


#49 Luna-

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Posted 26 December 2010 - 05:15 AM

I'm re-activating this topic as it seems to fit my issue.

My apathy and passivity are becoming irritating. I get nothing done. I don't want to do anything. Thinking back and looking around me, I see evidence of many projects that I tackled but these days would never get off the ground. It's not depression, as I'm doing OK. It's not flat affect or lethargy or anhedonia. I am just so damn passive and I didn't used to feel this way. SO ...

Now I'm stewing over whether it's my meds. Before I was dx'ed BP, I was mostly on serial monotherapy for MDD. I didn't have this apathy and passivity back then, except in active depression. Now I'm on 4 drugs for bipolar, 1 for hypothyroid and 2 for hypertension and this has worsened. I read about Apathy Syndrome, but since I didn't feel this way before, I don't think it fits.

Can anyone tell me if one of the following meds might have something to do with this?
Lamictal 400mg
Geodon 160mg
Wellbutrin 300mg
Effexor 150mg
Enalapril 25mg / HCTZ 12.5mg (for hypertension)

I've left my thyroxine off the list as I KNOW that without it, I'd never get out of bed. Wellbutrin gave me great energy in the first month or so but not much anymore. It's been a battle to find meds and I've had to settle; I hope I don't have to settle for this.

Someone here (Deep Sea Philosopher, maybe?) recently said I am on a lot of activating meds. If this is true, then WTF? I don't feel tired, I don't oversleep, I'm not particularly lethargic. I just don't care about much and I don't want to initiate anything. Not looking for support, I'm on the hunt for reasons, so I can fix it. (If I can ever get around to it. ;-) )

Edited by Luna-, 26 December 2010 - 05:59 AM.

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#50 Jerod Poore

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Posted 28 December 2010 - 04:08 PM

My apathy and passivity are becoming irritating. I get nothing done. I don't want to do anything. Thinking back and looking around me, I see evidence of many projects that I tackled but these days would never get off the ground. It's not depression, as I'm doing OK. It's not flat affect or lethargy or anhedonia. I am just so damn passive and I didn't used to feel this way. SO ...

Now I'm stewing over whether it's my meds. Before I was dx'ed BP, I was mostly on serial monotherapy for MDD. I didn't have this apathy and passivity back then, except in active depression.


The first thing to evaluate is: how much of what you're trying to get back is due to hypomania? Apathy is one thing, not being excited about something just because it's new and shiny is something else entirely.

Can anyone tell me if one of the following meds might have something to do with this?
Lamictal 400mg
Geodon 160mg
Wellbutrin 300mg
Effexor 150mg


Passivity is something that seems more like a side effect, although that, too, is a matter of perspective. The answer is: all of the above. Order of likelihood: Geodon, Lamictal, Effexor, Wellbutrin.
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#51 Luna-

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Posted 29 December 2010 - 07:08 PM

Thank you very much Jerod.

The first thing to evaluate is: how much of what you're trying to get back is due to hypomania? Apathy is one thing, not being excited about something just because it's new and shiny is something else entirely.

Wha-a-t? You mean this is as good as it gets? I want my money back! ;-)

I thought hard about this. Of course I would love the hypomanias back, not the manias, just the hypos. But no, the hypos aren't my "normal" state. Nor is this level of apathy, though. This is like the apathy I experienced on all 4 of the SSRIs that I tried. The emotional blunting, disconnection, kind of apathy, like I'm sitting on the side-lines of life. Not as much of a blob as I felt on lithium but still inert. Getting even basic things done requires a lot of effort. I'm not in depression though, so maybe this is what I have to settle for. :-(

Order of likelihood: Geodon, Lamictal, Effexor, Wellbutrin.

I have a chat with the pdoc due in a month. Will bring it up. Thanks, appreciate the help.

Edited by Luna-, 29 December 2010 - 07:09 PM.

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#52 Jerod Poore

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Posted 30 December 2010 - 12:26 PM

This is like the apathy I experienced on all 4 of the SSRIs that I tried.

Which must not have been related to...

Before I was dx'ed BP, I was mostly on serial monotherapy for MDD. I didn't have this apathy and passivity back then, except in active depression.


Based on the updated information, new order of likelihood/effect: Effexor, Geodon, Lamictal, Wellbutrin.
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Current meds: lamotrigine 300mg, topiramate 325mg, buspirone 60mg, protriptyline 60mg, EPA 600mg, methylphenidate 5-10mg, lorazepam 1mg PRN
Past meds (likely incomplete): Abilify, clonazepam, desipramine, diazepam, Gabitril, lithium, Neurontin, Paxil, prochlorperazine, Provigil, Prozac, Risperdal, Seroquel, Serzone, Strattera, Trileptal, Zyprexa

#53 Luna-

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Posted 31 December 2010 - 01:33 AM

Based on the updated information, new order of likelihood/effect: Effexor, Geodon, Lamictal, Wellbutrin.


Effexor? Effexor and I are lovers! Our 7-yr anniversary is coming up. We couldn't bear to part! :-)

I'm surprised. Would you mind telling me why you say this?

Perhaps I should have said: Before I was dx'ed BP, I was mostly on serial monotherapy for MDD. I didn't have this apathy and passivity back then, except in active depression and when on SSRIs. (I was touring all of the AD classes back then.)

One other piece of information: Effexor has made me switch a couple of times. It's mostly OK when buffered by a mood stabiliser. One such switch sent me to hospital despite the Lamictal. Effexor works fantastically for my mood, hence the love affair, but I know I walk a tightrope there. It doesn't help the physical symptoms of depression but the Wellbutrin takes care of those. To be honest I am afraid of dropping the Effexor and plunging. So if it is Effexor causing the apathy/passivity, it may then become a case of settling for what I can get and trying to gather together willpower to get moving. Fuelled by a moderate intake of coffee.

Feel free to point out if I am contradicting myself. Geodon made sense to me as Seroquel made me dull and stupid. Basically I just don't want to hear what you're telling me now. :-) Do I have my head in the sand or could you move Effexor a little further down the list?
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#54 Classically_James

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Posted 04 January 2011 - 12:17 AM

As far as SSRI's, the most stimulating seem to be Prozac (fluoxetine) and Zoloft (sertraline). I started Zoloft a few weeks ago and my appetite is just gone. It is stimulating and much less lethargic than Lexapro imo.

Bupropion is very helpful for energy, but I'm now on the SR version, because on XL I couldn't even tell I was taking it. The original i.m. Wellbutrin will get your ass up and moving - it's way more stimulating than SR and especially XL, I've found. Worth a try.

If you are taking an AAP, those can cause a lot of tiredness, apathy, and basically not giving a damn.

Alicia- The higher doses of Geodon are indeed more sedating. Try lowering the dose to 60 mg twice a day, or even 40 mg twice a day. Just watch for returning mania/psychosis. Good luck.

James

Edited by James H, 04 January 2011 - 12:21 AM.

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Diagnoses:

-Major Depressive Disorder (MDDAtypical Type)

-Somatoform Pain Disorder (Subtype: Psychological)

-Cotard's Syndrome (in remission)

-Borderline Personality Disorder (recovered)

 

 

Current Crazymeds:

-Abilify (proprietary aripiprazole by Otsuka) 10 mg QAM 

-Cymbalta (proprietary duloxetine delayed-release by Lilly) 120 mg QAM

-Forfivo XL (branded generic bupropion hcl extended-release by Edgemont) 450 mg QAM

-quetiapine (generic Seroquel by Lupin) 200 mg QHS

-baclofen (generic Kemstro by Zenith) 20 mg TID

 

 

Other Medications:

-Androgel 1.62% (proprietary topical testosterone gel by Abbott) 81 mg QAM

-atorvastatin (generic Lpitor by Dr. Reddy's) 20 mg QHS

 

 

 

 

 

 

 

 


#55 In_Remission_bonkers

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Posted 04 January 2011 - 09:50 AM

Hopefully this isnt hi-jacking a post but here goes. I'm undiagnosed Personality Disorder. (maybe Borderline, dont know and probably never will as psych refuses to accept my belief) Anyway was on MAOI uptill Christmas last year and started to feel depression and apathy amongst other things so doc pushed to change - so I did, he said Prozac, I said 'yes, boss' and TRUDGED through the past year. I had continuous problems with tiredness, weakness etc so GP suggested lower the dose by 20 mg. Now on 20mg one day and 40mg the next and so on. Lately been feeling 'patches' of apathy which seem to be growing. Would seem to be lack of meds on the face of it but beyond apathy just now, just as the person above posted- I could sit all day and glue myself to the tv. Im no angel but 'acheiving things and not wasting time' is one of my 'problems' so where have they gone cos I kinda dont really care..... I cant care. Being borderline or whatever Ive felt emotionally blocked but never this 'switched off'. Its like Ive lost some PD symptoms and the others have increased in strenght- basically I havnt felt 'well/even slightly rational/normal' all year since I started. Is this unusual? Is this possible for a PD person, would we feel totally different on Tranylcypromine as to being on prozac? Odd question, sorry but being a working single mother, Im not making a good go of things just now and I need to get back to 70% instead of bumbling about at 20%! I have a 15 and 16 yr old so I need to be as 'on the ball' as I can manage. Its my New Year reslolution to get myself better to an acceptable point- Im 40 and life is getting too short for this level of feeling 'bleah!' thanks.


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