[notfred]

I would suspect the Lex but many AD's are assoc. with apathy. I find Provigil is great for busting through apathy.

nf

[Yuna]

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.

[jook]

Yuna, on Sun 27 December 2009 12:32:23 GMT +0000, said:

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!

I've also been fighting the same 'feelings' lately.

I chalk it up to atypical depression/anxiety. Doesn't feel like run-of-the-mill depression or anxiety but it is nevertheless.

jook

[Yuna]

jook, on Sun 27 December 2009 13:10:52 GMT +0000, said:

Yuna, on Sun 27 December 2009 12:32:23 GMT +0000, said:

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!

I've also been fighting the same 'feelings' lately.

I chalk it up to atypical depression/anxiety. Doesn't feel like run-of-the-mill depression or anxiety but it is nevertheless.

jook

This shit is too much to handel now. Not looking for support but... I used to go to school, go to work, maintain a car, go to church, do things "outside the house". Now thats all gone and I haven't really left my house in the last year. Blood work is normal and the meds help and being off the meds or on don't make motivation any different. Does anyone know if a stimulant or one of those ADD meds could help, I don't know anything about them???

[Jerod Poore]

This has come up several times before, just all over the place. I've merged a few of the topics together. There are more, which may or may not be added to this one.

Yuna, on Sun 27 December 2009 11:32:23 GMT +0000, said:

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!

You've actually described a few different things.

"I get NO pleasure anymore." is anhedonia. That can be a problem by itself, a negative symptom of schizophrenia (and everything else with negative symptoms), and a symptom of stuff in the affective mood disorder spectrum (schizoaffective disorder and all of the bipolar and depression variants).

"Having bizzare thoughts like life doesn't matter anymore but I'm not suicidal at all. " Automatic negative thoughts. You find those in various forms of affective mood disorders, more often than in OCD.

And while it can all be bundled together as either or both of depression / negative symptoms or side effects, you've also described Apathy Syndrome (the neuropsychiatric condition that exists in the real world, and not just in video games and allied media). Here's a case for apathy syndrome to be in the DSM. I don't know if it is a stand-alone condition, but it is certainly part of various forms of brain cooties and, just to make us all feel super great about ourselves, a potential warning sign for Alzheimer's, Parkinson's, or both.

Yuna, on Sun 27 December 2009 11:32:23 GMT +0000, said:

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.

Mild stimulants such as Provigil (modafinil) and Ritalin (methylphenidate), and dopamenergics like Wellbutrin (bupropion) have been shown to help. Unfortunately most of the research is on geriatric patients. The bipolar + OCD combo is tricky, but you can still ask.

Provigil and methylphenidate (not at the same time) have helped me, but can do only so much. Especially since I'm epileptic and sometimes have to up my dosage of one anticonvulsant or another. I've pretty much given in to giving up about doing much of anything these days. At this point I'm happy with things not getting any worse.

[Yuna]

So I don't get alot of pleasure n e more. But I don't care either. Wait is that bad then?

I see how the depression part can be fixed possibly. When you use the term "negative symptom of the mood spectrum disorders" specifically you were referring to BOTH the apathy and anhedonia? And the stimulants and wellbutron can possibly help with the negative symptoms (both the apathy and anhedonia??). So if both the apathy and anhedonia aren't from depression then they can BOTH be from negative symptoms?

[Yuna]

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

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

[jook]

Yuna, on Mon 28 December 2009 19:02:08 GMT +0000, said:

So I don't get alot of pleasure n e more. But I don't care either. Wait is that bad then?

Depends on what you call 'bad'.

Yuna, on Mon 28 December 2009 19:02:08 GMT +0000, said:

I see how the depression part can be fixed possibly. When you use the term "negative symptom of the mood spectrum disorders" specifically you were referring to BOTH the apathy and anhedonia? And the stimulants and wellbutron can possibly help with the negative symptoms (both the apathy and anhedonia??). So if both the apathy and anhedonia aren't from depression then they can BOTH be from negative symptoms?

As Jerod pointed out, apathy and anhednoia can be caused by schizophrenia, schizoaffective disorder, bipolar disorder or major depressive disorder. My bet is it is a part of your depressive bipolar side since that is your diagnosis.

Stims are off-label treatment. ADs are mainline treatment.

Here again, apathy and anhedonia are both symptoms of depression. You don't have to feel suicidal to have depression. You don't have to stay in bed for days to have depression.

jook

[Kodos]

What's the rationale with the trileptal? Is that good for bipolar?

Anyhow, I've found that Wellbutrin helps with the apathy and motivation somewhat. I still have "reduced affect" - which, as you described, is sort of just existing while not being very sad or very happy. High functioning, but not enjoying life. Look up dysthymia sometime.

You could also look at switching the luvox to another SSRI. On Lexapro, after a while, I didn't want to do anything and didn't care about anything. The next two SSRIs I tried made me sick as a dog. I'm on Paxil (gasp) now, which I find is the best one so far.

Your psychiatrist may have other ideas.

[Yuna]

Yeah I take the trileptal for the bipolar and the luvox for the ocd. Tried the lexapro and felt the same way you did. The 100mg luvox is starting to knock me on my ass now though. Getting sick of this shit.

[jook]

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

This post has been edited by jook: 29 December 2009 - 08:19 AM

[creepy]

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.

Yuna, on Sun 27 December 2009 13:32:23 GMT +0000, said:

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.

[Yuna]

jook, on Tue 29 December 2009 9:15:50 GMT +0000, said:

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???

[jook]

Yuna, on Tue 29 December 2009 9:35:21 GMT +0000, said:

Who can answer this stuff???

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

[Yuna]

"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.

[Jerod Poore]

Yuna, on Mon 28 December 2009 18:11:58 GMT +0000, said:

"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.

Quote

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.

[Yuna]

"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?

[Jerod Poore]

Yuna, on Tue 29 December 2009 19:42:26 GMT +0000, said:

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...

Quote

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?

Quote

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.

Yuna, on Tue 29 December 2009 19:42:26 GMT +0000, said:

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.

[creepy]

Yuna, on Tue 29 December 2009 10:51:14 GMT +0000, said:

"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.

This post has been edited by creepy: 30 December 2009 - 03:02 PM

[dymphna]

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:

Quote

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.


Dymphna