apathy are there any meds that don't do this?

[RockiNToM]

So answering a topic related to Zoloft in one of the other threads, it reminded me how apathetic I felt while on Zoloft and got me thinking.

While I was on Zoloft it worked pretty great at getting me out of my depression but it made me just feel flat and emotionless. My anxiety was better but not by much either. However the strange thing is Paxil did the complete opposite: it gave me an almost manic type of happiness and extreme reduction in anxiety until it inevitably stopped working. Other serotonin inhibitors did pretty much the same as Zoloft except Celexa gave me more side-effects and Prozac on the other hand was too stimulating and Effexor was just smack in the middle.

The only other medication I've taken other than Paxil that hasn't caused apathy is Mirtazapine, but as some of you know I had a bad time with that one with the side-effects.

So my question is, are there any anti-depressants out there that don't cause this state of apathy so commonly felt with serotonin inhibitors?

I also understand that because of the way these medications work there is a reduction in dopamine, which as a result can cause a decrease in pleasure, also resulting in apathy. But how do you pick out the ones that do this the least? because in my experience certain medications have done this more than others.

I find it strange that other people post their reviews on their meds and don't really mention anything about apathy. Am I a minority in this strange problem that I experience with anti-depressants or is this more common than I realise?

[IllusionalFate]

Coming from someone who isn't depressed at all, Nardil lifted my mood and made me appreciate a lot of the more subtle things that life has to offer. Selegiline was pretty much a sugar pill.

I think the nonselective MAOIs are the least likely to induce apathy due to 5-HT and DA working together.

[jim_morrison]

Originally Posted by RockiNToM

However the strange thing is Paxil did the complete opposite: it gave me an almost manic type of happiness and extreme reduction in anxiety until it inevitably stopped working. Prozac on the other hand was too stimulating and Effexor was just smack in the middle.

Maybe you answered your own question.

Cymbalta is another option, since you suffer from chronic pain.

[RockiNToM]

Cymbalta scares the hell out of me. What if I want to have a drink while I'm on that? Is my liver gonna fall over? I think I'd rather pass lol.

I know the only thing that will counter the lower dopamine with serotonin inhibitors is to take something like adderall or ritalin but getting that is pretty much impossible for me.

Wellbutrin/Bupropion I tried once and that pretty much reminded me of my experiece with Roboxetine/Edronax - too much anxiety and paranoia.

I've been reading a lot about TCA's and a lot of people say that they don't get the apathy that they have had with SSRIs in the past. But why is this different?

A MAOI would definitely be something to consider but I doubt I would be able to get that seeing as more doctors prefer to steer away from them these days.

I just can't figure out why between the SSRIs why certain ones cause apathy more so than others. Are some of them hitting the serotonin more than others causing the apathy problem? I just don't know.

[jim_morrison]

Originally Posted by RockiNToM

Cymbalta scares the hell out of me. What if I want to have a drink while I'm on that? Is my liver gonna fall over? I think I'd rather pass lol.

Yeah, the cymbalta liver thing is a bit of a concern, I guess pristiq and Milnacipran might be better choices if you want to go up the SNRI path.

Originally Posted by RockiNToM

I've been reading a lot about TCA's and a lot of people say that they don't get the apathy that they have had with SSRIs in the past. But why is this different?

My guess is because most TCA's (with the exception of clomipramine) are far weaker SRI's and stronger NRI's than the SSRI's. Some of their side effects suck alot more than newer antidepressants, however some can work in your favour, ie their antihistamine effects can offset the insomnia that their degree of NRI would usually cause.

Heres a direct comparrison of the TCA's vs the SSRI's

http://www.emedexpert.com/compare/ssris-vs-tca.shtml

[RockiNToM]

Going by the article TCA's look like they are the medication I need. The only thing that's worse with TCA's as the article mentioned, are that they have a lot of weight gain, interactions with other medications and effects on the body when drinking alcohol.

What interests me is the binding profiles of the TCA's in this table from wikipedia:

http://en.wikipedia.org/wiki/Tricyclic_antidepressant

So it would some seem of them bind to the Dopamine transporter and the D2 receptor. Does this mean they may weakly inhibit the reuptake of dopamine or am I guessing there is some antagonistic action going on there instead much like anti-psychotics?

Never mind just saw this underneath the table: They function as antagonists at all sites listed - Bah!

[jim_morrison]

IMO the biggest downsides of TCA's are the anticholinergic side effects, and the sodium channel blocking cardiotoxic effects in overdose.

That table lists them as antagonists of the D2 receptor, but most are too weak and are ineffective as antipsychotics so I wouldnt be worried about any dopamine blocking activity, if anything TCA's will weakly enhance dopamine activity through a combination of noradrenaline reuptake and 5HT2 antagonism.

[JimiPePPeroni]

If you still plan to keep taking an SSRI, but still have difficulty obtaining a stimulant drug, perhaps you could test out L-Tyrosine & see if that helps out with the apathy issue.

I myself am sort of stuck in the same boat as you are. Though I find Lexapro to be helping me quite a lot in regards of overthinking & especially worrying, the "punchy" expression is telling me that something definitely needs to be adjuncted. Though playing with my DA levels alone did not do the deed, it may succeed in this way, as it may work for you. It's funny you post this, as this is something which has been on my mind for days.

[gillettecavalcad3]

Effexor XR 300mg works on dopamine. The way I see it with my drug combo is I get all the benefits, Serotonin, norepinephrine, dopamine and GABA from the Clonazepam.

I am sharper and more witty and able to attain large bouts of information. Generally I am just more motivated andfun to be around, .....and my anxiety is non existent.

[gillettecavalcad3]

http://http://www.adhdnews.com/testforum/test9909.htm

First paragraph, .......makes for an interesting read.

[IllusionalFate]

Originally Posted by RockiNToM

Cymbalta scares the hell out of me. What if I want to have a drink while I'm on that? Is my liver gonna fall over? I think I'd rather pass lol.

Originally Posted by jim_morrison

Yeah, the cymbalta liver thing is a bit of a concern, I guess pristiq and Milnacipran might be better choices if you want to go up the SNRI path.

This is the first time I've heard of Cymbalta being linked with hepatoxicity. Can anyone elaborate or provide any links regarding this issue?

[jim_morrison]

Originally Posted by IllusionalFate

This is the first time I've heard of Cymbalta being linked with hepatoxicity. Can anyone elaborate or provide any links regarding this issue?

http://www.anxietyinsights.info/eli_...arning_fda.htm

[jim_morrison]

Originally Posted by gillettecavalcad3

Effexor XR 300mg works on dopamine. The way I see it with my drug combo is I get all the benefits, Serotonin, norepinephrine, dopamine and GABA from the Clonazepam.

I am sharper and more witty and able to attain large bouts of information. Generally I am just more motivated andfun to be around, .....and my anxiety is non existent.

That's interesting, yeah as far as I'm aware Serotonin and GABA are anti anxiety/fear, whilst Dopamine and Norepinephrine are pro- confidence and motivation, so the combination of all four should be a very effective combination for SA.

[RockiNToM]

Originally Posted by JimiPePPeroni

If you still plan to keep taking an SSRI, but still have difficulty obtaining a stimulant drug, perhaps you could test out L-Tyrosine & see if that helps out with the apathy issue.

I myself am sort of stuck in the same boat as you are. Though I find Lexapro to be helping me quite a lot in regards of overthinking & especially worrying, the "punchy" expression is telling me that something definitely needs to be adjuncted. Though playing with my DA levels alone did not do the deed, it may succeed in this way, as it may work for you. It's funny you post this, as this is something which has been on my mind for days.

I have tried L-tyrosine many times over the past 6 months and although I found it helpful for concentration issues with work it but did absolutely no effect on my mood.

I'm thinking of trying Bupropion and Prozac the two medications that have gave me the worst anxiety and stimulating effects. Why? well if I can even get a tiny bit close to how I used to feel before with less apathy, I'm on my way hopefully to recovering.

I still experience apathy even now. While on tramadol yes it helped for both pain and my mood but because I've been taking it a while now at the same dose, it's lost it's mood altering effect. I'm in the process of trying to not take it on days where I feel mildly better despite there still being pain. Hopefully I can then move to an anti-depressant for my mood and something else just for the pain.

I'm weird with meds, alcohol, coffee. They work for a while in giving me a sense of pleasurable feelings then they stop working very quickly and they offer me no benefits. I've only had this problem over the past year. Whether that's because of all the things I've thrown at my brain and body I don't know. It's not like I'm doing hard drugs for anything. But understandably I've been on and off things so many times over the past 5 years my brain and body is probably confused.

The past 4 months have been the longest I have not drank alcohol and caffeine while being off an anti-depressant and to be quite honest, I don't notice any benefits really. I still feel practically the same.

I just find it odd and frustrating when I talk about this type of problem regarding apathy few people anywhere I visit forum wise can relate - unless some people do and are just not replying?

I kinda know what may be the problem but I am no doctor so it's only a guess and that would be more dopamine. But as I've said before about being put on a medication that acts on dopamine where I live and through my doctor is not going to happen. Bupropion is the most likely one I may get but it is used primarily for quitting smoking and I think it's dopamine reuptake is a bit negligible.

The main issue now is not wanting to be sedated anymore for anxiety, it's about stimulation. Sedation will only make my problem worse, and since in the past it's been the opposite way round when I had less apathy, stimulation seems to be the way to go.

Gah.

[jim_morrison]

If I was in your position and couldn't get wellbutrin from the doc then I'd opt for prozac, why not, it's easy to get a script for, cheap, easy to stop taking, and should raise levels of noradrenaline and dopamine like you want.

[RockiNToM]

Well the idea that I was thinking was that if by using bupropion and prozac together I would be getting double the benefit (in theory). However as you said, obtaining bupropion outside what's used for here in the UK (quitting smoking) is going to be hit and miss. The only way I was able to try bupropion before was let's just say I took someone elses that was who was trying to quit smoking as an experiment. It didn't benefit me at all but I'm willing to give it another go, like Prozac the first time I took it didn't benefit me.

I want to ask everyone something though, because this has been the case for me recently with all the meds I've taken.

Does anyone else find that during the first few weeks/month on an anti-depressant that the medications peaks in dealing with your mood?

For me, specifically Zoloft and Effexor I experienced a sense of euphoria for the first 4 weeks while on them, which was extremely pleasant and it greatly lifted my mood. Then, after my mood flattened and stayed the same with no lows or highs just smack in the middle - everything kinda dull. Now I don't know why this is, but this has seemed to be case in my most recent use of anti-depressants but not with any of the others before. I also find that when I'm withdrawing from an anti-depressant I sometimes feel like I have a bit of an overload of dopamine and I become almost manic for a while before once again becoming flattened. It's just so weird. It's like I have short bursts of highs that only last for a very small amount of time before then totally disappearing leaving me completely apathetic and emotionally flat. Sucks.

[jim_morrison]

Yeah as I've said before, SSRI's have done jack for me, but the only time when I was feeling at my happiest on them was when I was going through their withdrawls, I guess because of the dopamine rebound.

[IllusionalFate]

Originally Posted by RockiNToM

However as you said, obtaining bupropion outside what's used for here in the UK (quitting smoking) is going to be hit and miss.

Can't you just say you're trying to quit smoking? I doubt they'd check to see whether or not you're telling the truth, it's not like you're claiming that you're addicted to opiates and need buprenorphine...

[RockiNToM]

Yeah but I'm so clearly not a smoker if you looked at me or knew me. Also I'm not a very good liar I just get too anxious, it wouldn't work.

[jim_morrison]

No need to lie, they can legally prescribe it to you just 'off label' just depends how cool your doc is I spose.