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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 40. This is the beginning of the thread.
Posted by PsychoPharmaFiender on June 10, 2006, at 17:14:24
Everyone knows that great feeling certain meds and or combinations can induce. Just wondering what has worked for others. The best euphoria inducing meds for me were:1. Adderall + Celexa
2. Adderall + Lamictal
3. Wellbutrin + Remeron
4. Lamictal + Celexa + Ritalin
5. Prozac
6. Reboxetine + Adderall
Right now I am on Lamictal and Nardil. Just started Nardil a few days ago. I am looking for long term results, not something that works good then stops.
Posted by linkadge on June 10, 2006, at 19:02:38
In reply to Euphoria inducing Med Combinations, posted by PsychoPharmaFiender on June 10, 2006, at 17:14:24
I know this is the answer you are not looking for.
If you are looking for a combination of medications that will make you feel well, then you have a high likelyhood of achiving it.
If you are looking for medications to get high, then you are unlikely to find long term solutions.
When you take medications in this manner, you run the risk of both dammage to the neucleus accumbens (pleasure centres) and the prospect of permanantly altering the way your brain processes reward.
Even Ace was unable to maintin the "euphoria" he was looking for from Nardil. People may be able to maintain a theraputic effect though.
The pleasure centres of the brain have more homeostatic mechanisms than we have ways to fool it. The neucleus accumbens knows every trick in the book. There is no way to fool it long term.
It is always one step ahead.
Linkadge
Posted by linkadge on June 10, 2006, at 19:03:31
In reply to Re: Euphoria inducing Med Combinations, posted by linkadge on June 10, 2006, at 19:02:38
I was on a combination of celexa and ritalin at one point. Sure it was great. Now I'm off meds, and I have no ability to experience pleasure.
Linkadge
Posted by Declan on June 10, 2006, at 19:15:27
In reply to Re: Euphoria inducing Med Combinations, posted by linkadge on June 10, 2006, at 19:03:31
Hey Link
Was there a downside to the Celexa Ritalin combo while you were on it? Why did you stop?
With the 'no pleasure' thing, do you mean sex, or some global anhedonia?
Declan
Posted by linkadge on June 10, 2006, at 21:03:02
In reply to Re: Euphoria inducing Med Combinations » linkadge, posted by Declan on June 10, 2006, at 19:15:27
I stopped the ritalin when I read some of the recent studies linking it to chromisomal dammage.
After coming off meds I have little to no ability to experience pleasure of any sort.
Linkadge
Posted by minimal on June 11, 2006, at 0:08:04
In reply to Re: Euphoria inducing Med Combinations, posted by linkadge on June 10, 2006, at 21:03:02
Link, were you able to experience pleasure before you began the meds? If yes, then I wonder why even begin them in the first place? Was depression coexistent with moments of happiness, joy, and pleasure?
When I started meds around 7 yrs ago, I went through a period of 6 months unable to experience pleasure in any way, with on and off misery for several more years before that.
I don't want to appear like an apologist for the meds, because a day doesn't go by that I didn't wish for another way, but in my experience, I was unable to experience pleasure (sexual, and other forms like enjoyment in daily life) before the meds. When I try to withdraw, the feeling of inability to find joy in life appears not as a result of the meds but rather as return of the former self.
Just curious.
-Mini
Posted by linkadge on June 11, 2006, at 0:21:14
In reply to Re: Euphoria inducing Med Combinations - Link, posted by minimal on June 11, 2006, at 0:08:04
I was suffering depression, although I was prescribed the medications mainly for an anxiety disorder. I became dependant on the medication and it took me 6 years to quit.
Complete anhedonia was not a symptom, although complete anhedonia is now a symptom accompanied by complete loss of pleasure.
Its like certain areas of my brain won't turn on.
I've tried combatting it with from many different angles without effect.I am reminded of the study I read about mice who were raised on prozac. When the drug was removed, they suffered depression for the rest of their adulthood accompanied by altered responsivness of 5-ht systems.
Linkadge
Posted by Jost on June 11, 2006, at 1:21:45
In reply to Re: Euphoria inducing Med Combinations, posted by linkadge on June 10, 2006, at 19:03:31
> I was on a combination of celexa and ritalin at one point. Sure it was great. Now I'm off meds, and I have no ability to experience pleasure.
>
>
> Linkadge
Linkadge,If you experience no pleasure, and your life had that on the celexa and ritalin, are you sure you've making the best choice here?
I checked on Medline, through a University library database, and found only one article in a scientific journal that raised a serious question about chromosome damage with ritalin.
The study was this one:
[ El-Zein RA. Abdel-Rahman SZ. Hay MJ. Lopez MS. Bondy ML. Morris DL. Legator MS.Cytogenetic effects in children treated with methylphenidate.[see comment]. [Clinical Trial. Journal Article] Cancer Letters. 230(2):284-91, 2005 Dec 18.]
There was also an exchange of letters on the subject, in which some questions were raised about the report.
One important fact is that the study or report used only 12 test subjects, who were tested pre- and post-administration of 3 months of ritalin. This is an incredibly small sample, obviously.
They all showed some chromosomal damage--and of course this should be studied. But as the letter in response stated, there isn't any necessary link between chromosomal damage and cancer (for example). Moreover, there have been studies of outcomes in people, mostly children, receiving ritalin over longer time frames, with no greater mortality.
The letter-writers emphasized that the El-Zein report raised serious questions that needed to be investigated. They also raised some technical and methodological problems with how the study was done.
But still, your life is now; and the study was by no means definitive-- To live without pleasure is very difficult-- and esp. without clear and convincing proof of danger. It's worth at least checking further into the science. There are population studies and some mouse studies, and while the evidence isn't absolutely reassuring, it's by no means so alarming that you would necessarily sacrifice your quality of life for it.
I can try to copy the articles and letters, if you don't have access to them online.
Let me know if you're interested.
Jost
Posted by zeugma on June 11, 2006, at 6:59:46
In reply to Re: Euphoria inducing Med Combinations - Link, posted by linkadge on June 11, 2006, at 0:21:14
Its like certain areas of my brain won't turn on.>>
I have this symptom, and i know definitively it is not due to treatment with any psychotropic, as it was present long before I took my first dose of any psychoactive substance (including OTC remedies such as caffeine).
Are you sure you didn't have this symptom prior to SSRI's? Not questioning your statements, just wondering.
-z
Posted by SLS on June 11, 2006, at 7:45:15
In reply to Re: Euphoria inducing Med Combinations, posted by linkadge on June 10, 2006, at 19:02:38
Hi Link.
> The pleasure centres of the brain have more homeostatic mechanisms than we have ways to fool it. The neucleus accumbens knows every trick in the book. There is no way to fool it long term.
It is always one step ahead.What are some of the ways that the NA uses to maintain homeostasis?
- Scott
Posted by linkadge on June 11, 2006, at 15:21:44
In reply to Re: Euphoria inducing Med Combinations--Linkadge, posted by Jost on June 11, 2006, at 1:21:45
I understand what you are saying. I feel there is sufficiant reason for concern. From what I understand, the study found significant chromisomal abnormalities in all the children treated.
On the other side, I simply don't think such combinations are tested or safe. Psychostimulants plus antidepressant combinations are relatively untested. Theres no law that says every combination of meds must be tested.
Just the fact that my level of hedonia has gone from low normal, to nonextistent sends a message to me, that I have probably burnt out certain parts of my brain. It took me 6 months to relearn how to walk when I quit these meds.
There are reasons for my decision that I can't fully explain. Its the collaboration of hints and evidences that lead me to believe that I have done very bad things to my brain.
One evidence for isntacne: Before meds, I got my grade 10 in piano, but I can barely play at a 6th grade level now, I have lost the motor control. Now of course doctors excuse everything away, but I know, deep in my subcontious.
Linkadge
Posted by linkadge on June 11, 2006, at 15:36:49
In reply to Re: Euphoria inducing Med Combinations - Link » linkadge, posted by zeugma on June 11, 2006, at 6:59:46
There were certain things I would always be able to enjoy. Things that I get no pleasure from now. Like I said, sexual activity for one. I must have totally rewired that part of the brain. Before meds, no problem in that area, I enjoyed that part of my life. I get no pleasure from that now, literally none for a whole year.
Thats not uncommon. I have a few friends who have come off long term SSRI use and admit that (sorry for the detail) orgasms are almost nonexistent.Other things too, that before meds were never an issue.
Complete anhedonia was never a symptom of my depression. The drugs permamantly rewire your brain. I can take test doses of SSRI's which ususally confirm what I suspect. My movement problems ususally clear up immediately along with many of the other brain processes that seem to be dysfunctional now without them.
Linkadge
Posted by linkadge on June 11, 2006, at 15:52:57
In reply to Re: Euphoria inducing Med Combinations » linkadge, posted by SLS on June 11, 2006, at 7:45:15
Well, most people know that pleasure comes in gradients. You get a little bit, and you generally just want more.
I don't know a whole lot about it, but I do know that it works to constantly reset itself. I know of a few mechanisms such as the fact that people who abuse DAT inhibitors generally have long term compensatory changes in DAT expression. Drug free cocaine users generally have much higher DAT expression for a long period after drug sobriety. The same can actually be said for mice raised on methylphenidate. Adaptational changes to receptor expression also happens within the neucleus accumbens. I know that repeated nicotine exposure generally changes levels of d3 receptors in the neucleus accumbens. I've also read about how when you take certain stimulants, there are compensatory increases in cholinergic mechanisms to try and counteract it. I read a study that suggested that mice raised on certain stimulants and antidepressants had compensatory changes in acetycholinsterase, that lasted long after drug discontinuation.
I think it comes more down to glutamate release in the region than anything. A neurotransmitter may be responsible for intiating release, but you can only release so much at one point before the cells need to take breaks to recharge.
On the frontpage of www.biopsychiatry.com there is a lot of talk about how just about every drug we have in our collection falls short of the ability to produce perpetual euphoria.
It is coded within our genes for us to think that we have the ability to find everlasting happiness. Thats what keeps us going. Though, it is also within our genes that we never find everlasting happiness, since that too keeps us going.
Linkadge
Posted by PsychoPharmaFiender on June 11, 2006, at 16:43:55
In reply to Re: Euphoria inducing Med Combinations » SLS, posted by linkadge on June 11, 2006, at 15:52:57
Linkadge, I respect your knowledge and opinions having read many of your posts, but I disagree here.If the brain is so good at maintaining homeostasis (specifically in the nucleus accumbens) then everyone in the world would have problems regarding anhedonia and depression. The fact of the matter is that people with depression cant maintain homeostasis in the brain because they get depressed alot. Therefore, they are unable to maintain homeostasis. Meanwhile, people that are always happy are the opposite in my opinions, their brains are able to "bring them down, or homeostasis".
Sometimes Im bad at getting my point across but I hope you get the jist of it. I believe the endorphin system is much more involved then you are letting on. I can specifically cite an example regarding myself. I specifically remember about 6 years ago taking a hike with some friends and we got lost and we ended up having to walk a ridiculous amount in order to get back on track, something like 30 miles on all kinds of twists and hills. Anyways, after I got back that night I remember having the most amazing feeling Ive ever felt, I couldnt stop smiling all night, I felt completely free of depression. So, I think I had runners high from endorphins.
And yes, homeostasis brought me back to earth the next day. But I will continue to seek remission through meds until I find it. Lamictal and Nardil is my latest attempt.
Posted by linkadge on June 11, 2006, at 18:15:58
In reply to Linkadge-Counterargument regarding Reward Pathways, posted by PsychoPharmaFiender on June 11, 2006, at 16:43:55
>If the brain is so good at maintaining >homeostasis (specifically in the nucleus >accumbens) then everyone in the world would >have problems regarding anhedonia and >depression.
A properly working brain is very good at regulating the NAA. If it is working abnormally, producing prolonged periods of depression, or mania, one can run into problems. There is a difference between normal happiness, and euphoria. Normal happiness is sustainable wherase euphoria is not.
I'm not trying to be an appolgist for mental suffering or pain, in any way, I'm just suggesting that if you're looking to find an abnormal sence of wellbeing then you might run into problems down the road.
>The fact of the matter is that people with >depression cant maintain homeostasis in the >brain because they get depressed alot. >Therefore, they are unable to maintain >homeostasis. Meanwhile, people that are always >happy are the opposite in my opinions, their >brains are able to "bring them down, or >homeostasis".
It is hard to find anyone who lives in a perpetual state of euphora. While there are some people who appear to be this way, rigerous investiagions usually reveal that the story runs somewhat deeper.
>Sometimes Im bad at getting my point across but >I hope you get the jist of it. I believe the >endorphin system is much more involved then you >are letting on. I can specifically cite an >example regarding myself. I specifically >remember about 6 years ago taking a hike with >some friends and we got lost and we ended up >having to walk a ridiculous amount in order to >get back on track, something like 30 miles on .
>all kinds of twists and hills. Anyways, after I >got back that night I remember having the most >amazing feeling Ive ever felt, I couldnt stop >smiling all night, I felt completely free of >depression. So, I think I had runners high from >endorphins.People can become tollerant to the runner high. I don't know how common it is though, exercise addiction is a real entity, I am addicted to exercise.
The neuculeus accumbens has a good memory. We remember these mountaintop experiences even more than we remember what we had for breakfast. It is usually what perpetuates the search for more.
>And yes, homeostasis brought me back to earth >the next day. But I will continue to seek >remission through meds until I find it. >Lamictal and Nardil is my latest attempt.
I hope you do find remission from depression.
Linkadge
Posted by blueberry on June 11, 2006, at 18:19:13
In reply to Euphoria inducing Med Combinations, posted by PsychoPharmaFiender on June 10, 2006, at 17:14:24
Ritalin, adderall, tyrosine, and d-phenylalanine all produce euphoria for me. Sadly it only lasts a few hours and then followup doses do not restore the initial effects, and in the end I become more depressed from continued use or from the withdrawal. So I'm screwed either way. That is a dead end road for me.
Amisulpride provided a short 2 day euphoria when starting it, probably due to the flood of dopaminie similar to the other drugs mentioned above.
One med out of dozens I have tried that produced such a good antidepressant effect that it was close to euphoria, but not quite there, was adrafinil. By itself not. But in combination with an ssri and given a few weeks it was amazing. It showed no sign of poopout or tolerance even after a year. I think that is because it doesn't boost neuro levels thus inducing tolerance or adaptation, but instead acts as an exciter and agonist of receptors. Its metabolite modafinil didn't work like it at all.
So basically, for me anyway, dopamine equals euphoria. A high stakes losing game though.
The closest thing to it that can last and last is adrafinil plus ssri combo.
Posted by Phillipa on June 11, 2006, at 18:25:19
In reply to Re: Euphoria inducing Med Combinations, posted by blueberry on June 11, 2006, at 18:19:13
A runner's high is not experienced unless you run at least 30minutes and I ride my bike up and down hills and have more energy when done. I really believe the brain produces endorphins from excercise . The problem is people don't do it long enough to get the benfit. Love Phillipa
Posted by Phillipa on June 11, 2006, at 18:42:02
In reply to Re: Euphoria inducing Med Combinations, posted by Phillipa on June 11, 2006, at 18:25:19
Before I was depressed it worked but now it improves it. I don't get high. Just able to accomplish some thing afterwards. I wish I could ride in the am that maybe I'm have more motivation all day but I'm night time excerciser. Probably from working 3-ll or 7-7 when I was working. Now I sleep till ll am. Love Phillipa
Posted by willyee on June 11, 2006, at 21:59:34
In reply to Re: Euphoria inducing Med Combinations » SLS, posted by linkadge on June 11, 2006, at 15:52:57
> Well, most people know that pleasure comes in gradients. You get a little bit, and you generally just want more.
>
> I don't know a whole lot about it, but I do know that it works to constantly reset itself. I know of a few mechanisms such as the fact that people who abuse DAT inhibitors generally have long term compensatory changes in DAT expression. Drug free cocaine users generally have much higher DAT expression for a long period after drug sobriety. The same can actually be said for mice raised on methylphenidate. Adaptational changes to receptor expression also happens within the neucleus accumbens. I know that repeated nicotine exposure generally changes levels of d3 receptors in the neucleus accumbens. I've also read about how when you take certain stimulants, there are compensatory increases in cholinergic mechanisms to try and counteract it. I read a study that suggested that mice raised on certain stimulants and antidepressants had compensatory changes in acetycholinsterase, that lasted long after drug discontinuation.
>
> I think it comes more down to glutamate release in the region than anything. A neurotransmitter may be responsible for intiating release, but you can only release so much at one point before the cells need to take breaks to recharge.
>
> On the frontpage of www.biopsychiatry.com there is a lot of talk about how just about every drug we have in our collection falls short of the ability to produce perpetual euphoria.
>
> It is coded within our genes for us to think that we have the ability to find everlasting happiness. Thats what keeps us going. Though, it is also within our genes that we never find everlasting happiness, since that too keeps us going.
>
>
> Linkadge
>
>
>
>
>With all do respect how can u be so sure that "normal" people,are a number of people dont contain a mood very close to a state of Euphoria,keeping in mind that a state of Euphoria doesent mean simply "high" rather some people are always upbeat and usualy in a better than "ok" mood and these people usualy are capbable of handling stressful events with some ease.
Also and although u kinds skimmed it,im speaking to a more generalized theory,one in which it seems that people,mainly depressed people shouldent seek Euphoria but rather just feel ok.
Now id love a feeling of any total consistency,but on the same note why should we feel guilty or wrong in wanting euphoria,its almost taboo.We get this general thinking that we are depressed cause were not supposed to feel good,these people who say this i believe are among those who simply cant understand what feels like,and personaly i believe if anyone did deserve to feel some Euphoria in life,then anyone who lived with a clinical emotional disorder should be some of the first in line.
I watch certain friends,and the time it takes them to become excited about something,when hearing simple good news u can see a form of euphoria rise in there eyes as they are hearing it,then u see a entire emotional reaction,they do not stay feeling good,they easly escalte with proper postive stimulation.
Me on the other hand,if im not feeling well,i might appreciate news and the such,but im in a pyhsical state and i simply cant feel how i believe i should,and from watching others closly i notice again in them its autmatic like saying ouch to the touch of a hot iron,the fact this feeling doesent process in me is just more evidence in my eyes that something simply isnt right.
Posted by SLS on June 12, 2006, at 8:23:11
In reply to Re: Euphoria inducing Med Combinations » SLS, posted by linkadge on June 11, 2006, at 15:52:57
> Well, most people know that pleasure comes in gradients. You get a little bit, and you generally just want more.
>
> I don't know a whole lot about it, but I do know that it works to constantly reset itself. I know of a few mechanisms such as the fact that people who abuse DAT inhibitors generally have long term compensatory changes in DAT expression. Drug free cocaine users generally have much higher DAT expression for a long period after drug sobriety. The same can actually be said for mice raised on methylphenidate. Adaptational changes to receptor expression also happens within the neucleus accumbens. I know that repeated nicotine exposure generally changes levels of d3 receptors in the neucleus accumbens. I've also read about how when you take certain stimulants, there are compensatory increases in cholinergic mechanisms to try and counteract it. I read a study that suggested that mice raised on certain stimulants and antidepressants had compensatory changes in acetycholinsterase, that lasted long after drug discontinuation.
There is no doubt that antidepressants produce long-term, perhaps life-long, changes in CNS function. Evidence for this is the observation that one develops a refractoriness to a drug that had helped them on previous occasions. A personal observation that might support this notion is that MAOIs no longer prevent me from dreaming. My guess is that they no longer suppress REM. When discontinuing an MAOI, I no longer experience rebound dreaming, perhaps indicative of a lack of REM rebound. Another observation is that I experience little, if any, anticholinergic side effects from taking TCAs, even after periods of abstinence. There are more, but you get the idea.
- Scott
Posted by SLS on June 12, 2006, at 10:54:27
In reply to Linkadge-Counterargument regarding Reward Pathways, posted by PsychoPharmaFiender on June 11, 2006, at 16:43:55
> If the brain is so good at maintaining homeostasis
Too good.
I imagine it is the ability of the brain to maintain homeostasis that produces treatment resistance to antidepressants and the phenomenon of tachyphylaxis. Actually, it might be the brain's failed attempt to maintain homeostasis that produces the antidepressant effect. The system is reset, but to a different setting; the resulting dynamics more approximating the original healthy state.
Just pondering...
- Scott
Posted by honeybee on June 12, 2006, at 11:14:46
In reply to Re: Euphoria inducing Med Combinations » linkadge, posted by SLS on June 12, 2006, at 8:23:11
I sometimes am amazed at my brain's ability to ratchet me homostatically back to my depressed state. It's really quite impressive.
Posted by fairywings on June 12, 2006, at 15:10:52
In reply to Re: Euphoria inducing Med Combinations, posted by Phillipa on June 11, 2006, at 18:42:02
Phillipa, I'll lend you a couple of my kids - they'll get you up LONG before 11! ; )
fw
Posted by fairywings on June 12, 2006, at 15:16:01
In reply to Euphoria inducing Med Combinations, posted by PsychoPharmaFiender on June 10, 2006, at 17:14:24
I've never experienced euphoria...have no idea what it feels like.
I'm on one of those med combos now. I'm able to function so much better, but no euphoria. Since the extreme exercise worked so well for you, maybe that's a better idea than to keep trying to find a drug combo which might poop out on you in a short period of time? It's better for your body, probably better for your brain if you can do it consistently.fw
Posted by willyee on June 12, 2006, at 15:42:10
In reply to Re: Linkadge-Counterargument regarding Reward Path, posted by SLS on June 12, 2006, at 10:54:27
At times the Maoi im on has caused terrable dreaming,vivid nightmares,others it seems to prevent them,i dont think we have anything solid but theories,nothing more.
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