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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 64. This is the beginning of the thread.
Posted by garnet71 on May 2, 2009, at 15:37:27
The last drug I've been taking is dextroamphetamine--after a week or 2, it doesn't work that much at all. So I'm taking a break today and tomorrow from it.
I have zero motivation. I can't do anything..things I have to do..which is a lot...I've sat here all day so far--doing nothing. a friend stopped over earlier. I didn't have motivation to go anywhere with her. I have a lot of homework, but can't get myself to work on it. and a huge to do list. I'm not sad--but I can't do anything! wtf???? this is horrible
I'm looking for a drug, i guess from a different class, that works on motivation without debilitating side effects. one that works ALL the time-not just sometimes......
I don't have depression. I have anxiety but take 60 mg. buspirone which seems to be holding up.
I've been through this before but I forget where I left off last time. so I'm starting over.
8|
Posted by SLS on May 2, 2009, at 15:58:29
In reply to drug for motivation!, posted by garnet71 on May 2, 2009, at 15:37:27
> The last drug I've been taking is dextroamphetamine--after a week or 2, it doesn't work that much at all. So I'm taking a break today and tomorrow from it.
>
> I have zero motivation. I can't do anything..things I have to do..which is a lot...I've sat here all day so far--doing nothing. a friend stopped over earlier. I didn't have motivation to go anywhere with her. I have a lot of homework, but can't get myself to work on it. and a huge to do list. I'm not sad--but I can't do anything! wtf???? this is horrible
>
> I'm looking for a drug, i guess from a different class, that works on motivation without debilitating side effects. one that works ALL the time-not just sometimes......
>
> I don't have depression. I have anxiety but take 60 mg. buspirone which seems to be holding up.
>
> I've been through this before but I forget where I left off last time. so I'm starting over.
>
> 8|
What about Provigil (modafinil)?I suffer from a lack of energy, drive, interest, and motivation. I am not depressed, but I do suffer these things as they are features of bipolar depression.
At some point, if all else fails, you might have to start thinking bipolar with ADD.
Parnate + psychostimulant + Lamictal? If these drugs put you into a mania, it will be important to see whether it fits more of bipolar I or bipolar II. That will help determine whether or not lithium is indicated. Lithium has been known to be a good augmenter of Parnate, even in major depressive disorder.
- Scott
Posted by garnet71 on May 2, 2009, at 16:18:28
In reply to drug for motivation!, posted by garnet71 on May 2, 2009, at 15:37:27
I think I'm going to stop by PDocs ofc Monday and see if I can get some of the Pristiq samples he has. I just realized I have only 1 buspirone left for tonight, then I"m out. I do have 1 xanax too. I don't even have $5 right now to get my scripts filled.
My new PDoc appt. isn't for almost 2 months. He charges $300 though, so I have no idea how I'm going to pay him. I don't think Ill last till then. My current PDoc works mostly out of a hospital, stablizing patients. I don't think he is experienced in these types of treatments. I know he won't give me the Provigil--we discussed it last appt. He referred me to a new Psychopharmacologist.
But why would I need a mood stabilizer if I have no mood problems? I just don't understand that stuff. even so, I'm scared of lamictal--memory, cognitive problems, WEIGHT gain. yuck...I haven't yet lost the weight from last ADs. Sometimes I think it would be just better to die than live like that.
I can't even call my son's sister back who wants to know if I'm going to her wedding this month, and before that, didn't even check my voicemails for 2 days. I'm probably losing my friends again, because I've been ignoring calls and breaking plans. I hate this.
I guess I'll see what happens w/Pristiq; if that doesn't work, hopefully I'll be able to see new PDoc who will think up something more appropriate for my symptoms.
But I thought you were depressed Scott, you've always said that?
Posted by garnet71 on May 2, 2009, at 16:39:44
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 15:58:29
Scott--looking for your opinion here--If my PDoc thought I had BP--why after all these years would he let me try all these (non BP) treatments, treatments that end up failing? Why wouldn't he have suggested something like Lamictal? I mean, isn't that easy to get - isn't that pretty standard?
Posted by SLS on May 2, 2009, at 17:17:56
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 16:18:28
> But I thought you were depressed Scott, you've always said that?
I am depressed according to clinical diagnostics.
************************************************
A. The person experiences a single major depressive episode:
1. For a major depressive episode a person must have experienced at least five of the nine symptoms below for the same two weeks or more, for most of the time almost every day, and this is a change from his/her prior level of functioning. One of the symptoms must be either (a) depressed mood, or (b) loss of interest.
1. Depressed mood. For children and adolescents, this may be irritable mood.
2. A significantly reduced level of interest or pleasure in most or all activities.
3. A considerable loss or gain of weight (e.g., 5% or more change of weight in a month when not dieting). This may also be an increase or decrease in appetite. For children, they may not gain an expected amount of weight.
4. Difficulty falling or staying asleep (insomnia), or sleeping more than usual (hypersomnia).
5. Behavior that is agitated or slowed down. Others should be able to observe this.
6. Feeling fatigued, or diminished energy.
7. Thoughts of worthlessness or extreme guilt (not about being ill).
8. Ability to think, concentrate, or make decisions is reduced.
9. Frequent thoughts of death or suicide (with or without a specific plan), or attempt of suicide.************************************************
I am depressed, period. However, I am not melancholic. I don't dwell on negative thoughts. It is not "depressed mood" that has been my biggest problem.
Depression can present quite variably interindividually, and even intraindividually over time. Sadness and depressed mood are not necessary for one to be described as being depressed clinically. However, if depressed mood is not present, usually a lack of interest and motivation is. In addition, cognitive and memory impairments can be present.
- Scott
Posted by SLS on May 2, 2009, at 17:26:00
In reply to Re: drug for motivation! » SLS, posted by garnet71 on May 2, 2009, at 16:39:44
> Scott--looking for your opinion here--If my PDoc thought I had BP--why after all these years would he let me try all these (non BP) treatments, treatments that end up failing? Why wouldn't he have suggested something like Lamictal? I mean, isn't that easy to get - isn't that pretty standard?
It is hard to know what goes on in the mind of your doctor. Perhaps he is not convinced that you are bipolar in such a way that you would profit from using anticonvulsants. However, Lamictal can help as an augmenter in both unipolar and bipolar depressions. Abilify exerts antidepressant effects that are worth exploring, no matter what the diagnosis is. I would consider these types of strategies if you have not been sufficiently helped with standard unipolar treatments.
Have you tried combining an SRI with a tricyclic? I had a certain amount of success with Effexor + nortriptyline.
- Scott
Posted by garnet71 on May 2, 2009, at 17:37:48
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 17:17:56
I see what you mean....so I've been looking for information...and read your list there....but it sounds like I have ADD more than BP or those depression symptoms; read the 2nd column (ADD-inattentive type) of page 4 of this pdf:
http://www.devcogneuro.com/Publications/ADD.pdf
It sounds so much more like me....But Scott read this because maybe you have inattentive ADD despite having an initial BP episode, and are being treated for BP instead of ADD. ? ? ?
d/r has said something like the symptoms may fluctuate in intensity?, but I'm not sure how...
It could be that ADD and BP type II have commonalities--maybe they are related. Maybe the ADD-I is w/in the BP spectrum or vice versa. Maybe the mental health system got it all wrong...maybe its part of the autism spectrum...I don't think they have a clue. Nothing is cut and dry, yet everything blends together.
I wouldn't be surprised if 10 years from now, the mental health field people say "it's been this all along; we had it all wrong". No doctor has ever really known what's going on with me, I mean my treatments have been self directed, and I really don't know sh*t about psychotropics. But that makes me wonder how much THEY don't know....
Posted by SLS on May 2, 2009, at 17:55:05
In reply to Re: drug for motivation! » SLS, posted by garnet71 on May 2, 2009, at 17:37:48
That's an interesting article.
I am not so much inattentive as I am unable to process material that I remain focused on. It is an inability to concentrate rather than distractability. I don't know.
What I do know is that when my depression clears, so does my mind and my ability to read, learn, and remember. These things seem to be a symptom cluster integral to bipolar depression.
It is possible that yours is not an either-or illness. Bipolar disorder and ADD are frequently comorbid.
- Scott
Posted by garnet71 on May 2, 2009, at 18:10:10
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 17:55:05
Scott-isn't noritryptline one of the neurotoxic ones? Are you trying to kill me? lol.
I wonder if I went back to PDoc and begged and pleaded, or asked realllly extra sweeeet, he'd let me try the Provigil....hmm. Well I couldn't afford to buy it anyway.....but I have to try it. At least I can spell that one. Maybe PDoc was being nice and not wanting me to suffer all the side effects from those 'mood stablizing' or anticonvulsant drugs..he knows I'm a pharmaphobic too....and that I don't want my personality erased....
Well, stay motivated Scott : )
Posted by garnet71 on May 2, 2009, at 18:12:59
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 17:55:05
Scott-one more question! When you are in a state of BP depression - are you interested in some things or people but not others? motivated to do some things (such as interesting things) but not others? Or is it generally all or nothing?
Posted by SLS on May 2, 2009, at 18:28:02
In reply to Re: drug for motivation! » SLS, posted by garnet71 on May 2, 2009, at 18:12:59
> Or is it generally all or nothing?
Pretty much. When I am at my untreated baseline depression, I can maintain interest in staring blankly at a wall for hours on end.
- Scott
Posted by garnet71 on May 2, 2009, at 18:50:44
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 18:28:02
see - that's the thing! I am interested/motivated in some activities/people but not others......it seems like ADD amplified...symptoms have progressed real bad at this point...which is a reason I had previously asked if ADD could be progressive......so if I was in a depressive state-not just based soley on your ancedotal experience--but taking everything else into account--it would be 'all or nothing'. I remember being depressed years ago too. Well, a little bit. See what I mean, jellybean?
Well I'm going to try a little experiment-I don't think it's harmful at all...I'm going to take dextro one day, Ritalin the next. I just remembered I have a bunch of Ritalin left. I need some nicotine gum though...i wonder if you can get that free anywhere? I don't want to start up w/cigarettes again - when I almost had a breakdown in January, i started cigarettes again, but recently quit again.
I don't want to get caught up in mood stablizers/anti-convulsant trials unless necessary. I'll probably try the Pristiq next week. Just worried it will make me too tired to function for a while. But I could see how the dextro/ritalin experiment works first...only 2 more weeks till I graduate from UG school, can't screw it up now. and gotta sell my home. what to do - ? -
Thanks for all your help and advice Scott! Have a nice evening! :-)
Posted by Zana on May 2, 2009, at 18:54:07
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 18:28:02
You know how they do psychopharm. It's like checking to see if the pasta is done: you throw it at the wall. If it sticks; it's done.
Meds are not prescribed according to diagnosis. They aim at target symptoms. I don't get a really good idea of your symptoms from this thread but I would say Provigil helps me a great deal with lack of motivation and the generic is available through Canadian pharmacies on-line. You do not want Modalert 200 because you won't be able to divide the tablets and 200mgs is a huge dose. You want Modapro-200. Start with maybe 50mg in the am and another 50mg in the early afternoon. It's half-life is about 7 hours (on paper)so you don't want to take it too late in the day. I forget exactly what it costs but it's a fraction of the price of the US Provigil. I take it with klonopin and gabapentin because it is STIMULATING and I am prone to anxiety.I sympathize with the complete lack of motivation. Provigil is the only thing that gets me over the hump. I am taking Pristiq as well but without the Provigil I would still be staring at the wall.
Zana
Posted by garnet71 on May 2, 2009, at 19:04:26
In reply to Re: drug for motivation!, posted by Zana on May 2, 2009, at 18:54:07
No Zana-you throw pasta on the refrigerator-not the wall. Well I have plastered/textured walls.lol
Yeah, I get what you're saying. I shouldn't worry too much about diagnoses. It helps me make more sense of things though. Yes, I remember your discussion of Provigil--that sort of influenced me. I'd have to find a pharmacy I trust though; am a bit suspicious of some of those online places....I mean can they have imposters that look like the brand?
So you take-Klonopin, gaba, Pritiq, and provigil? Hmm. I don't think I'd want to take gaba. I have anxiety too; take buspirone for that and I was thinking about switching to klonipin if anxiety got out of hand.
So were your primary problems anxiety and ADD-is that what led you to that med combo? And how was Pristiq when you first started taking it--as far as side effects?
Posted by Zana on May 2, 2009, at 19:05:32
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 18:50:44
PS D-Amphetamine and Ritalin did nothing but make me nervous. Actually the D-Am. made me completely zoned out. I had a weird paradoxical reaction.
Sometime, when you have the time,
describe your symptoms. I can't tell, from what you've posted, what's going on.Zana
Posted by garnet71 on May 2, 2009, at 19:32:19
In reply to Re: drug for motivation!, posted by Zana on May 2, 2009, at 19:05:32
Zana-Maybe you started at too high of a dose? When I first took dextro, I cut it in half to .5 mg, well it was more like .4 because it was the smaller half. It was reallly stimulating but calming at the same time - (maybe that is the zombification effect?) strange. I didn't get any anxiety (except for once in my car) but that little .4 mg. would not let me sleep at all. But it did help me do spring cleaning for 18 hrs straight. It gave me motivation to do necessary stuff. After the first 3 days or so?, I went to the 10 mg as prescribed, and it's effects declined. After less than 2 weeks, just the other day, it didn't seem to affect me at all and I tried reading a math book (omg its 800 pages) and couldn't really do it. I'm not sure how much it would have helped me with the mental work since I began the trial during a 6 day break from school. Ritalin doesn't work very well-it only lasts about 2 hrs. and only for a week or so...and makes me real tired when it wears off..though that hour or 2 I could do more than w/o it...and Adderall gave me real bad bronchial spasms when it wore off. Still, I didn't feel withdraw effects from dextro at all when I didn't take it for a day. I don't understand why doctor's say it is addictive. Actually--any of them. I dont see how any of them are addictive. Maybe if they effective they are addictive? 8}
Main symptoms are anxiety and lack of motivation. that's about it. Can't stay on task-when I'm writing a paper, even after one sentence, I think - oh, I need to cut some tulips and put them in a vase; or - doing research online, i check this forum or get sidetracked when interesting stuff comes up from google and can't keep on task. And then the same thing, oh i need to get up and do this and that, should I take chicken out of the freezer? and the thoughts pop up right in the middle of nowhere...
Motivation-well I have tons of stuff to catch up on after being debilitated by SSRIs for so long-I can't get motivated to do all my important stuff. The short trials of ritalin and adderall gave me the kick i needed to get large school projects done just recently. But this semester was the absolute worst I've ever done as far as assignments. My GPA went down because I feel no motivation to do them anymore. Just this week though, I did sit down and create a really cool collage of pictures the other day- of colorful wooden doors of stucco houses in the mediterranean--I individually cut them out from some poster I bought a couple years ago on clearance..and frames from the dollar store-painted them w/several different colors for effect, attached the little picture hanging thingies, sanded them to make them look aged--I did that with complete focus!!!
Well I took a Ritalin a few minutes ago-i'm going to try to do this paper before it wears off. Then I have a Power Pnt. presentation to do. Still, I noticed these drugs help more w/motivation than actually staying on task. I think the key IS trying to do stuff that interests you...but only in an ideal world will that happen all the time, huh?
Still tell me about the Pristiq. Sorry I'm rambling a bit! Nice talking with you!
Posted by Emily Elizabeth on May 2, 2009, at 19:43:06
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 19:32:19
I tried Providgil and Dexadrine, but they didn't do much. Abilify is what helped me. In my case, the amotivation was part of (unipolar)depression and abilify helped treat what the lexapro and lithium were not sufficiently treating. I'm not sure of your diagnosis or your current meds, but I thought I'd suggest it just in case.
Best,
EE
Posted by linkadge on May 2, 2009, at 20:06:15
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 16:18:28
Stimulants are (contrary to popular belief) not always the best drugs for motivation.
Increased energy and concentration do not always readily equate to increased motivation.
Linkadge
Posted by Phillipa on May 2, 2009, at 20:11:31
In reply to Re: drug for motivation!, posted by linkadge on May 2, 2009, at 20:06:15
Link could you explain more please? Phillipa
Posted by rjlockheart on May 2, 2009, at 20:30:48
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 19:32:19
Have you tried self-hypnosis/ make a trial, repeat over, "going to get this done".
Take medication, may help.
Either way....good luck dude.
Posted by Zana on May 2, 2009, at 22:08:11
In reply to Re: drug for motivation! » Zana, posted by garnet71 on May 2, 2009, at 19:04:26
Nooo. I had an 18 month, I can't get out of bed, eat, bathe, kind of depression. Really the most horrible, frightening experience in my life. I have been on ADs since Prozac came out but this was something else.
I'll tell you more sometime if you want to know. But to answer your question about Pristiq- I had no side effects except for one thing- I have been anorgasmic since I have been on it. Now I have to say I had less than no interest in sex before I started it so the data is less than perfect and it's not supposed to have sexual side effects in women... Not supposed to... But it is an SSRI/SNRI. I have a bad feeling about the SSRI part and sexual side effects. Time will tell.
But, I have found it a great AD and I have been through them all including Effexor. I don't know what makes this one different. Probably the combo of meds I am on. I was taking 300mg of seroquel when I started it. I am now down to 200mg and planning on going off. I am hoping that I don't miss the seroquel but am a bit nervous that it has been making a contribution. Didn't do much at all for me before I started the Pristiq tho.By the way. You are absolutely right: it is the refridgerator. And I think a good diagnosis is important too.
Take care. You'll get this sorted out.
PS I used Pharmawebcanada.com. They seemed very legit.
Zana
Posted by garnet71 on May 2, 2009, at 22:44:59
In reply to Re: drug for motivation!, posted by Emily Elizabeth on May 2, 2009, at 19:43:06
EmilyElizabeth-Yes, thanks, that helps. When you had amotivitation as a manifestation of your depression, was it typically related to everything and anything, or only some things?
Posted by garnet71 on May 2, 2009, at 22:51:12
In reply to Re: drug for motivation!, posted by Zana on May 2, 2009, at 22:08:11
Wow Zana-sorry to hear that. That sounds horrible!! I wonder if an experience like that leads to a greater appreciation of life, in general?
Pristiq-Yeah the sexual side effects....I didn't think about this before, but when I took Effexor long ago, Wellbutrin helped negate that problem. Now, however, I can't take Wellbutrin to counteract xxRI sexual side effects since I can no longer tolerate it. hmm. will have to give that some more thought...Thanks for the heads up :-)
Posted by garnet71 on May 2, 2009, at 22:54:02
In reply to drug for motivation!, posted by garnet71 on May 2, 2009, at 15:37:27
f. not again.....now I'm back to thinking I have to choose between either having no personality, sexuality and emotions and doing NOTHING - or having those things and NOT being able to do anything!!!
Posted by greywolf on May 3, 2009, at 6:43:32
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 18:28:02
> > Or is it generally all or nothing?
>
> Pretty much. When I am at my untreated baseline depression, I can maintain interest in staring blankly at a wall for hours on end.
>
>
> - Scott
Been there. Perhaps that's why I change my living room paint scheme so often.Greywolf
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