![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by jerrympls on June 8, 2004, at 19:29:40
....you're depressed and have no energy? First of all here's my current cocktail:
Effexor XR 375
Valium 10mg/4x daily
Concerta 56mg am/18mg late afternoon
Seroquel 200mg (for insomnia and nighttime anxiety)
Ambien 20mg (in case I wake up and can't get back to sleep)
Synthroid 0.0125mcgI can get through work ok - but when I come home - cleaning my apt. is the last thing I want to do. It's gotten to the point where I don't take out the garbage for weeks, dishes sit in the sink, unopened mail is piled in boxes, clothes are everywhere, etc.
I know that in the past when I've had my apt. in order and clean I've felt better when coming home from work. I think my lack of motivation to keep things in OK shape is due to the Seroquel muting my dopamine and the Un-effective Effexor making me lethargic. I usually don't take the Valium as prescribed - I take it more at night because I get VERY anxious at night before bedtime - so I don't think the Valium is causing unnecessary effects. And even though I'm on a stimulant - it runs out by 6 or 7pm and then I just eat and watch TV.
I've told all this to my pdoc - but it's one ear out the other. And I really think this is a MEDICATION issue - because when I was on Nortryptaline, Dexedrine and Xanax I always kept my apt. clean even though I was severely depressed!
Am I alone here? I don't hoard or have OCD but it's getting to the point where I dread coming home after work because it's such a mess.
Any thoughts? experiences? comments? solutions??
Thanks!
Jerry
Posted by blanding on June 8, 2004, at 20:02:53
In reply to Is your apt. messy? How to clean when...., posted by jerrympls on June 8, 2004, at 19:29:40
> ....you're depressed and have no energy? First of all here's my current cocktail:
>
> Effexor XR 375
> Valium 10mg/4x daily
> Concerta 56mg am/18mg late afternoon
> Seroquel 200mg (for insomnia and nighttime anxiety)
> Ambien 20mg (in case I wake up and can't get back to sleep)
> Synthroid 0.0125mcg
>
> I can get through work ok - but when I come home - cleaning my apt. is the last thing I want to do. It's gotten to the point where I don't take out the garbage for weeks, dishes sit in the sink, unopened mail is piled in boxes, clothes are everywhere, etc.
>
> I know that in the past when I've had my apt. in order and clean I've felt better when coming home from work. I think my lack of motivation to keep things in OK shape is due to the Seroquel muting my dopamine and the Un-effective Effexor making me lethargic. I usually don't take the Valium as prescribed - I take it more at night because I get VERY anxious at night before bedtime - so I don't think the Valium is causing unnecessary effects. And even though I'm on a stimulant - it runs out by 6 or 7pm and then I just eat and watch TV.
>
> I've told all this to my pdoc - but it's one ear out the other. And I really think this is a MEDICATION issue - because when I was on Nortryptaline, Dexedrine and Xanax I always kept my apt. clean even though I was severely depressed!
>
> Am I alone here? I don't hoard or have OCD but it's getting to the point where I dread coming home after work because it's such a mess.
>
> Any thoughts? experiences? comments? solutions??
>
> Thanks!
> JerryHi Jerry,
I've got the same problem, and I've been on a combo of the TCA trimipramine (50 mg) and the SSRI sertraline (75 mg) since about a year.
These two meds decisevely keep me from falling into severe troughs of depressions, yet I have no "drive" or motivation to clean myself or apt.
Every second or third day I take either alprazolam (1 mg) or diazepam (10-20 mg), both benzodiazepines, in order to get the necessary "kick" to get these basic chores done.Since I'm afraid of getting addicted, I don't use them daily, so for the long run this is merely a mediocre type of solution.
You write about Seroquel muting your dopamine. Does this med enhance dopamine levels or inhibit dopamine's action?
Posted by jerrympls on June 8, 2004, at 20:26:19
In reply to The motivation issue, posted by blanding on June 8, 2004, at 20:02:53
>
> Hi Jerry,
>
> I've got the same problem, and I've been on a combo of the TCA trimipramine (50 mg) and the SSRI sertraline (75 mg) since about a year.
>
> These two meds decisevely keep me from falling into severe troughs of depressions, yet I have no "drive" or motivation to clean myself or apt.
> Every second or third day I take either alprazolam (1 mg) or diazepam (10-20 mg), both benzodiazepines, in order to get the necessary "kick" to get these basic chores done.
>
> Since I'm afraid of getting addicted, I don't use them daily, so for the long run this is merely a mediocre type of solution.
>
> You write about Seroquel muting your dopamine. Does this med enhance dopamine levels or inhibit dopamine's action?
>Hello!
From what I know about Seroquel - it effects MANY dopamine receptors and areas within the brain. The theory - as I understand it - is that those with schizophrenia have overactive dopamine in certain areas a sub-receptor types in the brain, so anti-psychotics like Seroquel kinda dampen things. My diagnosis is Major Depression recurrent w/ GAD - no schizophrenia. But, from what I've read, anti-psychotics used in depressed people can make them numb, apathetic, etc. because of the dampening effects of the dopamine/reward system. I could be wrong - perhaps CHEMIST could shed some light.
Anyway...ugh...I just wished I could get things together!
Jerry ;-)
Posted by King Vultan on June 8, 2004, at 22:19:19
In reply to Re: The motivation issue » blanding, posted by jerrympls on June 8, 2004, at 20:26:19
I don't have personal familiarity with atypical antipsychotics, but I've done some reading on them, and I question if they are really a good choice for people with unipolar depression and anxiety. It's a little bit hard for me to understand why they are being so widely prescribed to non-schizophrenics when they have so many drawbacks and side effects. Even my own pdoc, who I think quite highly of, suggested either Seroquel or Zyprexa (I forget which) as one option for my own MAOI insomnia.
Well, I managed to talk him into trazodone, which is what I had my heart set on. To my surprise, that wound up being a failure because while it did promote sleep, it left me feeling sluggish and depressed the next day. I filled in with Benadryl and a sleep/relaxation CD as a stopgap until the next time I saw him, at which point I asked him about Halcion. He thought that was a good choice but said I could only use it three or four times a week, so I am alternating between Halcion one night and Benadryl the next (still using the sleep/relaxation CD each night as well).
Now, this is working pretty darned good, but I had a tremendous advantage over the typical patient because I have some great reference books and have read "Essential Psychopharmacology" in its entirety, I've read countless posts on this board and others, and I always have a good idea of what direction I want to go in when I visit my pdoc (I do respect him and tend to ultimately defer to his judgement and wisdom, however). If I wasn't so well prepared and didn't have such firm ideas on what is in my best interest, however, I could easily see where I might be taking Zyprexa or Seroquel for insomnia. And I really don't think that would be such a good thing.
Todd
Posted by rvanson on June 9, 2004, at 6:54:14
In reply to Is your apt. messy? How to clean when...., posted by jerrympls on June 8, 2004, at 19:29:40
Try Wellbutrin, if you havent already. You'll get the housework done, as this is a motivational drug, but be prepared for the agitation this med usually causes.
Posted by King Vultan on June 9, 2004, at 12:17:24
In reply to Re: Is your apt. messy? How to clean when...., posted by rvanson on June 9, 2004, at 6:54:14
> Try Wellbutrin, if you havent already. You'll get the housework done, as this is a motivational drug, but be prepared for the agitation this med usually causes.
Something I noticed about Wellbutrin was that the end of my kitchen counter where I keep papers and stuff stayed noticeably more organized than it typically does. Somehow, it just became easier, almost automatic, to keep it tidy. I definitely noticed an increase in drive on Wellbutrin also.Todd
Posted by jerrympls on June 9, 2004, at 12:25:26
In reply to Re: Is your apt. messy? How to clean when...., posted by rvanson on June 9, 2004, at 6:54:14
> Try Wellbutrin, if you havent already. You'll get the housework done, as this is a motivational drug, but be prepared for the agitation this med usually causes.
I've been on Wellbutrin 3 or four times in the past 12 years - only thing it did form me was make me incredibly anxious a gave me horriffic insomnia...
but thanks for the advice...
Jerry :-)
Posted by partlycloudy on June 9, 2004, at 14:58:07
In reply to Re: Is your apt. messy? How to clean when.... » rvanson, posted by jerrympls on June 9, 2004, at 12:25:26
FWIW, I've been on Wellbutrin XR 300mg for months now and I'm as big a slob as ever! The only motivation to clean and pick up that works for me is the threat of company coming - especially my mom. How about you think, what if your landlord showed up unannounced?
Posted by Angel Girl on June 10, 2004, at 8:13:02
In reply to Re: Is your apt. messy? How to clean when...., posted by partlycloudy on June 9, 2004, at 14:58:07
> FWIW, I've been on Wellbutrin XR 300mg for months now and I'm as big a slob as ever! The only motivation to clean and pick up that works for me is the threat of company coming - especially my mom. How about you think, what if your landlord showed up unannounced?
partly cloudyI have the same lack of motivation to maintain my apartment by getting it clean and keeping it that way. Papers pile up as does dishes and laundry. I only seem to vacuum and dust when I find out somebody is coming over and for that I need lots of notice to get the job done.
I don't like that my apartment is so messy but yet I don't seem to have the motivation to do anything about it, other than walk past the mess.
I'm still looking for something to give me motivation other than the threat of impending visitors AND if somebody comes unannounced, I pretend I'm not home. lol!!!
There must be a better way. :(
AG
Posted by Keith Talent on June 10, 2004, at 8:26:50
In reply to Is your apt. messy? How to clean when...., posted by jerrympls on June 8, 2004, at 19:29:40
> Effexor XR 375
> Valium 10mg/4x daily
> Concerta 56mg am/18mg late afternoon
> Seroquel 200mg (for insomnia and nighttime anxiety)
> Ambien 20mg (in case I wake up and can't get back to sleep)
> Synthroid 0.0125mcg> I've told all this to my pdoc - but it's in one ear out the other.
New psychiatrist time?
> when I was on nortriptyline, dextroamphetamine and alprazolam I always kept my apt. clean even though I was severely depressed!
What doses of these three drugs were you on?
What is/are your diagnos(i/e)s?
If the main problems are depression and anxiety, then I would:
- substitute clonazepam (about 4 mg twice daily) for the diazepam
- drop the quetiapine
- drop the synthroid unless it's for a thyroid hormone deficiency
- substitute dexmethylphenidate (Focalin) for Concerta and take it every two waking hours until you finish work for the day (I know that's a pain, but it will have a rapid onset of action and keep smooth benefits throughout the day), or go back to dextroamphetamine (immediate release) taken three times daily
- try avoiding the stimulant in the few hours before bed, or as soon as you finish work for the day
- if still depressed, increase the venlafaxine extended-release to 300 mg twice per day (but only if you've wound up the stimulant dose to a really high level already, because the stimulant will augment the antidepressant's beneficial effect - especially relating to drive/motivation)
- if the venlafaxine still doesn't help enough, change to another antidepressant
- continue using the zolpidem 20 mg as needed
I'm sure that you can find a combination that serves you much better than your current one, Jerry.
Posted by Hattree on June 11, 2004, at 8:14:52
In reply to Re: Is your apt. messy? How to clean when.... » jerrympls, posted by Keith Talent on June 10, 2004, at 8:26:50
Plenty of healty people have messy homes. If you're also unmotivated to do things you enjoy, that's another matter. What about provigil, or some other psychostimulant?
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.