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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by Racer on July 26, 2005, at 13:50:24
Right now, what I'm fighting isn't so much depression, as total and complete amotivation. I can hardly manage to walk across the room, it feels like! I find myself just sitting here in front of the computer, idling away the day, just because I can't quite manage to do anything else... Even reading is often more energy than I really want to put into anything...
I'm taking 60mg Cymbalta -- which is my suspect in causing this -- 300mg Wellbutrin XL, and 100mg Provigil. My dx is major depression, anxiety, anorexia.
Any thoughts on stimulants to increase motivation? If so, any recommendations?
I just know SOMETHING has to change -- and soon. Right now, I'm "racing" so slowly I may as well go back to bed!
Thanks.
Posted by Nickengland on July 26, 2005, at 15:01:37
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
Hi Racer :-)
>Right now, what I'm fighting isn't so much depression, as total and complete amotivation.
Yep lol I'm pretty much feeling this too! I'm just really not fighting it as such though...I'm not trying to rise to it if that makes sense - in this way I've already won the fight so to speak.
>I'm taking 60mg Cymbalta -- which is my suspect in causing this
Have you thought about reducing the dosage of the Cymbalta? (see if you have more energy?) Or perhaps maybe changing the medication altogether? Just a thought...that way you'll get rid of the route cause of the problem?
>Any thoughts on stimulants to increase motivation? If so, any recommendations?
I wish I could be of some help here..but unfortnately here in the UK we (adults) don't get prescribed stimulants...even for ADHD so I hear!
I know its alternative...but i've found ginseng (siberian ginsing) to be extreamly good in the past for giving me extra energy and helping with motivation... I do not use it now though because of it making me alittle to high - like it did before I was diagnosed bipolar.
>I just know SOMETHING has to change -- and soon. Right now, I'm "racing" so slowly I may as well go back to bed!
FORCE yourself to do some exersise!...I know this is easier said than done but it can always help to give that extra "lift" and its free and very healthy ;-)
It can be hard this motivation thing...before when i've had raging anxiety, the motivation is there but cannot be used in the right places because of the anxiety in the first place...This in turn can sometimes make the depression worse.
Funny thing is I now seem to have the anxiety well under control and pretty much the depression....now the really weird thing is i'm left with no motivation! I much prefer having it this way round though compared to having raging anxiety with the motivation if you know what I mean.
Hmmm Stimulants I think about this alot...but its near impossible to get them over here. But then I think - actually i'm not ADD, why do I need them?..Then I think of the other parts of my life which need motivation, everyone get lazy now and then I guess :-(...still left with the nagging thought of would a stimulant make it easier?! lol
In conclusion, if I were you and had the opportunity to try a stimulant I think I definately would ... It may well be the 'thing' you need...
I hope things improve soon :-)
Kind regardsNick
Posted by ed_uk on July 26, 2005, at 15:01:37
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
Hi Racie,
Perhaps you could try a lower dose of Cymbalta?
~Ed
Posted by Declan on July 26, 2005, at 15:02:36
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
Sitting in front of the computer idling away the day.......That's me too, Racer (although I have no trouble making it to the other side of the room to the teapot). That's 2005 too. You know when the Nardil bloke mentioned having spontaneous positive thoughts? That would be good, along with with some spontaneous positive actions.
If you can hack Provigil and Wellbutrin, I guess you'd be OK with Dex, if that's what you had in mind.
Declan
Posted by ed_uk on July 26, 2005, at 15:03:40
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
Racie,
Have you ever tried desipramine?
~Ed x
Posted by Maximus on July 26, 2005, at 16:03:49
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
You might try Lamictal. It is activating and very good for depression too. Your anergia is probably a residual symptom of your depression.
Posted by Racer on July 26, 2005, at 17:29:37
In reply to Re: Might a stimulant help? » Racer, posted by Maximus on July 26, 2005, at 16:03:49
> You might try Lamictal. It is activating and very good for depression too.
Dr CattleProd did say that that was an option he'd want to try, but I did try that last year -- with fairly disasterous results. Of course -- long story, not worth going into right now -- that was one of the "hey, let's stop these three drugs and try these other four over here!" prescriptions from Dr EyeCandy. It's possible that it wasn't the Lamictal, but I'm still kinda hestitant to try it, you know? If it was the Lamictal -- well, I'm not eager to experience anything like that again...
On the other hand, if nothing else gets me past this sort of sluggishness, I will probably try it.
>Your anergia is probably a residual symptom of your depression.
>
>
>
>I've wondered about that, too. Muddy waters, of course, since I'm also cringing at how I look now that I've gained all this weight -- I can't stand being this heavy, and that's got to be adding to my mood right now.
Or, of course, it could just be that I've still got some residual depression going on...
Oh, yeah, and there's also a hit of stress that happened last week, which I'm sure also figures in some... Still, stressors happen in all lives, and if I can't handle something like this one, then I'm not near enough real remission...
Thanks.
Posted by Racer on July 26, 2005, at 17:37:13
In reply to Re: Might a stimulant help? » Racer, posted by ed_uk on July 26, 2005, at 15:01:37
> Hi Racie,
>
> Perhaps you could try a lower dose of Cymbalta?
>
> ~Ed{sigh} We tried lowering it to 30mg a while back, but my depression returned in a pretty big way. We also tried lowering the Wellbutrin to 150, same result. And we tried discontinuing the Provigil, because of tension and figeting, not a good result.
Forgot to mention that...
>>Have you ever tried desipramine?
Yeah, I did. Gave me unexpected, close up views of my carpetting. NOT a good thing -- way past time for new flooring... Hypotension is a big problem for me, and all the TCAs I've tried have created problems for me because of it. (My BP runs very low to begin with, and I have a problem at the best of times with orthostasis. For that matter, if I stand up for too long, I'll sometimes drop...) I asked Dr EyeCandy about Florinef last year, which he said was utterly impossible, ever. I also asked Dr CattleProd about it, and he said that if it came down to it, he'd have to do some research on it, but he was fine trying it if we needed to. He just didn't think that we'd have to go to anything that would cause problems, because we had so many other options left.
Ugh.
Oh, yeah, and the weight gain thing from ADs is a real problem for me. Aside from the basic part about the eating disorder, I've also gained A TON on every AD I've taken to date. Not ten or twenty pounds, but fifty to seventy pounds. I don't think I could handle that again, you know?
Thanks, Ed.
Posted by Racer on July 26, 2005, at 17:37:48
In reply to Re: Might a stimulant help? » Racer, posted by ed_uk on July 26, 2005, at 15:03:40
Posted by Maximus on July 26, 2005, at 17:55:11
In reply to Doh! Forgot: whaddaya think about a stim? (nm) » ed_uk, posted by Racer on July 26, 2005, at 17:37:48
I have had great results in the past with the Concerta 36 mg. Concerta is smooth AND effective. ""http://www.concerta.net/html/concerta/home.jsp?"" It is fast and you're going to see the result in 2 days.
BTW did you ever try Lithium? That is the ultimate add-on to maximize your antidepressant.
Posted by Maximus on July 26, 2005, at 18:09:44
In reply to Doh! Forgot: whaddaya think about a stim? (nm) » ed_uk, posted by Racer on July 26, 2005, at 17:37:48
I just want to add that a stimulant is an appetite suppressant (in general). In your case, i'm not sure if it would be reasonable?
Posted by Phillipa on July 26, 2005, at 18:57:50
In reply to Re: Doh! Forgot: whaddaya think about a stim? » Racer, posted by Maximus on July 26, 2005, at 18:09:44
Racer, I believe self esteem has an awful lot to do with how a person feels. Now if I looked like the models in the magazines I don't think I'd be depressed. Fondly , Phillipa
Posted by Racer on July 26, 2005, at 20:33:26
In reply to Re: Doh! Forgot: whaddaya think about a stim? » Racer, posted by Maximus on July 26, 2005, at 18:09:44
> I just want to add that a stimulant is an appetite suppressant (in general). In your case, i'm not sure if it would be reasonable?
>
>
>
>Heheheh... Therein lies the rub...
Dr CattleProd does get reports from my nutritional counselor, so he'd know if I started dropping weight or stopped eating what I'm supposed to. (Which, I have to admit, is more common than my treatment team would like...)
I have thought about the appetite suppression from stimulants, and hate to admit that that's a big plus from my point of view. On the other hand, being able to do more than sit like a lump might help with keeping me on track with food... At least, that's a theory I'm willing to explore...
Thanks for the comments. Tomorrow I'll be talking with my therapist about whether or not to try to make a sooner appointment with Dr CattleProd. I hate to do it -- I feel so needy when I have to make an extra appointment, but my next scheduled appointment is in September...
Posted by jerrympls on July 26, 2005, at 20:34:55
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
> Right now, what I'm fighting isn't so much depression, as total and complete amotivation. I can hardly manage to walk across the room, it feels like! I find myself just sitting here in front of the computer, idling away the day, just because I can't quite manage to do anything else... Even reading is often more energy than I really want to put into anything...
>
> I'm taking 60mg Cymbalta -- which is my suspect in causing this -- 300mg Wellbutrin XL, and 100mg Provigil. My dx is major depression, anxiety, anorexia.
>
> Any thoughts on stimulants to increase motivation? If so, any recommendations?
>
> I just know SOMETHING has to change -- and soon. Right now, I'm "racing" so slowly I may as well go back to bed!
>
> Thanks.Cymbalta made me so apathetic it was beyond belief.
Posted by alohashirt on July 26, 2005, at 20:36:20
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
How old are you?
Are you male?
Have you had your testosterone count measured?
Have you had thyroid measured?I'd recommend doing the eval at
""http://www.med.nyu.edu/psych/assets/adhdscreener.pdf""
I found Concerta made a huge difference> Right now, what I'm fighting isn't so much depression, as total and complete amotivation. I can hardly manage to walk across the room, it feels like! I find myself just sitting here in front of the computer, idling away the day, just because I can't quite manage to do anything else... Even reading is often more energy than I really want to put into anything...
>
> I'm taking 60mg Cymbalta -- which is my suspect in causing this -- 300mg Wellbutrin XL, and 100mg Provigil. My dx is major depression, anxiety, anorexia.
>
> Any thoughts on stimulants to increase motivation? If so, any recommendations?
>
> I just know SOMETHING has to change -- and soon. Right now, I'm "racing" so slowly I may as well go back to bed!
>
> Thanks.
Posted by Phillipa on July 26, 2005, at 21:09:28
In reply to Personal QNs( Re: Might a stimulant help?, posted by alohashirt on July 26, 2005, at 20:36:20
OH MAN! Racer, I'm sorry forgot about your eating disorder. I meant muscular, well defined bodies not like the shrunken faced fashion models. Sorry, i definitely wasn't thinking. Not good. Fondly,Phillipa
Posted by Emily Elizabeth on July 26, 2005, at 22:01:50
In reply to Re: Might a stimulant help? » Racer, posted by jerrympls on July 26, 2005, at 20:34:55
I have had problems with amotivation and sluggishness too. I am fairly certain that it is related to my depression though and not a side effect. I have added dexedrine to my mix and it helped some. Then bad stuff started happening in my professional life and I bottomed out again. I did find it useful for a while. I just added Lithium. I'll post if I find it to be helpful. I sure hope that it is...
AND I think you should call for an extra pdoc appt. Sept is too long to wait. This is your health and it is important!
Best,
EE
Posted by Racer on July 26, 2005, at 23:43:01
In reply to Re: Might a stimulant help?, posted by Emily Elizabeth on July 26, 2005, at 22:01:50
>
> AND I think you should call for an extra pdoc appt. Sept is too long to wait. This is your health and it is important!
>
> Best,
> EELOL! You know, I don't even think of that anymore, you know? I've been so bloody useless in my life for the past two years that I forget that there really is hope and I don't have to sit back and wait and play around with drugs forever and ever.
Thank you for the reminder, I will [try] to internalize the idea that, maybe, I might deserve something other than waiting around for my life to start again...
Posted by Racer on July 26, 2005, at 23:44:40
In reply to Re: Personal QNs( Re: Might a stimulant help?, posted by Phillipa on July 26, 2005, at 21:09:28
> OH MAN! Racer, I'm sorry forgot about your eating disorder. I meant muscular, well defined bodies not like the shrunken faced fashion models. Sorry, i definitely wasn't thinking. Not good. Fondly,Phillipa
Machts nichts, Phillipa. I know that you aren't trying to take a dig, and I know that you're usually very thoughtful and courteous. Don't worry your head about it, 'K?
Posted by Racer on July 26, 2005, at 23:48:50
In reply to Personal QNs( Re: Might a stimulant help?, posted by alohashirt on July 26, 2005, at 20:36:20
>
> How old are you?Middle aged -- early 40s, which I find very hard to believe...
> Are you male?
Not when I checked last, but I'm not prejudiced. Some of my best friends are male, and I'm even married to one... ;-D
> Have you had your testosterone count measured?
No, that's something I might want to think about, though -- testosterone does affect women, too.
> Have you had thyroid measured?
Yes, this is something my doctor is pretty interested in, and says that he will sometimes bump patients up to slightly hyperthyroid to get full response to ADs. Any experience with that yourself?
Thanks for your response.
Posted by Sarah T. on July 26, 2005, at 23:59:02
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
Hi Racer,
I think that a stimulant might help, but the first thing that came to mind was whether there is something in your current regimen that might be causing the amotivation and lethargy? Could it be the Cymbalta? Have you tried lowering the dose?
Posted by partlycloudy on July 27, 2005, at 5:40:36
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
Is the Provigil not a stimulant? Do you drink coffee or tea? I'm like you in that I'd hate to have to add another med if there was something myself I could do to feel better.
I know that it's not easy for you to get out of the house for regular exercise, but it is making a difference for my energy level, once I actually throw myself out there.
Is there any way you can structure another pilates class or yoga into your week to get out and moving? It's the chicken and the egg dilema for me - not having enough energy to get off the sofa to exercise; but having exercised, I do feel better for it. And are you taking in enough nourishment to fuel yourself? I have found that Cymbalta works much better for me when I've got the other elements going, you know?
partlycloudy
Posted by Nickengland on July 27, 2005, at 8:29:45
In reply to Might a stimulant help?, posted by Racer on July 26, 2005, at 13:50:24
Hi Racer,
Like I said before, its hard for me to say if a stimulant would help as I have no experience of them...(I guess the only way you would find out is to try one)
That said, I forget to mention something that may well help you now in the short-term, perhaps also in the long-term if the answer is a stimulant will help..
L-Tyrosine ~ I've been using it recently as from what i've been reading its like the closest thing I can get to using a 'natural' stimulant. It helps a little, albeit mild - and the best thing no-side effects.
If a stimulant will help - maybe L-tyrosine will help in the short-term before you can get one prescribed. Its an amino acid.
Kind regards
Nick
Posted by partlycloudy on July 27, 2005, at 13:15:47
In reply to Re: Might a stimulant help? » Racer, posted by partlycloudy on July 27, 2005, at 5:40:36
> Is the Provigil not a stimulant? Do you drink coffee or tea? I'm like you in that I'd hate to have to add another med if there was something myself I could do to feel better.
>
> I know that it's not easy for you to get out of the house for regular exercise, but it is making a difference for my energy level, once I actually throw myself out there.
> Is there any way you can structure another pilates class or yoga into your week to get out and moving? It's the chicken and the egg dilema for me - not having enough energy to get off the sofa to exercise; but having exercised, I do feel better for it. And are you taking in enough nourishment to fuel yourself? I have found that Cymbalta works much better for me when I've got the other elements going, you know?
> partlycloudy
>
>I think my post sounded harsh - "You Must Exercise" - I didn't mean to preach, sweetie.
pc
Posted by Ilene on July 27, 2005, at 14:27:24
In reply to Guess I forgot to mention... » ed_uk, posted by Racer on July 26, 2005, at 17:37:13
Gave me unexpected, close up views of my carpetting. NOT a good thing -- way past time for new flooring... Hypotension is a big problem for me, and all the TCAs I've tried have created problems for me because of it. (My BP runs very low to begin with, and I have a problem at the best of times with orthostasis. For that matter, if I stand up for too long, I'll sometimes drop...) I asked Dr EyeCandy about Florinef last year, which he said was utterly impossible, ever. I also asked Dr CattleProd about it, and he said that if it came down to it, he'd have to do some research on it, but he was fine trying it if we needed to. He just didn't think that we'd have to go to anything that would cause problems, because we had so many other options left.
Did Dr EyeCandy tell you what was wrong w/ Florinef? I've taken it for a couple of years. It's the only med that I take that I know is doing something, because I don't get light-headed or see stars like I used to. I've never actually passed out, fortunately.
Take care, I.
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