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Dr. Bob is Robert Hsiung, MD,
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Posted by Elanor Roosevelt on May 3, 2009, at 9:55:20
In reply to Re: drug for motivation! » greywolf, posted by SLS on May 3, 2009, at 7:36:45
Provigal is not a stimulant
Love the pasta analogy -- my pdoc is going to hate hearing it
lamictal seems to mysteriously help some TRD
it did not help me and the titration period is from hellhorny goat weed (with no additives if you are female) might help with the sexual side effects i have used natures way brand
lifting depression is a good start to helping with motivation but i do find that ADs can scatter me a bit and worsen by already limited interest in housework
straterra can help with focus but it is prohibitively exspensive even with insurance
Posted by Frustratedmama on May 3, 2009, at 10:27:31
In reply to Re: drug for motivation!, posted by Elanor Roosevelt on May 3, 2009, at 9:55:20
Hi, I am considering asking for Pristiq. I am still struggling with anger, anxiety, lack of motivation, irritability, etc. I went for a consult with a new doctor (who was very thorough but can't see me regularly as she can only see patients from her "county" on a regular basis). Well, she recommended a few things and included in that list was Cymbalta.... I talked it over with my current doctor and we ended up trying lexapro (to address the issues without weight gain). Well, after two days of worsening depression, major fatigue, feeling very spacy (forgetting where I had been and where I was driving) and some slight nausea I am reconsidering this decision. In researching Cymbalta it looks like this too causes fatigue...so I am wondering is Pristiq the right answer? Any suggestions?
Posted by Zana on May 3, 2009, at 11:00:38
In reply to Re: drug for motivation!, posted by Frustratedmama on May 3, 2009, at 10:27:31
I don't want to be a poster child for Pristiq and everyone is different but I have been on it for a little over 3 weeks and have had a very quick, very positive response without any side effects that I can detect except for the anorgasmia which is a complete drag. As you know, I am taking it with a bunch of other stuff but I have not experienced any SSRI apathy. I think the Provigil would mask, or overcome that aspect of the med if it exists. I think it is worth a try if you are in the neck of the AS world.
Zana
Posted by Frustratedmama on May 3, 2009, at 11:19:15
In reply to Re: drug for motivation!, posted by Zana on May 3, 2009, at 11:00:38
Zana thanks!!!!
I am taking vyvanse for adhd right now and zyrtec for allergies. I have a diagnosis of adhd and mood disorder (but my daughter has asperger's). I am thinking I will ask for pristiq- your posts seem to mirror my moods frequently. I have been reading a lot of posts lately! let's pray this works- the lexapro left me feeling worse!
Posted by seldomseen on May 3, 2009, at 11:19:29
In reply to drug for motivation!, posted by garnet71 on May 2, 2009, at 15:37:27
Have you told your pdoc that you recently quit smoking?
Man, I have said this before on this board, but I'm saying it again - quitting smoking radically changes your brain chemistry. When I quit, it felt like I was having to grow a whole new brain. Nicotine replacement helps, but I am convinced that nicotine is not the only psychoactive substance in cigarette smoke.
I couldn't concentrate on anything. Nothing. I felt really really stupid without the cognitive burst from a cigarette. Sluggish and anxious.
While I don't think qutting smoking *causes* mental illness, I certainly do think it can exacerbate an underlying one. Qutting smoking also creates its own unique set of symptoms.
Most docs are "Yipee! you quit smoking - good for you!" I wish pdocs were more enlightened as to the effect of such an act on our brain chemistry.
Seldom.
Posted by shasling on May 3, 2009, at 13:10:10
In reply to Re: drug for motivation!, posted by Emily Elizabeth on May 2, 2009, at 19:43:06
> 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
Combination of 60 mg Cymbalta and 10 mg Abilify helped me with motivation and cognition very siginificantly. I've since added 100 mg Vyvanse and these three in combination improve me 100% as far as motivation, anergia and an overwhelming propensity to just sit-and-stare are concerned. My mood, thats another thing: good in the morning, kinda lags toward evening.Good luck
Suzie
Posted by Emily Elizabeth on May 3, 2009, at 13:18:48
In reply to Re: drug for motivation! » Emily Elizabeth, posted by garnet71 on May 2, 2009, at 22:44:59
> 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?
My amotivation was pretty generalized. I didn't want to do anything other than lay on the couch and sleep.
EE
Posted by bleauberry on May 3, 2009, at 17:42:53
In reply to Re: drug for motivation!, posted by SLS on May 2, 2009, at 17:17:56
This caught my attention. If someone fits the following criteria, they are considered clinically depressed and the next likely step is to treat a brain chemical imbalance of some mysterious sort.
What caught my attention was that if one were to look at common symtpoms of Lyme disease, or common symptoms of an unsuspected yeast/candida overgrowth, the symptoms look exactly the same as depression. And there are other things often missed in routine physicals and labs that can have the same appearance as depression, such as hypoadrenalism or suboptimal thyroid.
But primarily I was kind of taken aback by how eerily the symptoms of infectious organisms echo the symptoms of "clinical depression".
Practically everyone with undiagnosed unsuspected Lyme disease, or undiagnosed unsuspected yeast, has all of the symptoms listed below.
The problem I think is diagnosis. They make it real hard and real tricky. It need not be. For yeast, simple. Start Nystatin at a low dose and see what happens. If nothing, raise the dose. Still nothing, get to the normal target dose. Nothing, stop. You do not have yeast. Done deal.
On the other hand, if you started getting a lot worse somewhere along the way...the Herx reaction of organism toxins...you just made a diagnosis with a high level of confidence. Same with Lyme, except the test meds would be Tetracycline or Doxycycline.Anyway, depression looks like Lyme looks like yeast. Very deceptive illnesses these are.
>
> 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 garnet71 on May 3, 2009, at 20:05:30
In reply to Re: drug for motivation!, posted by Zana on May 3, 2009, at 11:00:38
too late Zana - you have already been designated the poster child for Pritiq! haha
ps - maybe i'll take on that role if I get it next week, but i'm still undecided...
Posted by garnet71 on May 3, 2009, at 20:08:47
In reply to Re: drug for motivation!, posted by linkadge on May 2, 2009, at 20:06:15
Linkadge-I found quite the opposite--did you mean the opposite? I mean stimulants (for me anyway) work best for motivation; not as great for concentration/focus..but they do help considerably with that too; but it's not 100%. Interest still is an issue even with stimulants.
I mean, shortly after taking a ritalin last night, i returned several phone calls and finished 2 papers for school. This was after getting nothing accomplished all day...then I woke up this morning feeling much better overall. It seems easier to get up in the morning the next day.
Posted by garnet71 on May 3, 2009, at 20:20:11
In reply to Re: drug for motivation!, posted by seldomseen on May 3, 2009, at 11:19:29
Hey-if you look at the National Institute of Mental Health data, they contend that a high proportion of people who smoke have mental illnesses....this has been studied fairly often. It makes me wonder...it's something like 50 percent but I can't remember exactly but you can look it up...
But no-I don't feel any worse from quitting this time. I feel no withdraw symptoms except minor cravings a few times a day which makes me think of the gum. I think any psychotropic drugs help. One time I quit, I started getting panic attacks-i wasn't on any pscyho drugs. Another time I quit, I felt horrible and that sluggish feeling; and twice felt mentally foggy like you had indicated. But so far, so good.
So yeah, I've quit a few times. When I'd start back up-I'd try to be a social smoker only. I've been a closet smoker for a long period (not in public and/or just at night)...I've tried to smoke only when I drink alcohol....it only lasts so long. Then I've quit several times and just smoke other people's cigs on occasion-my son's friends that stop over, the neighbors, coworkers...Ill give it up for months, or a year at a time, and then change my mind in a crisis. I am just so sick of those things though. But no, didn't mention it to my doctor, but will tell my new PDoc if I ever get to see him. Thanks for mentioning this. How long has it been for you since you quit?
Posted by linkadge on May 3, 2009, at 20:40:32
In reply to Re: drug for motivation! » seldomseen, posted by garnet71 on May 3, 2009, at 20:20:11
Stimulants can improve motivation for some people and some tasks (especially well known tasks).
Stimulants don't always improve motivation however. It depends on the ballance of monoamines in the prefrontal cortex. If dopamine concentrations are already high in the prefrontal cortex, you can actually induce depression by elevating them further.
This is why people take their time and sip coffee when performing certain tasks. The right ratio of dopamine to serotonin will increase motivation, but if you increase dopamine too far you can start to induce depressive, antisocial and/or amotivational syndromes.
This is why some people compain of depression and apathy on stimulans. If you reach this point, the stimulant does not increase motivation but rather decreases it. In this case, you may actually benifit from a lower dose, or even the addition of an SSRI.
Linkadge
Posted by garnet71 on May 3, 2009, at 21:06:32
In reply to Re: drug for motivation!, posted by linkadge on May 3, 2009, at 20:40:32
Hmm. I think that's exactly what I wanted to hear.
I've never felt depressive or apathy from stimulants (yet); but SSRIs and Wellbutrin recently did just that--totally wiped out what little motivation i had and made me depressed and fatigued. I could barely even get out of bed!
That's one thing I like about the stimulants though-I don't feel too many negative side effects like with ADs I have taken; on the other hand, they don't work all the time and the effect doesn't last too long..and Ritalin in particular makes me tired when it wears off...
Well thanks Linkadge! I will keep all that in mind.
Posted by jane d on May 3, 2009, at 23:12:56
In reply to Re: drug for motivation!, posted by seldomseen on May 3, 2009, at 11:19:29
> Have you told your pdoc that you recently quit smoking?
>
> Man, I have said this before on this board, but I'm saying it again - quitting smoking radically changes your brain chemistry......
> Most docs are "Yipee! you quit smoking - good for you!" I wish pdocs were more enlightened as to the effect of such an act on our brain chemistry.
>
> Seldom.
AMEN!jane
Posted by softheprairie on May 3, 2009, at 23:59:40
In reply to Re: drug for motivation!, posted by Frustratedmama on May 3, 2009, at 11:19:15
> I am taking vyvanse for adhd right now and zyrtec for allergies. I have a diagnosis of adhd and mood disorder (but my daughter has asperger's). I am thinking I will ask for pristiq- your posts seem to mirror my moods frequently. I have been reading a lot of posts lately! let's pray this works- the lexapro left me feeling worse!I haven't read all of the posts on this thread yet, but I wanted to tell you that some of your fatigue is likely from the Zyrtec. I found it quite tiring. Clairitin (available as generic loratadine) is better in that department.
Posted by desolationrower on May 4, 2009, at 0:09:03
In reply to note to Frustratedmama, posted by softheprairie on May 3, 2009, at 23:59:40
hm. i haven't gottne any stimulants but i used nicotinei lozenges and they help with attention/distraction, but not motivation. my raction to nicotine before, was mostly just 'hm what a wierd tingly sensation'. never had any feel of addiction, though i do like the physicla routine of smoking, so i occasionally do socially, or smoke a pipe, but health/aftersmell kept me from smoking with any routine. dunno if lozenges woudl be worth a try, they might just make you wanta to smoke agian...
also, i probably asked before, but have you tried an nri? i'd fix hypothyroidism first though.
-d/r
Posted by Garnet71 on May 4, 2009, at 11:35:32
In reply to motivation/nicotine, posted by desolationrower on May 4, 2009, at 0:09:03
d/r - well I'm thinking distraction would be related to addiction to nicotine rather than it acting as an aid to concentration...
Yeah, I've tried Effexor....so what made you think of that?
Posted by metric on May 4, 2009, at 13:28:08
In reply to Re: drug for motivation!, posted by garnet71 on May 2, 2009, at 16:18:28
> I think I'm going to stop by PDocs ofc Monday and see if I can get some of the Pristiq samples he has.
If you've taken Effexor (venlafaxine), you've already taken Pristiq (desvenlafaxine). Pristiq is the primary active metabolite of Effexor. Wyeth's exclusivity protection on the extended-release formulation of venlafaxine (Effexor XR) will soon expire (hence Pristiq). I would take Effexor XR instead of Pristiq, if I were going to take either.
> 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.
Running out of buspirone is not a cause for panic; running out of Xanax is. I'm surprised anyone still manufactures buspirone.
> 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.
Is he going to require you to keep coming back to get new scripts/refills when you run out? Or just when you want to try something different?
> 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.
I don't think you'd like Provigil very much -- at least not on its own. If you can get some free samples, try it and see how it feels. But even if you like it, it's way too expensive without insurance. Importing it from overseas is a bad idea because it's a controlled substance in the U.S. (you could go to prison).
> But why would I need a mood stabilizer if I have no mood problems?
You wouldn't. Shrinks (not all, but many) will put you all sorts of weird drugs if you let them. Sedated mentally-disabled patients are easier to deal with. Be especially wary of the ones who promote the use of atypical neuroleptics for anxiety, insomnia, etc.
> 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.Does Xanax help?
Posted by metric on May 4, 2009, at 16:57:02
In reply to Re: drug for motivation!, posted by linkadge on May 3, 2009, at 20:40:32
> Stimulants don't always improve motivation however. It depends on the ballance of monoamines in the prefrontal cortex. If dopamine concentrations are already high in the prefrontal cortex, you can actually induce depression by elevating them further.
>
> This is why people take their time and sip coffee when performing certain tasks. The right ratio of dopamine to serotonin will increase motivation, but if you increase dopamine too far you can start to induce depressive, antisocial and/or amotivational syndromes.
>Wow. I had no idea that's why people sip their coffee. I thought they just savored the taste. Or preferred the sustained delivery and consequent minimization of crashes.
> This is why some people compain of depression and apathy on stimulans. If you reach this point, the stimulant does not increase motivation but rather decreases it. In this case, you may actually benifit from a lower dose, or even the addition of an SSRI.
Or neurotransmitter depletion and/or receptor desensitization and/or a million other factors.
Unfortunately, neuroscience hasn't reached the stage where such nuanced interpretations of neurochemical phenomena can be regarded as more than wild conjecture. The brain remains a black box, especially as it concerns the more subtle variations that give rise to changes in mood-related areas.
Posted by linkadge on May 4, 2009, at 17:34:38
In reply to Re: drug for motivation!, posted by metric on May 4, 2009, at 16:57:02
>Wow. I had no idea that's why people sip their >coffee. I thought they just savored the taste. >Or preferred the sustained delivery and >consequent minimization of crashes.Not necessarily. There is the same phenomina with smoking. Some studies show that smokers will smoke to reach a certain level of MAO inhibition. In certain animal models of depression there is an increase in prefrontal dopaminergic neurotransmission. The same appears to be true in humans. Depressed patients who responded to ketamine for instance experienced a decrease in prefrontal cortex metabolism. See:
http://www.sciencedaily.com/releases/2008/05/080506112416.htm
Increasing prefrontal cortex function doesn't always result in improved mood. There is a threshold effect beyond which you can worsen mood. For certain depressions, drugs which increase prefrontal metabolism can substantially worsen depression. Wellbutrin for instance, makes some people acutely worse.
>Unfortunately, neuroscience hasn't reached the >stage where such nuanced interpretations of >neurochemical phenomena can be regarded as more >than wild conjecture. The brain remains a black >box, especially as it concerns the more subtle >variations that give rise to changes in mood->related areas.
I like to think I am a step above conjecture.
Linakdge
Posted by garnet71 on May 4, 2009, at 19:14:39
In reply to Re: drug for motivation! » garnet71, posted by metric on May 4, 2009, at 13:28:08
Yeah, Metric, I know about the patent extender Pristiq. I thought I could get loads of it free since the drug reps are now pushing it. but I'm really having trouble getting myself to take it (ask for it)....I think I like my little experiment-alternating dextro with ritalin (for now!); every other day...until I see new doctor...I'd hate to take something that messes me all up whem my mood is good every single day.
Don't be angry at my buspirone...I love the stuff...you must be taking too much xanax (you forget we talked about this). lol
I don't know about new pdoc yet..appt is not for 2 months..but yeah, xanax helps w/anxiety....but not motivation. I still take .25 xanax...actually, more lately so I'll likely run out.
what I really need is treatment for hypothyrodism...been thinking about that since yesterday.
Posted by jane d on May 4, 2009, at 20:57:06
In reply to Re: drug for motivation! » garnet71, posted by metric on May 4, 2009, at 13:28:08
> I don't think you'd like Provigil very much -- at least not on its own. If you can get some free samples, try it and see how it feels. But even if you like it, it's way too expensive without insurance. Importing it from overseas is a bad idea because it's a controlled substance in the U.S. (you could go to prison).
>Since when is it a controlled substance?
I do agree it's way too expensive. And I don't think it's a miracle drug. But it certainly wasn't controlled when I took it. In fact I got the impression that perhaps some docs liked prescribing it instead of cheaper, more effective stimulatants just BECAUSE it wasn't controlled.
jane
Posted by Garnet71 on May 4, 2009, at 21:12:05
In reply to Re: drug for motivation! » metric, posted by jane d on May 4, 2009, at 20:57:06
Provigil: $ cha-ching
lol
http://www.usdrugstoreonline.com/DrugInfo.aspx?id=6010&RefID=Microsoft
Not that I would order it from that pharmacy if I had a script....I'm going to call the grocery store pharmacy that charges about 1/3 of the price with a AAA card....(and they even gave me 2 Buspirones for free yesterday!). Maybe it could be obtained much cheaper if anyone were to look around.
Posted by 10derHeart on May 4, 2009, at 23:38:09
In reply to Re: drug for motivation! » metric, posted by jane d on May 4, 2009, at 20:57:06
hi jane,
Not sure when, but it seems to be listed on Schedule IV of controlled substances, at least it was as of April 2008. (Along with valium, Xanax, ativan and many others far less familiar to me.)
Something like "low potential for abuse, but could cause a chemical or psychological depedence..."
http://www.deadiversion.usdoj.gov/21cfr/cfr/1308/1308_14.htm
I know - I was also surprised. Maybe they added it some time after you were taking it?
Posted by jane d on May 5, 2009, at 1:50:55
In reply to Re: drug for motivation! » jane d, posted by 10derHeart on May 4, 2009, at 23:38:09
> hi jane,
>
> Not sure when, but it seems to be listed on Schedule IV of controlled substances, at least it was as of April 2008. (Along with valium, Xanax, ativan and many others far less familiar to me.)
>
> Something like "low potential for abuse, but could cause a chemical or psychological depedence..."
>
> http://www.deadiversion.usdoj.gov/21cfr/cfr/1308/1308_14.htm
>
> I know - I was also surprised. Maybe they added it some time after you were taking it?Well so it is, 10derheart. Tucked in with all the "pams" as well as Sonata and Ambien. I imagine it always was there but having once jumped through the hoops required for Adderall & Ritalin (sched II) I didn't think of sched IV as being controlled. I wonder what the practical implications are if any?
" could cause a chemical or psychological depedence..." That sounds like a description of my chocolate Haagen Daz as well as most of the meds discussed here.
Thanks for finding and posting that link 10der. I should have tried to check before I posted.
Jane
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