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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 20 of 20. This is the beginning of the thread.
Posted by KarenRB53 on January 20, 2010, at 14:44:57
I've been on Celexa for about 8 months now. I does help with depression but I have no motivation or energy. I could care less about most things. Is this because Celexa is strictly an SSRI??? I was on Prozac for many years but eventually it caused hypomania. Celexa was good for the first few months after getting used to it but now I feel kind of disconnected from things. I've been thinking of going back on Prozac because I hate feeling this way. Any suggestions appreciated.
Karen
Posted by bleauberry on January 20, 2010, at 18:22:38
In reply to No Motivation or Energy on Celexa, posted by KarenRB53 on January 20, 2010, at 14:44:57
I saw a metastudy yesterday on the web that looked at this very topic. We've seen it here for years. It has several names, one of which is "SSRI induced apathy syndrome". In that study, 30% of patients complained of it as being their primary side effect, and it was the major side effect that caused them to eventually stop the medication. This was regardless of whether it actually helped their depression or not. A common complaint was that patients could not even cry at a funeral.
Maybe it has something to do with longterm serotonin potentiation, which is inhibitory, squashing out the function of the excitatory neurotransmitters dopamine and norepinephrine. I don't think enough research has been done on this. Much more is needed.
We do know that enhancement of norepinephrine and/or dopamine can reverse or minimize the apathy syndrome. That includes trials of additional agents such as Ritalin, Adderall, Wellbutrin, Desipramine, Savella, and sometimes one of the atypical antipsychotics can work, despite that they can also pose a risk of worsening it if doses are too high. Natural agents can work very well, including Tyrosine and/or DLPA. The addition of Rhodiola Rosea can work well too, as a few psychiatrists routinely add this herb to pharmaceutical antidepressants for that very reason.
I'm glad it wasn't so bad for you on Prozac. For me, Prozac was the friendliest in that regard, but it still left me quite motivationless. Not as bad as the others, but still bad. I had to take both Zyprexa and Adrafinil (or Ritalin) to overcome it, and even those weren't a perfect cure.
It's a tough issue. No easy answers. No real explanations from pharm companies or researchers. I think the basic message here is that serotonin function is now too strong, while NE/DA are too weak. The drug has caused a new chemical imbalance that helped depession but created apathy.
Posted by KarenRB53 on January 20, 2010, at 18:47:01
In reply to Re: No Motivation or Energy on Celexa, posted by bleauberry on January 20, 2010, at 18:22:38
> I saw a metastudy yesterday on the web that looked at this very topic. We've seen it here for years. It has several names, one of which is "SSRI induced apathy syndrome". In that study, 30% of patients complained of it as being their primary side effect, and it was the major side effect that caused them to eventually stop the medication. This was regardless of whether it actually helped their depression or not. A common complaint was that patients could not even cry at a funeral.
>
> Maybe it has something to do with longterm serotonin potentiation, which is inhibitory, squashing out the function of the excitatory neurotransmitters dopamine and norepinephrine. I don't think enough research has been done on this. Much more is needed.
>
> We do know that enhancement of norepinephrine and/or dopamine can reverse or minimize the apathy syndrome. That includes trials of additional agents such as Ritalin, Adderall, Wellbutrin, Desipramine, Savella, and sometimes one of the atypical antipsychotics can work, despite that they can also pose a risk of worsening it if doses are too high. Natural agents can work very well, including Tyrosine and/or DLPA. The addition of Rhodiola Rosea can work well too, as a few psychiatrists routinely add this herb to pharmaceutical antidepressants for that very reason.
>
> I'm glad it wasn't so bad for you on Prozac. For me, Prozac was the friendliest in that regard, but it still left me quite motivationless. Not as bad as the others, but still bad. I had to take both Zyprexa and Adrafinil (or Ritalin) to overcome it, and even those weren't a perfect cure.
>
> It's a tough issue. No easy answers. No real explanations from pharm companies or researchers. I think the basic message here is that serotonin function is now too strong, while NE/DA are too weak. The drug has caused a new chemical imbalance that helped depession but created apathy.
Thanks for such great information!!
Posted by Phillipa on January 20, 2010, at 22:19:39
In reply to Re: No Motivation or Energy on Celexa » bleauberry, posted by KarenRB53 on January 20, 2010, at 18:47:01
Can you give lexapro a try met some lexapro reps today and they said celexa different isomer and lex now starts at 5mg? Might be worth a try. Phillipa
Posted by orbital on January 20, 2010, at 22:28:21
In reply to No Motivation or Energy on Celexa, posted by KarenRB53 on January 20, 2010, at 14:44:57
I can definitely relate to your experience. I did quite well on Lexapro (not technically Celexa, I know), but after almost year on it, apathy hit me like a ton of bricks. I went through several major life changes during that time, yet I couldn't care less. It was horrible, "chemical lobotomy" doesn't begin to describe it. My doctor tinkered with my dosage, added a few things etc but it just kept getting worse. So I eventually discontinued the drug.
I'm not bashing this med -or ADs in general- as Lexapro did help me enormously for a while. But I do think that the apathy syndrome Bleauberry has described is very real, and that pdocs and patients need to be informed about it. I also think it's important to know when it's time to discontinue a med, and move on to something else as/if needed. FWIW, I've been on a low dose of Prozac for several months now and, while it's not helping me as much as Lexa for anxiety, I do feel more motivated and driven - thus, in my case, much less depressed.
> I've been on Celexa for about 8 months now. I does help with depression but I have no motivation or energy. I could care less about most things. Is this because Celexa is strictly an SSRI??? I was on Prozac for many years but eventually it caused hypomania. Celexa was good for the first few months after getting used to it but now I feel kind of disconnected from things. I've been thinking of going back on Prozac because I hate feeling this way. Any suggestions appreciated.
>
> Karen
Posted by topcatclr on January 20, 2010, at 22:40:09
In reply to Re: No Motivation or Energy on Celexa » KarenRB53, posted by orbital on January 20, 2010, at 22:28:21
That's why i take Cymbalta. After being on SSRIs for years, a lot of people graduate to SNRIs. They take a little getting used to, and i usually need a smaller dose. But after a while, you get your life back. I kind of feel normal on them, like how a person is supposed to feel, minus the panic and depression. They allow you to have emotions!
Posted by janejane on January 21, 2010, at 7:44:48
In reply to No Motivation or Energy on Celexa, posted by KarenRB53 on January 20, 2010, at 14:44:57
> I just posted earlier about what I could use with Celexa to help with the lack of motivation and fatigue I feel from taking Celexa and "bleauberry" responded with great info about Rhodiola Rosea so I'm glad someone else is using this. Is it working well for you...are you taking it with other AD's?
>
> ThanksHi Karen,
I've copied over your message to me from the other thread (see above) since I think it makes more sense to answer it here.
I sympathize with you about the low motivation and energy, and feeling "disconnected". I got that from prozac. If you want to read more about SSRI-induced apathy, do a search of the archives here. It's been discussed quite a bit.
I'm certainly no expert, but all the recommendations you got made a lot of sense to me. I think anything that increases dopamine/norepinephrine would be worth trying, including tyrosine and DLPA (amino acid supplements).
I'm currently taking rhodiola rosea, but I'm not sure I would recommend it as the first thing you should try since you have so many other options. Then again, it might be exactly what you need.
I'm not taking any Rx meds right now and I find the rhodiola to ease my depression (mostly despair and feeling overwhelmed) with no obvious side effects. I'm not sure yet whether it's going to work for the long term as I'm still experimenting. My depression isn't completely gone, and I've had some setbacks. I might try adding a little prozac back into the mix at some point to see whether there's a synergistic effect.
If you want to read more about rhodiola, there are a few threads in the archives here about it. Googling will come up with more. There is a book called "The Rhodiola Revolution", which I haven't read, but would probably be a good source of info, especially if you want to go to your p-doc with this (it was written by a psychopharmacologist who uses it as an add-on to ADs).
As far as brands, Mind Body Spirit by Verde Botanica is the one that stands out. Bleauberry recommends it, and it's the kind I've been using. The one online store that sells it isn't set up for customer reviews, but from everything I've been able to find about it elsewhere, it seems to be "smoother" and better tolerated than other formulations. It also doesn't have unnecessary fillers. Price is comparable to other brands.
Posted by KarenRB53 on January 21, 2010, at 8:31:32
In reply to Re: No Motivation or Energy on Celexa » KarenRB53, posted by Phillipa on January 20, 2010, at 22:19:39
> Can you give lexapro a try met some lexapro reps today and they said celexa different isomer and lex now starts at 5mg? Might be worth a try. Phillipa
I did try Lexapro before I tried the Celexa. It actually made me a little hypo and I broke out in a rash. Had to see dermatologist and it cleared up okay but was told to stop taking Lexapro.
Thanks
Posted by JohnJ777 on January 21, 2010, at 12:04:12
In reply to rhodiola rosea » KarenRB53, posted by janejane on January 21, 2010, at 7:44:48
> > I just posted earlier about what I could use with Celexa to help with the lack of motivation and fatigue I feel from taking Celexa and "bleauberry" responded with great info about Rhodiola Rosea so I'm glad someone else is using this. Is it working well for you...are you taking it with other AD's?
> >
> > Thanks
>
> Hi Karen,
>
> I've copied over your message to me from the other thread (see above) since I think it makes more sense to answer it here.
>
> I sympathize with you about the low motivation and energy, and feeling "disconnected". I got that from prozac. If you want to read more about SSRI-induced apathy, do a search of the archives here. It's been discussed quite a bit.
>
> I'm certainly no expert, but all the recommendations you got made a lot of sense to me. I think anything that increases dopamine/norepinephrine would be worth trying, including tyrosine and DLPA (amino acid supplements).
>
> I'm currently taking rhodiola rosea, but I'm not sure I would recommend it as the first thing you should try since you have so many other options. Then again, it might be exactly what you need.
>
> I'm not taking any Rx meds right now and I find the rhodiola to ease my depression (mostly despair and feeling overwhelmed) with no obvious side effects. I'm not sure yet whether it's going to work for the long term as I'm still experimenting. My depression isn't completely gone, and I've had some setbacks. I might try adding a little prozac back into the mix at some point to see whether there's a synergistic effect.
>
> If you want to read more about rhodiola, there are a few threads in the archives here about it. Googling will come up with more. There is a book called "The Rhodiola Revolution", which I haven't read, but would probably be a good source of info, especially if you want to go to your p-doc with this (it was written by a psychopharmacologist who uses it as an add-on to ADs).
>
> As far as brands, Mind Body Spirit by Verde Botanica is the one that stands out. Bleauberry recommends it, and it's the kind I've been using. The one online store that sells it isn't set up for customer reviews, but from everything I've been able to find about it elsewhere, it seems to be "smoother" and better tolerated than other formulations. It also doesn't have unnecessary fillers. Price is comparable to other brands.I've read the book suggested by JaneJane and enjoyed it. There's a big caveat, however, in that it was written a number of years ago and the brands/recommendations have all changed since then. I take the MBS Mind Body & Spirit mentioned above, and it wasn't even around when the book was written. I think there's a lot that's been discovered about Rhodiola since this book, most notably that it can't be combined with chemical additives as so many companies use (such as magnesium stearate, chromium dioxide, etc). Rhodiola seems as if it is a very sensitive, ultra-fussy herb, which is the only thing that can explain to me why I can take 500 mg in one capsule from one company, and then get more effect out of a 150 mg capsule from another. What's up with that!
I've also discovered this with Maca, another herb I enjoy taking. There is such a difference between types of the same herb.
Posted by janejane on January 21, 2010, at 17:53:18
In reply to Re: rhodiola rosea, posted by JohnJ777 on January 21, 2010, at 12:04:12
JohnJ777,
Are you by any chance the same person as JohnL, who posted about rhodiola in the past? Either way, I have questions for you! I'm currently taking it, but could use some pointers. I've read that adaptogens require occasional breaks but have seen nothing definitive about this with respect to rhodiola. Do you find the need to take breaks or cycle it? Any other dosing or augmentation tips?
Also, what does maca do for you, and do you have any brand recommendations? I've tried Energy Reserves by Verde Botanica and have not noticed much additional benefit. I feel like to need to look for other strategies.
Thanks so much!!!
-Jane
Posted by JohnJ777 on January 26, 2010, at 11:53:32
In reply to Re: rhodiola rosea » JohnJ777, posted by janejane on January 21, 2010, at 17:53:18
> JohnJ777,
>
> Are you by any chance the same person as JohnL, who posted about rhodiola in the past? Either way, I have questions for you! I'm currently taking it, but could use some pointers. I've read that adaptogens require occasional breaks but have seen nothing definitive about this with respect to rhodiola. Do you find the need to take breaks or cycle it? Any other dosing or augmentation tips?
>
> Also, what does maca do for you, and do you have any brand recommendations? I've tried Energy Reserves by Verde Botanica and have not noticed much additional benefit. I feel like to need to look for other strategies.
>
> Thanks so much!!!
>
> -JaneHi Jane, no I don't "cycle" my Rhodiola. I think that's an old wives tale. I want the benefit every day. I take Energy Reserves as well, but it isn't a Rhodiola product. It has a small dose of Rhodiola in it, but it is primarily an add-on product for those who take Mind Body & Spirit (according to the brochure inside the box of MBS). I take it when I need the extra PHYSICAL energy it provides -- while the MBS does the mental energy and clarity side.
I find that Maca and Rhodiola both have a sexual benefit. Maca doesn't have much mood impact, but it is stimulating to the sex drive, and good Rhodiola has a similar effect (when taken over the 450 mg a day barrier). The problem with Maca is that there are a bunch of really low-end, poor processing products out there. Clumpy, smelly looking powders, etc. It's hard to find a good one, just as with Rhodiola.
Posted by janejane on January 26, 2010, at 12:27:42
In reply to Re: rhodiola rosea, posted by JohnJ777 on January 26, 2010, at 11:53:32
Thanks, John. I was quite concerned that the benefit would wane if I took it continually. As it is, I do feel like it's pooping out somewhat. When I first took it, the despair disappeared, and though I still had generally low mood, it wasn't as bad as my previous baseline. Occasional bouts of despair have since resurfaced and my overall mood has slumped a bit as well. Does this mean I need to take more? I just started taking a small amount of prozac (in addition to the rhodiola) to see if it'll help, but it's too soon to tell.
Do you have any advice you could offer me in terms of dosing or augmentation? It doesn't seem like maca is something I'd be interested in, at least at the moment. The depression/dysthymia is really the primary issue. And I figured as much, about the Energy Reserves being more for physical energy rather than mood. (Oh well.) Thanks for any additional help you can offer!
Posted by JohnJ777 on January 29, 2010, at 11:37:08
In reply to Re: rhodiola rosea » JohnJ777, posted by janejane on January 26, 2010, at 12:27:42
> Thanks, John. I was quite concerned that the benefit would wane if I took it continually. As it is, I do feel like it's pooping out somewhat. When I first took it, the despair disappeared, and though I still had generally low mood, it wasn't as bad as my previous baseline. Occasional bouts of despair have since resurfaced and my overall mood has slumped a bit as well. Does this mean I need to take more? I just started taking a small amount of prozac (in addition to the rhodiola) to see if it'll help, but it's too soon to tell.
>
> Do you have any advice you could offer me in terms of dosing or augmentation? It doesn't seem like maca is something I'd be interested in, at least at the moment. The depression/dysthymia is really the primary issue. And I figured as much, about the Energy Reserves being more for physical energy rather than mood. (Oh well.) Thanks for any additional help you can offer!I take three capsules a day, have for some time (another Swedish brand before that, same potency) and have had ups and downs, but generally stable in mood and depression levels are so low now compared to my former norm. Occasionally I have run out and have to buy something in a store - only to find that my issues take a dramatic downwards turn until I get back on the Mind Body Spirit product. So -- I'd suggest that you forget about their "two capsules" approach on the box, and use more than that. ): J
Posted by KarenRB53 on January 29, 2010, at 19:46:56
In reply to Re: No Motivation or Energy on Celexa, posted by topcatclr on January 20, 2010, at 22:40:09
I talked to my pdoc today and I'm going to add a small amount of Wellbutrin with the Celexa and see if that helps. Thanks for all the input and I'll post how it works out.
Karen
Posted by KarenRB53 on November 1, 2010, at 9:58:19
In reply to Re: No Motivation or Energy on Celexa, posted by topcatclr on January 20, 2010, at 22:40:09
> That's why i take Cymbalta. After being on SSRIs for years, a lot of people graduate to SNRIs. They take a little getting used to, and i usually need a smaller dose. But after a while, you get your life back. I kind of feel normal on them, like how a person is supposed to feel, minus the panic and depression. They allow you to have emotions!
Are you still on the Cymbalta.....is it still working well for you?
Posted by KarenRB53 on November 1, 2010, at 10:02:23
In reply to Re: No Motivation or Energy on Celexa, posted by KarenRB53 on January 29, 2010, at 19:46:56
I've been on the combo of WellbutrinXL 150mg daily with 20mg Celexa. After the initial start up the Wellbutrin worked well, gave me motivation, energy etc. But now I'm feeling the depression kicking back in. I'm going to up the dosage of WellbutrinXL to 300mg and then I'll up the dosage of Celexa to 30g. I'm thinking maybe its the Celexa thats not working because it never did work all that well with me. Anyone have any suggestions of what SSRI might work better with Wellbutrin?
Posted by ggggg123 on November 2, 2010, at 7:18:56
In reply to Re: No Motivation or Energy on Celexa, posted by KarenRB53 on November 1, 2010, at 10:02:23
There are numerous tca's which target the norepinephrine system. Also a low dose of a dopamine agonist may be helpful. Personally I would lower the dose of celexa to no more than 10mg and keep trying with the wellbutrin, but maybe add a small dose of a dopamine agonist. Other things to try would include stimulants, but how sustainable that method would be is questionable. I have suffered the same problem on celexa and have quit the drug and am trying to get my motivation back, today I am starting reboxetine an nri, its not available in the us though. You might fair better on a tca, although the side effects could prove problematic. but 30mg of celexa will probably not improve things, I would definately drop the dose.
Personally I don't find wellbutrin very potent and the half life feels quite short, thats why I would maybe add a small amount of a dopamine agonist to give it a boost. It might be worth trying the adhd drugs and narcolepsy drugs but I have'nt tried them.
Anti-depressant options include changing to venlafaxine, which is supposed to be very stimulating in higher doses. Switching to a tca which has high affinity for norepinephrine.
Lowering celexa/increasing wellbutrin - maybe adding another stimulating drug?
some find the maoi's much more stimulating but they're bad news if u like cheese.
Posted by ggggg123 on November 2, 2010, at 11:16:47
In reply to Re: No Motivation or Energy on Celexa, posted by bleauberry on January 20, 2010, at 18:22:38
Well done blueberry you are right on the nose!! you explained my situation to a t, some psychiatrist are aware of this problem and I think soooo many people are affected many will be branded into different categories, some will be branded retarded depressives, some will be branded treatment resistant and some will be said to have learned helplessness, the truth is this is ssri induced anhedonia!!!!! NE AND DA are the problem, and without treatment I think it is difficult to reverse, the best bet is to get on an NRI long term and spit the ssri in the bin, I don't see what benefit continuing with ssri's will bring if you develop ssri apathy, it will never improve, psychiatry really needs some new drugs for the 30% who ssri's turn into apathetic zombs.It seems for some people including myself ssri's can reduce ones chance of recovering from depression as they take every bit of pleasure out of life and make the point of life very hard to see. But they may reduce your anxiety, in my book its a very horizontal move and even counterproductive, a depressed person needs to be able to enjoy life and feel confident, this may be controversial but, I don't care ssri's have ruined too many lives, if you have experienced apathy you will understand how awful an existence it is. GET BETTER DITCH THE SSRI, GET SOMETHING THAT WORKS!!
Posted by ggggg123 on November 3, 2010, at 2:37:45
In reply to Re: No Motivation or Energy on Celexa, posted by ggggg123 on November 2, 2010, at 7:18:56
I would like to add a disclaimer: that this is all my own opinion, you don't have to listen to a word.
Posted by KarenRB53 on November 3, 2010, at 8:41:18
In reply to Re: No Motivation or Energy on Celexa, posted by ggggg123 on November 2, 2010, at 7:18:56
> There are numerous tca's which target the norepinephrine system. Also a low dose of a dopamine agonist may be helpful. Personally I would lower the dose of celexa to no more than 10mg and keep trying with the wellbutrin, but maybe add a small dose of a dopamine agonist. Other things to try would include stimulants, but how sustainable that method would be is questionable. I have suffered the same problem on celexa and have quit the drug and am trying to get my motivation back, today I am starting reboxetine an nri, its not available in the us though. You might fair better on a tca, although the side effects could prove problematic. but 30mg of celexa will probably not improve things, I would definately drop the dose.
>
> Personally I don't find wellbutrin very potent and the half life feels quite short, thats why I would maybe add a small amount of a dopamine agonist to give it a boost. It might be worth trying the adhd drugs and narcolepsy drugs but I have'nt tried them.
>
> Anti-depressant options include changing to venlafaxine, which is supposed to be very stimulating in higher doses. Switching to a tca which has high affinity for norepinephrine.
> Lowering celexa/increasing wellbutrin - maybe adding another stimulating drug?
> some find the maoi's much more stimulating but they're bad news if u like cheese.Thanks for your very informative opinion. I appreciate it.
This is the end of the thread.
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