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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by ed_uk on November 11, 2004, at 10:19:07
Hello!
At the moment, I take citalopram (Celexa/Cipramil) for anxiety/OCD and lofepramine (Gamanil) for depression. The medication seems to have been effective but I find the Celexa makes me feel very lazy and lacking in motivation. I don't have any major side effects from the lofepramine (a TCA similar to desipramine). Another side effect of Celexa is that I always need to sleep twice a day. Once at night and again in the afternoon.
I don't want to reduce the dose of Celexa because I didn't benefit from lower doses. (I take 60mg/day.)
I would very much like to hear from anyone who has succesfully used additional medication to reverse amotivation caused by an SSRI.
Ritalin? Dexedrine? Provigil? Wellbutrin?
Selegiline? - bit worried about the small risk of serotonin syndrome with this combination.
Ed
Posted by linkadge on November 11, 2004, at 10:26:32
In reply to SSRIs and amotivation, posted by ed_uk on November 11, 2004, at 10:19:07
I think your first be would be to increase the lofepramine or add wellbutrin.
THe celexa wellbutrin combination has been used extesivly, and appears to be safe, and robustly synergistic.
Linkadge
Posted by Peddidle on November 11, 2004, at 14:51:37
In reply to Re: SSRIs and amotivation, posted by linkadge on November 11, 2004, at 10:26:32
I'm on zoloft, and the same thing happens to me-- I could care less about anything, I get happy and sad, but I don't really have any desire to do anything (I have no motivation to do school work, etc.). I've decreased my dose recently, and things have gotten a tiny bit better, but nothing significant. A few weeks ago, my pdoc gave me strattera, I haven't noticed any change yet though, except that I am a lot more tired than usual. Although, she warned me it would take a number of weeks to start working. She said if it doesn't work by then, I might be able to try stimulants (ie ritalin, dexadrine, etc.)
Posted by lalaland7 on November 11, 2004, at 19:50:27
In reply to Re: SSRIs and amotivation, posted by Peddidle on November 11, 2004, at 14:51:37
Finally! I do not feel so alone....I am still tired and unmotivated from prozac and wellbutrin. I added Ritalin and it helped for about 3 weeks. Then it really did nothing. I wasn't about to mess around with it and just keep raising the dose for effectiveness. I do not need an addiction on top of everything else! I am going to ask my Dr about Provigil tomorrow...so if I try it I will post about my experience. But I am totally open for suggestions from anyone elses experiences.
Also I was under the impression that Effexor was suppose to help with motivation but everyone has been posting how tired it makes them so it is confusing.
Posted by ed_uk on November 12, 2004, at 7:00:57
In reply to Re: SSRIs and amotivation, posted by lalaland7 on November 11, 2004, at 19:50:27
Hi!
I already take the maximum dose of lofepramine. It helps with depression but not with motivation or concentration. I took Effexor a while back but it wasn't any different to the SSRIs as far as motivation is concerned. In fact, I couldn't distinguish it from an SSRI at all! I think I'd like to try Dexedrine.
Ed
Posted by j. Backer on November 12, 2004, at 13:59:23
In reply to Re: SSRIs and amotivation, posted by ed_uk on November 12, 2004, at 7:00:57
im on effexor 300mg and dexadrine 20mg time-release.
i slept like 16 hours the other day im always exausted, i just dont get it. iv always been like this, i failed school because i was always sleepin (even on adderal). i can fall asleep after a tripple esspresso EASY. i struggle staying awake at work, behind the wheel ect...i defently could use suggestions, any.
peace j
Posted by RetiredYoung on November 12, 2004, at 14:51:48
In reply to Re: SSRIs and amotivation, posted by j. Backer on November 12, 2004, at 13:59:23
Your symptoms certainly make it sound like you're very low in norepinephrine. Perhaps Nortriptyline or Wellbutrin may be more helpful for you? Also, you might be experiencing crashing effects from the stimulants...
Posted by KaraS on November 12, 2004, at 15:27:22
In reply to Re: SSRIs and amotivation, posted by j. Backer on November 12, 2004, at 13:59:23
> im on effexor 300mg and dexadrine 20mg time-release.
> i slept like 16 hours the other day im always exausted, i just dont get it. iv always been like this, i failed school because i was always sleepin (even on adderal). i can fall asleep after a tripple esspresso EASY. i struggle staying awake at work, behind the wheel ect...
>
> i defently could use suggestions, any.
> peace jDo you EVER feel any stimulation from stimulants?
If not, you might have what I have: hypersensitive presynaptic dopamine autoreceptors. In this condition the autoreceptors are overly vigilant in keeping low levels of dopamine in your synapses. When more dopamine is introduced, instead of stimulation, your autoreceptors reduce their output and the net effect is that you feel tired. I have recently found this out about myself and am exploring ways to deal with it.Serotonergics (including Effexor) also have a dampening effect on dopamine.
K
Posted by Laree on November 12, 2004, at 22:03:10
In reply to Re: SSRIs and amotivation, posted by j. Backer on November 12, 2004, at 13:59:23
Can I ask how old you are and what you were put on the Dexadrine for? the sleepiness?
Have you ever been diagnosed with Narcolepsy or Excessive Daytime Sleepiness (EDS)??
Perhaps a combo of a stimulant (such as shorter-acting Dexadrine, Adderall, Ritalin, or Desoxyn)
+ Provigil would prove to be of help? Have you tried Desoxyn? It is technically methamphetamine and is more potent than dextroamphetamine. Maybe the time-release thing just isn't working out for you--have you tried immediate-release stimulant(s)? I'd also get checked out by a doctor if you haven't already, get some blood work done, etc.
Best,
L.> im on effexor 300mg and dexadrine 20mg time-release.
> i slept like 16 hours the other day im always exausted, i just dont get it. iv always been like this, i failed school because i was always sleepin (even on adderal). i can fall asleep after a tripple esspresso EASY. i struggle staying awake at work, behind the wheel ect...
>
> i defently could use suggestions, any.
> peace j
Posted by Keith Talent on November 13, 2004, at 23:03:58
In reply to SSRIs and amotivation, posted by ed_uk on November 11, 2004, at 10:19:07
I'd replace the citalopram with escitalopram (Lexapro) 30 mg per day straight away. It doesn't contain the R-citalopram enantiomer which causes more peripheral side effects yet has less potency in the brain.
Personally, I found dextroamphetamine worked well, but the effect burnt out after only four weeks. Perhaps methylphenidate (or dexmethylphenidate, if available where you live) would provide more sustainable benefits? Other than that, would a dopamine-2 receptor partial agonist/modulator like aripiprazole (Abilify) be worth trialling?
I've tried quite a few noradrenergic antidepressants, and they didn't help the anergia/amotivation caused by serotonergic antidepressants. There definitely seems to be a dopaminergic problem here.
Posted by ed_uk on November 14, 2004, at 2:10:54
In reply to Re: SSRIs and amotivation, posted by Keith Talent on November 13, 2004, at 23:03:58
Thank you Keith,
I'm not sure replacing citalopram with escitalopram is the answer. I've been on loads of different SSRIs and they're all the same as far as motivation goes!!
The noradrenergic AD lofepramine has improved my depression but it certainly doesn't get me motivated :-( I'd like to try methylphenidate but I doubt my pdoc would prescribe it. (Dexmethylphenidate is not available). I live in England and SSRIs seem to be the only drugs pdocs use over here. If you don't like one they just give you another! I definately don't want to try an AP because the last time I tried one I ended up in the emergency department and had to be sedated. The akathisia was like torture.Ed
Posted by j. Backer on November 15, 2004, at 8:29:50
In reply to Re: SSRIs and amotivation, posted by ed_uk on November 14, 2004, at 2:10:54
i have had blood tests like 2 months ago and im 100%. i am on the dexadrine for ADD and it does effect me positively but not enough. o ya and im 18, never been diagnosed with EDS or narcolepsy but i wouldnt be surprised if i was narcoleptic.
peace J
Posted by Keith Talent on November 16, 2004, at 6:42:42
In reply to Re: SSRIs and amotivation, posted by ed_uk on November 14, 2004, at 2:10:54
Ed,
I just meant that your side effects would be less with escitalopram because you only need half of it to get the same benefits.
Posted by ed_uk on November 16, 2004, at 8:13:51
In reply to Re: SSRIs and amotivation, posted by Keith Talent on November 16, 2004, at 6:42:42
Hi Keith,
Thanks for your reply :-)Sadly, it's a myth promoted by the pharm companies that more potent equals less side effects, this is not always the case. It's basically just an effective way of advertising Lexapro. 60mg citalopram contains 30mg escitalopram and 30mg R-citalopram. There isn't actually any good evidence to show that R-citalopram causes any side effects so there is little reason to eliminate it!! R-citalopram seems to have minimal pharmacological acivity. Anyway, I don't have anything to loose by trying escitalopram.
Regards,
Ed
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