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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 18 of 18. This is the beginning of the thread.
Posted by Nixon on February 12, 2005, at 15:46:09
Hi Everyone,
After taking ssri's,aed's etc.. for about ten years I have a low dose poly pharmacy combination that has worked well. My problems unmedicated are chronic and consist of 1. Depression 2. Anxiety (GAD + Panic)
3. Mood swings (Hypomania)
My med regimen consists of low dose:
1.Prozac 20mg (eliminates panic w/some stimulation)
2.Remeron 15mg (Helps w/sleep,anxiety,focus,depr.
3.Depakote er 250mg(Works well for m'swings at low dose.
4.Librium 20mg(Works great no need to increase)
All amounts are per day. I am an executive with agood job but that doesn't matter we are all in the same boat. I am sharp psychologically and suffer no cognitive impairment. My problem is alot of days I have NO MOTIVATION. I am calm, not depressed, but it is if I have no passion often. Eliminate one of these meds and symptoms return. Any Ideas? Thanks
Posted by Ritch on February 12, 2005, at 16:20:20
In reply to Ideas for Motivation, posted by Nixon on February 12, 2005, at 15:46:09
> Hi Everyone,
>
> After taking ssri's,aed's etc.. for about ten years I have a low dose poly pharmacy combination that has worked well. My problems unmedicated are chronic and consist of 1. Depression 2. Anxiety (GAD + Panic)
> 3. Mood swings (Hypomania)
> My med regimen consists of low dose:
> 1.Prozac 20mg (eliminates panic w/some stimulation)
> 2.Remeron 15mg (Helps w/sleep,anxiety,focus,depr.
> 3.Depakote er 250mg(Works well for m'swings at low dose.
> 4.Librium 20mg(Works great no need to increase)
> All amounts are per day. I am an executive with agood job but that doesn't matter we are all in the same boat. I am sharp psychologically and suffer no cognitive impairment. My problem is alot of days I have NO MOTIVATION. I am calm, not depressed, but it is if I have no passion often. Eliminate one of these meds and symptoms return. Any Ideas? Thanks
>Med-wise maybe add a small dose of Provigil as needed just on those particular days. You might be cycling back and forth from normal (euthymia) to hypo and you are just euthymic on those days? Calm and not depressed sounds pretty nice to me. But, if you are used to being driven by the challenge of new projects, etc. and find yourself without new ideas and unmotivated.. it could make you feel there's something wrong when maybe there really isn't. I'm BP-II and I don't like it when there isn't *something* going on for me to work at vigorously. Sometimes even though I'm not feeling motivated or even depressed, if I'm challenged to do something difficult I snap out of it and get moving ok. I just have trouble *self-starting* when I get blahed out. Maybe these unmotivated times would be a good time to ask other people about their ideas and stir the pot that way? Hope this helps some.
Posted by smith562 on February 12, 2005, at 16:27:11
In reply to Ideas for Motivation, posted by Nixon on February 12, 2005, at 15:46:09
Hey Nixon,
I am in a similar boat ... take similar meds (zoloft 75, lithium 450, klonopin 1) ... have a prominant job ... I am having the same motivation problems. This is was has helped me thus far ....
1. Coffee/Caffiene
2. Low dose lamictal (25 to 50mgs only .. higher and to much anxiety)
3. Low dose wellbutrin (25 to 50 mgs twice/day)What might help the most is switch to an MAOI like parnate/nardil. Nardil worked the best for me mood wise .... but SOOOOOO many side effects.
Hope this helps ...
Posted by Nixon on February 12, 2005, at 17:17:30
In reply to Re: Ideas for Motivation » Nixon, posted by Ritch on February 12, 2005, at 16:20:20
Hey Ritch,
Thanks alot. I can relate to the feelings you describe. I would say I tend to lean toward BPII except I just have too much DP. I say BPII because from experience if I just take an ssri or even combine a benzo with it forget it. Up then down ya know. I will say one thing about BP, I NEVER have those wonderfull creative highs for extended periods . Maybe you're right, just get off my *ss and look to others. Never tried Provigil if you have time let me know about it. Going to the Doc Monday. Thanks again. JN
Posted by Nixon on February 12, 2005, at 17:25:05
In reply to Re: Ideas for Motivation » Nixon, posted by smith562 on February 12, 2005, at 16:27:11
Hey Smith,
Yes Lamictal is the only MS I have not tried and believe me like you I have tried many. I took Topamax for 2 days and dropped a pizza then had a coffee and thought I was going to freak for about 5 minutes. I even tried the Dreyfus method of Dilantin, that's like acid. I took 100mg for 3 weeks was in my Barber chair and literally thought I was gonna die. Never happened before. For anyone thinking of Dilantin for mood forget it. Anyway maybe you're right about Lamictal. Will it effect low dose Depakote? Also what about Trileptal? Better feeling than Depakote. I just like Depakote because it brings me down no BS. Thanks again. JN
Posted by ed_uk on February 12, 2005, at 19:27:19
In reply to Ideas for Motivation, posted by Nixon on February 12, 2005, at 15:46:09
Hi!
>Prozac 20mg
Some people find that Prozac reduces motivation, this can be a problem with all SSRIs- it's not universal though. Have you always taken 20mg/day? Have you ever tried taking 20mg on alternate days? Some people do better on a low dose.
>I am an executive with agood job
Lol, it doesn't sound like your motivation is too bad if you've progressed to such a good job :-)
>Mood swings (Hypomania)
What symptoms of hypomania do you get?
Ed.
Posted by Phillipa on February 12, 2005, at 19:34:09
In reply to Re: Ideas for Motivation, posted by ed_uk on February 12, 2005, at 19:27:19
Do you like your job? Or have you been taking the med for a long time? Maybe you need to go up or change AD's. Just a thought. Fondly, Phillipa
Posted by theo on February 12, 2005, at 19:56:30
In reply to Re: Ideas for Motivation » Nixon, posted by smith562 on February 12, 2005, at 16:27:11
When do you take your Lamictal, morning or night?
Posted by Nixon on February 12, 2005, at 20:00:58
In reply to Re: Ideas for Motivation, posted by ed_uk on February 12, 2005, at 19:27:19
Ed,
Thanks for the response. I have been on ssri's for 10 years zoloft for about 5 tried paxil,lexapro then for the last 2 years prozac. Ed, I stopped the prozac in November 04 and by last month I found myself getting anxiety and almost panic for No Reason at all. I thought what you suggested but I had no choice but to go back. I drop Remeron and I have less focus and can't sleep. I drop depakote and Hmania starts with mini cycles. Overreacting, angry quick, transient anxiety. As for the job, I am not a millionaire, just an account executive who is good with people and a fighter, I have to get the job done and I do, I just won't quit, I just rarely enjoy it along the way. At 32, I know I need meds for the rest of my life. I am fine with that. My genetic shortcomings are what motivate me. Take away the meds and I would not be productive. Thanks. JN
Posted by ed_uk on February 12, 2005, at 20:54:27
In reply to Re: Ideas for Motivation, posted by Nixon on February 12, 2005, at 20:00:58
Hi,
Have you ever taken any of the following drugs: Ritalin, Dexedrine, Adderall, Wellbutrin, or Provigil?
>Ed, I stopped the prozac in November 04 and by last month I found myself getting anxiety and almost panic for No Reason at all.
I wasn't suggesting that you come of it, perhaps a small dose reduction would be helpful though. What do you think?
Ed.
Posted by Nixon on February 12, 2005, at 21:01:44
In reply to Re: Ideas for Motivation, posted by ed_uk on February 12, 2005, at 20:54:27
Ed,
Sounds like it might work. Good premise regarding prozac. I see were you going regarding adderall, welbutrin, that's a possibility too. What do you think about switching or adding an AED that will lighten me up, will Trileptal stabilize with some AD qualities? Let me know. Thanks
Posted by ed_uk on February 12, 2005, at 21:11:37
In reply to Re: Ideas for Motivation, posted by Nixon on February 12, 2005, at 21:01:44
Hi,
Trileptal is often useful for irritability/hypomania but it doesn't generally help depression that much. You might prefer it to Depakote though. You'll have to experiment! Lamictal has more antidepressant action but it's not particularly reliable in preventing hypomania, some people find it makes them irritable.
Ed.
Posted by Nixon on February 12, 2005, at 21:25:25
In reply to Re: Ideas for Motivation, posted by ed_uk on February 12, 2005, at 21:11:37
Allright Maybe some experimenation is in order. If trileptal helps somewhat with irritability you are right I might prefer it to depakote which I notice when I up the dose with irritabilty surfaces. Lamictal is an option. Thanks again.PS. I am going to answer some posts from now on so try not to make me look too stupid.lol JN
Posted by ed_uk on February 12, 2005, at 21:36:07
In reply to Re: Ideas for Motivation, posted by Nixon on February 12, 2005, at 21:25:25
Hi,
>I am going to answer some posts from now on so try not to make me look too stupid.lol
Sorry, that wasn't my intention, you're not stupid at all.
I'm not looking forward to tomorrow, people are going start having a go at me because of what I said about Effexor. I wonder why I start threads like that sometimes. I was just making a joke about how Effexor has much more effect on serotonin than NE but inevitably people (not you LOL) will take what I said too seriously.
Best Regards,
Ed.PS. Welcome to p-babble :-)
Posted by smith562 on February 13, 2005, at 6:21:43
In reply to Re: Ideas for Motivation » smith562, posted by theo on February 12, 2005, at 19:56:30
Posted by smith562 on February 13, 2005, at 6:35:17
In reply to Ideas for Motivation, posted by Nixon on February 12, 2005, at 15:46:09
Hey Nixon,
If you wanted to consider other mood stablizers that might "lighten" you up, how about:
1. Low dose Lithium or Lamictal .... still the only two mood stablizers with antidepressant properties. The only problem with lithium is that is reported to be not as helpful with cycling (sounds like you might have been cycling off the depakote)
2. Depakote is very potent, even a switch to a more moderate MS like trileptal might be helpfulThe two best sources of information for me has been 1. www.psycheducation.org/depression/meds/moodstabilizers.htm and 2) Mitch (he really knows his stuff)
Over all I have a feeling you might have to add a more stimulating AD to the mix or switch your SSRI all together. It is probably the prozac that is inducing your apathy.
Hope this helps .....
Smith
PS I ended up sleeping all yesterday afternoon due to my apathy on zoloft. I miss my nardil!
Posted by Nixon on February 13, 2005, at 7:07:24
In reply to Re: Other Mood Stablizers » Nixon, posted by smith562 on February 13, 2005, at 6:35:17
Hey thanks Ed, Smith, Mitch for the help. Like I said I am going to the doc tommorow so I have all day today to try an figure out what I want. Appreciate the ideas. JN
Posted by awatts on February 13, 2005, at 21:42:28
In reply to Re: Thanks, posted by Nixon on February 13, 2005, at 7:07:24
> Hey thanks Ed, Smith, Mitch for the help. Like I said I am going to the doc tommorow so I have all day today to try an figure out what I want. Appreciate the ideas. JN
Please consider asking him about Provigil and posting his reply tomorrow. I go to the doc on Wednesday, and he will be starting me on Provigil for motivation. It would be helpful to hear what your doc thinks about this use of the drug.
Thanks
This is the end of the thread.
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