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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Onestone on March 30, 2009, at 6:56:43
Hello, Babble.
Why is anhedonia regarded as facet of depression? All my internet searches suggest this categorisation is universal, but is there any scientific evidence to suggest this is valid?
I think I was anhedonistic as a young child. Yet I threw myself with vigour into all the things that young children vigorously throw themselves into; at that stage I wasn't yet depressed. As far as I can remember.
My anhedonia isn't a facet of my depression, it's the cause of it. This surely explains why trying to treat me with antidepressants hasn't worked. Why should it, any more than using antibiotics would?
--
Onestone.
Posted by SLS on March 30, 2009, at 7:21:14
In reply to Why is anhedonia regarded as a part of depression?, posted by Onestone on March 30, 2009, at 6:56:43
> Hello, Babble.
>
> Why is anhedonia regarded as facet of depression? All my internet searches suggest this categorisation is universal, but is there any scientific evidence to suggest this is valid?
>
> I think I was anhedonistic as a young child. Yet I threw myself with vigour into all the things that young children vigorously throw themselves into; at that stage I wasn't yet depressed. As far as I can remember.
>
> My anhedonia isn't a facet of my depression, it's the cause of it. This surely explains why trying to treat me with antidepressants hasn't worked. Why should it, any more than using antibiotics would?At best, anhedonia can only be regarded as a pervasive symptom of depression. I imagine it is possible to have anhedonia in the absence of feelings of sadness, melancholia, lack of interest, loss of libido, amotivation, and anergia. It would be easily understandable that you would become frustrated and angry - even depressed.
What are the symptoms of depression that you currently experience that are not part of anhedonia?
By the way, some depressions can be treated with antibiotics, and has been discussed here previously. I am partially being a wise-guy. However, I am suggesting that the spectrum of causes and presentations of depression are extremely variable.
Can you describe some more details of how you experience anhedonia in the absence of depression?
Have you ever tried a dopamine receptor agonist or an autoreceptor selective neuroleptic?
- Scott
Posted by Onestone on March 30, 2009, at 9:10:03
In reply to Re: Why is anhedonia regarded as a part of depression? » Onestone, posted by SLS on March 30, 2009, at 7:21:14
> > Hello, Babble.
> >
> > Why is anhedonia regarded as facet of depression? All my internet searches suggest this categorisation is universal, but is there any scientific evidence to suggest this is valid?
> >
> > I think I was anhedonistic as a young child. Yet I threw myself with vigour into all the things that young children vigorously throw themselves into; at that stage I wasn't yet depressed. As far as I can remember.
> >
> > My anhedonia isn't a facet of my depression, it's the cause of it. This surely explains why trying to treat me with antidepressants hasn't worked. Why should it, any more than using antibiotics would?
>
> At best, anhedonia can only be regarded as a pervasive symptom of depression.Why? Why can it not be regarded as problem in its own right?
> I imagine it is possible to have anhedonia in the absence of feelings of sadness, melancholia, lack of interest, loss of libido, amotivation, and anergia. It would be easily understandable that you would become frustrated and angry - even depressed.
Yes. I can't imagine it's possible to suffer anhedonia for very long without getting depression too.
> What are the symptoms of depression that you currently experience that are not part of anhedonia?
None, really. Pretty bad lethargy, but that feels like part of the anhedonia.
> By the way, some depressions can be treated with antibiotics, and has been discussed here previously. I am partially being a wise-guy.
Ah! Sorry, my little rhetorical trick has backfired on me. But my point was serious: if my problem is anhedonia rather than depression, why should an antidepressant work? Surely I need an "antianhedonist" drug, after which the depression would resolve itself of its own accord.
> However, I am suggesting that the spectrum of causes and presentations of depression are extremely variable.
> Can you describe some more details of how you experience anhedonia in the absence of depression?
Well, it's been several decades, 2 at the very least, since I haven't been depressed. But from memory, perhaps around ages 7 - 11, I just got on with life much like any other boy. Only with hindsight can I see that I wasn't getting the requisite feedback.
> Have you ever tried a dopamine receptor agonist or an autoreceptor selective neuroleptic?
No. I started with bupropion 7 weeks ago. It's countered the lethargy somewhat, but doesn't seem to have had much effect on the anhedonia yet.
But I'll admit I don't really understand the words you're using there.
> - Scott
--
Onestone.
Posted by Zana on March 30, 2009, at 12:22:24
In reply to Re: Why is anhedonia regarded as a part of depress, posted by Onestone on March 30, 2009, at 9:10:03
It seems to me that you are asking a chicken and egg question here. Which came first the anhedonia or the depression and that you are struggling to diagnose yourself.
If by anhedion you mean that you do not take pleasure in anything, it sounds to me like you are depressed. Anhedonia is actually not part of the diagnostic criteria for a major depressive episode - "markedly diminished interest or pleasure in all, or almost all activites of most days, nearly every day" is how the DSM IV puts it. Is that what you are experiencing?
It sounds like Wellbutrin is not the right drug for you or that you need something in addition. You do not mention having anxiety so I would agree that ADs at the more stimulating end of the spectrum might be helpful. Have you tried any other meds?
Zana
Posted by Phillipa on March 30, 2009, at 12:33:32
In reply to Re: Why is anhedonia regarded as a part of depress, posted by Zana on March 30, 2009, at 12:22:24
Why would antibiotics help depression unless a bacterial disease is also present? Phillipa
Posted by Alexanderfromdenmark on March 30, 2009, at 15:23:30
In reply to Why is anhedonia regarded as a part of depression?, posted by Onestone on March 30, 2009, at 6:56:43
Scott, how old are you?
Is wellbutrin your first antidepressant? What's your med history?
Posted by SLS on March 30, 2009, at 15:34:35
In reply to Re: Why is anhedonia regarded as a part of depress, posted by Onestone on March 30, 2009, at 9:10:03
Have you ever thought that you might be suffering from dysthymia rather than depression? Anhedonia is certainly a potential feature of dysthymia, and you would not experience the other features of Major Depressive Disorder.
- Scott
Posted by Onestone on March 30, 2009, at 15:58:02
In reply to Re: Why is anhedonia regarded as a part of depress, posted by Zana on March 30, 2009, at 12:22:24
Hi, Z,
Thanks for the reply!
> It seems to me that you are asking a chicken and egg question here. Which came first the anhedonia or the depression and that you are struggling to diagnose yourself.
More, I was putting around the idea for discussion, that anhedonia could be a condition distinct from depression, that it should be studied in its own right, and regarding it merely as a facet of depression or a type of depression has inhibited the development of effective treatment.
> If by anhedonia you mean that you do not take pleasure in anything, it sounds to me like you are depressed.
I am most assuredly depressed, though the severity of my depression goes up and down from year to year dependent on other things. It's pretty bad at the moment. ;-(
> Anhedonia is actually not part of the diagnostic criteria for a major depressive episode - "markedly diminished interest or pleasure in all, or almost all activites of most days, nearly every day" is how the DSM IV puts it. Is that what you are experiencing?
Almost. "markedly diminished" doesn't really apply, since there hasn't been a higher level to diminish from, except for a couple of days in the last 30 years or so, and one of those came from an opioid pain killer after I'd injured myself. "Episode" sort of implies something of a timescale of weeks or months rather than decades.
> It sounds like Wellbutrin is not the right drug for you or that you need something in addition.
Why do you say this? The idea of prescribing it, my idea really, was to test whether a dopmaine deficiency was the cause. So far, the drug has been of some limited help, and the side effects seem tolerable, so far.
> You do not mention having anxiety so I would agree that ADs at the more stimulating end of the spectrum might be helpful. Have you tried any other meds?
Over the years, several SSRIs, one MAOI, possibly a tricyclic, all of which had side effects worse than any benefits. More recently Edronax, which was frighteningly bad, and Venlafaxine, which was just horrible. Only St. John's wort was really any use at all, but not by much.
Were you thinking of any drug in particular? My problem seems to be a genetic one which has been in the family for generations. It may afflict men worse than women, and is a lifelong curse rather than something which occurs in episodes.
> Zana
--
Onestone.
Posted by bleauberry on March 30, 2009, at 16:45:00
In reply to Why is anhedonia regarded as a part of depression?, posted by Onestone on March 30, 2009, at 6:56:43
Anhedonia is a tough one to figure out. I've seen references at pubmed where it is described as a stand alone syndrome separate from depression, though it is also a primary symptom of depression.
After I had been on Prozac for a long time, I told my doc I felt fine except I really didn't feel pleasure in anything. I told him the lows are gone, I work great, sleep great, everything's fine and dandy, except I just find no pleasure in anything, not even hobbies I know I love.
So we had me fill out the depression survey. On each question I scored the best possible. But when it came to the question asking about enjoying previous activities and hobbies, I scored the worst possible. Yet because the total points of all the questions added up showed that I was in remission and did not have depression, the issue was dismissed as nonsignificant. But to me it was hugely significant.
Was it pure anhedonia, untouched by serotonin meds? Or was it instead a depression-anhedonia transformed into a serotonin-apathy-anhedonia? Like I said, it is a tough call.
Anhedonia can also be in the spectrum of schizoaffective disorders. That's why when APs knock a lot of people out or make zombies out of them, for some people they restore the ability to feel pleasure. Probably something intricate in the dopamine/serotonin circuits is my best guess.
Meds with the potential to treat it would probably include things like Abilify, Ritalin, Adderall, Wellbutrin, Nortriptyline, Desipramine, and the MAOIs. I was only on Milnacipran for two weeks due to severe side effects, but in that short time it did a respectable job in targeting anhedonia, indicating a norepinephrine link.
But, some people's anhedonia disappears on something as simple as Celexa or Zoloft, so go figure.
Posted by Onestone on March 30, 2009, at 16:56:10
In reply to Re: Why is anhedonia regarded as a part of depress » Onestone, posted by SLS on March 30, 2009, at 15:34:35
> Have you ever thought that you might be suffering from dysthymia rather than depression?
[Takes a another quick trip to wikipedia]
Yes, dysthymia looks like an accurate description.
> Anhedonia is certainly a potential feature of dysthymia, and you would not experience the other features of Major Depressive Disorder.
> - Scott
--
Onestone.
Posted by raisinb on March 31, 2009, at 8:29:52
In reply to Why is anhedonia regarded as a part of depression?, posted by Onestone on March 30, 2009, at 6:56:43
Speaking from personal experience only, anhedonia and debilitating depression are synonymous. Sadness, anger, self-loathing--all these I experienced for years and kept plugging on through. But not caring at all got me suicidal in a month or two.
Posted by shasling on April 7, 2009, at 23:26:20
In reply to Re: Why is anhedonia regarded as a part of depression? » Onestone, posted by SLS on March 30, 2009, at 7:21:14
>Have you ever tried ...an autoreceptor selective neuroleptic?
A what??
thanks,
Suzie
Posted by SLS on April 8, 2009, at 1:37:50
In reply to Re: Why is anhedonia regarded as a part of depression? » SLS, posted by shasling on April 7, 2009, at 23:26:20
> >Have you ever tried ...an autoreceptor selective neuroleptic?
>
> A what??A subtype of a dopamine (DA) receptor blocker (antagonist) antipsychotic that favors presynaptic receptors:
sulpiride
amisulpiride
- Scott
Posted by Economist on March 30, 2010, at 22:07:47
In reply to Re: Why is anhedonia regarded as a part of depress » Zana, posted by Onestone on March 30, 2009, at 15:58:02
"anhedonia could be a condition distinct from depression, that it should be studied in its own right, and regarding it merely as a facet of depression or a type of depression has inhibited the development of effective treatment."
Anhedonia that causes depression (rather than depression that causes anhedonia) is extremely rare, I think, and that's why it has not been given its own standalone category as a disorder. I've been suffering from it for two years now. I had to change majors because I no longer feel interest in anything except researching the internet trying to find a cure for anhedonia. Thus I'm working towards doing medical research on this. If I make it there in 5 or so years, maybe you and a few others here can be my first case studies.
Posted by conundrum on March 31, 2010, at 23:13:05
In reply to Re: Why is anhedonia regarded as a part of depress » Onestone, posted by Economist on March 30, 2010, at 22:07:47
Finding a cure for anhedonia got me an obsessive personality label from a psychiatrist. In away thats kind of true, but its more like persistance. If your psych sees you putting too much effort into this they might think you have some kind of anxiety disorder instead.
Posted by Economist on April 1, 2010, at 13:10:46
In reply to Re: Why is anhedonia regarded as a part of depress » Economist, posted by conundrum on March 31, 2010, at 23:13:05
Same here -- my doctor thought my non-stop search for anhedonia treatment was an indication of anxiety.
Conundrum, have you really found nothing over the years to help you with anhedonia? How many doctors have you seen? How many years have you had this? The stress and agony of anhedonia impairs my focusing in school and keeps me awake at night, every night.
Posted by conundrum on April 2, 2010, at 15:14:06
In reply to Re: Why is anhedonia regarded as a part of depress » conundrum, posted by Economist on April 1, 2010, at 13:10:46
Hi Economist,
I was going to reply yesterday but must not have confirmed the message. I haven't found anything that helps, but most of what I tried during my 7 years off Prozac was natural. The reason is that I was convinced these drugs were really bad and damaging. I do believe that SSRIs can be damaging if taken for along time. It took me a long time to feel comfortable trying drugs again. Basically after diet change, exercise, natural remedies, and meditation failed.
I just started with psych drugs again last summer and unfortunately they take long trials and dose titrations. There were some natural things that helped a tiny bit. The first thing that helped was neuro optimizer, but it made me ill after taking it, with diarrhea and constipation so I was affraid of the permanent effects of taking it. It only partially helped with certain symptoms. When I tried it again recently it did not work and just gave me headaches. In later years I tried chinese medicine and one of the herbal concoctions helped a little bit adding motivation.
So other than the TCM practitioner, I have seen a normal MD, who prescribed me Lexapro, budeprion, fluoxetine, buspirone, and pristiq.
I saw a psychiatrist that prescribed ritalin. It didn't do anything for me. Then when I told him what I thought I needed and the reasoning he said I have an obsessive personality. He then prescribed nefazodone, which I never took because of the liver failure thing, and haven't seen him since.
The only thing from those drugs that helped was 2.5 mg fluoxetine with 10 mgs buspirone. It helped improve motivation and a little with anhedonia. Pristiq 50mgs helped me feel more color for a few weeks before it started to feel just like an SSRI.
I think that antiserotonergic drugs that block post synaptic serotonergic receptors can help with motivation and that increasing norepinephrine can help with anhedonia. It would be nice if there was a DRI that worked for 24 hours and not week like wellbutrin. I'm wondering about Wellbutrin XL vs the cheap generic budeprion I took. Maybe I'll try adrafinil first.
Opiates, maryjane, and alchohol haven't helped at all.
I had trouble with school as well. Its amazing I graduated. Now im thinking of getting a masters. not sure how im gonna do that.
Posted by Economist on April 2, 2010, at 18:24:01
In reply to Re: Why is anhedonia regarded as a part of depress » Economist, posted by conundrum on April 2, 2010, at 15:14:06
"Then when I told him what I thought I needed and the reasoning he said I have an obsessive personality."
What did you tell him was bothering you? What did you think the reason was?
Posted by Onestone on April 3, 2010, at 12:22:09
In reply to Re: Why is anhedonia regarded as a part of depress » Onestone, posted by Economist on March 30, 2010, at 22:07:47
> Anhedonia that causes depression (rather than depression that causes anhedonia) is extremely rare, I think, and that's why it has not been given its own standalone category as a disorder. I've been suffering from it for two years now.
Sorry to welcome you to the club. :-(
>I had to change majors because I no longer feel interest in anything except researching the internet trying to find a cure for anhedonia. Thus I'm working towards doing medical research on this. If I make it there in 5 or so years, maybe you and a few others here can be my first case studies.
Certainly! Currently, I'm being treated by bupropion and Abilify which, respectively, diminish the resulting depression and lethargy. They have no effect on my anhedonia.
Posted by conundrum on April 3, 2010, at 17:24:26
In reply to Re: Why is anhedonia regarded as a part of depress » Economist, posted by Onestone on April 3, 2010, at 12:22:09
I would think ability would increase anhedonia since it agonizes DA autoreceptors. A D2 antagonist might work better for some.
Posted by Economist on April 3, 2010, at 18:45:59
In reply to Re: Why is anhedonia regarded as a part of depress, posted by conundrum on April 3, 2010, at 17:24:26
What is an autoreceptor and what happens when you agonize it?
Posted by conundrum on April 4, 2010, at 10:22:08
In reply to Re: Why is anhedonia regarded as a part of depress » conundrum, posted by Economist on April 2, 2010, at 18:24:01
Well I was trying to explain why I thought remeron would help based on the fact that low dose prozac helped. I started to explain that low dose prozac antagonizes the 5 HT2C receptor which causes dopamine release in the PFC. (This was back when I thought all I needed was dopamine. It also increase norepinephrine release).
Remeron also blocks this receptor as well as others that increase DA and NE release.
So after telling him this he said that my main problem wasn't a dysphoric disorder but an obsessive disorder. I can be a little obsessive about this, but I definitely don't have OCPD. I only am like this with my brain and these drugs. It has to do with my fear of them. I feel like prozac kinda messed me up and I don't wanna take a drug that could make my memory worse. Also I don't want to waste time on trials for drugs that might not work.
Other than dealing with my brain I'm not very obsessive, my bedroom looks like a cyclone hit it and I'm usually not on time with things. I don't really care about germs or watch what I eat any more. Basically I just worry about the effects that poorly choosen drugs could have. Other than that I don't even have anxiety. And since trying pristiq and still being alive (lol) even the fear of drugs is leaving me.
He said you choose drugs like throwing a dart on a board, you just have to try them. It was like he said don't try to think it through. He even said I was smart, but made it sound like he doesn't want my input.
I'm thinking of seeing a new pdoc, maybe a female doc my mom sees. So far of the two male psychiatrist I've seen I don't like them very much. I feel like they say one thing and do another.
I hope I can find someone who can take my anhedonia seriously and accept that it was caused by drugs that they give out, SSRIs, and not try to give me anymore serotonergic enhancing drugs.
Posted by conundrum on April 4, 2010, at 10:29:24
In reply to Re: Why is anhedonia regarded as a part of depress » conundrum, posted by Economist on April 3, 2010, at 18:45:59
Well I'll try to make this brief so that the thread doesn't get redirected to the neurotransmitters page. Basically its a receptor that turns off the release of a neuotransmitter. the D2 receptor is an autoreceptor when it is on dopaminergic neurones. When more dopamine releases it hits that neuron, it agonizes it. Agonizing is a fancy way of saying activating. So dopamine activates this receptor and then the cell won't release any more dopamine. Its a feedback loop that prevents the brain from continually releasing neurotransmitters. Abilify also activates this receptor and shuts down dopamine release, when it attaches to receptors on dopaminergic presynaptic receptors. However when it binds to post synaptic receptors, that aren't autoreceptors it can create pleasure, and drive.
A drug like Zyprexa or any of the other aytpical antipsychotics would block that autoreceptors and the feedback loop would be broken to some extent and your brain would release more dopamine. The down side is that some post synaptic receptors would also be blocked so the pleasurable effects could decrease especially at higher doses.
Posted by Economist on April 8, 2010, at 12:27:41
In reply to Re: Why is anhedonia regarded as a part of depress » Economist, posted by conundrum on April 2, 2010, at 15:14:06
Oh, here it is.
Posted by bulldog2 on April 11, 2010, at 18:36:09
In reply to Why is anhedonia regarded as a part of depression?, posted by Onestone on March 30, 2009, at 6:56:43
> Hello, Babble.
>
> Why is anhedonia regarded as facet of depression? All my internet searches suggest this categorisation is universal, but is there any scientific evidence to suggest this is valid?
>
> I think I was anhedonistic as a young child. Yet I threw myself with vigour into all the things that young children vigorously throw themselves into; at that stage I wasn't yet depressed. As far as I can remember.
>
> My anhedonia isn't a facet of my depression, it's the cause of it. This surely explains why trying to treat me with antidepressants hasn't worked. Why should it, any more than using antibiotics would?
>
> --
> Onestone.For me anhedonia does lead to depression. When I stop feeling emotions than I get the feeling of my life has no meaning. After all we are taught that feelings are what makes life worthwhile.So my life is now not worthwhile so big depression. Therefore some of this is learned. Society tells us that emotions are what makes us human and special. Maybe they are right. If I don't feel I am a robot performing tasks. So what's the point. I certainly want to feel joy and excitement about things. For me that is a thermometer that tells me if I am getting sick. When I start enjoying things I am getting better.
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