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Dr. Bob is Robert Hsiung, MD,
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Posted by Deneb on October 17, 2009, at 16:22:39
In reply to Re: What is the best med for lack of motivation?, posted by bulldog2 on October 17, 2009, at 16:16:07
> > How do I get more norepinephrine?
>
> You could add nortriptyline to you ssri or switch to an snri such as cymbalta or minalciprin. The good thing about adding nortriptyline to an ssri is the ratio of norepinephrine can be controlled.Is nortriptyline a TCA? I heard those are dangerous in overdose. I haven't OD'd in a while now though so maybe it would be OK.
What does norepinephrine do? What happens if I get too much?
Posted by Maxime on October 17, 2009, at 16:43:31
In reply to What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 14:13:54
9 years for one degree? I don't think the problem is meds. I think you need to get out of the sciences. Clearly it's not something that really interests you or you would have been done by now.
Posted by Deneb on October 17, 2009, at 16:56:49
In reply to Re: What is the best med for lack of motivation?, posted by Maxime on October 17, 2009, at 16:43:31
The sciences are the only thing that interests me. Sigh. I am 4 classes away from graduating, but maybe school isn't for me.
In fact, nothing much interests me at all. I can't seem to do anything but the easiest of tasks.
I don't seem to have much of a future. I am unemployed and have been living with my parents my whole life. I only have two classes this semester and I can't even manage that.
I spent thousands and thousands of dollars on my education, only to come out empty handed?
When I do well and study I really enjoy what I am learning. It is really interesting. The problem is that I get into those phases where I have a complete lack of motivation.
Sigh.
Posted by bulldog2 on October 17, 2009, at 17:13:54
In reply to Re: What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 16:22:39
> > > How do I get more norepinephrine?
> >
> > You could add nortriptyline to you ssri or switch to an snri such as cymbalta or minalciprin. The good thing about adding nortriptyline to an ssri is the ratio of norepinephrine can be controlled.
>
> Is nortriptyline a TCA? I heard those are dangerous in overdose. I haven't OD'd in a while now though so maybe it would be OK.
>
> What does norepinephrine do? What happens if I get too much?
>
>Nortriptyline is a tca and we're talking about low dose such as 25 mg which is very safe. Norepinephrine is more of a motivator neuro. Serotonin is more of a mood modulator. Sometimes norepinephrine is needed to establish some balance.
Posted by Deneb on October 17, 2009, at 17:19:48
In reply to Re: What is the best med for lack of motivation?, posted by bulldog2 on October 17, 2009, at 17:13:54
Thanks for that info Bulldog2. The next time I see my pdoc, I will ask about nortriptyline
Posted by Deneb on October 17, 2009, at 17:42:09
In reply to Re: What is the best med for lack of motivation? » bulldog2, posted by Deneb on October 17, 2009, at 17:19:48
It is not just lack of motivation for studying that I have. I just seem to have a lack of motivation for most things in life. My favourite thing to do is sleep. I can sleep more than 14 hours a day.
Just the other day I slept from about 3 AM to 3:30 PM, got up for a bit, grew tired again and went back to bed until 7:30 PM. I only woke up at 7:30 PM because that is when my Mom gets home from work. I don't want her knowing I spent the whole day sleeping.
I slept like that on a regular basis, especially when I don't have classes. Sometimes I wake up early for class only to go home to sleep some more.
My room and my bathroom is completely disorganized and messy. I tell myself I should clean it, but again I have a lack of motivation. It stays messy for months at a time until one day I get up enough motivation to clean it. The last time I tried to clean my room, all I could do was pick up a couple of things off the floor every two days or so. This went on for months. It's not that I have a hoarding problem either. I have no trouble tossing things in the trash. I just don't have the motivation to sort through it all.
Posted by psych chat on October 17, 2009, at 18:24:44
In reply to What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 14:13:54
I'm obviously not a doctor,but from what you described, you may have atypical depression. Usually an MAOI is indicated...after trying Wellbutrin. It may be a good idea to give Wellbutrin a trial first.
Good luck...I'm going through a similar phase in my life right now. It sucks.
Posted by Deneb on October 17, 2009, at 18:38:00
In reply to Re: What is the best med for lack of motivation?, posted by psych chat on October 17, 2009, at 18:24:44
I tried Wellbutrin a long time ago. I am notoriously bad at estimating how I am doing so I'm not sure whether it helped or not. I never noticed a huge difference. I got Wellbutrin while my pdoc was on maternity leave. She quickly took me off if because of my bulimia. I don't purge anymore though. She put me on Prozac and I think that helped my bulimia.
I've heard MAOI's are good for atypical depression, but I am worried about the side effects and restrictions that come with MAOI's.
I agree and think my depression was/is of the atypical variety since I find I am still able to have good moods sometimes and when I am depressed I have hypersomnia instead of insomnia.
Posted by metafunj on October 17, 2009, at 19:02:04
In reply to Re: What is the best med for lack of motivation? » Maxime, posted by Deneb on October 17, 2009, at 16:56:49
This is because you are low on dopamine. Dopamine gives you interest and pleasure. In the prefrontal cortex dopamine is reuptaked by norepinephrine transporters. When you block norepinephrine transporters you increase dopamine which is why people feel more motivated on SNRIs, wellbutrin, and the stimulants, and some TCAs.
I think celexa + prozac may be dampening your dopamingeric transmittion too much.
If you could get by on just prozac you may notice a difference.
Posted by metafunj on October 17, 2009, at 19:05:11
In reply to Re: What is the best med for lack of motivation?, posted by Deneb on October 17, 2009, at 17:42:09
That all sounds familiar. Does anything in this thread seem familiar?
Posted by Deneb on October 17, 2009, at 19:18:54
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by metafunj on October 17, 2009, at 19:02:04
I often wonder if it is necessary to take two SSRI's at the same time. It seems like SSRI overkill to me.
Regarding the anhedonia, I'm not sure that is what I have. I do experience pleasure a lot along with my depressive bouts. I have mood regulation problems. I tend to get really excited and happy one minute and depressed and suicidal the next. It is probably my borderline personality.
I read that TCA aren't good for people with borderline personality, but I think my borderline traits have gone way down. I've made a lot of progress in that regard.
Posted by psych chat on October 17, 2009, at 19:21:58
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by metafunj on October 17, 2009, at 19:02:04
I agree with the adverse effects on dopamine from SSRIs, becuase it happened to me. I got worse from SSRIs in terms of motivation.
But I quit ssris and have been taking d- amphetamine, and it isn't doing it for me. It helps with motivation, but I still have the depression as well. It's not working as good as it used to, even for the motivation, but it never worked 100% of the time anyway. I guess it can be more complicated than just dopamine deficiency. I'm just about ready to try a MAOI.
Posted by psych chat on October 17, 2009, at 19:24:50
In reply to Re: What is the best med for lack of motivation? » metafunj, posted by psych chat on October 17, 2009, at 19:21:58
But my Tdoc wants me to try lamictal first. I'm really hesitant. Plus, has that helped anyone for motivation and/or atypical depression? He wants me to try it becaues it's something I've never taken in the past.
Posted by Deneb on October 17, 2009, at 19:33:07
In reply to Re: What is the best med for lack of motivation? » metafunj, posted by psych chat on October 17, 2009, at 19:21:58
What is d-amphetamine? Is it a stimulant?
Sorry to hear your depression is still bad. I haven't taken that many meds yet. I've been on/am on Zoloft, Celexa, Wellbutrin, Prozac, Risperdal, Trazodone (for sleep) and propranolol. It's mostly SSRI's. They seem to work for depression somewhat, but never 100%, but I think maybe my depressive bouts may be normal for borderline personality.
My main problem is the motivation issue now that I have the suicidality controlled for the most part.
Posted by Deneb on October 17, 2009, at 19:35:10
In reply to Re: What is the best med for lack of motivation?, posted by psych chat on October 17, 2009, at 19:24:50
Lamictal is an anticonvulsant right? It is supposed to be for epilepsy and bipolar right?
Why are you hesitant? Are the side effects bad?
Posted by psych chat on October 17, 2009, at 19:36:19
In reply to Re: What is the best med for lack of motivation? » psych chat, posted by Deneb on October 17, 2009, at 19:33:07
d amphetamine..it's a stimulant/ADD type of medication.
Maybe PDocs need to be more educated on the motivational issues and/or atypical depression, I'm not sure.
Do you think maybe it's self sabatoge, being your almost at the graduation point? Or an adjustment disorder? Something to talk to a T about...
Posted by emme on October 17, 2009, at 19:38:10
In reply to Re: What is the best med for lack of motivation? » metafunj, posted by Deneb on October 17, 2009, at 19:18:54
Deneb,
You've gotten several good suggestions in this thread. I am also wondering if you would benefit from a consulting opinion from a psychopharmacologist. I know you have a good relationship with your pdoc, but a fresh set of eyes might give you and your doctor some new ideas to work with.
I believe there's a biological component to the whole apathy thing. I've experienced it strongly myself and have been amazed at how much the right medication can help. Like night and day. It simply should not be such a struggle for you to engage in ordinary living - I think you can have better.
emme
Posted by Deneb on October 17, 2009, at 19:52:55
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by emme on October 17, 2009, at 19:38:10
I've often wondered if my pdoc really knew what she was doing. We seem to focus so much on therapy that we never even discuss meds. Maybe I should ask for her rational for the meds I'm on. I've asked about the two SSRI thing online and so far most places have said it isn't useful to be on two SSRIs.
I don't know how to get a second opinion though. Should I just ask my pdoc to recommend someone? I have no idea how that works. I'm not even sure there are psychopharmacologists in Ottawa. That seems awfully specialized. We're not a super large city. We don't even have DBT here.
What medication helped you emme?
> Deneb,
>
> You've gotten several good suggestions in this thread. I am also wondering if you would benefit from a consulting opinion from a psychopharmacologist. I know you have a good relationship with your pdoc, but a fresh set of eyes might give you and your doctor some new ideas to work with.
>
> I believe there's a biological component to the whole apathy thing. I've experienced it strongly myself and have been amazed at how much the right medication can help. Like night and day. It simply should not be such a struggle for you to engage in ordinary living - I think you can have better.
>
> emme
>
Posted by Deneb on October 17, 2009, at 19:56:31
In reply to Re: What is the best med for lack of motivation?, posted by psych chat on October 17, 2009, at 19:36:19
I was diagnosed with an adjustment disorder while in the psych ward about 5 years ago. To my knowledge adjustment disorders are self limiting. I'm not sure if it is possible to have an adjustment disorder for 5 years, but I could be wrong.
I think it is possible there are many psychological factors at work here too. I know for sure I am scared about the future. My pdoc is my T, maybe I should explore this with her more.
Deneb
> d amphetamine..it's a stimulant/ADD type of medication.
>
> Maybe PDocs need to be more educated on the motivational issues and/or atypical depression, I'm not sure.
>
> Do you think maybe it's self sabatoge, being your almost at the graduation point? Or an adjustment disorder? Something to talk to a T about...
Posted by Phillipa on October 17, 2009, at 20:00:32
In reply to Re: What is the best med for lack of motivation? » psych chat, posted by Deneb on October 17, 2009, at 19:56:31
Hi Deneb known you for a long time. Your're a brilliant future scientist for sure. Some of the times you've posted I could never ever understand. You say your suicidality has gone done also and I watched you kind of blossom. Right now I think your T and you need a great talk. What do you think? Love Phillipa
Posted by Deneb on October 17, 2009, at 20:04:52
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by Phillipa on October 17, 2009, at 20:00:32
Thanks Phillipa
I'm not sure about the brilliant part though. LOL I agree I need to talk to my pdoc/T. I'm going to write some of this stuff down as I always forget what to say.
> Hi Deneb known you for a long time. Your're a brilliant future scientist for sure. Some of the times you've posted I could never ever understand. You say your suicidality has gone done also and I watched you kind of blossom. Right now I think your T and you need a great talk. What do you think? Love Phillipa
Posted by Maxime on October 17, 2009, at 20:28:42
In reply to Re: What is the best med for lack of motivation? » emme, posted by Deneb on October 17, 2009, at 19:52:55
I'm positive that there is a psychopharmacologist at one of Ottawa's hospital. You should ask your pdoc for a referral.
Posted by Deneb on October 17, 2009, at 21:17:09
In reply to Re: What is the best med for lack of motivation? » Deneb, posted by Maxime on October 17, 2009, at 20:28:42
Thanks for that info Maxime.
I'm not sure a psychopharmacologist is needed at this point though. I haven't really tried a lot of meds. I feel like other people need a psychopharm more than me.
But then again, it will probably take a really long time to get an appointment so maybe I should start the process now.
Posted by delna on October 18, 2009, at 1:24:19
In reply to Re: What is the best med for lack of motivation?, posted by psych chat on October 17, 2009, at 19:24:50
> But my Tdoc wants me to try lamictal first. I'm really hesitant. Plus, has that helped anyone for motivation and/or atypical depression? He wants me to try it becaues it's something I've never taken in the past.
Frankly Lamictal had no effect on me whatsoever for atypical depression and certainly not for motivation.
I took it for dysphoric highs (agitation, severe anxiety, verbal aggression, ranting and raving etc.) It is a fabulous drug for that (for me at least)
If your pdoc says it may help, maybe it will. It helps with atypical depression (which is also nearly the same as bipolar depression) and there is alot of info about that (BP depression.
What is your hesitation? I have found it a really easy drug to tolerate (have been taking it for >5 years with no real side effects worth mentioning. Infact I am hard pressed to think of one- except perhaps blunting of emotions (but I was way to intense so this is a great thing for me) and a bit of dumbness (which may be depression speaking because when Geodon picked up my depression , I was sharp again).
Anyway, hope you decide on a good course of action
Good Luck
TC
D
Posted by delna on October 18, 2009, at 2:46:58
In reply to Re: What is the best med for lack of motivation? » Maxime, posted by Deneb on October 17, 2009, at 21:17:09
**Long post**
Deneb,
You sound frighteningly like me when I was at college! Firstly I too am a scientist and secondly I too had to prolong both my degrees.
>Starting my last year of high school I was put on Zoloft, whereby I started having very intense mood swingsOk, this is exactly what happened to me. I had depression and anxiety and was put on Paxil by a GP and went 'high' for a few weeks. Then I slumped into apathy. The doc kept increasing my dose and I started swinging mood wise. (more about that later)
>It is not just lack of motivation for studying that I have. I just seem to have a lack of motivation for most things in life. My favourite thing to do is sleep. I can sleep more than 14 hours a day.
>Just the other day I slept from about 3 AM to 3:30 PM, got up for a bit, grew tired again and went back to bed until 7:30 PM.
Sometimes I wake up early for class only to go home to sleep some more.Again this is just like I was. I'd come home from a lecture and pass out for many hours. I too had no motivation for anything.
>My room and my bathroom is completely disorganized and messy.
Me too
> I have mood regulation problems. I tend to get really excited and happy one minute and depressed and suicidal the next. It is probably my borderline personality.
Ok this is the scary part. Exactly like me. I too was diagnosed with borderline personality disorder. I'm not trying to diagnose you but I can tell you that eventually it turned out that I had bipolar disorder. Your depressions fit the atypical variety (seen in bipolar) and the fact that you swing makes me suspicious.
It took some years and a clever pdoc to look at my past and find that I did infact have a history of spontaneous hypomanias and mixed episodes plus all the other indicators of bipolar. Many bipolars are originally misdiagnosed as either depressed or as having BPD. Just to clarify I am not saying that you are actually bipolar- its just that I was, and my clinical picture looked more like yours but eventually the bipolar came out in a big way.
IMHO I think you need an expert diagnosis. It took years for my diagnosis to change from borderline to depression and anxiety to bipolar II rapid cycling and finally to the dreaded bipolar I rapid cycling.
I had a therapist too and she told me I was not bipolar (there was no such thing) and I was happy to believe her because it meant no harsh drugs. But actually she ruined things for me because it just delayed my treatment and now I am a pretty resistant case.
But from what I see you are already on some 'hardcore' drugs like antipsychotics which personally I only agreed to take when I was confirmed to be bipolar I because I was so terrified of them. A full diagnosis will really help because then you can be treated properly...
Sorry if I am confusing your already complex situation but I had to share this because our stories are too similar. It's only at 33 that I got a really thorough diagnosis and it turned out to be bipolar I, even though I spend nearly all my time in the depressive phase (which is common in BP)
Again I am not trying to diagnose you... I just
think an expert pdoc needs to review your history.
>I often wonder if it is necessary to take two SSRI's at the same time. It seems like SSRI overkill to me.I have never in my life heard of such a treatment rationale. Infact 2 at once is not safe. SSRI's definitely promote apathy- they are infamous for it! You usually augment the first SSRI with Wellbutrin or Provigil or another agent. I know alot of people are taking nortryptiline with success but personally (with no disrespect to others) I would not take it. Firstly if you are indeed bipolar it might make you swing madly as TCAs are infamous for that. But ofcourse if you are not, it can work wonders!
Now I am on a mood stabilizer (lamictal), provigil and have just started a MAOI (since the SSRI just didn't work and I crashed into depression despite it.)
I was torn between Parnate (MAOI which is supposed to be the last word in atypical depression) and Effexor (SNRI, which helped in the past with mood, motivation, anxiety, OCD etc)but chose parnate in the end. The reason being that effexor has a very difficult and long withdrawal period and if it didn't work well I could not switch to Parnate for ages . But SNRI's DO tend to work (at high enough doses) much better than SSRI's- especially for those with motivation problems.
parnate is not scaring me at all in terms of food interactions and drug interactions (you just have to be extra careful) but then I have only been on it for 15 days....For me the only side effect that sucks is sedation but I believe that gets better in time and at the right dose. Haven't seen much benefit yet..
Incidentally, what REALLY helped my mood, motivation whilst keeping me stable was low dose Geodon. It was miraculous! Like waking up from a coma. But sadly, I had to give it up (after 2 years) because i had a bizarre reaction to it.
My pdoc (a psychopharmacologist in NYC) said Abilify was the next best thing (especially if you are sensitive to sedation)But I didn't try it because of fears of TD (which I think I had on Geodon- not sure)Well I hope I haven't rambled on too much and caused confusion......Please forgive me if I have. Your story just hit home for me.
I hope you find some decent help and find a good drug (or combo) that works for you.
Good luck
Take care
Love
DPS: Sorry if I went off on a tangent. If I did please ignore this post.
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