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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 25 of 41. This is the beginning of the thread.
Posted by Economist on March 23, 2010, at 13:07:29
Has anyone here experienced severe, treatment-resistant anhedonia? I don't mean anhedonia that is caused by sadness or depression. Just pure anhedonia and subsequent boredom, as described by the negative symptoms of schizophrenia.
How do you manage to keep on living?
Posted by Phillipa on March 23, 2010, at 13:27:44
In reply to Severe anhedonia...I can't live like this anymore., posted by Economist on March 23, 2010, at 13:07:29
ahedonia? schizophrenia? I don't quite understand. Sorry about that. Phillipa
Posted by linkadge on March 23, 2010, at 19:28:44
In reply to Severe anhedonia...I can't live like this anymore., posted by Economist on March 23, 2010, at 13:07:29
Are you taking an antipsychotic?
Linkadge
Posted by Economist on March 23, 2010, at 20:43:17
In reply to Re: Severe anhedonia...I can't live like this anymore., posted by linkadge on March 23, 2010, at 19:28:44
No, I haven't for over two years now.
Posted by conundrum on March 23, 2010, at 23:15:42
In reply to Re: Severe anhedonia...I can't live like this anym » linkadge, posted by Economist on March 23, 2010, at 20:43:17
have you tried drugs that increase norepinephrine or opiates?
Posted by Economist on March 23, 2010, at 23:34:01
In reply to Re: Severe anhedonia...I can't live like this anym » Economist, posted by conundrum on March 23, 2010, at 23:15:42
I have not tried opiates. I thought that increasing norepinephrine simply increases your energy and wakefulness.
I am aggressively targeting dopamine right now (EMSAM + amisulpride + Adderall + DLPA) but that's doing jack sh*t.
Posted by Petrucci914 on March 24, 2010, at 20:02:04
In reply to Re: Severe anhedonia...I can't live like this anym » conundrum, posted by Economist on March 23, 2010, at 23:34:01
You are taking an antipsychotic, that is Amisulpride. If you have Schizophrenia then you may want to try another one, and I doubt that EMSAM and Adderall are helping your condition. I generally think they can worsen your condition, and taking those extra medications with an MAOI probably isn't that great of an idea either.
Posted by conundrum on March 24, 2010, at 21:36:46
In reply to Re: Severe anhedonia...I can't live like this anym » conundrum, posted by Economist on March 23, 2010, at 23:34:01
Nah, I thought that too, but it seems to make the world seem more colorful. It sounds like you've tried a lot of different things to hit dopamine and none have worked so maybe you don't need it?
I guess you have played around with the amulsipride dose. It can promote or reduce anhedonia depending on the dose.
If you can get your hands on an NRI tricyclic I would try that.
Interestingly, animals don't respond to drugs reward if they are NE depleted. Heck its possible you might even need some serotonin. Maybe lower than the normal theraputic dose. The other thing to try is opiates. They don't work for me, but they seem to help some people.
Posted by Economist on March 24, 2010, at 21:46:43
In reply to Re: Severe anhedonia...I can't live like this anym, posted by Petrucci914 on March 24, 2010, at 20:02:04
I am taking low dose amisulpride (50 mg). At that dose it is used as an antidepressant and is supposed to increase dopamine levels.
Posted by conundrum on March 24, 2010, at 23:26:33
In reply to Re: Severe anhedonia...I can't live like this anym, posted by Economist on March 24, 2010, at 21:46:43
I would seriously consider trying a tricyclic like nortriptyline, vivactil, or desipramine. The nice thing is they seem to work faster than drugs that work on serotonin.
If you have given your dopaminergic regimen enough time its probably time to move on to a new strategy.
Think of anhedonia like this. You have cable tv. There is the cable company sending you the signal, thats the stimulus. Then there is the wire connecting to the cable company to your house. Thats serotonin, then there is norepinephrine which is the converter box that goes to your tv. Then your TV is dopamine. If any thing goes wrong with any of those parts your image won't be clear. Your first guess might be to blame the TV(dopamine), but it could be your box or the cables to and from the box. Its not as simple as low dopamine being the cause for anhedonia all the time for every person.
Check out the abstract link below. I would have posted it but some of the symbols displayed wrong in the preview mode.
Noradrenaline is necessary for the hedonic properties of addictive drugs
Posted by Jeroen on March 25, 2010, at 9:45:10
In reply to Re: Severe anhedonia...I can't live like this anym » Economist, posted by conundrum on March 24, 2010, at 23:26:33
too bad but i have it too.
i recommend Clozapine (hardcore), or Sertindole
or Glycine (NMDA receptor modulate) it's natural anti psychotic studied for negative symptoms
those i am trying right now, they appear to be helpfull for negative symptoms
Posted by bleauberry on March 25, 2010, at 19:33:53
In reply to Severe anhedonia...I can't live like this anymore., posted by Economist on March 23, 2010, at 13:07:29
Sounds like either a norepinephrine or a dopamine problem, or both. Whether it is a syndrome of anhedonia which can stand alone without depression, or whether it is what is labelled negative symptoms of schizophrenia, who knows, doesn't matter. What matters is focusing on meds that will target that cluster of symptoms. That includes things like low dose amisulpride, savella, savella with low dose risperdal, ritalin, and sometimes even low dose ssri with low dose antipsychotic. You'll want to avoid high doses of anything as they'll probably make it worse or create other problems. For anhedonia it is tricky to tweak things in a fine sensitive window of opportunity, where either too much or too little is not helpful.
The above meds were mentioned based on hundreds of hours surfing pubmed studies and my own experiences.
Forgot to mention adrafinil with prozac. Low doses each, holding consistent with the overall theme.
Posted by Economist on March 25, 2010, at 20:53:15
In reply to Re: Severe anhedonia...I can't live like this anym, posted by bleauberry on March 25, 2010, at 19:33:53
bleauberry,
Did you have anhedonia too? How long did it last and what caused it (depression or negative symptoms)?
I think I have been excessively targeting dopamine for the past three months to no avail. I have tried Wellbutrin, low-dose amisulpride, Adderall, and now low dose EMSAM/seligiline. The supplements I have tried are glycine, pregnenolone, panax ginseng, NAC, and now DLPA.
I can't see how norepinephrine would be factor in this anhedonia. I don't feel sluggish or lack energy. I just can't feel emotions and have no interest in any thing, any person, any activity, or any thoughts.
Posted by conundrum on March 26, 2010, at 15:10:18
In reply to Re: Severe anhedonia...I can't live like this anym » bleauberry, posted by Economist on March 25, 2010, at 20:53:15
norepinephrine does increase interests? Did you look at that link I posted? Animals that are depleted in norepinephrine don't have a hedonic response to drugs. The only thing they still respond to without norepinephrine is food.
Drugs that increase NE can increase pleasure. Dopamine is overestimated in its role in anhedonia. The body is unfortunately way more complicated than that. Some people respond to dopamine but not all. Just look at tricyclics. They all increase Norepinephrine some only increase norepinephrine and yet they are usesful in treating anhedonia. They don't really boost dopamine except through some post synaptic antagonism.
I've found low doses of prozac increase interest. Norepinephrine seems to add color.
It seems like you've done all you can do to try to boost DA, you need to try something different. It seems that the antidepressant response to most drugs with the exception of maybe lexapro depends on some increase in norepinephrine.
Bottom line it doesn't just give you energy and raise blood pressure, it has mood effects. I used to think the same things you are, but I've found DA drugs and supplements don't do squat for me. ie Wellbutrin, Ritalin, NADH, L-Tyrosine with Vit C and B6, Mucan Puriens, Rhodiola Rosea.
Also I would say anhedonia is my worst symptom. So far low dose prozac and NRI have been the only thing to help.
Posted by Economist on March 26, 2010, at 17:52:16
In reply to Re: Severe anhedonia...I can't live like this anym » Economist, posted by conundrum on March 26, 2010, at 15:10:18
conundrum,
I'll take a look at it. I am scheduled to increase my EMSAM to 9 mg, at which point it becomes an MAO-A inhibitor. Do you know anything about that drug or the MAOIs and their impact on norepinephrine?
What kind of anhedonia do you have? Is it depressed anhedonia or no-emotion, flat anhedonia?
Posted by conundrum on March 26, 2010, at 21:32:25
In reply to Re: Severe anhedonia...I can't live like this anym » conundrum, posted by Economist on March 26, 2010, at 17:52:16
I know that MAOIs can cause a drop in norepinephrine and often lower blood pressure. I have heard many here augment parnate with nortriptyline for norepinephrine support.
I would say my anhedonia is my only really bad mood symptom. I don't get down or sad. I feel like the world is in black and white. To me a day at the beach in florida feels no different than shoveling a foot of snow in the winter. I can't really enjoy music anymore. I wouldn't say i'm totally flat. I can still laugh and display normal emotions, but I don't feel them fully and never feel real satisfaction.
Posted by Economist on March 26, 2010, at 22:49:49
In reply to Re: Severe anhedonia...I can't live like this anym » Economist, posted by conundrum on March 26, 2010, at 21:32:25
When you think about how you can't feel fun, does it make you really frustrated and tortured? Or do you simply not care about the fact that you can't feel anything?
When did the anhedonia start?
I am starting up a blog about my experience with anhedonia, and eventually I'd like to compile a bunch of experiences from other people with anhedonia. Would you like to be a part if it?
Posted by conundrum on March 26, 2010, at 23:36:54
In reply to Re: Severe anhedonia...I can't live like this anym » conundrum, posted by Economist on March 26, 2010, at 22:49:49
I'd say it bothers me. I can't just except it. Its not on my mind all the time, but somethings wrong. It started when I came off prozac and was moderately bad for 2 years. During those two years I took ginko biloba religiously everyday. When i stopped that herb the anhedonia got worse.
Its funny you mention a blog because I was thinking of starting a blog or website for Post SSRI syndrome. Mainly for people who have had bad experiences after stopping SSRIs, not while still on them. Thats a different can of worms but related.
But yest I would participate. I didn't have this while on prozac the first time. I also didn't have it before i started the drug, I just had anxiety and sadness then. IMO this is worse. I'd probably have gotten over the anxiety on my own. Now I can't even feel real anxiety or sadness. I'm hoping that an NRI can help with that.
Posted by conundrum on March 26, 2010, at 23:38:15
In reply to Re: Severe anhedonia...I can't live like this anym » conundrum, posted by Economist on March 26, 2010, at 22:49:49
I should mention I've had this for about 7 years after stopping prozac. For 6 years I hadn't taken any meds. The brain does not seem to go back to baseline, like Bleauberry recently said.
Posted by bleauberry on March 27, 2010, at 19:21:18
In reply to Re: Severe anhedonia...I can't live like this anym » bleauberry, posted by Economist on March 25, 2010, at 20:53:15
> bleauberry,
>
> Did you have anhedonia too? How long did it last and what caused it (depression or negative symptoms)?Yes, it was (is) my primary symptom. Better in the last year, but still a heavy crutch. I can identify things that may have caused it, but who knows:
Longterm SSRI usage.
Amalgam fillings and mercury toxicity.
Lyme.>
> I think I have been excessively targeting dopamine for the past three months to no avail. I have tried Wellbutrin, low-dose amisulpride, Adderall, and now low dose EMSAM/seligiline. The supplements I have tried are glycine, pregnenolone, panax ginseng, NAC, and now DLPA.Glycine is more in the family of GABA, so I can see why that didn't help. Wellbutrin, yuck. Adderall, mmm, with an ssri sometimes good not always, by itself usually not. The only reliable gingseng I am aware of is actually not a true ginseng...Siberian Ginseng (eleuthero)...but it takes several months to do its thing. NAC is primarily involved in the toxicity cleanup department. DLPA will go to both dopamine and NE, as well as preserving the length of time the endorphins circulate. But, it all depends on whether our bodies metabolize it properly and manufacture the stuff the way a textbook says it should. That's a huge assumption. A lot of things can go wrong in that process. Precursors only work when all the downstream factories are working like they are supposed to.
Amisulpride should have helped, but maybe the dose was too high. I know the doses are usually talked about as being 50mg-100mg. Me, I find anything over 25mg is not helpful, under is.
All that said, the one biggest success I had against anhedonia was Savella. Huge difference. So forget the theory stuff and the textbook stuff. NE is a big player, and since savella also hits serotonin a little, that also plays into the picture. Since it also blocks NE in a part of the brain where no dopamine reuptake receptors exist and dopamine is taken up by the NE receptors, savella increases dopamine also. I think the important point is...it isn't this neuro or that neuro, it's all of them in concert...at the right balance. Things are too complicated to analyze. We as humans know only a fraction of what there is to know.
>
> I can't see how norepinephrine would be factor in this anhedonia. I don't feel sluggish or lack energy. I just can't feel emotions and have no interest in any thing, any person, any activity, or any thoughts.Not feeling sluggish doesn't mean you don't have a NE problem. There is epinephrine, norepinephrine, and adrenaline, just for starters, all similar but different, different roles. You could have one or two working just fine for physical stuff and one or two working bad for psychological stuff. Add to that the interplay with the serotonin, dopamine, and opioid systems, and well, you just gotta throw the theory book out the window.
Posted by bleauberry on March 28, 2010, at 8:14:48
In reply to Severe anhedonia...I can't live like this anymore., posted by Economist on March 23, 2010, at 13:07:29
When it comes to anhedonia, I think it deserves mention that another component besides just meds is very important for potential recovery.
Let's assume someone has had a severe knife wound that damaged a nerve in the wrist. Now the hand is partially paralyzed with a lot of numbness and lack of feeling.
To heal that damaged nerve, no pill alone is going to do that. Certainly an anti inflammatory might help. Probably some other meds I'm not aware of. But it is not going to heal without physical therapy. That is, movement, exercise, routine, massage... To just let that injured hand sit in a sling indefinitely month after month, year after year, it aint gonna recover its feelings. That nerve however can recover in time if it is encouraged to do so.
I do not see the nerves in the brain as being much different. That hand may never recover completely, or it might, but it will certainly recover more thoroughly with encouragement and therapy than it will with merely a prescription.
That's why physical therapy plays such a large role in medicine. It's heals injured stuff and returns it to optimal function.I see the same thing with anhedonia. A part of the brain has gone numb. Don't know why, it just did. Maybe a pill can wake it up, maybe not. But for sure, exercising that part of the brain will encourage it to start working again.
That means going out and forcing oneself to do things that are almost universally fun to normal healthy people, regardless that you feel no emotion and no fun in it yourself. A roller coaster, a horse ride, a walk on the beach, some kind of game, movies of some kind, anything...force input into that part of the brain that is asleep.
It is forced behavior. It is exercise. It is actually not much different than going to the gym when you don't feel like it. The muscles still need work whether you feel like it or not. And they are not going to do anything except deteriorate if you don't.
Results I believe are slow, come in waves, and happen in tiny steps. But for sure, the brain can learn how to have pleasure again, and to feel again, but it has to be exposed to the kinds of environments surrounded by pleasures and emotions. It has to be challenged. It has to be exercised, no different than a muscle or a nerve. It has to be worked.
Just my thoughts on that.
Anhedonia is my primary symptom. Over 3 years I have gained back some of those emotions. The only pill that ever had any impact was Savella. Other than that, all my gains have come from forcing myself to do something that was supposedly fun even though it wasn't to me. Over time the brain learns and reconfigures itself. The brain has amazing recovery and adaptability powers, but it needs to be pushed in the desired direction to put the chain reactions into play.
Again, just my thoughts on the topic. Nobody ever said life was easy. Nobody ever said healing sickness was easy. They aren't. They take purposeful goal oriented forced work. Which is especially hard for us who are ill, but even more critical because of that. The harder it is for us to do something, the more we need to do it.
As for specific meds, I would focus on the noradrenergic and/or dopaminergic, especially the ones that do not have overwhelming sedating or anticholinergic side effects. Somewhere in there serotonin probably plays a role too, but will likely worsen things if it is manipulated more than the others.
Use it or lose it.
Posted by conundrum on March 28, 2010, at 10:05:28
In reply to Re: Severe anhedonia...I can't live like this anymore., posted by bleauberry on March 28, 2010, at 8:14:48
Didn't you say that adrafinil with prozac helped with anhedonia as well as savella?
Posted by bleauberry on March 29, 2010, at 19:17:24
In reply to Re: Severe anhedonia...I can't live like this anymore. » bleauberry, posted by conundrum on March 28, 2010, at 10:05:28
> Didn't you say that adrafinil with prozac helped with anhedonia as well as savella?
Yes definitely. Sorry I temporarily misplaced that one. ECT still gets me sometimes.
Posted by Laney on March 30, 2010, at 18:49:34
In reply to Re: Severe anhedonia...I can't live like this anymore., posted by bleauberry on March 28, 2010, at 8:14:48
Bleauberry,
That was very enlightening to read. It does make sense. Thanks for you input!
Laney
Posted by Economist on April 3, 2010, at 15:52:58
In reply to Re: Severe anhedonia...I can't live like this anym » Economist, posted by conundrum on March 24, 2010, at 21:36:46
Amphetamines work on norepinephrine too, right? Well whenever I take Adderall it does not cause a change in my motivation or interest in things. All it does is increase my heart rate.
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