# apathy are there any meds that don't do this?



## RockiNToM (Jun 15, 2009)

So answering a topic related to Zoloft in one of the other threads, it reminded me how apathetic I felt while on Zoloft and got me thinking.

While I was on Zoloft it worked pretty great at getting me out of my depression but it made me just feel flat and emotionless. My anxiety was better but not by much either. However the strange thing is Paxil did the complete opposite: it gave me an almost manic type of happiness and extreme reduction in anxiety until it inevitably stopped working. Other serotonin inhibitors did pretty much the same as Zoloft except Celexa gave me more side-effects and Prozac on the other hand was too stimulating and Effexor was just smack in the middle.

The only other medication I've taken other than Paxil that hasn't caused apathy is Mirtazapine, but as some of you know I had a bad time with that one with the side-effects.

So my question is, are there any anti-depressants out there that don't cause this state of apathy so commonly felt with serotonin inhibitors?

I also understand that because of the way these medications work there is a reduction in dopamine, which as a result can cause a decrease in pleasure, also resulting in apathy. But how do you pick out the ones that do this the least? because in my experience certain medications have done this more than others.

I find it strange that other people post their reviews on their meds and don't really mention anything about apathy. Am I a minority in this strange problem that I experience with anti-depressants or is this more common than I realise?


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## IllusionalFate (Sep 10, 2008)

Coming from someone who isn't depressed at all, Nardil lifted my mood and made me appreciate a lot of the more subtle things that life has to offer. Selegiline was pretty much a sugar pill.

I think the nonselective MAOIs are the least likely to induce apathy due to 5-HT and DA working together.


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> However the strange thing is Paxil did the complete opposite: it gave me an almost manic type of happiness and extreme reduction in anxiety until it inevitably stopped working. Prozac on the other hand was too stimulating and Effexor was just smack in the middle.


Maybe you answered your own question.

Cymbalta is another option, since you suffer from chronic pain.


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## RockiNToM (Jun 15, 2009)

Cymbalta scares the hell out of me. What if I want to have a drink while I'm on that? Is my liver gonna fall over? I think I'd rather pass lol.

I know the only thing that will counter the lower dopamine with serotonin inhibitors is to take something like adderall or ritalin but getting that is pretty much impossible for me.

Wellbutrin/Bupropion I tried once and that pretty much reminded me of my experiece with Roboxetine/Edronax - too much anxiety and paranoia.

I've been reading a lot about TCA's and a lot of people say that they don't get the apathy that they have had with SSRIs in the past. But why is this different?

A MAOI would definitely be something to consider but I doubt I would be able to get that seeing as more doctors prefer to steer away from them these days. 

I just can't figure out why between the SSRIs why certain ones cause apathy more so than others. Are some of them hitting the serotonin more than others causing the apathy problem? I just don't know.


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## jim_morrison (Aug 17, 2008)

RockiNToM said:


> Cymbalta scares the hell out of me. What if I want to have a drink while I'm on that? Is my liver gonna fall over? I think I'd rather pass lol.


Yeah, the cymbalta liver thing is a bit of a concern, I guess pristiq and Milnacipran might be better choices if you want to go up the SNRI path.



RockiNToM said:


> I've been reading a lot about TCA's and a lot of people say that they don't get the apathy that they have had with SSRIs in the past. But why is this different?


My guess is because most TCA's (with the exception of clomipramine) are far weaker SRI's and stronger NRI's than the SSRI's. Some of their side effects suck alot more than newer antidepressants, however some can work in your favour, ie their antihistamine effects can offset the insomnia that their degree of NRI would usually cause.

Heres a direct comparrison of the TCA's vs the SSRI's

http://www.emedexpert.com/compare/ssris-vs-tca.shtml


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## RockiNToM (Jun 15, 2009)

Going by the article TCA's look like they are the medication I need. The only thing that's worse with TCA's as the article mentioned, are that they have a lot of weight gain, interactions with other medications and effects on the body when drinking alcohol.

What interests me is the binding profiles of the TCA's in this table from wikipedia:

http://en.wikipedia.org/wiki/Tricyclic_antidepressant

So it would some seem of them bind to the Dopamine transporter and the D2 receptor. Does this mean they may weakly inhibit the reuptake of dopamine or am I guessing there is some antagonistic action going on there instead much like anti-psychotics?

Never mind just saw this underneath the table: They function as antagonists at all sites listed - Bah!


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## jim_morrison (Aug 17, 2008)

IMO the biggest downsides of TCA's are the anticholinergic side effects, and the sodium channel blocking cardiotoxic effects in overdose. 

That table lists them as antagonists of the D2 receptor, but most are too weak and are ineffective as antipsychotics so I wouldnt be worried about any dopamine blocking activity, if anything TCA's will weakly enhance dopamine activity through a combination of noradrenaline reuptake and 5HT2 antagonism.


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## JimiPePPeroni (Sep 1, 2009)

If you still plan to keep taking an SSRI, but still have difficulty obtaining a stimulant drug, perhaps you could test out L-Tyrosine & see if that helps out with the apathy issue.

I myself am sort of stuck in the same boat as you are. Though I find Lexapro to be helping me quite a lot in regards of overthinking & especially worrying, the "punchy" expression is telling me that something definitely needs to be adjuncted. Though playing with my DA levels alone did not do the deed, it may succeed in this way, as it may work for you. It's funny you post this, as this is something which has been on my mind for days.


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## gillettecavalcad3 (Jul 9, 2009)

Effexor XR 300mg works on dopamine. The way I see it with my drug combo is I get all the benefits, Serotonin, norepinephrine, dopamine and GABA from the Clonazepam.

I am sharper and more witty and able to attain large bouts of information. Generally I am just more motivated andfun to be around, .....and my anxiety is non existent.


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## gillettecavalcad3 (Jul 9, 2009)

http://http://www.adhdnews.com/testforum/test9909.htm

First paragraph, .......makes for an interesting read.


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## IllusionalFate (Sep 10, 2008)

RockiNToM said:


> Cymbalta scares the hell out of me. What if I want to have a drink while I'm on that? Is my liver gonna fall over? I think I'd rather pass lol.





jim_morrison said:


> Yeah, the cymbalta liver thing is a bit of a concern, I guess pristiq and Milnacipran might be better choices if you want to go up the SNRI path.


This is the first time I've heard of Cymbalta being linked with hepatoxicity. Can anyone elaborate or provide any links regarding this issue?


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## jim_morrison (Aug 17, 2008)

IllusionalFate said:


> This is the first time I've heard of Cymbalta being linked with hepatoxicity. Can anyone elaborate or provide any links regarding this issue?


 http://www.anxietyinsights.info/eli_lilly_expands_cymbalta_duloxetine_liver_warning_fda.htm


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## jim_morrison (Aug 17, 2008)

gillettecavalcad3 said:


> Effexor XR 300mg works on dopamine. The way I see it with my drug combo is I get all the benefits, Serotonin, norepinephrine, dopamine and GABA from the Clonazepam.
> 
> I am sharper and more witty and able to attain large bouts of information. Generally I am just more motivated andfun to be around, .....and my anxiety is non existent.


That's interesting, yeah as far as I'm aware Serotonin and GABA are anti anxiety/fear, whilst Dopamine and Norepinephrine are pro- confidence and motivation, so the combination of all four should be a very effective combination for SA.


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## RockiNToM (Jun 15, 2009)

JimiPePPeroni said:


> If you still plan to keep taking an SSRI, but still have difficulty obtaining a stimulant drug, perhaps you could test out L-Tyrosine & see if that helps out with the apathy issue.
> 
> I myself am sort of stuck in the same boat as you are. Though I find Lexapro to be helping me quite a lot in regards of overthinking & especially worrying, the "punchy" expression is telling me that something definitely needs to be adjuncted. Though playing with my DA levels alone did not do the deed, it may succeed in this way, as it may work for you. It's funny you post this, as this is something which has been on my mind for days.


I have tried L-tyrosine many times over the past 6 months and although I found it helpful for concentration issues with work it but did absolutely no effect on my mood.

I'm thinking of trying Bupropion and Prozac the two medications that have gave me the worst anxiety and stimulating effects. Why? well if I can even get a tiny bit close to how I used to feel before with less apathy, I'm on my way hopefully to recovering.

I still experience apathy even now. While on tramadol yes it helped for both pain and my mood but because I've been taking it a while now at the same dose, it's lost it's mood altering effect. I'm in the process of trying to not take it on days where I feel mildly better despite there still being pain. Hopefully I can then move to an anti-depressant for my mood and something else just for the pain.

I'm weird with meds, alcohol, coffee. They work for a while in giving me a sense of pleasurable feelings then they stop working very quickly and they offer me no benefits. I've only had this problem over the past year. Whether that's because of all the things I've thrown at my brain and body I don't know. It's not like I'm doing hard drugs for anything. But understandably I've been on and off things so many times over the past 5 years my brain and body is probably confused.

The past 4 months have been the longest I have not drank alcohol and caffeine while being off an anti-depressant and to be quite honest, I don't notice any benefits really. I still feel practically the same.

I just find it odd and frustrating when I talk about this type of problem regarding apathy few people anywhere I visit forum wise can relate - unless some people do and are just not replying? :b

I kinda know what may be the problem but I am no doctor so it's only a guess and that would be more dopamine. But as I've said before about being put on a medication that acts on dopamine where I live and through my doctor is not going to happen. Bupropion is the most likely one I may get but it is used primarily for quitting smoking and I think it's dopamine reuptake is a bit negligible.

The main issue now is not wanting to be sedated anymore for anxiety, it's about stimulation. Sedation will only make my problem worse, and since in the past it's been the opposite way round when I had less apathy, stimulation seems to be the way to go.

Gah.


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## jim_morrison (Aug 17, 2008)

If I was in your position and couldn't get wellbutrin from the doc then I'd opt for prozac, why not, it's easy to get a script for, cheap, easy to stop taking, and should raise levels of noradrenaline and dopamine like you want.


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## RockiNToM (Jun 15, 2009)

Well the idea that I was thinking was that if by using bupropion and prozac together I would be getting double the benefit (in theory). However as you said, obtaining bupropion outside what's used for here in the UK (quitting smoking) is going to be hit and miss. The only way I was able to try bupropion before was let's just say I took someone elses that was who was trying to quit smoking as an experiment. It didn't benefit me at all but I'm willing to give it another go, like Prozac the first time I took it didn't benefit me.

I want to ask everyone something though, because this has been the case for me recently with all the meds I've taken.

Does anyone else find that during the first few weeks/month on an anti-depressant that the medications peaks in dealing with your mood?

For me, specifically Zoloft and Effexor I experienced a sense of euphoria for the first 4 weeks while on them, which was extremely pleasant and it greatly lifted my mood. Then, after my mood flattened and stayed the same with no lows or highs just smack in the middle - everything kinda dull. Now I don't know why this is, but this has seemed to be case in my most recent use of anti-depressants but not with any of the others before. I also find that when I'm withdrawing from an anti-depressant I sometimes feel like I have a bit of an overload of dopamine and I become almost manic for a while before once again becoming flattened. It's just so weird. It's like I have short bursts of highs that only last for a very small amount of time before then totally disappearing leaving me completely apathetic and emotionally flat. Sucks.


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## jim_morrison (Aug 17, 2008)

Yeah as I've said before, SSRI's have done jack for me, but the only time when I was feeling at my happiest on them was when I was going through their withdrawls, I guess because of the dopamine rebound.


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## IllusionalFate (Sep 10, 2008)

RockiNToM said:


> However as you said, obtaining bupropion outside what's used for here in the UK (quitting smoking) is going to be hit and miss.


Can't you just say you're trying to quit smoking? I doubt they'd check to see whether or not you're telling the truth, it's not like you're claiming that you're addicted to opiates and need buprenorphine...


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## RockiNToM (Jun 15, 2009)

Yeah but I'm so clearly not a smoker if you looked at me or knew me. Also I'm not a very good liar I just get too anxious, it wouldn't work.


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## jim_morrison (Aug 17, 2008)

No need to lie, they can legally prescribe it to you just 'off label' just depends how cool your doc is I spose.


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## IllusionalFate (Sep 10, 2008)

Any doctor that won't hand out a bupropion script shouldn't be getting your money. I think it's one of the top 10 most frequently prescribed antidepressants, so I can't imagine why you'd be denied it.

You can also say, "The SSRIs make me sluggish and apathetic, do you think bupropion could help with that and give me more energy and motivation?". Since the obvious answer is yes, the only reason I could see him not get out the pen and pad immediately is if he just doesn't care at all about your mental well-being.


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## jim_morrison (Aug 17, 2008)

Yeah it's weird but in australia, and I believe also the UK, bupropion isn't available as an antidepressant, yet reboxetine, which has been shown to have the least efficacy as an antidepressant is widely available. Doesnt make much sence to me.


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## crayzyMed (Nov 2, 2006)

jim_morrison said:


> Yeah it's weird but in australia, and I believe also the UK, bupropion isn't available as an antidepressant, yet reboxetine, which has been shown to have the least efficacy as an antidepressant is widely available. Doesnt make much sence to me.


I wonder how that crap even got approved, when looking for experiences with that drug 95% of them are completely negative.


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## RockiNToM (Jun 15, 2009)

IllusionalFate said:


> Any doctor that won't hand out a bupropion script shouldn't be getting your money. I think it's one of the top 10 most frequently prescribed antidepressants, so I can't imagine why you'd be denied it.
> 
> You can also say, "The SSRIs make me sluggish and apathetic, do you think bupropion could help with that and give me more energy and motivation?". Since the obvious answer is yes, the only reason I could see him not get out the pen and pad immediately is if he just doesn't care at all about your mental well-being.


Well here in the UK it's free healthcare, we only pay for the prescriptions at a standard fee of £7.20 or so. So because of that there's always a shortage of money in the system meaning things are harder to get medication wise, even though our taxes also go towards the healthcare.

It's mostly to do with prioritization and who they deem worthy of certain treatments/medications to cut back costs. If something is licensed here for something totally different elsewhere in the world and you want to use it, you won't be given it unless it's specifically used for what it's licensed for where you live. Getting doctors here to 'try' things off label is very tough and rare. That's why I often wonder how some people who post here from the UK with SA are able to get adderall/ritalin and I can't even get bupropion...Very lucky people.



jim_morrison said:


> Yeah it's weird but in australia, and I believe also the UK, bupropion isn't available as an antidepressant, yet reboxetine, which has been shown to have the least efficacy as an antidepressant is widely available. Doesnt make much sence to me.


That's true it's totally messed up. I said to my doctor one day (a few years ago) I was fed up of the fatigue of the SSRI I was taking and I was then immediately told Roboxetine is really good and I should try that. So I did and let's just it's probably wasn't a good idea...



crayzyMed said:


> I wonder how that crap even got approved, when looking for experiences with that drug 95% of them are completely negative.


Yeah I've seen this too. I only found out when I tried it out and started getting horrendous side-effects. I started reading up on it and realised how few people were actually responding well to it. Doesn't make sense that something like that is even used.


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## euphoria (Jan 21, 2009)

I was once offered reboxetine . What an awful drug, glad I never took it.


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## crayzyMed (Nov 2, 2006)

euphoria said:


> I was offered reboxetine, and recently aripiprazole. What a bunch of ****ty drugs. I really hope my current med combo works because the other options are horrendous. The best I can think of is either low dose tryptophan added to my SSRI (Netdoctor says it's licensed) or switching to Nardil. They'll probably shoot down both ideas and suggest some more bull**** like antipsychotics.
> 
> Another thing: I told my psych I am getting extreme SA when eating with my family, to the point where I can't eat & have to leave, and she told me I'll have to just hide in my room until the meds start working. Of course no benzo prescription, even though this is exactly the sort of short-term use they are licensed for.
> 
> Yeah, UK psychiatry leaves a lot to be desired. Not that they're incompetent, but just the general attitude of rules before patient quality of life, and always playing it safe unless you're running naked in the streets shouting you're the son of god. I guess paying for medical care would have its benefits.


Cant you just go to a random docter to get a benzo prescribed? I get all my benzo's that way, when one refuses just go to the next one:b.


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## Vini Vidi Vici (Jul 4, 2009)

euphoria said:


> I was offered reboxetine, and recently aripiprazole. What a bunch of ****ty drugs. I really hope my current med combo works because the other options are horrendous. The best I can think of is either low dose tryptophan added to my SSRI (Netdoctor says it's licensed) or switching to Nardil. They'll probably shoot down both ideas and suggest some more bull**** like antipsychotics.
> 
> Another thing: I told my psych I am getting extreme SA when eating with my family, to the point where I can't eat & have to leave, and she told me I'll have to just hide in my room until the meds start working. Of course no benzo prescription, even though this is exactly the sort of short-term use they are licensed for.
> 
> Yeah, UK psychiatry leaves a lot to be desired. Not that they're incompetent, but just the general attitude of rules before patient quality of life, and always playing it safe unless you're running naked in the streets shouting you're the son of god. I guess paying for medical care would have its benefits.


well so does american psychiatry...i was offered the same things, arpiprazole and they tried to get me to take antipsychotics. i never ate lunch in the cafeteria at school..i couldn't even chew i was so anxious. i still get sort of anxious around my family. and psychiatrists have the same super safe attitude here....it took me years to get an MAOI...and if the literature says anything is "contradicted", there is virtually no way to explain to them that its safe.... the whole practice of psychopharmeceutical medicine, with all the SSRIs and SNRIs, is lame and quite below par. but SSRIs did help me, im not complaining. however there is so much room for improvement. 50 years from now, think of what doctors will be saying about "SSRIs"..


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## gillettecavalcad3 (Jul 9, 2009)

> If something is licensed here for something totally different elsewhere in the world and you want to use it, you won't be given it unless it's specifically used for what it's licensed for where you live. Getting doctors here to 'try' things off label is very tough and rare.


Go and see the head of the unit, .....these people are are generally older if they are the head of a practice. That's what I done and I am on off label meds. 
Plus it helps if you know your stuff when you go see a pdoc.

BTW, ....all the young pdocs I seen were a waste of time, ....they had to look up their books to find out what meds I was talking about, didn't know about half the things I was talking about. It was like I was giving them a free lesson on medication and I was getting sweet fa in return.


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## RockiNToM (Jun 15, 2009)

I think that's practically impossible for me to see a head of the unit/department. The doctor I see is pretty high up in comparison to the others I have seen before. For the record as well he is an older guy too, and he is very by the book. Whenever I enquire about something medication related he always gets his book out to check. Very annoying. 

The next time I see him I'm really going to raise a lot of questions and go in armed with research on paper to back up my facts. I hate knowing all this stuff that he doesn't know and having the case being practically closed because he is the doctor and that is the be all end all.


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## IllusionalFate (Sep 10, 2008)

RockiNToM said:


> The next time I see him I'm really going to raise a lot of questions and go in armed with research on paper to back up my facts. I hate knowing all this stuff that he doesn't know and having the case being practically closed because he is the doctor and that is the be all end all.


That's what you gotta do. Go in there and put them in their place, these psychiatrists know so little about pharmacology it's pathetic. I've taught my pdoc so much about pharmacology that I can get pretty much anything I want now. I think by challenging him so much, he respects me more and sees I know more than he does about treating my own disorder - or that if he denies me a script he'll get owned in a debate. :b


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