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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by n_shrimpie on February 3, 2012, at 0:00:54
first time i took prozac (20 mg) (started dec 1) i had no response except numbness and apathy, so i quit after 4 weeks (i should have given it 6 but i was desperate to try something else). once it started washing out of my system i felt great, 100% almost, for about 3 weeks, able to experience pleasure for the first time in years. i've heard that low doses of prozac increase dopamine, so could that be why it "worked" while it was washing out? once it was gone (about 4 weeks later) i reverted back to depression/anhedonia. I tried a second course because i only gave the first 4 weeks which may not have been a sufficient trial, and again, after 4 weeks i had to reduce it to 10 mg because of horrid anhedonia and flatness. my doc added abilify (dopaminergic right?), 1 week of 2.5mg and a week of 5 mg so far, and it's not doing anything except giving me insomnia, so maybe the anhedonia is not dopamine related? It's severe, i'm just going through the motions of life, and i've read that that's a dopamnine related issue. tonight, in desperation, i took 10mg of ritalin along with the 5mg of abilify, and i still feel numb. what is going on? i've had moderate-severe anhedonia all my life since i did a 6 mo prozac trial when i was 22. the only relief i've ever had is with lamictal, which was a miracle drug that eventually pooped out. also have horrid cognitive problems. will this ever get better? what can i do about the anhedonia? Every year my family takes me and my brother on an amazing 2 week ski vacation, and every year i force myself to laugh and pretend to have fun because i don't want to disappoint them or burden them with my depression issues. We're going to telluride early march, and i'm terrified that i'm going to have to fake it again. and the thought of being on such an amazing vacation yet not being able to actually experience it is heartbreaking.
Posted by Tomatheus on February 3, 2012, at 10:19:25
In reply to prozac/abilify, posted by n_shrimpie on February 3, 2012, at 0:00:54
n_shrimpie,
I'm sorry to hear that you haven't been getting any relief from your anhedonia with the medications that you've been trying. I experience some anhedonia as part of my anergic depression, and I can certainly relate to the frustration associated with failing trials with one medication after another. I would not give up on trying to treat your anhedonia with pharmacological treatments, though. You mentioned selegiline in your other post, and I think that it might be worth trying. When I took selegiline, I experienced a pronounced reduction in all of my depressive symptoms for about three days followed by a loss of effectiveness and the emergence of cognitive impairment and agitation thereafter. However, my temporary response to selegiline does not seem to be very typical, so I wouldn't base your decision on whether or not to try selegiline completely on my response to the medication.
Since you're looking at something to increase dopaminergic neurotransmission, you might want to consider trying Provigil (modafinil) or Nuvigil (armodafinil) if you haven't already. Provigil is a dopamine reuptake inhibitor (Volkow et al., 2009), and Nuvigil may be as well, considering that it's derived from Provigil. Also worth considering, in my opinion, are the supplements l-tyrosine and dl-phenylalanine, as well as possibly St. John's Wort and SAM-e. All are thought to increase dopaminergic neurotransmission in some way.
Finally, I would like to say that I wouldn't look at Abilify as being a medication that increases dopaminergic neurotransmission. Abilify is a partial agonist at D2 receptor sites, which means that it does activate the receptors but with less strength than a full agonist. One use of Abilify is in the treatment of schizophrenia, a condition in which dopaminergic neurotransmission is thought to be overactive. It's my understanding that even though Abilify activates the D2 receptors to an extent, it also competes with the dopamine molecules for binding at the receptor sites. The activation that Abilify produces at D2 receptor sites is thought to be weak with the medication being a partial agonist, and because the D2 receptors are occupied by Abilify when the medication is taken, the dopamine molecules themselves theoretically shouldn't be able to reach the receptors and fully activate them. This may be why Abilify is said to reduce the activity of dopamine when it's too high and increase the activity of the neurotransmitter when it's too low. So, I know that Abilify is a dopamine agonist of sorts, but a partial agonist is different from a full agonist, and at least the understanding is that partial agonists don't simply increase the activity of the neurotransmitters that they're associated with like full agonists do.
At any rate, I'd like to wish you luck with your ongoing battles against anhedonia. I hope you find an effective treatment, whether that ends up being something that works on the dopaminergic system or not.
Tomatheus
==
REFERENCE
Volkow, N.D., Fowler, J.S., Logan, J., Alexoff, D., Zhu, W., Telang, F., et al. (2009). Effects of modafinil on dopamine and dopamine transporters in the male human brain: Clinical implications. JAMA: The Journal of the American Medical Association, 301, 1148-1154. Abstract: http://www.ncbi.nlm.nih.gov/pubmed/19293415
Posted by Laney on February 6, 2012, at 17:09:02
In reply to Re: prozac/abilify, posted by Tomatheus on February 3, 2012, at 10:19:25
I felt like that as well and that is what caused me to seek out treatment. I don't think I would have ever encountered any longterm, although who knows for sure, depressive illness had I not taken paxil for an off-label purpose and tried desperately to get off of it because I didn't want to be tied to it forever and those desperate attempts left me feeling how you describe.
The only thing thus far that has helped me was Nortriptyline. Probably desiprimine as well. But nothing like Nortriptyline. I went off of it because of a 22lb. weight gain in 9 months.
I may have to take it again. We'll see.
I completely understand what your talking about. You are not alone. Keep asking and investigating until you get some results.
Best wishes,
Laney
Posted by phidippus on February 8, 2012, at 16:26:06
In reply to prozac/abilify, posted by n_shrimpie on February 3, 2012, at 0:00:54
>i had no response except numbness and apathy, so i >quit after 4 weeks
it takes 6 to 8 weeks for the drug to actually start working.
>1 week of 2.5mg and a week of 5 mg so far, and >it's not doing anything except giving me insomnia
its supposed to boost your antidepressant, which may be too low. Insomnia is a side effect of Abilify.
<so maybe the anhedonia is not dopamine related?
Anhedonia is a complex matter. If dopamine were related it would have the effect of reducing anhedonia, because dopamine effects reward centers of the brain. Abilify is a dopamine antagonist which means it suppresses dopamine. Prozac agonizes dopamine, therby increasing it.
>i've had moderate-severe anhedonia all my life >since
You should try amitryptaline or chlomipramine. TCAs have a good track record with treating anehedonia.
Get off the Abilify and the Prozac and try a TCA.
Eric
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