Overcoming Inertia/lack of pleasure without stimulants?

[Blahblah]

A main symptom of my depression is this debilitating inertia, lack of pleasure/reward and total boredom. It's like the feedback mechanism that motivates me into action & rewards me for taking action in pleasurable activities is completely broken...

Despite this lack of reward/pleasure, I do take tons of action as far as forcing myself to exercise 3-4 days per week, eat right, socialize weekly, try creative projects, all kinds of new/different things incl volunteering to engage or distract myself, but I am fighting tooth & nail, ready to give up because I am always crazy bored and i'd rather just lay in bed or waste time online being unproductive (which in turn makes depression more severe). I feel useless and lazy. All of these positive things do not matter, I still feel the same and I'm afraid this will never change.

Is there any OTHER solution other that stimulants or dopamine-type meds for this issue? Have stims cured this problem for you? I am afraid to get completely hooked on them. i don't even know if I really have ADD - or whether this issue is an ADD thing?? I know I quickly build tolerance to stimulants, they will stop working & then my reward system will be even more screwed for life never to return! Anyone have any feedback/thoughts around this topic?

[notloki]

I found Abilify to be a "mood brightener", everything ceased being grey, mood wise. Wellbutrin made a big difference on motivation. I notice with depression I have zero motivation to do anything. Stimulants work very well for me they restore interest in a lot of things but  they are limited to being effective for a short period after taking them and have to be stopped several hours prior to sleeping. So they are not a 24/7 solution unlike the other meds I mentioned. They cover most of the waking hours so they will do. If I were to take a holiday from stims  I would be tired and fatigued for a few days, very sleepy, and then return to baseline. About what I would expect to happen.

[Blahblah]

4 hours ago, notloki said:

I found Abilify to be a "mood brightener", everything ceased being grey, mood wise. Wellbutrin made a big difference on motivation. I notice with depression I have zero motivation to do anything. Stimulants work very well for me they restore interest in a lot of things but  they are limited to being effective for a short period after taking them and have to be stopped several hours prior to sleeping. So they are not a 24/7 solution unlike the other meds I mentioned. They cover most of the waking hours so they will do. If I were to take a holiday from stims  I would be tired and fatigued for a few days, very sleepy, and then return to baseline. About what I would expect to happen.

I don't know if the Abilify I'm on is doing anything to be honest. I hate to raise the dose because just going up to 5mg has made me hungry all of the time. I eat and yet I'm a bottomless pit, stomach growling & everything. I guess I could try raising the dose again, but worry that this symptom will get worse and I'll inevitably gain weight (a total no-go for me.) Wellbutrin had no effect on me whatsoever even at 400mg. I read that it's dopamine inhibitor/release action is extremely "mild" so may not be enough of a hitter for me.

I have to agree with you on the stimulants. It seems they are not a long-term consistent solution really. You build a tolerance quickly and then just have to take breaks, deal with 3 days fatigue, crankiness and laying around unproductive. I worry it would exacerbate my depression... I feel hopeless in this issue ever going away.

[jt07]

The only non-stimulant medication that has ever touched my anhedonia (lack of pleasure) has been Abilify. It really only started to work for me at 10 mg. I can't speak as to whether it's going to make you more hungry at 10 mg than at 5 mg. In terms of my appetite problems, Remeron is by far the worst offender for me.

I would invite you to consider (with your pdoc) a Wellbutrin/Abilify combo because even if Wellbutrin does nothing for your mood, it might offset some of the hunger you feel from the Abilify. I took Wellbutrin and Risperdal and actually lost weight. Moreover, Wellbutrin is less numbing than other antidepressants. Finally, the fact that Wellbutrin might not be enough of a "hitter" for you is exactly why Abilify is an adjunctive med that is not usually prescribed alone for depression. It bolsters the antidepressant.

[Blahblah]

1 hour ago, jt07 said:

The only non-stimulant medication that has ever touched my anhedonia (lack of pleasure) has been Abilify. It really only started to work for me at 10 mg. I can't speak as to whether it's going to make you more hungry at 10 mg than at 5 mg. In terms of my appetite problems, Remeron is by far the worst offender for me.

I would invite you to consider (with your pdoc) a Wellbutrin/Abilify combo because even if Wellbutrin does nothing for your mood, it might offset some of the hunger you feel from the Abilify. I took Wellbutrin and Risperdal and actually lost weight. Moreover, Wellbutrin is less numbing than other antidepressants. Finally, the fact that Wellbutrin might not be enough of a "hitter" for you is exactly why Abilify is an adjunctive med that is not usually prescribed alone for depression. It bolsters the antidepressant.

Thanks jt07 - the above combo is a really good idea. I had never thought about Abilify as a better & more effective adjunct med than by itself. In fact, I have yet to encounter anyone who is on it by itself!! I will talk to pdoc about moving up on it. Perhaps like you said, the Wellbutrin would be potentiated by the Abilify and make a difference there. The Lamictal is not doing anything for me in this area, so I'm considering eventually tapering down on that and tweaking my combo.

Meant to add: is there a particular reason that you went off of Wellbutrin or did you switch it with something that worked better for a certain symptom?

Edited March 13, 2017 by Blahblah

[notloki]

a) You can go to 450 with Wellbutrin, it is not mild at that dose !

b) Your Abilify dose is too low, Abilify has a changing side effect profile as you increase the dose (10-15 mg) and the only way to know is to try. 

Edited March 14, 2017 by notloki

[notloki]

19 hours ago, Blahblah said:

I have to agree with you on the stimulants. It seems they are not a long-term consistent solution really. You build a tolerance quickly and then just have to take breaks, deal with 3 days fatigue, crankiness and laying around unproductive. I worry it would exacerbate my depression... I feel hopeless in this issue ever going away.

I disagree, They are an acceptable but not perfect long term solution.

Edited March 14, 2017 by notloki

[confused]

Consult with your pdoc about the abilify. The antipsychotic vs adjunct antidepressant dosages are different.(if you add an antidepressant)

jt mentioned wellbutrin. That is one of the meds I tolerate well and it seems to be pretty effective for me

 

[Blahblah]

6 hours ago, notloki said:

a) You can go to 450 with Wellbutrin, it is not mild at that dose !

b) Your Abilify dose is too low, Abilify has a changing side effect profile as you increase the dose (10-15 mg) and the only way to know is to try. 

When I was on Wellbutrin previously, my doc said anything above 400mg is likely to cause seizures (combined with other meds).... he said if I didn't notice any benefit at 400mg, going to 450mg wouldn't make a difference....dunno if this is true?

I started 2.5mg of Abilify because it's for adjunct to an antidepressant & I'm quite sensitive to most meds. When I was previously on 10mg Abilify I had major issue with akathisia & increased appetite so I stopped it. I know things can change the 2nd time around though, so bearing this in mind.

5 hours ago, confused said:

Consult with your pdoc about the abilify. The antipsychotic vs adjunct antidepressant dosages are different.(if you add an antidepressant)

jt mentioned wellbutrin. That is one of the meds I tolerate well and it seems to be pretty effective for me

 

Correct the dosages change depending on rx. 10mg+ seems it has more antipsychotic properties and as little as 2mg supposedly works as an adjunct. So I think 5mg is a decent dose....I will discuss with the pdoc.

Edited March 14, 2017 by Blahblah

[Blahblah]

On 3/13/2017 at 2:40 PM, notloki said:

So they are not a 24/7 solution unlike the other meds I mentioned. They cover most of the waking hours so they will do. If I were to take a holiday from stims  I would be tired and fatigued for a few days, very sleepy, and then return to baseline. About what I would expect to happen.

notloki: Do you ever take breaks from stims or do you take them every single day? How long have you been on them & do you have to switch them around every 6 months and/or tweak dosages so that they continue to work effectively? (i.e. work effectively on the lack of motivation/interest symptoms, not just for attention deficit issue as i know they typically remain effective longterm for ADHD) As I mentioned, my reason for taking them would be more as an antidepressant adjunct to better treat the lack of motivation/interest (and less for inattention/distraction issues)

Edited March 14, 2017 by Blahblah

[notloki]

1 hour ago, Blahblah said:

notloki: Do you ever take breaks from stims or do you take them every single day? How long have you been on them & do you have to switch them around every 6 months and/or tweak dosages so that they continue to work effectively? (i.e. work effectively on the lack of motivation/interest symptoms, not just for attention deficit issue as i know they typically remain effective longterm for ADHD) As I mentioned, my reason for taking them would be more as an antidepressant adjunct to better treat the lack of motivation/interest (and less for inattention/distraction issues)

I take weekend breaks sometimes. I'm given great flexibility to tailor my dose. If I am going to be most busy in the PM I might lower my AM dose and add it to the PM dose. My dose has gone from 75 mg/day to 90 mg/day over 5 or so years.

[Blahblah]

11 hours ago, notloki said:

I take weekend breaks sometimes. I'm given great flexibility to tailor my dose. If I am going to be most busy in the PM I might lower my AM dose and add it to the PM dose. My dose has gone from 75 mg/day to 90 mg/day over 5 or so years.

OK. Thanks. Sorry for so many questions, but I've never heard of Zenzedi (is it like dexadrine?) Are you at the max dose of that? I'm assuming you have tried both methylphenidate as well as adderall? Did those not work as well?

[notloki]

7 hours ago, Blahblah said:

OK. Thanks. Sorry for so many questions, but I've never heard of Zenzedi (is it like dexadrine?) Are you at the max dose of that? I'm assuming you have tried both methylphenidate as well as adderall? Did those not work as well?

Zenzedi is dextroamphetamine sulfate, also know as dexedrine or d-amphetamine. I hate methylphenidate, makes me jumpy. I don't like l-amphetamine so I avoid Adderall. l-amphetamine has too many additional side effects, it makes me sweat more, heart beat faster and blood pressure to increase more than d-amphetamine. I'm above the max dose, which is 60 mg/day for narcolepsy and 40 mg/day for ADHD. The PI states rare cases may require more.

[Blahblah]

15 minutes ago, notloki said:

Zenzedi is dextroamphetamine sulfate, also know as dexedrine or d-amphetamine. I hate methylphenidate, makes me jumpy. I don't like l-amphetamine so I avoid Adderall. l-amphetamine has too many additional side effects, it makes me sweat more, heart beat faster and blood pressure to increase more than d-amphetamine. I'm above the max dose, which is 60 mg/day for narcolepsy and 40 mg/day for ADHD. The PI states rare cases may require more.

Thank you for clarifying! This is very helpful. If you were to break the stimulant efficacy into a percentage - what would that look like? I guess I'm asking because I wonder if the stimulant mainly improves your ADD symptoms (distraction/lack of focus/staying on task) with just a slight boost in depression symptoms (lack of interest/motivation/physical & mental lethargy)? And so forth...I know it's more complicated that a simple breakdown, but this helps me understand the overall treatment better.

(Just as an example): 90% treating ADD symptoms to 10% treating depression symptoms.

[notloki]

For me I find amphetamine to be an effective antidepressant except for that you cannot be on it all the time. For me it is more of a mood brightener. I would say it is 50%/50%. The combination of Wellbutrin, Abilify, and amphetamine has put my depression in long term remission. My major ADD complaint is inattention and amphetamine treats that very well.

[Iceberg]

Has anyone mentioned rexulti?

[Blahblah]

13 hours ago, notloki said:

For me I find amphetamine to be an effective antidepressant except for that you cannot be on it all the time. For me it is more of a mood brightener. I would say it is 50%/50%. The combination of Wellbutrin, Abilify, and amphetamine has put my depression in long term remission. My major ADD complaint is inattention and amphetamine treats that very well.

This is such great news to hear. Your combo above sounds like it works together very well. I will def check with my pdoc about this. Thank you for all of the feedback!

9 hours ago, Iceberg said:

Has anyone mentioned rexulti?

Nope...Have you tried it? I have not heard much about Rexulti (even on this board) I read it's an atypical A/P (like the newer version of Abilify, but with some of the side effects reduced perhaps) Unfortunately, since it's so new, the brand is like $1,000 per month or something crazy. I can't afford that.

[notloki]

1 hour ago, Blahblah said:

 

Nope...Have you tried it? I have not heard much about Rexulti (even on this board) I read it's an atypical A/P (like the newer version of Abilify, but with some of the side effects reduced perhaps) Unfortunately, since it's so new, the brand is like $1,000 per month or something crazy. I can't afford that.

 

You could probably get a prior authorization from your insurer if Abilify did not work or had unacceptable side effects, and then only pay a copay.

[Iceberg]

I got a PA with no trouble....it worked for me at lower doses (1-2 mg) for depresson and was activating helped me sleep less...for manic symptoms we went to 3mg and then gave up cuz it wasn't working...but I'd say worth a try for depressive issues 

[JustNuts]

I wouldn't jump to psychostimulants without a firmly established ADHD diagnosis (but if you have one, quit delaying and get on the psychostimulants!! They do a particularly good job at reducing ADHD-related/caused symptoms of anxiety/depression alongside their normal beneficial effects for people with ADHD, which is why I say to get on them ASAP if you're diagnosed already). If you don't have ADHD, try your (numerous) other options first (a long line of different antidepressants, especially the activating ones like bupropion and the SNRIs!) before resorting to psychostimulants. They're still a pretty good last resort option but they're not a magic bullet and they come with enough disadvantages that I wouldn't recommend relying on them until absolutely necessary for this case.

[Blahblah]

40 minutes ago, JustNuts said:

I wouldn't jump to psychostimulants without a firmly established ADHD diagnosis (but if you have one, quit delaying and get on the psychostimulants!! They do a particularly good job at reducing ADHD-related/caused symptoms of anxiety/depression alongside their normal beneficial effects for people with ADHD, which is why I say to get on them ASAP if you're diagnosed already). If you don't have ADHD, try your (numerous) other options first (a long line of different antidepressants, especially the activating ones like bupropion and the SNRIs!) before resorting to psychostimulants. They're still a pretty good last resort option but they're not a magic bullet and they come with enough disadvantages that I wouldn't recommend relying on them until absolutely necessary for this case.

Most all pdocs say that all of my symptoms (even all of the ADD-inattentive/ easily bored/distracted ones) are likely just due to depression. Depression had been my longterm primary diagnosis since my late teens, so pdocs have always focused on treating that. Any ADD symptoms I have are overlooked like they aren't as important or of issue in my case - maybe they are right, I'm not a professional. Doctors give me the run-around, say that they don't diagnose ADD or cannot prescribe stimulants, they must send me to someone else (I don't know why bc I never display any kind of drug seeking behavior & I've had no addictions of any kind).

The ADHD trend in diagnosing children wasn't happening when I was young. So I could very likely be ADD, but pdocs are all reluctant to diagnose me as an adult now since I'm over 40+. I managed to graduate HS, College & hold onto jobs. Many of the pdocs I've encountered really do not believe in ADD or that it should be treated unless you have serious hyperactive/behavioral issue, unable to hold a job or complete school.

I have tried 2 of the major SNRIs and Buproprion with poor efficacy or no effect. I know there are "newer improved" versions, but it feels redundant to keep trying almost identical drugs of the same class that don't really help. Also, my pdoc does not recommend MAO's or TCA's in my case.

Edited March 17, 2017 by Blahblah

[Iceberg]

My doc says he thinks stims can be a last resort adjunct to an antidepressant (probably excluding Wellbutrin and maybe the MAOIS 

[jt07]

My doctor prescribes me Ritalin for my depression. It doesn't do a whole lot for my depression and nothing for my lack of motivation and anhedonia. However, when Abilify was added, the Ritalin turns out to work well with the Abiilify.

The biggest benefit I get from Ritalin even my psychiatrist doesn't know about, but it is the main reason I still take it. It helps wake me out of the fog of untreated sleep apnea in the mornings. That and coffee. Otherwise, it's really slow going.

[Iceberg]

I use it for mornings as well

[Blahblah]

45 minutes ago, jt07 said:

My doctor prescribes me Ritalin for my depression. It doesn't do a whole lot for my depression and nothing for my lack of motivation and anhedonia. However, when Abilify was added, the Ritalin turns out to work well with the Abiilify.

The biggest benefit I get from Ritalin even my psychiatrist doesn't know about, but it is the main reason I still take it. It helps wake me out of the fog of untreated sleep apnea in the mornings. That and coffee. Otherwise, it's really slow going.

Yep mornings are the worst. It's to the point where 4-5 cups of coffee does nothing but barely help me open my eyes. I think my entire day would go differently if i had an initial boost immediately when waking up so that I could do what i need to do and get into the right "flow" of my day.

[Iceberg]

That's why I use ir adderall...problem is the potential resulting crash 

[notloki]

16 hours ago, Iceberg said:

My doc says he thinks stims can be a last resort adjunct to an antidepressant (probably excluding Wellbutrin and maybe the MAOIS 

Maoi's and amphetamine....I have saved that for the last ditch effort prior to ECT.

[WinterRosie]

amphetamine is a stimulant, though - which the title says isn't an acceptable option.

[notloki]

Right, I was merely stating what I would do.

[Blahblah]

On 3/20/2017 at 2:02 PM, WinterRosie said:

amphetamine is a stimulant, though - which the title says isn't an acceptable option.

Maybe I should've clarified my question: how do you best overcome the inertia - with either stimulants or other techniques? It's a catch-22 in that I don't want to be on stimulants, yet I feel like it's my only great option because many of the other things people mention here I'm already doing & they aren't really helping. I guess stimulants are probably a better resort compared to say, ECT (not to say that ect doesn't work for ppl)...

Nothing rewards me. I continue to force healthy habits and I exhaust myself...I am far from thriving as I should. It's near impossible to continue forcing when you don't begin to feel better.

Do many of you here beat yourself up when you fail to do these coping "distractions"? Sometimes (like today) I just give into the inertia and for a second it feels good to avoid doing anything, yet on the other hand, it makes me feel worse as the day goes on, the ruminations start up. If i give into inertia, i look at the day and haven't accomplished anything and it sucks big time.

Edited March 22, 2017 by Blahblah

[Iceberg]

I would get up to 300 450 on the wellbutrin first and give that a little time. that looks like a pretty activating combo to add a stim, and that can cause irritability and other nasty stuff

[Blahblah]

2 hours ago, Iceberg said:

I would get up to 300 450 on the wellbutrin first and give that a little time. that looks like a pretty activating combo to add a stim, and that can cause irritability and other nasty stuff

Thanks Iceberg. How long does it usually take for Wellbutrin to "kick-in?" when I tried it several years ago, it really didn't have a noticeable effect. But now I am on 2 other meds, so maybe that will make a difference?

I've heard people here say that it works within a week or so. Will I notice anything at 150mg? I will go up to 300mg in 2 weeks (split morning/afternoon). I'm on the IR version (immediate release I believe) which is what my pdoc rx's.

Edited March 22, 2017 by Blahblah

[Iceberg]

Probably at least 2 weeks...the lucky ones get one week