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BrianOCD

When you reach Anhedonia...

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Well sadly I'm here again...My depression has hit that flat point where everything around me is exactly the same, whether I go out, go here and there, I feel lifeless.

When you get to this point what do you do?  How do you survive under Anhedonia?  I haven't learned yet to live with this, it did go away before after medication, but I'm already on meds and no dice...

I think the Seroquel may have some value in helping, even the Ativan, but I'm reluctant to tamper with meds at this point as I've tried so hard to level myself out...Do you guy have any suggestions when you're in this state?

Edited by BrianOCD

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Anhedonia is a major symptom of my depression. It is really, really hard to treat with meds or otherwise. I know you don't want to mess with your meds, and I can understand that, but the ONLY thing that has touched my anhedonia is Abilify. I suppose Rexulti would also since they are related. But antidepressants just tended to make my anhedonia worse because they numbed me, but the Abilify was like wow, I wanted to experience life again.

As far as non-medical treatments go, I don't know because nothing has worked for me.

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I'm in this exact boat too. Yeah for me it's a catch-22...If I feel unstable and depressed, I start antidepressants and Lamictal, which make the really low moods go away - but I feel like all the meds that I'm on might be pulling down any positive feelings, and interest as a result. I've never been Bipolar (up & down) but it's like I can only feel the positive/pleasure side of life when I'm not on meds..which eventually I get triggered and go into severe depressed, so can't be off meds so I go on antidepressants again, lose my sex drive, interest in everything, etc. 

Ritalin was helpful in the beginning, but you grow tolerance to that particular effect and then it just helps with focus. I feel like there's no way getting around the anhedonia. I guess I just have to take the meds it if I want lasting stability and forget ever feeling "Good"!

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Anhedonia is one of my 2 biggest symptoms. I cope by having a lot of structure in my life and by doing my best be mindful and get the most out of times that are a little better. The structure means that I do things that should theoretically help, even if I'm not getting a strong response from them. This includes things like physical activity, fresh air, some social interaction. I try to build small doses of them into my week and the structure makes them happen even though I don't feel like it. These things don't change the anhedonia, but I think they help me cope with it

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5 hours ago, Blahblah said:

I'm in this exact boat too. Yeah for me it's a catch-22...If I feel unstable and depressed, I start antidepressants and Lamictal, which make the really low moods go away - but I feel like all the meds that I'm on might be pulling down any positive feelings, and interest as a result. I've never been Bipolar (up & down) but it's like I can only feel the positive/pleasure side of life when I'm not on meds..which eventually I get triggered and go into severe depressed, so can't be off meds so I go on antidepressants again, lose my sex drive, interest in everything, etc. 

Ritalin was helpful in the beginning, but you grow tolerance to that particular effect and then it just helps with focus. I feel like there's no way getting around the anhedonia. I guess I just have to take the meds it if I want lasting stability and forget ever feeling "Good"!

Nothing made it worse, just sometimes I feel like it's not ending, I guess that makes me feel more despair...Luckily the anhedonia seems to come and go, but when it comes I get really agitated and restless...Since my drug seems to have been failing, I haven't really felt many good moments in the last 6 months...

How's your Effexor going Blahblah?  I'm actually thinking about lowering mine, the generic is not as good as the brand name...way too many side effects...

4 hours ago, Ion said:

Anhedonia is one of my 2 biggest symptoms. I cope by having a lot of structure in my life and by doing my best be mindful and get the most out of times that are a little better. The structure means that I do things that should theoretically help, even if I'm not getting a strong response from them. This includes things like physical activity, fresh air, some social interaction. I try to build small doses of them into my week and the structure makes them happen even though I don't feel like it. These things don't change the anhedonia, but I think they help me cope with it

exercise is the only thing i find works well too

Edited by BrianOCD
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@BrianOCD I don't know, not really noticing a huge change compared to before I started it to be honest. Maybe it has created more of a "buffer" as far as the deep dark moods and those don't last as long, but i am still very unhappy and in a negative mood every day. I am starting to believe that there is no way out of it.

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I don't know about others here - but I am beyond terrified to go through ECT. I know it's not like "One flew over the cuckoos nest" torture style, yet since my psych hospitalizations, I have become completely phobic of hospitals, in-patient wards, beds and restraints, in general. I have nightmares still about my experience. I think I'd dissociate and experience trauma having to go through that. Because it's not just 1-2 treatments, you must go like every 2 weeks for months. And then, in many cases, that doesn't do enough, or it doesn't last, so you must go back and do a bunch more!

I am also terrified about memory loss and cognitive impairment (both i hear are quite common). I know that many people that benefit are probably the ones that do not post in these forums, but personally, I only needed to read 2-3 cases about people that did ECT and became permanently disabled (unable to work) and experienced pretty severe memory loss for the slight benefit lasting only 1 month after the treatment!! Not worth it to me! Maybe if I was standing on the edge ready to leap to my death, I don't know. Hopefully, in the future, more places will have legal assisted death and when I'm old, alone, feeble with dementia, I can end it all in peace, without suffering.

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I think typically...at least from my experience it's three times a week for (not an exact science) but 2-4 weeks. They don't always do mantainance. In Europe (idk where ur from) it's typical twice a week I think.. They also use  a different (lower I believe) electric "dose" 

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On 3/24/2018 at 1:47 AM, BrianOCD said:

Well sadly I'm here again...My depression has hit that flat point where everything around me is exactly the same, whether I go out, go here and there, I feel lifeless.

When you get to this point what do you do?  How do you survive under Anhedonia?  I haven't learned yet to live with this, it did go away before after medication, but I'm already on meds and no dice...

I think the Seroquel may have some value in helping, even the Ativan, but I'm reluctant to tamper with meds at this point as I've tried so hard to level myself out...Do you guy have any suggestions when you're in this state?

In terms of medication, it doesn't look like you've had a med trial of Wellbutrin (bupropion); might be worth a try. You could also try a "wakefulness drug" like Modafinil. It's FDA-approved for narcolepsy, shift work disorder, and fatigue from sleep apnea, but some people endorse getting energy from it. Personally, I tried it up to 400mg/day and didn't notice much, if anything. I also don't know how much it would cost you because it'd be an off-label usage.

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2 hours ago, zisforzyprexa said:

In terms of medication, it doesn't look like you've had a med trial of Wellbutrin (bupropion); might be worth a try. You could also try a "wakefulness drug" like Modafinil. It's FDA-approved for narcolepsy, shift work disorder, and fatigue from sleep apnea, but some people endorse getting energy from it. Personally, I tried it up to 400mg/day and didn't notice much, if anything. I also don't know how much it would cost you because it'd be an off-label usage.

could also try a stim

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1 hour ago, looking for answers said:

could also try a stim

That might definetly be worth bringing up looking is right. Many doc's won't do it but it might be worth a shot 

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On 3/26/2018 at 11:45 AM, Blahblah said:

@BrianOCD I don't know, not really noticing a huge change compared to before I started it to be honest. Maybe it has created more of a "buffer" as far as the deep dark moods and those don't last as long, but i am still very unhappy and in a negative mood every day. I am starting to believe that there is no way out of it.

That's how I feel.  Only can distract myself.  Ativan and seroquel do provide me some comfort.

Luckily the Anhedonia is coming and going.  I'm having very severe mood swings since it's likely my AD is pooping out...The Generic Effexor is nothing like the brand.

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On 3/24/2018 at 3:37 AM, jt07 said:

the ONLY thing that has touched my anhedonia is Abilify

 

On 3/24/2018 at 5:24 AM, notloki said:

Abilify. You can also try some amphetamine like Adderall,

 

On 3/25/2018 at 2:18 PM, Blahblah said:

Ritalin was helpful in the beginning, but you grow tolerance to that particular effect and then it just helps with focus.

These.

Ritalin has never helped me, but amphetamine and Abilify have been the only things to put a dent in anhedonia for me. Ritalin helped my mom when she was suffering from it.

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I would certainly +1 augmentation was a low-dose stim. The combo of Trintellix+Rexulti+Vyvanse does WONDERS for me. Only other meds that really touched anhedonia for me were Viibryd and Wellbutrin. But Viibryd had unacceptable GI side effects and Wellbutrin made my anxiety levels unmanageable. Granted I never took Wellbutrin with a dopamine partial agonist like Abilify, Rexulti, or Vraylar. So that particular combo may be worth looking into. Some people swear by the combo of Wellbutrin+Abilify. The idea being that you would come off of Seroquel and maybe even Effexor for that depending on what your doctor decides.

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Anhedonia is one of my worst symptoms. In the past, adderall worked well for the anhedonia, but my doctor won't prescribe it for me, which I think is bullshit because he's recommending ECT next (if my current med trial doesn't work). I am a severe case and I think that warrants doing something off-label, taking some chances. I'm currently taking Rexulti and am in the third week of increased doses of imipramine and wellbutrin. So far, I haven't seen much improvement.

I don't know how some people find doctors who are willing to go out of the box. Hell, some people are actually being prescribed Suboxone (buprenorphine) for treatment resistant depression. That's going way out on a limb but it works. Granted you'll probably have to be on it forever, but I would take my chances at this point. I've been in a "double depression" for the better part of the past 7 years or so and I honestly don't know how I'm still even alive.

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2 minutes ago, DopamineSick said:

Anhedonia is one of my worst symptoms. In the past, adderall worked well for the anhedonia, but my doctor won't prescribe it for me, which I think is bullshit because he's recommending ECT next (if my current med trial doesn't work). I am a severe case and I think that warrants doing something off-label, taking some chances. I'm currently taking Rexulti and am in the third week of increased doses of imipramine and wellbutrin. So far, I haven't seen much improvement.

I don't know how some people find doctors who are willing to go out of the box. Hell, some people are actually being prescribed Suboxone (buprenorphine) for treatment resistant depression. That's going way out on a limb but it works. Granted you'll probably have to be on it forever, but I would take my chances at this point. I've been in a "double depression" for the better part of the past 7 years or so and I honestly don't know how I'm still even alive.

Believe it or not a lot of recent studies are implicating the opioid system in major depression. Alkermes is working on two different combo drugs right now that use samidorphan as a backbone, which is a modified form of naltrexone. The one combo is samidorphan/olanzapine which in trials provided the antipsychotic efficacy of olanzapine with less weight gain due to the weight loss that can be caused by opioid antagonists like samidorphan, naltrexone, and naloxone. The other combo drug is samidorphan/buprenorphine which is in trials for use as an augmentation to an antidepressant for treatment-resistant depression.

Samidorphan is slightly more selective than naltrexone and supposedly has fewer side effects but other than that, there doesn't seem to be much of a difference.

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