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BrianOCD

When you reach Anhedonia...

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6 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.

I guess I've been quite lucky to have found 2 psychiatrists in my life who go outside of the box. One was to prescribe carbamazepine (Tegretol) to a non-bipolar person and also Risperdal. My current psychiatrist took over the cocktail the previous psychiatrist prescribed and added Ritalin. 

I will add that all this happened after I had a serious suicide attempt and hospitalization. It was like they finally began to take me seriously and began to think outside the box. Before that, it was just antidepressant after antidepressant.

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Wellbutrin + gabapentin did it for me.

Had to drop gabapentin though. So back to being flat but not exactly depression type of flat. Easy come easy go I guess.

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I forgot to mention Wellbutrin, it can be effective, too. I'm on Wellbutrin + Abilify + amphetamine. 

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I'm still new to Abilify, but it's been starting to help with anhedonia. I found Wellbutrin helped briefly, but I couldn't tolerate it

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38 minutes ago, Ion said:

I'm still new to Abilify, but it's been starting to help with anhedonia. I found Wellbutrin helped briefly, but I couldn't tolerate it

To me Abilify causes a bit of alhedonia, but I'm schizoaffective bipolar with more manic episodes then deppressive ones, but I've heard that many can feel that 'power' again while taking that, especially with small doses so I assume it might be helpful for you.

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amphetamines (Vyvanse and Adderall) as well as Wellbutrin both did it for me. But getting on a combo of amphetamines plus a dopamine partial agonist was the real game-changer, and that seems to be a recurring theme for a lot of people. Either Vraylar/Rexulti/Abilify + Either Wellbutrin/stim

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Ritalin and amphetamine are different enough that I would try both, at least until I found one that works.  The amphetamines target dopamine exclusively and anhedonia seems to respond to dopamine affecting meds. 

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Hated Wellbutrin, I was on it for about a month or so a little while ago.

When I take seroquel/ativan I get a bit of a response, but I can't really take high dosages of it during the day because my job involves driving.  So my days are very apathetic and dull.

Exercise brings me out of it for maybe an hour or so, but I can't stay on the treadmill all day long ya know?  Lately I've been suspicious even trying new drugs, but I guess I don't have much of a choice at this point this I've been taking them for over a decade...

Edited by BrianOCD

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You need to be far longer on Wellbutrin than 1 month to get to 300 mg for 4-6 weeks. 300 is the effective dose that the manufacturer indicated is the min. effective dose. You will not know if the side effects will wane unless you tried and gave some time to 300 mg.

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12 hours ago, notloki said:

You need to be far longer on Wellbutrin than 1 month to get to 300 mg for 4-6 weeks. 300 is the effective dose that the manufacturer indicated is the min. effective dose. You will not know if the side effects will wane unless you tried and gave some time to 300 mg.

Well i was probably on 150 for 4-5 weeks and about the same on 300mg, but it simply didn't agree with me.

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On 4/5/2018 at 2:04 AM, BrianOCD said:

Well i was probably on 150 for 4-5 weeks and about the same on 300mg, but it simply didn't agree with me.

like @notloki pointed out 150mg on its own for depression isn't particularly useful. However, if it's being used to augment a serotonergic antidepressant, it can be a very useful dosage. Not just because of its effects on norepinephrine and dopamine but also its inhibitory effects on other antidepressants. Wellbutrin inhibits CYP2D6 moderately which metabolizes a significant portion of the 1st-gen SSRIs like Lexapro. Even 150mg of Wellbutrin can increase Lexapro blood levels and subsequently serotonin levels while providing modest norepinephrine elevation and some increases in dopamine as well. 

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On 3/27/2018 at 8:01 PM, looking for answers said:

could also try a stim

Me personally? I've thought about it and I'm pretty sure my psychiatrist wouldn't care, but between working in the field and seeing the dark side of amphetamines, amphetamine abuse and amphetamine-induced psychosis and worrying about becoming dependent on or taking too much of the klonopin I'm already prescribed, I'm reluctant to take that leap. I can see it working well for some people though.

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@zisforzyprexa there are other options that are a bit milder than amphetamines- I know a few psychs who use focalin as a first line cuz it can be less harsh (can be- depends on the person obviously) 

Also Provigil/Nuvigil but those are more for wakefulness than anhedonia 

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I think when it comes to anhedonia in major depressive disorder it does seem like @Iceberg said that methylphenidate products are commonly used to augment an AD to fight anhedonia. However, Adderall/Dexedrine/Vyvanse have their use cases as well. I find the combination of Vyvanse+Rexulti to be absolutely fabulous. Additionally, Trintellix doesn't cause me much anhedonia to begin with. So I've actually improved from baseline on the combo of Trintellix+Rexulti+Vyvanse. Compared to combinations of older SSRIs with dopamine antagonists, I was always so lifeless. Getting to this combo has changed things quite dramatically for the better.

Keep in mind that I am diagnosed as Bipolar 2 and not MDD. A best guess at bipolar depression would indicate that during manic/hypomanic episodes, people with bipolar disorder experience sudden sustained increases in serotonin and dopamine. When the brain tries to down-compensate for the uptick, it overshoots it and dopamine levels plummet. It would seem that antagonizing serotonin receptors as well as taking something like Vyvanse should increase dopamine levels and keep them increased, while preventing another plummet. Then dopamine partial agonism takes care of modulation to make sure it isn't all over-done or under-done. 

Mind you, I only take 30mg of Vyvanse, which by most people's accounts is quite low....almost pediatric in fact. However, I feel like it is enough for me. I can handle 40mg as well, but I usually reserve that for Fall/Winter. When I get to 50mg, it can start to get a bit much. Correct me if I'm wrong everyone, but I believe it is roughly as follows:

Adderall XR > Vyvanse

10mg > 30mg

20mg > 50mg

30mg > 70mg

I recall that I could handle about 20mg/day of Adderall. So I'm not sure why I can't tolerate 50mg of Vyvanse just as well. But hey, 30mg works so w/e. Ymmv.

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