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mikl_pls

Endless unadulterated anhedonia

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My mood has been absolutely deplorable for the past month or so. I honestly don't know how to begin to describe how bad it is. I have a lot of the "negative" symptoms, a profound deficit of positive affect. Nothing in life gives me pleasure, suicidal thoughts begin to surface, and I sometimes descend further into psychotic depression. These are my depressive episodes. I don't know how else to paint the picture more thoroughly because I never know what to say, and it really bothers me when I'm like that when I'm around my boyfriend. I want to talk, but I can never think of anything to say, so I rely on him to start conversations.

I don't get it... Dopamine has been posited to be a central neurotransmitter in the pathenogenesis of anhedonia, and I'm on multiple meds that supposedly on their own and in combinations with other meds I'm taking can treat anhedonia. What am I missing??

I'm on Dexedrine up to 60 mg as needed, Vyvanse 50 mg, Wellbutrin 200 mg, Viibryd 40 mg (increases dopamine via postsynaptic 5-HT1A receptor stimulation), Vraylar 3 mg... What else could possibly help?

There's no relief in sight when I'm like this.

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3 hours ago, mikl_pls said:

There's no relief in sight when I'm like this.

I don't have much advice, but I wanted to let you know you're not alone..........I have felt like this for months, maybe years...............I try to hold on to hope...

Edited by CrazyRedhead

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3 hours ago, CrazyRedhead said:

I don't have much advice, but I wanted to let you know you're not alone..........I have felt like this for months, maybe years...............I try to hold on to hope...

Thank you for your response. I'm sorry you go through this. I have, in the last year or so, felt better, but it comes in little bursts of a few weeks long, and then I go back into depression. I was okay for actually a whole year or so with high dose Abilify, but the Abilify was making me spend compulsively. Both my credit cards are still maxed out. I had to get off Abilify.

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9 hours ago, mikl_pls said:

My mood has been absolutely deplorable for the past month or so. I honestly don't know how to begin to describe how bad it is. I have a lot of the "negative" symptoms, a profound deficit of positive affect. Nothing in life gives me pleasure, suicidal thoughts begin to surface, and I sometimes descend further into psychotic depression. These are my depressive episodes. I don't know how else to paint the picture more thoroughly because I never know what to say, and it really bothers me when I'm like that when I'm around my boyfriend. I want to talk, but I can never think of anything to say, so I rely on him to start conversations.

I don't get it... Dopamine has been posited to be a central neurotransmitter in the pathenogenesis of anhedonia, and I'm on multiple meds that supposedly on their own and in combinations with other meds I'm taking can treat anhedonia. What am I missing??

I'm on Dexedrine up to 60 mg as needed, Vyvanse 50 mg, Wellbutrin 200 mg, Viibryd 40 mg (increases dopamine via postsynaptic 5-HT1A receptor stimulation), Vraylar 3 mg... What else could possibly help?

There's no relief in sight when I'm like this.

 Would doc bump Wellbutrin? 

I know some docs who Rx cytomel for “the blahs”

Ketamine 

Edited by Iceberg
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Honestly, the ONLY medication to help with this the most for me has been Clozaril/Clozapine. I was constantly psychotic, depressed, paranoid, or manic. I had no pleasure. I felt like I was barely alive. Trileptal is helping as well, but I believe you are already on this? Paxil helps as well, mostly with the anxiety and OCD. Maybe you could try clozaril/clozapine and eliminate some of your other medications?

 

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4 hours ago, Iceberg said:

 Would doc bump Wellbutrin? 

I know some docs who Rx cytomel for “the blahs”

Ketamine 

Yes, she would I believe.

I was on Cytomel 50 mcg by my NP and I had never felt better (more or less) and then I got referred to a endocrinologist who switched me to Synthroid (on 150 mcg now). I sorta felt the same "never been better" for a while but it kinda seems to have faded over time.

I've looked around and the closest ketamine clinic near me is one state over, about a 3-4 hour drive one way. Do you know if there are any ketamine clinics in Alabama or a way for me to find out? I did ask my pdoc this last time about Spravato (esketamine) and she said she likes it but she doesn't have a whole lot of patients on it so she couldn't exactly tell me whether I'd be a good candidate. I think next time I see her I'm going to request it.

4 hours ago, Butterflykisses said:

Honestly, the ONLY medication to help with this the most for me has been Clozaril/Clozapine. I was constantly psychotic, depressed, paranoid, or manic. I had no pleasure. I felt like I was barely alive. Trileptal is helping as well, but I believe you are already on this? Paxil helps as well, mostly with the anxiety and OCD. Maybe you could try clozaril/clozapine and eliminate some of your other medications?

 

I have honestly been thinking of asking for a (really) low dose of clozapine, something like 25-100 mg? I don't know if it would be effective as an adjunct or not. Yes I'm already on Trileptal 1200 mg, and it has helped in the past, particularly with my anxiety. Perhaps so, I do have a lot of meds. It would be nice to find a one-treats-all pill...

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4 hours ago, Butterflykisses said:

Honestly, the ONLY medication to help with this the most for me has been Clozaril/Clozapine. I was constantly psychotic, depressed, paranoid, or manic. I had no pleasure. I felt like I was barely alive. Trileptal is helping as well, but I believe you are already on this? Paxil helps as well, mostly with the anxiety and OCD. Maybe you could try clozaril/clozapine and eliminate some of your other medications?

 

Clozaril alone not so much (but I think I was overdosed) but cloz+adderall was my best combo for that. I also mentioned ketamine before because it helped when we felt clozaril had no more to give but the expense is hefty. I’d definetly Pursue spravato  And please let us know how it goes if pdoc gives the green light! 

Edited by Iceberg

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1 minute ago, Iceberg said:

Clozaril alone not so much (but I think I was overdosed) but cloz+adderall was my best combo for that. I also mentioned ketamine before because it helped when we felt clozaril had no more to give 

I would need to keep taking my stimulant for sure if I were on clozapine if not for the ADHD/hypersomnia (the latter of which would get much worse on clozapine) then also to help keep the weight gain down (I think weight loss as a goal on clozapine is next to impossible for me as olanzapine caused tremendous weight gain when I took it for just a week or two).

I would absolutely love to give ketamine a try. I just wish I didn't have to go to Georgia to get it. I could try rechecking that website, though, it's been a while. It was a supposed directory of ketamine clinics.

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1 hour ago, Iceberg said:

I would assume the spravato might become more prolific if it works well 

Meaning more access

True.

I looked into where there might be some ketamine clinics near me, and not to my surprise, Alabama still has none... T_T The closest one is in Marietta, GA, about a 2.5 hour-ish drive. Traveling wouldn't be the only inconvenience, I don't know if I could afford ketamine treatments, nor do I know if my family could afford to help me out with it.

I'm wondering if ECT or TMS is another option that might help with all this... I know Huntsville Hospital does ECT, and there are I believe a few psychiatrists who do TMS (not rTMS though) around Huntsville which is very near by relatively speaking.

If none of those work, then I guess it would be time to start considering vagus nerve stimulation or deep brain stimulation... 😮 

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I’d definitely look into ECT it did get my energy back but might be expensive too based on insurance situation 

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Didnt lamotrigine work for you but you got bad acne? Your med list is...heroic for lack of a better description but what about adding the lamotrigine back then something else for the acne?

methylene blue? It is a rima, not sure how you can get some short of fish tank cleaner, but the could be a possibility if you’re completely out of options. And it makes your pee blue so that’s also a plus. 

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35 minutes ago, argh said:

Didnt lamotrigine work for you but you got bad acne? Your med list is...heroic for lack of a better description but what about adding the lamotrigine back then something else for the acne?

methylene blue? It is a rima, not sure how you can get some short of fish tank cleaner, but the could be a possibility if you’re completely out of options. And it makes your pee blue so that’s also a plus. 

I actually asked my pdoc about that this past visit and she turned the idea down. I think she sees something I don't. Heh, yeah, I've been on quite a few meds before. I take minocycline for acne now, and have several topical medicines I'm (supposed to be) using. They've never helped in the past with lamotrigine-induced acne though. I've tried taking antihistamines with lamotrigine before in case it could've been a histmine thing, but it must not have because that didn't work either. Lamotrigine is "ehh" at best for me. When I first started it, it was a life saver, but it eventually pooped out and has never worked the same for me.

Methylene blue? I really doubt my pdoc would go for that, she has become rather conservative in her prescribing compared to how she used to be. It couldn't hurt to ask because I've been on EVERYTHING save for a few meds. Blue pee sounds interesting lol. How do you take methylene blue anyway?

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25 minutes ago, mikl_pls said:

I actually asked my pdoc about that this past visit and she turned the idea down. I think she sees something I don't. Heh, yeah, I've been on quite a few meds before. I take minocycline for acne now, and have several topical medicines I'm (supposed to be) using. They've never helped in the past with lamotrigine-induced acne though. I've tried taking antihistamines with lamotrigine before in case it could've been a histmine thing, but it must not have because that didn't work either. Lamotrigine is "ehh" at best for me. When I first started it, it was a life saver, but it eventually pooped out and has never worked the same for me.

Methylene blue? I really doubt my pdoc would go for that, she has become rather conservative in her prescribing compared to how she used to be. It couldn't hurt to ask because I've been on EVERYTHING save for a few meds. Blue pee sounds interesting lol. How do you take methylene blue anyway?

it seems you can get it at one of those nootropic stores. so failing getting it from your pdoc, that could be a solution. doesn't seem cheap though. i've seem it mostly as IV in the medical sense online, but i think there is one oral solution too. might be weird to get a 30 day supply of a drug that's  taken as a one off.

it is a damn shame we don't get RIMAs here. I wonder if you can somehow get an RX for that RIMA that starts with an M and get some from canadian mail order pharmacies. like you said, you've been on damn near everything.

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1 hour ago, argh said:

it seems you can get it at one of those nootropic stores. so failing getting it from your pdoc, that could be a solution. doesn't seem cheap though. i've seem it mostly as IV in the medical sense online, but i think there is one oral solution too. might be weird to get a 30 day supply of a drug that's  taken as a one off.

it is a damn shame we don't get RIMAs here. I wonder if you can somehow get an RX for that RIMA that starts with an M and get some from canadian mail order pharmacies. like you said, you've been on damn near everything.

I can't remember if it was here or if it was on crazymeds back when it was still up, but I tried to post thread about how to import meds from other countries with a prescription from my pdoc for the medicine in question that are used for depression that aren't available here, such as amisulpride, sulpiride, flupenthixol, reboxetine, etc., and my thread got shut down. I specifically stated in my thread that I was looking for a legal way to import the medications and take them under the supervision of my pdoc, and they said they were shutting it down because whichever site it was doesn't condone "illegally" importing medicines, and I was like, "IF YOU WOULD HAVE JUST READ MY POST YOU'D SEE THAT I WASN'T-..." I dunno. It was a smack in the face for sure. I put a lot of time into carefully wording that post.

It is a shame that the FDA doesn't approve various medications that would probably actually work for some and increase treatment options.

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Though I still experience it to some degree, I did notice some improvement when I started forcing myself to take Abby on brisk walks early every morning...it’s something I still loathe but I do feel a good degree better the rest of the day...I know everyone suggests exercise and I always wanted to tell them to fuck off, but now if I skip a day, I feel much worse. Ntm guilty as hell. It doesn’t help much if I don’t put much effort into it. But when I force myself to walk relatively fast, there’s definitely a pretty big improvement. Just a thought. 

PS if you already do this just tell me to shut up. 

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On 8/15/2019 at 5:08 AM, mikl_pls said:

My mood has been absolutely deplorable for the past month or so. I honestly don't know how to begin to describe how bad it is. I have a lot of the "negative" symptoms, a profound deficit of positive affect. Nothing in life gives me pleasure, suicidal thoughts begin to surface, and I sometimes descend further into psychotic depression. These are my depressive episodes. I don't know how else to paint the picture more thoroughly because I never know what to say, and it really bothers me when I'm like that when I'm around my boyfriend. I want to talk, but I can never think of anything to say, so I rely on him to start conversations.

I don't get it... Dopamine has been posited to be a central neurotransmitter in the pathenogenesis of anhedonia, and I'm on multiple meds that supposedly on their own and in combinations with other meds I'm taking can treat anhedonia. What am I missing??

I'm on Dexedrine up to 60 mg as needed, Vyvanse 50 mg, Wellbutrin 200 mg, Viibryd 40 mg (increases dopamine via postsynaptic 5-HT1A receptor stimulation), Vraylar 3 mg... What else could possibly help?

There's no relief in sight when I'm like this.

I’m so sorry Mikl. I know how awful that is. Zyprexa really saved the day for me and I’m watching my weight closely and I’m actually losing weight slowly! I’m also on Abilify and lamictal and klonopin for pure psych meds.

 

 

I agree with the low dose clozapine suggestions. Higher doses really wiped me out and came with a high cost side effects wise IME.

What about symbyax (sp?)? 

120 mg of latuda?

Wellbutrin IR or SR?

celexa?

Upping the seroquel to a more therapeutic dose for the psychosis or trying the XR version (my personal preference)? Like 800 mg regularly?

How is your full panel of thyroid looking? Has that been done recently?

Sorry if unhelpful. Just trying to think of possibilities.

 

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14 minutes ago, Wonderful.Cheese said:

I agree with the low dose clozapine suggestions. Higher doses really wiped me out and came with a high cost side effects wise IME.

What about symbyax (sp?)? 

120 mg of latuda?

Wellbutrin IR or SR?

celexa?

Upping the seroquel to a more therapeutic dose for the psychosis or trying the XR version (my personal preference)? Like 800 mg regularly?

How is your full panel of thyroid looking? Has that been done recently?

Sorry if unhelpful. Just trying to think of possibilities.

I had never thought of trying Symbyax, but I think it might be better if I just tried the two meds seperately, it might actually be cheaper.

Last time I was on Latuda 120 mg, I got parkinsonism, but I wouldn't mind giving it another try! My pdoc actually mentioned going back to Latuda as a possibility other than Vraylar, but I want to get to the 12 week mark with Vraylar before I give it up because that's when it reaches steady state. I've been on it 8 or 9 weeks now. At my next pdoc appointment I think we will see what's going on and make a decision from there.

I'm currently on Wellbutrin IR 200 mg, but have plenty of room to go up. I have to be careful though because of seizures.

I want to stay away from Celexa if I can because it's related to Lexapro which I had a horrible time with in high school. Also, the Lexapro sapped every ounce of will to do anything out of me, I was so lazy my room got piled up even worse than it is now! lol

I've thought about Seroquel XR before, but never gave it a try. I think I'd try that after Latuda but probably before Clozaril.

My thyroid is doing fine I believe. I'm on Synthroid 150 mcg and was doing very well until this recent bout of depression hit me.

Thanks for all your suggestions and your response!

Thank you everyone, btw!

 

1 hour ago, DammitJanet said:

Though I still experience it to some degree, I did notice some improvement when I started forcing myself to take Abby on brisk walks early every morning...it’s something I still loathe but I do feel a good degree better the rest of the day...I know everyone suggests exercise and I always wanted to tell them to fuck off, but now if I skip a day, I feel much worse. Ntm guilty as hell. It doesn’t help much if I don’t put much effort into it. But when I force myself to walk relatively fast, there’s definitely a pretty big improvement. Just a thought. 

PS if you already do this just tell me to shut up. 

That makes a lot of sense, as I'm very, very sedentary. I could start going to the park and walking or something, or just walk around at the house since we have a lot of space around our house. Just have to watch out for snakes is all... ugh!

I wouldn't tell you to shut up for making a suggestion to help me! Thank you for your suggestion!

Thank you, everyone, for your suggestions! :) 

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5 hours ago, mikl_pls said:

That makes a lot of sense, as I'm very, very sedentary. I could start going to the park and walking or something, or just walk around at the house since we have a lot of space around our house. Just have to watch out for snakes is all... ugh!

Physical activity was one of the lifestyle interventions I tried while I didn't have a pdoc or meds. In my experience it helps some -- not nearly as much as fitness "influencers" claim, but enough to be worth the effort. I walked around inside my house and used a pedometer app on my phone

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I want to note that in my experience, mild exercise that doesn’t drastically increase my heart rate didn’t help whatsoever. Only when I put in a lot of effort and sweat profusely did it start to help quite a bit. 

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