Posted by JohnL on April 5, 2001, at 16:05:31
In reply to Paxil and motivation, posted by Pari on April 3, 2001, at 23:31:29
> I am a diagnosed BP and have recently switched from Welbutrin to Paxil. My doc switched me to Paxil due to intense anxiety and loss of appetite I was having, and we thought some of it might be from the Welbutrin. I am now on my 6th or 7th week on Paxil 20mg and the anxiety has lessened. The problem is that I still can't seem to motivate myself on a consistent basis to do even basic life things (like eat and go to work) and have been resorting to trying to stay in bed to sleep it off. Of course I know this is irrational, and I want to change. Does the Paxil lower motivations along with anxiety?
The phenomenon of becoming emotionally numb is not uncommon with serotonin medicines like Paxil.
If someone has a depression that is being caused by low serotonin, then increasing serotonin will lift the depression and restore motivation. However, if the depression is not caused by low serotonin, then increasing serotonin can just make things numb. No lows, but no highs either. Not depressed, but not motivated either. No crying, but not much laughing either. Blahness.
In the clinical world this type of response is considered success, since it usually means the patient has improved at least 50%. In my thinking though anything less than total recovery is not acceptable. I actually think a lot of people who have been numbed by serotonin meds have been told they are now well, simply because they aren't depressed any more. I don't buy it.
What can be added to an antidepressant to correct the blah numbness? In my personal experience small doses of the antipsychotics Zyprexa, Risperdal, or Amisulpride work the best. They interact with serotonin, dopamine, and NE systems in ways that can enhance antidepressant efficacy. Other common choices include Wellbutrin, Ritalin, or Adderall. But those are probably not good choices if anxiety has been a problem. Mood stabilizers could be tried as well, but I've just noticed a lot more success stories with the small dose antipsychotic approach. Zyprexa by the way is not only good for depression and blahness, but it is approved for treating bipolar. In the first week sedation can be bothersome. After that it goes away. Appetite is increased and weight gain is common. But the joy of feeling alive is well worth gaining a few pounds, as I see it.
I'm just rambling but I hope there is something here that might be helpful. At this point in your therapy I would look no further than Zyprexa, Risperdal, or Amisulpride. Each could be sampled for a couple weeks each to discover which might be a favorite.
John
poster:JohnL
thread:58600
URL: http://www.dr-bob.org/babble/20010403/msgs/58823.html