Posted by bleauberry on June 18, 2008, at 20:30:06
In reply to Seeking Advice on Med Combo, posted by chiron on June 18, 2008, at 17:44:05
There are various terms used to describe your symptoms. Depression really is not what it is. More specifically it would be anhedonia, or apathy. Anhedonia is just one specific part of depression, but it is not depression. It is a distinct syndrome that can be experienced in the absence of depression. It can stand alone without depression, but it is always part of depression as well. Anhedonia is the inability to experience pleasure/joy in pleasurable things.
Often times doctors figure you must still be depressed if unable to experience joy. But that might not be the case. Are you depressed? If so, then maybe that's why. If not, then there is something else going on.
A common cause of anhedonia, weird as it sounds, is ssri antidepressants like yours. They often numb emotions to where you do not feel lows any more, but you do not feel highs either. Very flatline emotions.
Not sure how you would rate celexa in your treatment, but if I had to place a bet on any one med in your combo that is either causing or worsening ahedonia, that would be it.
I had decent success years ago in treating depression with paxil, later prozac, lexapro, zoloft. In all cases, depression was mostly gone but I was just so flat and emotionless there was no point in life. No joy at all. I wast quite crippled, though not majorly depressed like I was. Mileage varies, but things people have found to improve anhedonia include modafinil, adrafinil, ritalin, adderall, mirapex. Mirapex is the one I think I've seen the most literature on. The one that worked pretty good for me for a few years was adrafinil, but not the others. While antipsychotics basically numb people out, they can actually work well on the negative symptoms of schizophrenia which just happen to have anhedonia as a core symptom. I found zyprexa helped me quite a bit, but not completely.
Celexa is pretty powerful stuff and I doubt the wellbutrin has the power to overcome it. You might discuss with the doc any combination of the following possibilities:
Lower celexa
Eliminate celexa
Increase wellbutrin
Add on an anhedonia specific med, which is generally accepted as being a specific pro-dopamine med.
poster:bleauberry
thread:835319
URL: http://www.dr-bob.org/babble/20080617/msgs/835356.html