Posted by bleauberry on April 17, 2010, at 11:12:24
In reply to Severe anhedonia, posted by Maximus on April 16, 2010, at 11:48:18
Broadly speaking anhedonia seems to me to be a hypo-excitatory thing. Too much inhibition going on, not enough excitement going on. Inside the brain's workings that is.
Lamictal as I see it is definitely putting the brakes on excitation. I mean, that's what it is supposed to do, right? Stop seizures? Anti-excitation?
Effexor is predominantly serotonin, with a distant smidgen of norepinephrine and dopamine in there. The NE and DA increase more at the highest doses, but still is a tiny percent compared to the whopping effect on serotonin. Serotonin is inhibitory, not excitatory. Despite the weak effect on NE and DA, serotonin is likely squashing them out.
Abilify I think is harder to armchair quarterback. The way it interacts with dopamine and serotonin receptors in two different opposing directions, varying from person to person, and varying from dose-size to dose-size, means that at a certain dose it could be good for anhedonia and at another dose bad. But would vary from person to person. Generally speaking, based off of most comments of abilify users here over the last couple years, doses below 5mg were best for anhedonia. Doses at or above 5mg were too dulling and too much like a full-on antipsychotic. Just comments, not my own opinions. I don't have much personal experience with it.
It is risky to play around with doses. But from an armchair quarterback position, I would say the best way to improve the anhedonia thing would be to lessen the doses of all three meds to the bare minimum dose that keeps you well. If you aren't even at that goal on the doses you are on, then I can't even see the reasoning to keep them at all.
Take my comments with a grain of salt and please don't do anything without talking to your doctor. I just wanted to say that I see too much anti-excitatory stuff in this cocktail. Which is a good thing if control of BP is crucial. Not so good for anhedonia. It is a fine line to try to balance them out. At the current doses, the balance seems to be in favor of stability at the cost of pleasure.
poster:bleauberry
thread:943565
URL: http://www.dr-bob.org/babble/20100416/msgs/943695.html