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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Ame Sans Vie on February 25, 2003, at 8:39:21
Hi,
I'm 20 years old; was diagnosed with social anxiety at the age of 14. I've run through pretty much all of the medications used for treating anxiety, some of them two, three, even four times. I'm finally settled on a combination of two meds that control my anxiety exceptionally well-- 2mg clonazepam bid + 30mg buspirone tid. Only one problem now: I can't bring myself to get up off my ass to do anything! I feel exponentially better than I did prior to trying this med combo, but what can I do about the absolute lack of inclination? I'm pretty sure it's not a side effect of the medications; I've had quite a problem with motivation ever since my childhood ADHD sort of downgraded to ADD during my teens.
I have taken Adderall, methamphetamine, and methylphenidate in the past to control my ADHD symptoms. Recently I tried Provigil, and for the six weeks that it worked I felt better than I can ever remember. At the time I was also taking Valrelease and amobarbital for the anxiety... I have to switch back and forth between benzos and barbs occasionally as I tend to develop a tolerance rapidly.
Anyway, I have an appointment with my psychiatrist on Thursday-- right now I'm thinking of talking to him about some form of amphetamine (Ritalin made me much too jittery). But I'm not entirely sure he'll prescribe it... I've brought it up in the past and he seemed opposed to the idea of having me on both a tranquilizer and a stimulant. He knows I don't abuse my meds, he's just a bit on the conservative side.
He may consider Cylert, but I know it doesn't work for everyone. Even still, I'd be interested to hear from anyone who's taken this drug.
So right now the only non-scheduled drugs I can think of are Strattera and Wellbutrin. I've tried Parnate (30mg) for this problem before, but it seems I'm practically immune to MAOIs... Nardil (105mg) didn't help in the least either.
I know most of these drugs aren't known to be activating anyway, but for the sake of completion I'll list them anyway.
Prozac (20mg), Effexor (225mg), and Serzone (450mg) seemed little more than placebos to me; Paxil (60mg) and Luvox (200mg) were completely unbearable, so I see no need to try other SSRIs. Amitriptyline (200mg), Remeron (30mg), and trazodone (400mg) were great for sleep, that's about it.
I've tried pretty much all the standard anticonvulsants/mood-stabilizers, except lithium and Topamax. I'm guessing neither of these would be much help, correct me if I'm wrong. Neurontin (2400mg), Gabitril (36mg), Lamictal (300mg), Tegretol (800mg), and Depakote (3000mg) were all useless. I've always been wary of the APs, so I've only tried them in pretty low doses, to no effect-- Risperdal (2mg), Seroquel (150mg), thioridazine (75mg).
Maybe higher-dose Prozac or Effexor would be worth a try? How about Abilify? Really, I'm just trying to find anything that's not quite so noradrenergic as Wellbutrin or Strattera. I'm not quite sure about it's method of action (5-HT/NE?), but what is the general consensus on reboxetine? How about the 'narcoleptic' TCA's, like protriptyline?
*Any* input on this would be a great help... I've just got to take care of this soon. Because of this problem I've already had to forfeit *two* full scholarships, and I owe over $900 to the government for a grant that was never used due to a suicide attempt and hospital stay. Somehow they decided to give me another chance at the university in the fall, but I'm afraid this will be my last opportunity and I don't want to mess it up.
Thanks in advance for any opinions/information.
Posted by zeugma on February 25, 2003, at 10:42:50
In reply to Non-controlled drugs for motivation?, posted by Ame Sans Vie on February 25, 2003, at 8:39:21
Why are you looking for something less noradrenergic than Strattera or Wellbutrin? Have you had a bad experience with either of these meds?
Protriptyline is actually the least 'narcoleptic' and most 'activating' of the TCA's.
Posted by Ame Sans Vie on February 25, 2003, at 12:40:49
In reply to Re: Non-controlled drugs for motivation? » Ame Sans Vie, posted by zeugma on February 25, 2003, at 10:42:50
Sorry about that, I should have been more clear about protriptyline-- I was using the word 'narcoleptic' to indicate that it was prescribed occasionally for narcolepsy/ADHD. Aren't there some other TCA's used for this purpose as well? Maybe desipramine?
I suppose it's pretty irrational, but for some reason I'm a little scared to try a NE-increasing medication. Especially considering how often I hear of Wellbutrin causing horrible anxiety; I couldn't put up with that. On the other hand, I know Wellbutrin isn't a selectively NE active drug-- maybe a low dose (10mg) of propranolol several times a day would help even things out? After all, psychic anxiety isn't really much of a problem for me while taking the clonazepam/buspirone. It's the peripheral effects of increased NE that I worry about.
Posted by Ron Hill on February 25, 2003, at 13:23:58
In reply to Non-controlled drugs for motivation?, posted by Ame Sans Vie on February 25, 2003, at 8:39:21
Ame Sans Vie,
Wow, you've tried a lot of medications during your young life, huh?
A few weeks ago, Enada NADH seemed to be helping your motivation. From your current post it is clear that it must have pooped out. Can you take a minute or two and tell me what happened?
Also, do you enjoy rigorous aerobic exercise? Does your lack of motivation inhibit you from exercising?
I send you my best wishes.
-- Ron
---------------------------------------> Hi,
>
> I'm 20 years old; was diagnosed with social anxiety at the age of 14. I've run through pretty much all of the medications used for treating anxiety, some of them two, three, even four times. I'm finally settled on a combination of two meds that control my anxiety exceptionally well-- 2mg clonazepam bid + 30mg buspirone tid. Only one problem now: I can't bring myself to get up off my ass to do anything! I feel exponentially better than I did prior to trying this med combo, but what can I do about the absolute lack of inclination? I'm pretty sure it's not a side effect of the medications; I've had quite a problem with motivation ever since my childhood ADHD sort of downgraded to ADD during my teens.
>
> I have taken Adderall, methamphetamine, and methylphenidate in the past to control my ADHD symptoms. Recently I tried Provigil, and for the six weeks that it worked I felt better than I can ever remember. At the time I was also taking Valrelease and amobarbital for the anxiety... I have to switch back and forth between benzos and barbs occasionally as I tend to develop a tolerance rapidly.
>
> Anyway, I have an appointment with my psychiatrist on Thursday-- right now I'm thinking of talking to him about some form of amphetamine (Ritalin made me much too jittery). But I'm not entirely sure he'll prescribe it... I've brought it up in the past and he seemed opposed to the idea of having me on both a tranquilizer and a stimulant. He knows I don't abuse my meds, he's just a bit on the conservative side.
>
> He may consider Cylert, but I know it doesn't work for everyone. Even still, I'd be interested to hear from anyone who's taken this drug.
>
> So right now the only non-scheduled drugs I can think of are Strattera and Wellbutrin. I've tried Parnate (30mg) for this problem before, but it seems I'm practically immune to MAOIs... Nardil (105mg) didn't help in the least either.
>
> I know most of these drugs aren't known to be activating anyway, but for the sake of completion I'll list them anyway.
>
> Prozac (20mg), Effexor (225mg), and Serzone (450mg) seemed little more than placebos to me; Paxil (60mg) and Luvox (200mg) were completely unbearable, so I see no need to try other SSRIs. Amitriptyline (200mg), Remeron (30mg), and trazodone (400mg) were great for sleep, that's about it.
>
> I've tried pretty much all the standard anticonvulsants/mood-stabilizers, except lithium and Topamax. I'm guessing neither of these would be much help, correct me if I'm wrong. Neurontin (2400mg), Gabitril (36mg), Lamictal (300mg), Tegretol (800mg), and Depakote (3000mg) were all useless. I've always been wary of the APs, so I've only tried them in pretty low doses, to no effect-- Risperdal (2mg), Seroquel (150mg), thioridazine (75mg).
>
> Maybe higher-dose Prozac or Effexor would be worth a try? How about Abilify? Really, I'm just trying to find anything that's not quite so noradrenergic as Wellbutrin or Strattera. I'm not quite sure about it's method of action (5-HT/NE?), but what is the general consensus on reboxetine? How about the 'narcoleptic' TCA's, like protriptyline?
>
> *Any* input on this would be a great help... I've just got to take care of this soon. Because of this problem I've already had to forfeit *two* full scholarships, and I owe over $900 to the government for a grant that was never used due to a suicide attempt and hospital stay. Somehow they decided to give me another chance at the university in the fall, but I'm afraid this will be my last opportunity and I don't want to mess it up.
>
> Thanks in advance for any opinions/information.
>
>
>
>
Posted by Ame Sans Vie on February 25, 2003, at 15:42:50
In reply to Re: Non-controlled drugs for motivation? » Ame Sans Vie, posted by Ron Hill on February 25, 2003, at 13:23:58
Hi there, I had completely forgotten about the Enada trial a few weeks ago-- unfortunately it started giving me horrible nausea that I was only able to keep under control with some dronabinol I had left over from a few months ago. I wasn't too thrilled with the idea of having THC detectable in my system, on the off-chance I may one day actually be able to work and have to submit to a UA. Legal or not, there's still quite a stigma attached there. It's a shame though... the NADH was great while it lasted. Maybe I can try it again sometime, but only stay on it for a few weeks at a time.
I actually work out quite a bit; I have a decent-sized cable-based weight system in my house, and I try to use it three, four times a week. Aerobic exercise has always posed a bit of a problem for me though, due to bad exercise-induced asthma. Regardless, lifting weights does provide me with substantially more energy throughout the day... it just doesn't do much to bring me out of this apathetic way of thinking. I'm just so confused as to what to do at this point. There seem to be plenty of options available to me, especially now that I have my anxiety entirely under control. I just don't know which one to suggest! I sometimes wish I were one of those people who just let the doctor decide on the meds and took them without question... I think too much. :-/
Posted by Ame Sans Vie on February 25, 2003, at 15:43:35
In reply to Re: Non-controlled drugs for motivation? » Ame Sans Vie, posted by Ron Hill on February 25, 2003, at 13:23:58
Oh, by the way, are you still taking the NADH? If so, how is it working out for you?
Posted by zeugma on February 25, 2003, at 20:23:00
In reply to Re: Non-controlled drugs for motivation? » zeugma, posted by Ame Sans Vie on February 25, 2003, at 12:40:49
> Sorry about that, I should have been more clear about protriptyline-- I was using the word 'narcoleptic' to indicate that it was prescribed occasionally for narcolepsy/ADHD. Aren't there some other TCA's used for this purpose as well? Maybe desipramine?
>
> I suppose it's pretty irrational, but for some reason I'm a little scared to try a NE-increasing medication. Especially considering how often I hear of Wellbutrin causing horrible anxiety; I couldn't put up with that. On the other hand, I know Wellbutrin isn't a selectively NE active drug-- maybe a low dose (10mg) of propranolol several times a day would help even things out? After all, psychic anxiety isn't really much of a problem for me while taking the clonazepam/buspirone. It's the peripheral effects of increased NE that I worry about.I think NE drugs are generally good for ADD. Stimulants boost NE too, but not everyone can handle that level of activation. Which peripheral effects (other than anxiety) are you referring to? The irritability can get out of hand, but the buspirone should help with that. By the way, I have found the nortriptyline/buspirone combination to be the most beneficial medication regimen I have experienced.
Posted by Ame Sans Vie on February 25, 2003, at 20:50:32
In reply to Re: Non-controlled drugs for motivation? » Ame Sans Vie, posted by zeugma on February 25, 2003, at 20:23:00
Well, your mention of NE and irritability reminded me of a pretty nasty temper that developed while on Effexor and again on amitriptyline. I naturally have a bit of a short fuse and in fact have taken Tenex on and off in the past to control my anger, with quite a bit of success. In fact, the only reason I don't take it at the moment is because I never leave my house-- there isn't much in my room that pisses me off! lol But what I'm getting at is that, seeing as how a noradrenergic antagonist helped to calm me down and two separate NE-active drugs had me all strung out like that, maybe Strattera/Wellbutrin wouldn't be such great ideas? I mean, I'm always willing to give them a shot, but I'd much rather try something else first.
Other than the possibility of increased irritability/anxiety, I suppose I'm mostly worried about trembling, sweating... basically anything that could potentially trigger more anxiety. I'm just assuming that since NE-antagonists tend to minimize these symptoms, agonists/reuptake-inhibitors would tend to increase them. I suppose these things are hard to predict, though...
re: nortriptyline, this is a medication I've considered, but I have to wonder-- since amitriptyline didn't work out very well, would a trial of nortrip even be worth a shot? It's a metabolite of amitriptyline, right?
Posted by zeugma on February 25, 2003, at 21:49:08
In reply to Re: Non-controlled drugs for motivation? » zeugma, posted by Ame Sans Vie on February 25, 2003, at 20:50:32
Nortriptyline is the noradrenergic metabolite of amitriptyline- so if amitriptyline was too NE- active, nortriptyline would be something you'd want to stay as far as possible from. The same goes for Strattera and Wellbutrin. Do you know that clonidine is sometimes used for ADD? You may have the right idea with the NE- antagonists. Clonidine would also probably help with anxiety and irritability. Seems bizarre that NE-agonists and NE-antagonists could help with the same psychiatric problem, but why not make the best of it?
Posted by Ame Sans Vie on February 26, 2003, at 8:08:12
In reply to Re: Non-controlled drugs for motivation? » Ame Sans Vie, posted by zeugma on February 25, 2003, at 21:49:08
Actually, I have tried clonidine in the past and found it worked pretty well... my current pdoc prefers to use guanfacine (alpha-2 antagonist) instead, but there really doesn't seem to be much difference between the two. Maybe a bit more sedation on guanfacine, but in my case that's always a good thing.
Anyway, I think come tomorrow I'll just bring up amphetamines, pemoline, and high-dose fluoxetine as options, in that respective order. I know the schedule II stims (excepting Ritalin) help me out with this problem, but if he's only willing to try Prozac/Cylert and they don't work, I suppose I could always go back to the pdoc who was treating my childhood ADHD.
Posted by Hattree on February 26, 2003, at 10:07:48
In reply to Re: Non-controlled drugs for motivation? » zeugma, posted by Ame Sans Vie on February 26, 2003, at 8:08:12
Provigil?
Posted by Ame Sans Vie on February 26, 2003, at 10:40:13
In reply to Re: Non-controlled drugs for motivation?, posted by Hattree on February 26, 2003, at 10:07:48
Guess you missed that part, I didn't exactly make it very clear. But yes, I've tried Provigil before and it seemed to work for five or six weeks then suddenly pooped out on me. While I'm not all too keen on the idea of spending money on my medications (I have Medicaid) or importing my prescription, I understand adrafinil is considerably less expensive. Do you know how it compares to modafinil?
Posted by fairnymph on February 26, 2003, at 11:42:11
In reply to Non-controlled drugs for motivation?, posted by Ame Sans Vie on February 25, 2003, at 8:39:21
I would give the Strattera a try.
I have OCD (anxiety) and also, severe lethargic depression. I found Stattera's sister drug (reboxetine) to be EXCELLENT for motivation and energy -- and while it didn't improve my anxiety at all, it also didn't worsen it. Thus I imagine if you are on other anxiety meds simultanseously you should be just fine. I really don't think norepinephrine is anxiety inducing, personally.
good luck.
Posted by Ame Sans Vie on February 26, 2003, at 12:54:07
In reply to Re: Non-controlled drugs for motivation? » Ame Sans Vie, posted by fairnymph on February 26, 2003, at 11:42:11
Maybe I will give reboxetine a try-- couldn't hurt! Thanks for the suggestion!
This is the end of the thread.
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