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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 27. This is the beginning of the thread.
Posted by lostforwards on March 25, 2006, at 13:44:07
has anybody heard of this? Can antidepressants make someone lazy?
Posted by med_empowered on March 25, 2006, at 14:29:41
In reply to amotivational syndrome, posted by lostforwards on March 25, 2006, at 13:44:07
hi! antidepressants can often make people lethargic and unmotivated--its a sort of "flatness" induced by the AD.
Posted by SLS on March 25, 2006, at 14:34:15
In reply to amotivational syndrome, posted by med_empowered on March 25, 2006, at 14:29:41
> hi! antidepressants can often make people lethargic and unmotivated--its a sort of "flatness" induced by the AD.
I think the SRI (serotonin reuptake inhibitor) antidepressants are most likely to produce this effect. Flat affect can also be a side effect of lithium.
- Scott
Posted by lostforwards on March 25, 2006, at 15:05:41
In reply to amotivational syndrome, posted by med_empowered on March 25, 2006, at 14:29:41
darn. that sucks. I was hoping to improve my motivation and my mood. My doc put me on an AD. But lately I've been feeling more "blank".
Posted by SLS on March 25, 2006, at 15:09:09
In reply to Re: amotivational syndrome, posted by lostforwards on March 25, 2006, at 15:05:41
> darn. that sucks. I was hoping to improve my motivation and my mood. My doc put me on an AD. But lately I've been feeling more "blank".
Which AD?
What dosage?
How long have you been taking it?
- Scott
Posted by lostforwards on March 25, 2006, at 15:36:06
In reply to Re: amotivational syndrome » lostforwards, posted by SLS on March 25, 2006, at 15:09:09
3 - 4 weeks. 37.5mg effexor
Posted by SLS on March 25, 2006, at 15:48:06
In reply to Re: amotivational syndrome » SLS, posted by lostforwards on March 25, 2006, at 15:36:06
> 3 - 4 weeks. 37.5mg effexor
If you are using Effexor to treat depression or an anxiety disorder, I doubt you will glean much therapeutic effect from such a low dosage.
The flat affect and amotivation might not get any worse as you raise the dosage. I don't think it is so dosage-dependent. On the other hand, obtaining an antidepressant response is dosage dependent. The range of dosages that I feel are reasonable are between 150mg - 300mg. If it is the right drug for you, the antidepressant effect might predominate over the affective and motivational side effects. I think you are wasting you time at 37.5mg/day.
- Scott
Posted by med_empowered on March 25, 2006, at 16:16:13
In reply to Re: amotivational syndrome » lostforwards, posted by SLS on March 25, 2006, at 15:48:06
flat affect and what not is pretty bad on the SSRIs, but there are problems with other classes, too (TCAs can cause sedation, cardiovascular problems, and cognitive impairment; MAOIs are..tricky). Some people benefit from ssri+wellbutrin combos. As for effexor...at lower-end doses, its pretty much only workin on serotonin. As you move up, you'll hit norepinephrine and maybe a little bit of dopamine. Cymbalta is effexor-ish, but is equipotent w/ serotonin and norepinephrine, so at the standard dose (60mgs/day) you'll be getting more or less equal reuptake of both.
As for the apathy...I read one study where they used atypical antipsychotics. I think thats a bad idea, given the side effects and cost, but I guess its an option. BuSpar might help, too.
Posted by linkadge on March 25, 2006, at 16:33:45
In reply to amotivational syndrome on antidepressants, posted by med_empowered on March 25, 2006, at 16:16:13
Effexor should be better in this regard than the SSRI's. If you develop amotivational syndrome, taking a medication holliday can help.
Linkadge
Posted by Phillipa on March 25, 2006, at 20:02:42
In reply to Re: amotivational syndrome » SLS, posted by lostforwards on March 25, 2006, at 15:36:06
Hi lostforwards do you have a first name you're comfortable using if not that's okay. But weren't you on antipsychotics? I know you saw your doc today did he change your diagnosis? Love Phillipa
Posted by lostforwards on March 26, 2006, at 9:40:05
In reply to Re: amotivational syndrome » lostforwards, posted by Phillipa on March 25, 2006, at 20:02:42
> Hi lostforwards do you have a first name you're comfortable using if not that's okay. But weren't you on antipsychotics? I know you saw your doc today did he change your diagnosis? Love Phillipa
Actually I haven't seen my doc today. My appointment is on the 27th or 28th. My diagnosis is, as far as I know, still bipolar. I'd rather stick to the name lostforwards.
Posted by zazenduck on March 26, 2006, at 11:33:06
In reply to Re: amotivational syndrome, posted by lostforwards on March 25, 2006, at 15:05:41
I think that's a pretty common problem unfortunately. Wellbutrin is supposed to be energizing...maybe try that. Or add a stimulant tho that might just make you jazzed up and not motivated
Posted by River1924 on March 28, 2006, at 1:16:12
In reply to Re: amotivational syndrome, posted by lostforwards on March 26, 2006, at 9:40:05
Five comments (which may or may not apply:)
1) When I first began AD's in the early 1990's, I found them disturbing. Eventually, I realized that I had become so accustomed to depression that "I" felt empty without it. Suddenly a huge chunk of my psychic life and focus was gone. It can take awhile to "get and life" and direct one's interest outward. If one has some obsessive/compulsive tendencies, their reduction can leave one feeling lazy when the behaviors weren't very useful in the first place. Although society loves them, workaholics aren't always very happy... just busy.
2) Sometimes I think people on this board expect too much of meds. ***They won't give one's life meaning but will, sometimes, give one some space aside from depression, to pursue interests/ relationships. In my case, the answer to depression questionare's which asked "are you less happy than you used to be" were problematic and still are. I was a morose worrier (or in better terms, thoughtful and sensitive) even as a child.
3) I agree that, sometimes, drugs create the "ideal" feeling, a gleeful joy and concentration... but, for me it does not last. This personality change is a nice change. In my view, therapy and reading which gave me ideas, insight, healthier relationships and a little boost to courage were necessary in addition to medication.
4) Sometimes, I'll stop my AD and I'll feel more engaged with life and I seem to have more ideas. Meds usually demand a trade-off. Overtime this engagement is overtaken. My tendency to think about suicide and obsess and worry and become frozen with indecision or go into debt buying things and doing things grasping at "happiness" increases. Overtime, I'll decide to go back on meds.
5) For a time, I lived in a zen monastery. I didn't need meds. The supportive community, the direction from schedule and the meditation and processing of emotions... lowered my mental turmoil enormously. But I couldn't see myself there for my whole life. I often wonder if that was a mistake. But that is a decision I live with.... and the society I live in requires a person with my tempermant to take medication. That's disturbing but that's how it is right now.(see: http://www.peterwhybrow.com/books/americanmania/excerpts.html )
Later, River.
Posted by jedi on March 28, 2006, at 2:24:02
In reply to amotivational syndrome, posted by lostforwards on March 25, 2006, at 13:44:07
> has anybody heard of this? Can antidepressants make someone lazy?
>This happened to me after long term use of SSRIs. They took the edge off of the depression, but made me feel like I could not accomplish anything. To make matters worse, I didn't really care. What's the difference between ignorance and apathy? - I don't know and I don't care.
JediHere are several abstracts concerning the apathy syndrome and SSRIs:
Selective serotonin reuptake inhibitor-induced apathy: a pediatric case series.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16553543&query_hl=18&itool=pubmed_docsumSSRI-induced apathy syndrome: a clinical review.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15330228&query_hl=18&itool=pubmed_docsumOlanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12019662&query_hl=30&itool=pubmed_docsumAmotivational syndrome associated with selective serotonin reuptake inhibitors in children and adolescents.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11436958&query_hl=30&itool=pubmed_docsumApathy and indifference in patients on fluvoxamine and fluoxetine.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2124218&query_hl=30&itool=pubmed_DocSum
Posted by SLS on March 28, 2006, at 7:02:01
In reply to Re: amotivational syndrome » lostforwards, posted by jedi on March 28, 2006, at 2:24:02
I guess I was wrong. These abstracts indicate that the amotivational/apathy syndrome is dosage-dependent. The problem is, none of them reported finding a therapeutic window within which one can obtain an antidepressant response without the appearance of amotivation.
It is important to note that one of the abstracts describes a reversal of the syndrome using Zyprexa (olanzapine). One can only guess at which properties are responsible for this. I first thought of the ability of Zyprexa to block 5-HT2a receptors. However, it also produces an increased release of dopamine in the prefrontal cortex. I guess that if adding Remeron does not mitigate amotivational effects of SSRIs, then perhaps it is the DA release that is important.
- Scott
> Here are several abstracts concerning the apathy syndrome and SSRIs:
>
> Selective serotonin reuptake inhibitor-induced apathy: a pediatric case series.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16553543&query_hl=18&itool=pubmed_docsum
>
> SSRI-induced apathy syndrome: a clinical review.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15330228&query_hl=18&itool=pubmed_docsum
>
> Olanzapine in the treatment of apathy in previously depressed participants maintained with selective serotonin reuptake inhibitors: an open-label, flexible-dose study.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12019662&query_hl=30&itool=pubmed_docsum
>
> Amotivational syndrome associated with selective serotonin reuptake inhibitors in children and adolescents.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11436958&query_hl=30&itool=pubmed_docsum
>
> Apathy and indifference in patients on fluvoxamine and fluoxetine.
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=2124218&query_hl=30&itool=pubmed_DocSum
>
>
>
>
Posted by linkadge on March 28, 2006, at 11:12:48
In reply to Re: amotivational syndrome, posted by SLS on March 28, 2006, at 7:02:01
The 5-ht2c receptors are also important. Agonism at 5-ht2c will reduce dopamine release in the frontal cortex and in the neucleus accumbens.
Zyprexa may offer some help as it is an antagonist at 5-ht2a/c receptors, but part of the problem is that even if it does allow for increased dopamine release, some of that dopamine will be blocked via its d1/d2 antagonism.
I found that periactin (antihistamine with 5-ht2a,c antagonism), was as good as zyprexa for reducing SSRI apathy, but it may be hard to get nowadays.
I think the big thing is that with the SSRI's you are going to get decreased frontal cortex dopaminergic function. OCD may have overactive frontal cortex dopamine, and may be why they help in these instances.
The problem with apathy, is that when it strikes, you don't really care !!
Zoloft and periactin was a good combination,
the periactin had a short half life and needed to be taken a few times a day.
Linkadge
Posted by scatterbrained on March 28, 2006, at 17:03:40
In reply to amotivational syndrome on antidepressants, posted by med_empowered on March 25, 2006, at 16:16:13
from my understanding, SSRI's cause more cognitive impairment than trycyclics. In fact the trycyclins noripinephrine and desipramine are used for post stroke depression and ADD.
Posted by flmm on March 28, 2006, at 21:55:14
In reply to Re: amotivational syndrome, posted by linkadge on March 28, 2006, at 11:12:48
Well said River! Drugs can only do so much and there is a trade off. That said I am always better on them than off. Happiness will never be found in a pill, but some will continue to look....................
Posted by ian34 on March 28, 2006, at 23:00:20
In reply to Re: amotivational syndrome on antidepressants » med_empowered, posted by linkadge on March 25, 2006, at 16:33:45
> Effexor should be better in this regard than the SSRI's. If you develop amotivational syndrome, taking a medication holliday can help.
>
> Linkadge
Linkadge,
I can't help but notice that every thime you post you either make outright claims about how dangerous drugs are or you are more subtle about it. It's so obvious if you just look at your posts on this page.
Posted by kingcolon on March 29, 2006, at 10:33:40
In reply to Re: amotivational syndrome on antidepressants, posted by ian34 on March 28, 2006, at 23:00:20
I've posted on the dopamine agonists for amotivational syndrome, and have found Requip very helpful. Another member is trying it now. Mirapex is an alternative.
It seems to drive goal directed behavior in me, regardless of whether I particularly "want" to do it. There is information separating "wanting" from "liking" tied to dopamine receptors. I believe the opioid system seems to modulate pleasure more than the dopaminergic system. At least, they interact in both respects.
There's also data on Provigil for this.
Posted by linkadge on March 29, 2006, at 14:31:02
In reply to Re: amotivational syndrome on antidepressants, posted by ian34 on March 28, 2006, at 23:00:20
> Effexor should be better in this regard than the SSRI's. If you develop amotivational syndrome, taking a medication holliday can help.
>
> Linkadge
>I can't help but notice that every thime you >post you either make outright claims about how >dangerous drugs are or you are more subtle about >it. It's so obvious if you just look at your >posts on this page.I suppose then you'd have no problem showing me a single quote which shows my "outright claims" about the danger in the drugs.
I was simply saying that Effexor can be a better choice for somebody who has an amotivational responce to an SSRI. The noradrenergic mechanism of effexor may act to counterballance serotonergically mediated apathy.
The suggestion about taking a medication holliday was not a cue to stop medications entirely. Many doctors have observed that sometimes taking a breif break from the medication can actually help it to work better, once it is restarted.
Linkadge
Posted by jerrympls on March 30, 2006, at 1:21:32
In reply to amotivational syndrome on antidepressants, posted by med_empowered on March 25, 2006, at 16:16:13
>
> As for the apathy...I read one study where they used atypical antipsychotics. I think thats a bad idea, given the side effects and cost, but I guess its an option. BuSpar might help, too.
I'm on 300mg Seroquel for insomnia and it makes me so apathetic it's horrible. Not to mention that it makes me seriously depressed - but it's the only thing that puts me to sleep right now.Jerry
I'd ban antipsychotics for depression treatment if I could!!
Posted by SLS on March 30, 2006, at 6:24:43
In reply to Re: amotivational syndrome on antidepressants » med_empowered, posted by jerrympls on March 30, 2006, at 1:21:32
> I'd ban antipsychotics for depression treatment if I could!!
No you wouldn't.
:-)
They help too many people whom don't respond to anything else.
- Scott
Posted by deniseuk on March 30, 2006, at 10:39:51
In reply to Re: amotivational syndrome on antidepressants » jerrympls, posted by SLS on March 30, 2006, at 6:24:43
:-) Very true. God help me if they ever banned Zyprexa.
Denise
Posted by MoparFan91 on March 31, 2006, at 13:56:09
In reply to Re: amotivational syndrome on antidepressants, posted by deniseuk on March 30, 2006, at 10:39:51
I take Lexapro at 20mg and although it works pretty good, I'm appearing to get a little bit of amotivational problems as well.
If you get such a problem on a pure SSRI, is Cymbalta a good alternative, too, since it hits norepinephrine as well.
I wondered, too, if taking the amino acid Tyrosine along with the SSRI would help as well, esp. if you were responding well to the SSRI in other ways as far as OCD/depression are concerned.
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