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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by robot on August 9, 2004, at 22:43:40
I guess I just need some encouragement. Ive been on medication for about 5 months now, and Ive been recovering somewhat. Im hitting another hard part now though.
It was probably about 6 years ago that signs of real depression started to show. I sudenly found that often I wouldnt be able to enjoy anything--music, movies, reading. writing, whatever. Often I thought it was just a phase, that I need to get into new things and new friends. It only got worse in the subsequent years, though, until just about everyting became a constant effort.
There's nothong much worse than perpetually watching yourself not enjoying things. In the last 2 years I developed this speech problem, related to anxiety i guess, where its been intensely difficult to pronounce words naturally and correctly, when usually I am a fine speaker.
I totally lost any feeling of self. I wasnt able to think straight, everything was fuzzy.
Nothing I used to love is meaningful now to me. I can hardly remember what its like to really enjoy the lift of music, or the joy of working on a creative project I can see through to the end.
I just cant see these things ever coming back. half a year on medication, and still this lack of enjoyment, the speaking problem that keeps me away from people, not to mention lack of libido, persists.
A few years ago I experienced what could only be called semi-manic episodes, when I had periods of euphoria and ecstatic well-being. This serves to further confuse me. I have no idea what I am trying to get to now, I have no concept of what I need to feel. It seems that if I never feel that good again, life isnt worth living--even if this so-called depression lifts enough to become bearable. I feel that the euphoric periods have ruined me in some way. Can I ever be satisfied with anything less now?
And can I ever even get near that great place again?
The depression and the subsequent treatment has made my concept of self forever changed. I cant ever trust in the goodness of things again--I know now its all chemicals in my head. Before I could get excited about things, I thought they were good things in a generally good universe. how can ever I think that now, even If I feel better? It seems to me to take the motivation out of everything. Its like to be motivated and joyful you have to take things for granted, without thinking about them--and this is what depression takes away from you. You realized that the universe is not benevolent; what universe steals 7 years of your finite life away? I will never say "it was all worth it," because it wasnt, and saying so does a disservice to the very real suffering my past self has felt. Taking away the most basic goodnesses of life, the only things that make it all worth it, is a kind of death. many of us on this forum have died in this sense.
The cosmos plays such silly tricks on us.
sorry for the long entry, guys. i guess i just had to get it out of my system.
Posted by King Vultan on August 10, 2004, at 8:27:16
In reply to enjoyment, posted by robot on August 9, 2004, at 22:43:40
Every so often, I run across someone who has a story that reminds me so much of my own. I really know where you're coming from and do sympathize profoundly. I have/had many of the same issues as you do, and central to all of them seems to be a profound anhedonia, or lack of enjoyment and pleasure. It's been so long since I've had a true feeling of enjoyment that I can't even remember what it feels like.
I've been under treatment for dysthymia/depression for over ten years now and have only recently begun to realize that I am not fundamentally depressed to begin with, but rather, it is the chronic lack of enjoyment that has induced the depression and apathy which I have suffered for such a long time. I hope you will keep in mind that my mindset was once very, very similar to yours in its pessimistic outlook, and that I have managed to turn things around to some extent in the last couple years and get at least half way back to where I want to be. In my case, this has involved learning as much as I can about psychopharmacology and giving my doctor an enormous amount of input as to my own treatment. After trying no less than ten drugs in the last two years, I've come to the firm conclusion that my anhedonia, which in the past has been just as profound and crippling as yours is, is fundamentally being caused by a lack of dopamine.
With that in mind, I am going to be starting the MAOI Parnate in a couple weeks, as I am just finishing tapering off the other MAOI still available in the US, Nardil. My own hypothesis is that many people who have a central anhedonia problem, such as you seem to, may be suffering from a dysfunctional dopamine system more than anything else. I'm curious as to what ADs you've tried, as some of the common ones actually deplete dopamine, unfortunately.
As for your concerns about the semi-manic/euphoric feelings you've also experienced, while it's been a long time since I've felt anything like that, I actually have experienced the same thing at distant points in the past, this after the onset of my depression/anhedonia. In my case, this seemed to coincide with periods of intense mental or emotional effort. I am hoping that the right antidepressant will allow me to achieve a sense of well being without undue effort and also to experience the excitement and enthusiasm that has been so profoundly lacking in my life for so long, and perhaps even a bit of euphoria every now and then.
Todd
Posted by linkadge on August 10, 2004, at 14:13:03
In reply to enjoyment, posted by robot on August 9, 2004, at 22:43:40
I can relate to you in some terms. I had a single, hypomanic episode, and ever since they brought be down from that I've been living in constant fear. The first time I took lithium it took away all confidence I had in myself. It put me into this neitherworld feeling where my mind never stops slowly wiserping to me, you don't know what you are doing everything you try, you will fail.
I have been in the worst state of anhedonia known to man. I think my prefrontal cortex is dammaged because it is almost like I cannot make any sence out of pleasureable things. This constant mild state of worry totally has burned out any remaining pleasure centers in my brain.We have dropped all mood stabalizers long ago and are just using antidepressants. The more I take, the more disconnected from reality I become.
Linkadge
Posted by mike lynch on August 10, 2004, at 23:23:01
In reply to Re: enjoyment, posted by linkadge on August 10, 2004, at 14:13:03
Umm ya me to....I think the drugs have worsened all the problems.. I to have developed sudden speech problems, Like you I have trouble pronouncing words clearly..It just scares me that ever since I started these SSRi's i am beginning to have more cognitive related problems..it's as if my brain is slowly detiriorating..I don't even ffeel depressed now I feel NOTHING...major anehedonia..The dopomaine depletion really scares me..Everything I use to enjoy...I may enjoy mildly..but I can't even GET MYSELF to get up and partake in activivites I use to have an enormous thirst for...I was never like this before the meds...even when I was depressed..I did enjoy things and such..I just had long periods where I was sad...that persisted up to 4 to 5 weeks..I'd say I'd rather be in that position then the one I am in now..
Posted by mike lynch on August 10, 2004, at 23:24:57
In reply to Re: enjoyment, posted by mike lynch on August 10, 2004, at 23:23:01
Oh ya and I can't think straight and have to lost a feeling of SELF..I do not feel the same at all...and that is really all I want...is to have my identity back...who I was...not what I am now...someone I am basically ashamed of..and who I hate..I want the person that existed before meds...
Posted by robot on August 11, 2004, at 21:28:24
In reply to Re: enjoyment, posted by mike lynch on August 10, 2004, at 23:24:57
Im starting to become convinced that for most people just an SSRI wont be enough. got my doc to get me on wellbutrin too--it hits the dopamine and norepinephrine, the 2 other major neurotransmitters.
Maybe you could go off the meds and see how you do. If/when depression returns you could try a new med other than an SSRI. It might be a bit liberating to be off meds for a while anyway in your case.
Just an idea. For me, the speech and identity problems persisted long before I got on meds, and I must say I am not in as dark a place (for the most part--I do have my days) as I used to be. I fear Im starting to do badly again though.
Really Im sick of constantly thinking about how I feel, or what I need to take to make me feel better, rather than just feeling and living life.
Im sure you feel the same way.> Oh ya and I can't think straight and have to lost a feeling of SELF..I do not feel the same at all...and that is really all I want...is to have my identity back...who I was...not what I am now...someone I am basically ashamed of..and who I hate..I want the person that existed before meds...
Posted by robot on August 11, 2004, at 22:10:05
In reply to Re: enjoyment » robot, posted by King Vultan on August 10, 2004, at 8:27:16
Im SO GLAD you responded. Its a relief to hear from someone who has experienced some of the same things.
So many depression-sufferers seem to either have multiple diagnoses, or depression symptoms I dont quite relate too. I dont really have relationship problems. i dont cry for no reason. Im not really 'sad' except because of the lack of enjoyment/desire. And even when Ive ben motivated over the past few years, it never lasts, I think because my brain's reward system is screwed up. So that problem has finally crushed my motivation. I dont have emotional disruptions--I usually have no emotions (unless boredom and hopelessness are emotions :-)
Im a very 'cerebral' type person (my therapist says its schizo disconnection from my body)--im historically pretty introverted, a bookworm, not really socially successful. But I used to have pleasure in being with people as well as pursuing my own interests.
The more I think about it, I suspect that my anhedonia has pretty deep roots--maybe I was destined to develop it. It was partially brought about by intense loneliness in my college years as well as a religious belief system that was oppressive to me. But once the depression/anhedonia came, the anhedonia only worsened over the years and I think was the symptom that made the depression chronic. Then the symptoms just reenforced themselves.How can you be motivated if you have no pleasure in the present or future? How can you develop relationships if your ability/desire to be with people rises and falls without rhyme or reason? How can you be creative if everything you see is grey and meaningless?
It just used to be more interesting to be inside of myself.
While I believed that through will and spiritual searching I could overcome and triumph, I had brief periods during which I felt very well. Then it would pass. And I would think I was doing somehting wrong. Eventually all the pain and uncertainty took its toll and those periods stopped happening. Still I tried to beat it.
Its like being tortured and, finally, broken. Now even if I feel slightly okay I cannot trust it and it brings on anxiety about it leaving. Things I used to enjoy are so colored with dissapointment that I cant bring myself to pursuit them again. One thing Ive always been able to enjoy is food--especially chocolate and ice cream :-)
I think my problem lies in the dopamine system too, and maybe norepinephrine. How the 2 sites below explain the various neurotransmitter deficiencies makes me think so. I wish I knew more about it.http://drugfreeoptions.com/display.php?r=good_stuff
http://www.crossroadsinstitute.org/neurotransmit.html
Ive been on Lexapro (ssri) for 5 months, and I just started Wellbutrin a few weeks ago. It works on dopamine, and many experts say norepinephrine too. Im curious why your doc gave you an MAOI. Are they more effective for some types of depression?
Thanks again for responding, I hope we can talk some more.
> Every so often, I run across someone who has a story that reminds me so much of my own. I really know where you're coming from and do sympathize profoundly. I have/had many of the same issues as you do, and central to all of them seems to be a profound anhedonia, or lack of enjoyment and pleasure. It's been so long since I've had a true feeling of enjoyment that I can't even remember what it feels like.
>
> I've been under treatment for dysthymia/depression for over ten years now and have only recently begun to realize that I am not fundamentally depressed to begin with, but rather, it is the chronic lack of enjoyment that has induced the depression and apathy which I have suffered for such a long time. I hope you will keep in mind that my mindset was once very, very similar to yours in its pessimistic outlook, and that I have managed to turn things around to some extent in the last couple years and get at least half way back to where I want to be. In my case, this has involved learning as much as I can about psychopharmacology and giving my doctor an enormous amount of input as to my own treatment. After trying no less than ten drugs in the last two years, I've come to the firm conclusion that my anhedonia, which in the past has been just as profound and crippling as yours is, is fundamentally being caused by a lack of dopamine.
>
> With that in mind, I am going to be starting the MAOI Parnate in a couple weeks, as I am just finishing tapering off the other MAOI still available in the US, Nardil. My own hypothesis is that many people who have a central anhedonia problem, such as you seem to, may be suffering from a dysfunctional dopamine system more than anything else. I'm curious as to what ADs you've tried, as some of the common ones actually deplete dopamine, unfortunately.
>
> As for your concerns about the semi-manic/euphoric feelings you've also experienced, while it's been a long time since I've felt anything like that, I actually have experienced the same thing at distant points in the past, this after the onset of my depression/anhedonia. In my case, this seemed to coincide with periods of intense mental or emotional effort. I am hoping that the right antidepressant will allow me to achieve a sense of well being without undue effort and also to experience the excitement and enthusiasm that has been so profoundly lacking in my life for so long, and perhaps even a bit of euphoria every now and then.
>
> Todd
Posted by mike lynch on August 11, 2004, at 22:39:15
In reply to Re: enjoyment » King Vultan, posted by robot on August 11, 2004, at 22:10:05
I guess natural supplements will be my next route...I am weaning myself off the prozac and seem to becoming slower , and more incoherent as I gradually lower the dose...my brain feels very awkward and slow without the ad's, but the ad's just make it worse in other ways..One thing I don't feel is depressed...the only reason I were to go on these were for the exteme cognitive slowness I feel off them...a feeling I never felt before going on meds in the first place I think my brain has been scrambled some how by these drugs..I dunno why i'm even bothering to go off them..I always end up going back on..it is just hard to function and socialize when my mind can no longer keep up with daily happenings...btw im only 18...
Posted by robot on August 11, 2004, at 23:22:22
In reply to Re: enjoyment, posted by mike lynch on August 11, 2004, at 22:39:15
Cognitive slowness..I can relate to that, but I did have it before meds. i feel more clearheaded than I used to. I have had constant fears about getting my brains scrambled by depression or meds. I suspect that though our experience changes alot, its generally not due to MAJOR changes in the nuts and bolts of our brain. It still may take some time to figure out the problem and correct it though.
On supplements--can I give out some advice, even though Im not an expert? There are a few things I would try before trying other things. You can get Lecithin in the form of granules at health food stores, and its easy to sprinkle it on your cereal in the morning. It doesnt taste bad at all (in fact I like the flavor).Here's an article about lecithin:http://www.bodyandfitness.com/Information/Health/Research/lecithin.htm
Also, go to Psychobabble Alternative--there has been a thread (or 2) about Fish Oil recently. Our brains canot function without essential fatty acids (EFAs). Ive been taking this and can tell a difference.
You could try taking supplemental Tyrosine amino acid. It helps create dopamine (and norepinephrine i think). You can also get 5-HTP, which is a precursor to seretonin (the transmitter youd be getting from the SSRI prozac--you might find this would substitute for the SSRI if you go off it). If you take amino acids like this Im told its essential that you back it up with an amino acid complex that has all the amino acids. You can find info about how to take them on the net.
Take a multivitamin, and a b-vitamin complex.
I hope this helps. It took some time but I think these things have helped me.
good luck mike.> I guess natural supplements will be my next route...I am weaning myself off the prozac and seem to becoming slower , and more incoherent as I gradually lower the dose...my brain feels very awkward and slow without the ad's, but the ad's just make it worse in other ways..One thing I don't feel is depressed...the only reason I were to go on these were for the exteme cognitive slowness I feel off them...a feeling I never felt before going on meds in the first place I think my brain has been scrambled some how by these drugs..I dunno why i'm even bothering to go off them..I always end up going back on..it is just hard to function and socialize when my mind can no longer keep up with daily happenings...btw im only 18...
Posted by robot on August 12, 2004, at 0:24:28
In reply to Re: enjoyment, posted by linkadge on August 10, 2004, at 14:13:03
Im with you. I think there are not too many people that need to be on multiple meds. The mental side effects just seem to multiply, along with the worry about them becoming hard to ween yrself off of. Plus you dont know what med is doing what. My limit (as of now) is 2 ADs. We'll see if that lasts...
I have felt something like that fear, but not so sustained over a long period. For awhile it came and went. Thinking about it now makes me realize how far Ive come; so far yet to go, though.
I do still have what I can only call anxiety attacks, I guess. Everything just seems like abad idea, I dont know who I am or what to do with myself. I start thinking of suicide and violence like I want to hit something.
Yeah us biped mammals got it tough. Our pleasure system is more complex than those lucky reptiles. Like you said, it has some connection to the prefontal cortices but Im not sure what exactly. I dont think shrinkage or reduced activity is permanent, though (the # of receptor sites for receptors can increase). ANd I know that the hippocampus can actually grow new brain cells (contrary to long-standing medical belief).
I wish you well on your decision to quit the meds. Im just a novice at supplementation but my advice is contained in one of my other posts in this thread, if your interested. Psychobabble Alternative has alot of experts on it.> I can relate to you in some terms. I had a single, hypomanic episode, and ever since they brought be down from that I've been living in constant fear. The first time I took lithium it took away all confidence I had in myself. It put me into this neitherworld feeling where my mind never stops slowly wiserping to me, you don't know what you are doing everything you try, you will fail.
>
>
> I have been in the worst state of anhedonia known to man. I think my prefrontal cortex is dammaged because it is almost like I cannot make any sence out of pleasureable things. This constant mild state of worry totally has burned out any remaining pleasure centers in my brain.
>
> We have dropped all mood stabalizers long ago and are just using antidepressants. The more I take, the more disconnected from reality I become.
>
> Linkadge
>
>
>
Posted by JahL on August 12, 2004, at 1:21:04
In reply to enjoyment, posted by robot on August 9, 2004, at 22:43:40
> It seems that if I never feel that good again, life isnt worth living--even if this so-called depression lifts enough to become bearable. I feel that the euphoric periods have ruined me in some way. Can I ever be satisfied with anything less now?
I can relate. I had never felt anything resembling normalcy until I was suddenly blessed with a few weeks of blissful euthymia on SSRIs a few years back. I suddenly realised what I had been missing out on my whole life. If I can't recapture something approaching that feeling I will gladly catch the bus sooner rather than later.
I likened it to being shown around Heaven before being given your permanent berth in Hell. (not religious BTW)
J.
Posted by mike lynch on August 12, 2004, at 2:01:50
In reply to Re: enjoyment, posted by JahL on August 12, 2004, at 1:21:04
> > It seems that if I never feel that good again, life isnt worth living--even if this so-called depression lifts enough to become bearable. I feel that the euphoric periods have ruined me in some way. Can I ever be satisfied with anything less now?
>
> I can relate. I had never felt anything resembling normalcy until I was suddenly blessed with a few weeks of blissful euthymia on SSRIs a few years back. I suddenly realised what I had been missing out on my whole life. If I can't recapture something approaching that feeling I will gladly catch the bus sooner rather than later.
>
> I likened it to being shown around Heaven before being given your permanent berth in Hell. (not religious BTW)
>
> J.
For whatever reason changing the dosage suddenly...or taking my med at a different time period brings out a couple days of what I would call normalcy and mere lucidness when it comes to everything including mental functioning...I have no idea why..but I just seem to function normal during this period of change..But it where's off..funny during this *period* people are said to be at risk of an increase of suicidal thoughts..whatever sparks this seemingly has the exact opposite effect on me...I 've heard other people who experienced this effect as well..very vague explanations though..
If all of my future plans don't work out im just going to go on this awkward schedule..not knowing the potentiol problems that can arise from constantly changing the dose(if there are any) of the med...but frankly i really dont' care anymore..i just want to be normal and this seems to be the closest i can get to it..
Posted by linkadge on August 12, 2004, at 8:19:39
In reply to Re: enjoyment » linkadge, posted by robot on August 12, 2004, at 0:24:28
The last thing that really pissed me off was this. I told the doctor I was so depressed that I would sit in the courner for hours and stare at the wall, and that I was suicial all day long. (which was entirely truthful) He gave me a prescription for phenominal ammounts of trileptal and said for me to prepare to start feeling better.
It is that kind of ignorance that bothers me. Giving me mega doses of a relativly poorly established mood stabalizer with little/no antidepressant qualities is a testamint to what these doctors priorities are.
Trileptal was just released here in canada and obviously he wanted to risk me as the guinny pig to find out for himself weather this med works or not. Thats like a doctor treating a congestive heart failure patient with hawthorn berries or something.
Linkadge
Posted by robot on August 12, 2004, at 16:20:26
In reply to Re: enjoyment, posted by mike lynch on August 12, 2004, at 2:01:50
Thats interesting. Just another thing no one can explain yet.
Two things about meds have made me suicidal. One, the dark panicky feeling I have gotten sometimes, especially when starting ssri. Two, I think when youve been up and down so long, once your finally pushed a bit up again you cant stand the idea that your probably going down again after finally seeing whats been missing all this time, plus youre just well enough to actually overcome the lethargy and follow thorugh with it.
Thats great that you have good feelings when upping or changing doses. At least I think so. Im probably wrong, but I suspect that the anxiety meds give you at first is just a byproduct of soaking in more NTs than usual. If the anxiety subsides after awhile, that is your brain adjusting to it. Probably by increasing the number of receptor sites? I dont know.
> For whatever reason changing the dosage suddenly...or taking my med at a different time period brings out a couple days of what I would call normalcy and mere lucidness when it comes to everything including mental functioning...I have no idea why..but I just seem to function normal during this period of change..But it where's off..funny during this *period* people are said to be at risk of an increase of suicidal thoughts..whatever sparks this seemingly has the exact opposite effect on me...
>
> I 've heard other people who experienced this effect as well..very vague explanations though..
>
> If all of my future plans don't work out im just going to go on this awkward schedule..not knowing the potentiol problems that can arise from constantly changing the dose(if there are any) of the med...but frankly i really dont' care anymore..i just want to be normal and this seems to be the closest i can get to it..
>
Posted by tendency on August 13, 2004, at 11:26:22
In reply to enjoyment, posted by robot on August 9, 2004, at 22:43:40
wow..i can sympathize as well..im only beginning to come to terms with my 'mental' issues and, after reading these posts, see much of myself in what you describe. For me this began to develop in my late teens and has steadily worsened..yes, just a simple inability to experience enjoyment and pleasure.
Has anyone tried stimulants for this? I've always thought this was part of my ADD symptoms. Interestingly, when I take adderall these symptoms almost completely vanish and I have tremendous enthusiasm and excitement, pleasure, enjoyment in activities - like being a child again.
So, yes, clearly it appears to be dopamine related. I'm hoping that the soon to come selegiline patch may prove useful.
Best,
tendency
Posted by nolagirl on August 15, 2004, at 19:30:49
In reply to Re: enjoyment, posted by tendency on August 13, 2004, at 11:26:22
Hi y'all,
I really identify. Over the past 4 years ( been on and off meds for 14) I have lost all interest in things that used to give me pleasure as well as lost my sense of self. I don't even have facial expressions anymore. Good for wrinkle prevention perhaps. I too have been on many ssri's and am now off lexapro for the past two weeks. I live in the states and am uninsured at the moment so can't really afford a pdoc now. I am hoping that by getting free of meds for awhile I can rediscover myself. I had never heard of anhedonia before but it suits where I am at to a tee. I have felt very hopeless the past few years because I just can't seem to break out of this numbed state. Wellbutrin worked way back but ultimately the rage and lack of impulse conrol side effects took a toll and I stopped. I know that I need to find a good doctor and start the process again. I just feel that it's a trick bag that will again disappoint. Blah, blah, blah. I am even rambling in a monotone.
This is the end of the thread.
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