![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 31. This is the beginning of the thread.
Posted by Meri-Tuuli on November 23, 2005, at 9:35:33
I have always suffered from a complete and utter lack of motivation. I can only do something if I am stressed, as in the deadline is impending. This applies to everything I do, from the washing up to school work to my working life.
I just seem to be completely incapable of doing anything without the stress to get me to do it. What is this indicative of?
Also, I can only do something if I am 100% interested in it, like modules at school you aren't really interested in, but you have to take - I always do really badly in them, even through I have the intelligence to do okay in them.
It is VERY frustrating.
Posted by pseudoname on November 23, 2005, at 10:10:00
In reply to Best med for complete lack of motivation?, posted by Meri-Tuuli on November 23, 2005, at 9:35:33
Meri–
I read you've tried Effexor and Celexa, I think. Are you still on Celexa?
Have you tried stimulants?
What else have you tried?
Thanks.
–PN
Posted by Meri-Tuuli on November 23, 2005, at 11:01:02
In reply to What's been tried? » Meri-Tuuli, posted by pseudoname on November 23, 2005, at 10:10:00
Hey!
I'm on St John's wort, and caffine ;o)
It was more of hypothetical post, as I live in the UK and stimulants are RARELY prescribed, or so I am led to believe.
I was just wondering what a lack of motivation could be indicative of. I guess a million things.
Anyway, here is the list:
I've tried Prozac, Effexor, Celexa, Reboxetine, Wellbutrin with no success. Effexor and Celexa made me sleep too much and even more apathic than I was on before. Prozac I just went abit mental on (it was the first I tried - maybe it was alright?) , and reboxtine gave me bad acne and no periods, and wellbutrin gave me a weird rash and I couldn't stop itching.
The stimilating meds (like Prozac, wellbutrin and reboxetine) make me really anxious. I've only ever taken the 'normal' low dosages for these meds. Like 75mg for Effexor, 20mg for Celexa etc. I seem to be particulary sensitive to them!
I seem to suffer from atypical depression, with maybe ADD.
Although this is not diagonised by a pdoc.I'm getting referred to a pdoc on the NHS - although the consulation will probably will be after Christmas. I have no idea what that will be like. I might post something to see if anyone has had any luck. But then I don't want to be influenced by other peoples' negative experiences.
Posted by xbunny on November 23, 2005, at 12:13:55
In reply to Re: What's been tried?, posted by Meri-Tuuli on November 23, 2005, at 11:01:02
Have you tried therapy?
I saw from your list of meds that you dont seem to have tried mirtazapine yet, thats always worth a try too. Theres also the tricyclics like dothiepin and clomipramine to try.
I think the referal to the NHS consultant will be helpful. A check over by a professional can be really eye opening he might come up with ideas you havent heard before. The difficult part is explaining to him how you have been feeling, writing notes beforehand can help. I tend to find the consultants are deliberately obtuse they will say as little as possible and expect you to just be able to blurt everything out without prompting, its a little disconcerting.Best regards Bunny
Posted by Declan on November 23, 2005, at 12:46:31
In reply to Best med for complete lack of motivation?, posted by Meri-Tuuli on November 23, 2005, at 9:35:33
There's apathy, laziness and a complete lack of motivation. I have a lot of things I should do but it's like I have an aversion to it (whatever that means), so I put it off. There are really important things in my life that I simply cannot or will not address. Like organising my finances properly. Maybe I'm so used to feeling anxious and baffled about it all that I just wait for the deadline to approach. Anyway I seriously doubt that there's a med to help this. Once I took some amphetamine and was motivated enough to take a lawnmower engine apart, but that was 30 years ago, it wouldn't work like that now.
Declan
Posted by Jedi on November 23, 2005, at 13:28:49
In reply to Re: What's been tried?, posted by Meri-Tuuli on November 23, 2005, at 11:01:02
> I seem to suffer from atypical depression, with maybe ADD.
> Although this is not diagonised by a pdoc.If your depression is atypical with social anxiety and treatment resistant, Nardil(phenelzine) will probably fix it. The SSRIs and SNRIs all left me apathetic and anhedonic. A lot of PDOCs won't use a MAOI, but I would find one that will before suffering through another five unsuccessful med trials. I believe Link Pharmaceuticals brews phenelzine HCL that is available in the UK. Ed_UK would know.
Good Luck,
JediPS IMHO St. John's Wort is too mild a MAOI to use for treatment resistant depression.
Posted by lunesta on November 23, 2005, at 15:58:52
In reply to Best med for complete lack of motivation?, posted by Meri-Tuuli on November 23, 2005, at 9:35:33
It sounds like you may be a good canidate for Provigil, probably augmented with something like .5klonopin 2wice daily , or neurontin daily. Provigil is a unique drug. It is technically not an ampetamine, but produces similar benfits without many of the negatives of amphets. It targets specific brain areas. It is very good for depression, motivation, fatigue. It works great for social anxiety, but I have found that to do so it must be augmented with some sort of GABAergic agent.
lunny
Posted by blueberry on November 23, 2005, at 16:02:19
In reply to Best med for complete lack of motivation?, posted by Meri-Tuuli on November 23, 2005, at 9:35:33
It is just my opinion, but I believe apathy and lack of motivation is a hypo-dopamine thing. Sometimes it is a hypo-norepinephrine thing, and sometimes a mix. Rarely is it a serotonin thing. Actually, serotonin meds usually tend to make it worse, because they are squashing out dopamine and norepinephrine. Just my thoughts though.
I'm not sure, but do you have the antipsychotic amisulpride (also known as deniban or solian) in your country? I think you do. That is one marvelous medication for apathy and lack of motivation. At low doses, 25mg to 100mg, it stimulates dopamine release. It is well researched for depression, dysthymia, negative symptoms of schizophrenia (like apathy, amotivation, lack of pleasure, social withdrawal). I tried it for a few months years ago for the symptoms you described, and it was just awesome. But I had to get it mailorder, lost a refill shipment in the mail, and just never followed up after that. Seriously thinking of going back to it.
Posted by lunesta on November 23, 2005, at 16:27:33
In reply to Re: Best med for complete lack of motivation?, posted by blueberry on November 23, 2005, at 16:02:19
actually dopamine involvement is highly speculated to be imvolved in motivation though alittle contradictory results here see :
http://news.bbc.co.uk/1/hi/sci/tech/3557310.stm
Dont know what dopamine receptor was targeted though.
Posted by Phillipa on November 23, 2005, at 20:19:48
In reply to Re: Best med for complete lack of motivation? » Meri-Tuuli, posted by Declan on November 23, 2005, at 12:46:31
Declan did you fix the lawnmower He He He. Fondly, Phillipa
Posted by Meri-Tuuli on November 24, 2005, at 3:48:54
In reply to Re: What's been tried? » Meri-Tuuli, posted by Jedi on November 23, 2005, at 13:28:49
Hey there Jedi!
> If your depression is atypical with social anxiety and treatment resistant, Nardil(phenelzine) will probably fix it.
Would like to try it (although it scares me abit) I'm seeing an NHS pdoc after christmas (I think and hope!). although I have no idea what he will recommend.
>The SSRIs and SNRIs all left me apathetic and anhedonic.
Me too! They made me worse if anything.
A lot of PDOCs won't use a MAOI, but I would find one that will before suffering through another five unsuccessful med trials.
I'll try.....although if this NHS pdoc won't prescribe one (NHS is the free) then I'll have to go private and pay. I don't know what my options are on the NHS, like if I can just request to see another pdoc if this one won't prescribe one. I guess we'll see!
> PS IMHO St. John's Wort is too mild a MAOI to use for treatment resistant depression.I know, but its all I've got at the moment. :o(
Anyway kind regards
Meri
Posted by Meri-Tuuli on November 24, 2005, at 3:52:07
In reply to Re: Best med for complete lack of motivation? » Meri-Tuuli, posted by lunesta on November 23, 2005, at 15:58:52
Hi!
I am definately interested in Provigil, I'm going to try asking for it, although i don't know if its available in the UK. Is it the same as Anarfinil?Kind regards
Meri
Posted by Meri-Tuuli on November 24, 2005, at 3:57:28
In reply to Re: Best med for complete lack of motivation?, posted by blueberry on November 23, 2005, at 16:02:19
Hi Blueberry!
> It is just my opinion, but I believe apathy and lack of motivation is a hypo-dopamine thing. Sometimes it is a hypo-norepinephrine thing, and sometimes a mix. Rarely is it a serotonin thing. Actually, serotonin meds usually tend to make it worse, because they are squashing out dopamine and norepinephrine. Just my thoughts though.
Yeah I think that would make sense, like why the SSRIs didn't help.....
> I'm not sure, but do you have the antipsychotic amisulpride (also known as deniban or solian) in your country?
Very interesting.....I'm going to add it to my list of things to try and ask the doc for. How does it differ from say, the stimulants etc which are involved with dopamine?
Anyway, thanks for the post!
Kind regards
Meri
Posted by Meri-Tuuli on November 24, 2005, at 4:00:33
In reply to Re: Best med for complete lack of motivation? » blueberry, posted by lunesta on November 23, 2005, at 16:27:33
Hey!
Nice article. I could sure use some extra dopamine......!
Kid regards
Meri
Posted by blueberry on November 24, 2005, at 6:10:33
In reply to Re: Best med for complete lack of motivation? » blueberry, posted by Meri-Tuuli on November 24, 2005, at 3:57:28
>
> > I'm not sure, but do you have the antipsychotic amisulpride (also known as deniban or solian) in your country?
>
> Very interesting.....I'm going to add it to my list of things to try and ask the doc for. How does it differ from say, the stimulants etc which are involved with dopamine?How does amisulpride differ from stimulants? Actually, quite a bit. Stimulants create an accelerated release of dopamine and norepinephrine and a little serotonin, and also have dopamine and norepinephrine reuptake inhibition. And all this goes on in many parts of the brain and body.
Amisulpride only creates an accelerated release of dopamine, with no effect at all on norepinephrine or serotonin, and no reuptake inhibition. And this goes on in only very specific parts of the brain, in the mesolimbic area, associated with mood, pleasure, and motivation. It has no effect anywhere else.
St Johns Wort can be dangerous with other meds because it either increases or decreases the blood levels of other ongoing meds significantly, either causing adverse reactions from increased plasma levels or decreased efficacy from decreased plasma levels. Sjw affects the metabolism significantly for many meds, partially through liver enzyme activity and partially through gut enzyme activity. Amisulpride however I think would be safe, because it is not broken down in the liver, and much of it is actually passed through urine as unchanged drug.
Posted by Tom Twilight on November 24, 2005, at 9:17:28
In reply to Re: What's been tried?, posted by Meri-Tuuli on November 24, 2005, at 3:48:54
Hey Meri
Its good to hear from you, although I'm sorry about the circumstances
I think I owed you a babblemail, at least I meant to contact you but didn't get around to it....
Talk about lack of motivation!I'm wondering how you reacted to Wellbutrin?
I though it was working quite well, and it was the allergic reaction that made you stop taking it.Have I got it right? Or did Wellbutrin make you jittery?
The fact that you respond well to Caffeine suggests that a stimulant or at least stimulating med is what you need.
Here is a list of things that might be worth trying.
I haven't included any traditional stimulants in this list1) Adrafanil or Provigil
2) Sellegiline-Deprenyl
3) Aricept
4) Parnate
Parnate is the most stimulating of the MAOIs, it actually has an Amphetamine like structure, it might help with motivation and depression.
I personally did not react well to Amisulpride, it just made me sleeping, can't see how it would help with motivation, but were all different!
Posted by Meri-Tuuli on November 24, 2005, at 16:39:17
In reply to Re: What's been tried?, posted by Tom Twilight on November 24, 2005, at 9:17:28
Hiya Tom!!
> I think I owed you a babblemail, at least I meant to contact you but didn't get around to it....
No worries !! :o)
> I'm wondering how you reacted to Wellbutrin?
> I though it was working quite well, and it was the allergic reaction that made you stop taking it.Have I got it right? Or did Wellbutrin make you jittery?I kinda got more anxious on it (but I could probably handle that) but it was the allergic/side effect reaction that made me stop. I saw a GP about it (like it says to on the packet!) and she wanted me to stop right away and start up in another couple of weeks and to see how that went.
I didn't bother - I then just decided to try St John's Wort. I get easily freaked out by medications!
> The fact that you respond well to Caffeine suggests that a stimulant or at least stimulating med is what you need.
Hmm I agree! How do I get the pdoc to understand!??
> Here is a list of things that might be worth trying.
> I haven't included any traditional stimulants in this list> 1) Adrafanil or Provigil
Is this commonly prescribed by GPs or pdocs?
> 2) Sellegiline-DeprenylIs this a MAOI?
Thanks for the info Tom! I hope you are okay - hows the sleeping been going?
Kind regards
Meri
Posted by Sarah T. on November 25, 2005, at 1:16:10
In reply to Re: Best med for complete lack of motivation? » lunesta, posted by Meri-Tuuli on November 24, 2005, at 3:52:07
> Hi!
> I am definately interested in Provigil, I'm going to try asking for it, although i don't know if its available in the UK. Is it the same as Anarfinil? > > Kind regards> MeriHi Meri,
I believe that Provigil is the same as Adrafinil, NOT Anafranil. Isn't it awful that the spelling and pronunciation of these drugs is so similar? That's so dangerous! Anafranil is the same as Clomipramine, an old antidepressant that is often used for OCD, obsessive-compulsive disorder.
Posted by Jedi on November 25, 2005, at 16:22:50
In reply to Re: Best med for complete lack of motivation?, posted by Sarah T. on November 25, 2005, at 1:16:10
> I believe that Provigil is the same as Adrafinil, NOT Anafranil.
Hi,
Modafinil(Provigil) is a younger cousin of Adrafinil."What are the differences between Modafinil and Adrafinil?"
Modafinil (Provigil) is a recently developed analogue of Adrafinil; it is more potent, more expensive, and has fewer side-effects. Average doses of Adrafinil are in the region of 600 mg to 1200 mg daily, compared to Modafinil's 200 mg to 400 mg daily. Adrafinil is attributed to some possible side effects that have not been associated with Modafinil (Provigil), including skin irritation in long term use (over 3 months), and an increase in liver enzyme levels, (which is reversible by reduction or withdrawal). Adrafinil may require regular blood testing to monitor liver enzyme levels if used on a regular basis."
Jedixxx
Posted by Dr. Bob on November 25, 2005, at 23:21:46
In reply to Re: Best med for complete lack of motivation? » Sarah T., posted by Jedi on November 25, 2005, at 16:22:50
> xxx
Please don't use this site to exchange information that could be used to import into the US prescription medication without a prescription or medication that hasn't been approved by the US Food and Drug Administration.
If you or others have questions about this or about posting policies in general, or are interested in alternative ways of expressing yourself, please see the FAQ:
http://www.dr-bob.org/babble/faq.html#illegal
Follow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
Posted by Sarah T. on November 26, 2005, at 2:03:40
In reply to Re: Best med for complete lack of motivation? » Sarah T., posted by Jedi on November 25, 2005, at 16:22:50
Hi Jedi,
Oops! You're so right. I apologize for the incorrect information. I had forgotten that Modafinil and Adrafinil were not the same. Several years ago, another PB poster named "IsoM" used to take Adrafinil. After a while, she switched to Modafinil, I think. I haven't seen her around here in a long time, but you can check the archives for her very helpful posts.
Posted by ed_uk on November 26, 2005, at 14:03:55
In reply to Re: medication without a prescription » Jedi, posted by Dr. Bob on November 25, 2005, at 23:21:46
Hi
What is xxx?
Thanks
Ed
Posted by Jedi on November 26, 2005, at 14:46:30
In reply to Re: medication without a prescription » Dr. Bob, posted by ed_uk on November 26, 2005, at 14:03:55
Ed,
xxx is a deleted link to an article I should not have linked to.
See post in admin:
http://www.dr-bob.org/babble/admin/20051013/msgs/582382.html
Jedi
Posted by ed_uk on November 26, 2005, at 15:59:32
In reply to Re: medication without a prescription » ed_uk, posted by Jedi on November 26, 2005, at 14:46:30
Hi Jedi
So Dr. Bob changed what you wrote to xxx?
Ed
Posted by Jedi on November 26, 2005, at 17:44:35
In reply to Re: medication without a prescription » Jedi, posted by ed_uk on November 26, 2005, at 15:59:32
Go forward in thread:
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.