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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by AMenz on August 1, 2001, at 0:05:36
My husband is on Zoloft and it has evened out his mood swings (don't ask me how a BPII can get better on an AD but such is the case). He feels amotivational however and continues to have ADD symptoms (I think this is a separate issue). Mainly the ADD complaint is a great deal of difficulty focusing and planning.
What combo might he try to also cover ADD symptoms and fix amotivational symptom.
ADD symptoms so severe that he is having trouble making a living
Posted by Mitch on August 1, 2001, at 0:49:17
In reply to Amotivational on Zoloft-Help anyone?, posted by AMenz on August 1, 2001, at 0:05:36
> My husband is on Zoloft and it has evened out his mood swings (don't ask me how a BPII can get better on an AD but such is the case). He feels amotivational however and continues to have ADD symptoms (I think this is a separate issue). Mainly the ADD complaint is a great deal of difficulty focusing and planning.
>
> What combo might he try to also cover ADD symptoms and fix amotivational symptom.
>
> ADD symptoms so severe that he is having trouble making a livingAMenz,
1) Does your husband RIGHT NOW taken any other meds besides Zoloft??
2) If not, (he is on Zoloft monotherapy), you could try adding a low dose of Neurontin, say 300-600mg/day (which has been shown to be helpful for ADHD folks and helps to stabilize bipolar).
3) The Zoloft dose could be too high. Also, all SSRi's can worsen ADHD (except possibly for Prozac). Perhaps a switch to Prozac could fix it. Yep, if he is ONLY taking Zoloft, I would try the Prozac switch-I have ADHD and bipolar and Prozac was the only SSRi that helped depression and ADHD. You said he was *better* on the AD (Zoloft), with exception to motivation and ADHD symptoms.
Mitch
Posted by MM on August 1, 2001, at 17:29:42
In reply to Re: Amotivational on Zoloft-Help anyone? » AMenz, posted by Mitch on August 1, 2001, at 0:49:17
> 2) If not, (he is on Zoloft monotherapy), you could try adding a low dose of Neurontin, say 300-600mg/day (which has been shown to be helpful for ADHD folks and helps to stabilize bipolar).Hey Mitch, I'm sorry to keep bringing up Neurontin (don't mean to be a pain in the arse) but I searched the net before asking this, and couldn't find anything about neurontin and ADD, so could you tell me where you found that out, or any info? All I found was about neurontin and Bipolar. I have concentration problems (seems like everyone does) so I'm just kinda curious what neurontin does for that. Thanks if you can.
Posted by Kingfish on August 1, 2001, at 18:05:21
In reply to Re: Amotivational on Zoloft-Help anyone? » Mitch, posted by MM on August 1, 2001, at 17:29:42
I was thinking of you the other day and wondered where you were because I am in a similar situation to your husband and you had posted something about this before.
I am feeling better but have been very unmotivated and very tired. I'm on a plethora of things though, so I don't know if my med list can actually help - Topamax, 250, Prozac 40, Neurontin 2400, Lamictal - just started.
The Topamax is the sedation culprit. The Prozac did help with that.
I think Mitch's advice is very sound. Also, if your husband were to go on a stabilizer, which I know you know he should be on by most accounts, I would suggest Lamictal over Topamax because it is supposedly activating.
Sometimes it is hard to differentiate among depression and sedation and that drugged-up feeling of being unmotivated.
If one is feeling well, one should feel motivated to accomplish things, even if it's not in the realm of what one did before one started "getting well".
Good luck! I don't think this is an unusual side effect. It's one I'm dealing with, so I am empathetic (as I'm sure is my husband :) ).
- K.
Posted by Mitch on August 2, 2001, at 0:17:09
In reply to Re: Amotivational on Zoloft-Help anyone? » Mitch, posted by MM on August 1, 2001, at 17:29:42
>
> > 2) If not, (he is on Zoloft monotherapy), you could try adding a low dose of Neurontin, say 300-600mg/day (which has been shown to be helpful for ADHD folks and helps to stabilize bipolar).
>
> Hey Mitch, I'm sorry to keep bringing up Neurontin (don't mean to be a pain in the arse) but I searched the net before asking this, and couldn't find anything about neurontin and ADD, so could you tell me where you found that out, or any info? All I found was about neurontin and Bipolar. I have concentration problems (seems like everyone does) so I'm just kinda curious what neurontin does for that. Thanks if you can.Sure MM,
I got the info right here in the "tips" section a long time ago!
A pdoc was talking about how an ADHD patient had marked improvement when Adderall and gabapentin were combined (just by accident). And then another pdoc was talking about using gabapentin for ADHD by itself as well. He also said that Neurontin appears to be somewhat *stimulating* at lower doses. I could look about and find it, but I will put that off until tomorrow maybe, I am a little tired (just off from work).It just happens that I *do* have comorbid ADHD and bipolarII (they are in fact distinct things-not just seemingly overlapping phenomena). If I stop Neurontin abruptly I get VERY TIRED AND UNFOCUSED AND DEPRESSED AND AGITATED. It is the only "mood stabilizer" that if stopped abruptly made me inattentive+depressed nearly immediately.
Mitch
Posted by MM on August 2, 2001, at 2:34:24
In reply to Re: Amotivational on Zoloft-Help anyone? » MM, posted by Mitch on August 2, 2001, at 0:17:09
> >
> > > 2) If not, (he is on Zoloft monotherapy), you could try adding a low dose of Neurontin, say 300-600mg/day (which has been shown to be helpful for ADHD folks and helps to stabilize bipolar).
> >
> > Hey Mitch, I'm sorry to keep bringing up Neurontin (don't mean to be a pain in the arse) but I searched the net before asking this, and couldn't find anything about neurontin and ADD, so could you tell me where you found that out, or any info? All I found was about neurontin and Bipolar. I have concentration problems (seems like everyone does) so I'm just kinda curious what neurontin does for that. Thanks if you can.
>
> Sure MM,
>
> I got the info right here in the "tips" section a long time ago!
> A pdoc was talking about how an ADHD patient had marked improvement when Adderall and gabapentin were combined (just by accident). And then another pdoc was talking about using gabapentin for ADHD by itself as well. He also said that Neurontin appears to be somewhat *stimulating* at lower doses. I could look about and find it, but I will put that off until tomorrow maybe, I am a little tired (just off from work).
>
> It just happens that I *do* have comorbid ADHD and bipolarII (they are in fact distinct things-not just seemingly overlapping phenomena). If I stop Neurontin abruptly I get VERY TIRED AND UNFOCUSED AND DEPRESSED AND AGITATED. It is the only "mood stabilizer" that if stopped abruptly made me inattentive+depressed nearly immediately.
>
> Mitch
Posted by AMenz on August 3, 2001, at 0:25:16
In reply to Re: Amotivational on Zoloft-Help anyone?-AMenz, posted by Kingfish on August 1, 2001, at 18:05:21
Yes my husband is on Zoloft monotherapy. However, his moods are stable just on the AD. No doctor has ever wanted to prescribe a stabilizer. I think therefore for now the Neurontin is out of the question.
How about Adrafanil-( we ordered it but are having trouble receiving it) Could that help him together with the Zoloft (or Prozac if we can get that changed. I thought this arousal issue would get resolved by Adrafanil.Also is it possible to have antisocial personality disorder comorbid with ADD. He has a lot of the traits (not criminal behavior though).
He is perpetually in trouble about finances from he says inability to plan and to maintain focus in his activities. This is such a long standing pattern that all I'm hoping is to convince him to take a job and leave his business which is below his level of ability at which he can function without trying.
Thank you all for your response. I'm very discouraged by this problem which is affecting my ability to achieve mood stability.
> I was thinking of you the other day and wondered where you were because I am in a similar situation to your husband and you had posted something about this before.
>
> I am feeling better but have been very unmotivated and very tired. I'm on a plethora of things though, so I don't know if my med list can actually help - Topamax, 250, Prozac 40, Neurontin 2400, Lamictal - just started.
>
> The Topamax is the sedation culprit. The Prozac did help with that.
>
> I think Mitch's advice is very sound. Also, if your husband were to go on a stabilizer, which I know you know he should be on by most accounts, I would suggest Lamictal over Topamax because it is supposedly activating.
>
> Sometimes it is hard to differentiate among depression and sedation and that drugged-up feeling of being unmotivated.
>
> If one is feeling well, one should feel motivated to accomplish things, even if it's not in the realm of what one did before one started "getting well".
>
> Good luck! I don't think this is an unusual side effect. It's one I'm dealing with, so I am empathetic (as I'm sure is my husband :) ).
>
> - K.
Posted by Mitch on August 3, 2001, at 1:49:01
In reply to Re: Amotivational on Zoloft-Mitch and Kingfish, posted by AMenz on August 3, 2001, at 0:25:16
> Yes my husband is on Zoloft monotherapy. However, his moods are stable just on the AD. No doctor has ever wanted to prescribe a stabilizer. I think therefore for now the Neurontin is out of the question.
How is his sleeping patterns? Is he routinely getting consistent, adequate sleep every nite?
I guess my question is: what were his "moods" like BEFORE he started taking Zoloft and what has changed since for better or worse?
> How about Adrafanil-( we ordered it but are having trouble receiving it) Could that help him together with the Zoloft (or Prozac if we can get that changed. I thought this arousal issue would get resolved by Adrafanil.
> Also is it possible to have antisocial personality disorder comorbid with ADD. He has a lot of the traits (not criminal behavior though).I wouldn't even consider something such as Adrafanil at this point. You still are just trying to figure out just what the heck is going on! I think that ADD is most likely to be a differential diagnosis for someone that had been previously labeled as an "antisocial personality" rather than a "comorbid diagnosis". I guess it is possible, but ADD is more of a "treatable" entity than any personality disorder per se. A stimulant is the best treatment for ADD generally, but if he is responding positively to an SSRi antidepressant such as Zoloft-that complicates the diagnosis. For example-you mentioned all of the antisocial stuff-was he angry and temperamental before he started taking the Zoloft and now he is less temperamental, but can't focus?????
> He is perpetually in trouble about finances from he says inability to plan and to maintain focus in his activities. This is such a long standing pattern that all I'm hoping is to convince him to take a job and leave his business which is below his level of ability at which he can function without trying.Ok, so Zoloft didn't *cause* his attentiveness problem, then? (a "long-standing pattern").
>
> Thank you all for your response. I'm very discouraged by this problem which is affecting my ability to achieve mood stability.It sounds to me that he might have been quite temperamental and callous in the past and the Zoloft helped a lot with that. You may be interpreting (rightly so) his temper as being pathologically anti-social. So, now he is much less grouchy, but his attentiveness is still shot like it always has been?? You have solved one big problem, but still have this trouble..
I dunno.. I still have this hunch if you tried a *little* Neurontin it might help the ADD (say 100mg 3x daily). Forget the idea of it being a "mood stabilizer", or whether any pdoc thinks he ought to be taking one. Neurontin has been used for ADHD children, adults with some success. Yes, I still think you ought to try that route first.
Mitch
Posted by Kingfish on August 3, 2001, at 7:31:44
In reply to Re: Amotivational on Zoloft-Mitch and Kingfish » AMenz, posted by Mitch on August 3, 2001, at 1:49:01
AMenz:
I am not well-versed enough about meds to offer a good opinion here beyond what I mentioned. I would keep searching for another pdoc who can help. You are obviously "at the end of your rope" so to speak and this is greatly interfering with your ability to take care of yourself.
I think Mitch's questions are very valid - what was your husband like prior to this? Is this a huge change in personality, or a continuation of a problem? (I'm assuming it's a change, or you would not have addressed it.)
Regardless, you need a pdoc who will speak to the both of you about this for the good of both of you.
Good luck!
- K.
This is the end of the thread.
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