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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 linkadge on July 1, 2002, at 17:31:42
I was diagnosed with depression a year ago
and have since been sustained with varying ammounts of celexa. I am currently on 10 mg.
I am in a delema and want help from anyone who can help. I play the piano and am going to try my grade 10 in 2 months. Without celexa my anxiety would be to great for me to practice. On the celexa I can practice I just seem to loose musical motivation. It is very hard to explain I think It may have something to do with dopamine.
I am happy, I enjoy Seinfeld more than ever, I just don't enjoy the piano like I used to. The notes just don't envoke the same emotion. I find my mind just drifts right in the middle of practicing. I can concentrate on math and even reading but just not music. I was wondering if Remeron would be a better alternative. Music lovers out there, which AD's affect your appreciation of music the most. The music doesn't go through my mind like it did. Without Celexa I stay up all night with Mozart going through my mind. Don't get me wrong - It is not a stupifying effect of the Celexa - lingusitically I am faster than ever - jokes and humour come much more easily to me just not music. I know I've been bableing but help me out here anybody.Linkadge
Posted by PhoenixGirl on July 1, 2002, at 20:54:59
In reply to Help Antidepressant for Musician , posted by linkadge on July 1, 2002, at 17:31:42
Hi Linkadge. The antidepressants which strongly affect seratonin are the ones that are known to "blunt" your emotions. Apathy is an unfortunate side effect of these drugs. Apathy can also result from mood stabilizers and anti-anxiety drugs. I remember being on tthe seratonin drugs like Celexa, and I couldn't cry, even when I was in terrible emotional pain. Currently I'm taking Depakote (a mood stabilizer), and Klonopin (a benzodiazipine anti-anxiety drug similar to Valium). I have developed some apathy, disinterest, and lack of excitement from these drugs.
Drugs that are less likely to cause apathy and "emotional blunting" are ones like desipramine (it affects mainly norepinephrine), and Wellbutrin (which may affect dopamine and norepinephrine). Note: desipramine is one of the old tricyclics and has side effects like dry mouth, constipation, and others associated with the tricyclics. Also, you may want to try Provigil, which is a unique drug somewhat like stimulants, but has a more even effect. Scientists aren't sure how it works, but it may affect norepinephrine and/or dopamine. I've been on it for about 3 months and have not developed a tolerance to it. Its effects last a few hours after each dose.
When I tried the older, traditional stimulants like ritalin and adderall, tolerance occurred within a few months and they no longer had an effect on me.
Have you tried desipramine, Wellbutrin, or Provigil?p.s. -- I am not a doctor, just a well-informed layperson who has learned a lot about these drugs in my own quest for emotional wellness. Do a little research into these drugs and the apathy side effect. Check up on these ideas with your doctor, too. Also remember that different doctors can have different opinions. That's why I try to stay well-educated about psychiatric care so that I can choose the right psychiatrist and be an active participant in my own treatment.
Posted by linkadge on July 1, 2002, at 21:20:54
In reply to Re: Help Antidepressant for Musician , posted by PhoenixGirl on July 1, 2002, at 20:54:59
I don't think my doctor has a clue as to the
mechanizms of different AD's except that some
work for some and others don't. I am a little leary of trying stimulants and the norepenephrine route because I tried effexor and it made me nuts. I have way too much adreniline to begin with. I can run miles and miles. I don't need any more. I don't think I am manic because my thoughts don't race and I don't feel high. I am also in control of my energy. I havn't cried since I've taken Celexa. I just don't want an activating med because God knows I won't settle down. Effexor was excellent for the piano practicing it just made me way too nervous.
Without Celexa I have the energy and the ability to practice but not the will. With Celexa I feel I have the will but not the ability anymore.Does remeron cause emotional blunting like the
SSRI's
Posted by Mats on July 2, 2002, at 2:39:26
In reply to Re: Help Antidepressant for Musician , posted by linkadge on July 1, 2002, at 21:20:54
Purhapse your musical skills are highly dependent on different emotions that you cant recall when on a ssri? I have found that sad music like ballads and classical that i really liked before aint getting to me anymore when i am on ssri.
Remeron is great for depression but makes me to tired. I am now on zoloft+sam-e with very good results tough music choise lean to happy ones:).
Explane your problem with your doctor and maybe shift med./Mats
Posted by katekite on July 2, 2002, at 10:30:40
In reply to Help Antidepressant for Musician , posted by linkadge on July 1, 2002, at 17:31:42
I really liked moclobemide. It's not available in the US but that didn't stop me: it is commonly used for depression and anxiety in Europe, Japan, etc, there may be politics getting in the way of approval in the US. Getting it is something one would have to research on one's own.
Moclobemide is a maoi but has no food restrictions and a good side effect profile. It inhibits the 'reuptake' of dopamine, norepinephrine and serotonin. The reason I think of it for 'musicality' is that a study showed it to actually improve sex for some non-depressed people. I felt I could concentrate better and actually feel more with it, really deep feeling. As I took it for longer this effect was less pronounced but it was certainly there short term.
The other nice thing about maois is that people who respond tend to do so quickly, often within a week or so, so you could try it quickly and know one way or another, rather than the six weeks for ssris.Other drugs you might consider: the stimulants (adderall or ritalin) if you have attentional problems. Know in a couple days if will help.
Other older maois.
Desipramine, remeron, effexor, serzone.
Posted by Roo on July 2, 2002, at 15:25:45
In reply to moclobemide maybe?, posted by katekite on July 2, 2002, at 10:30:40
Are you still taking it? Did you have sexual side
effects with it? How much did it cost you per month?
Posted by Jerrympls on July 2, 2002, at 20:06:21
In reply to Help Antidepressant for Musician , posted by linkadge on July 1, 2002, at 17:31:42
Linkadge-
I can certainly empathize with you. I am a cellist and a huge fan of film scores. I've been battling depression for 10 years (I'm 30) and I can tell you that one of the worst effects of depression is when it takes the warm feeling of music away. It's horrible and empty. Major chords don't ring, beautiful melodies are greyed out.....terrible.
In my experience some SSRIs have helped and some have blunted my musical emotions. I think Luvox was the best - as far as NOT making the music stop. I've been on all the SSRIs, Remeron, Serzone, Trazodone, Effexor, ascendin, nortriptyline, imipramine, naltrexone, ritalin, adderall, dexedrine, wellbutrin, tegretol, nurontin, lithium, seroquel (great med but made me fat), provigil and currently desipramine (w/ dexedrine).
Contrary to what others have posted about Desipramine - as far as in my personal experiences - did not bring back the music and while the addition of dexedrine did help, the symphony inside feventually faded. Wellbutrin made me to anxious to think about music and Remeron kept me in bed asleep. Serzone didn't seem to bring on too much apathy for me and niether did Trazodone. Trazodone was the first AD I was put on 10 years ago.....at 75mg and in two weeks I was loving life and composing music and falling in love. After about 3 months on it I thought I was "back on track" and went off of it. The depression returned and every attempt to ward it off with Trazodone and every other medication failed - as did ECT. Don't ever do ECT if you are a musician--in my opinion. It robs you of the song inside. It erased my memory and I had to relearn how to read music. This is just my experience , however, I would warn any artist to steer clear of ECT.
Anyhow, I believe this flattening of music within has to do alot with Dopamine. When I took Ritalin, in a hour I was enjoying music again - singing and playing and making tapes - the warm feeling of music came back....at least for a couple hours each day. Also, I've noticed whenever I've been on a med like Vicodin or Darvocet (in the past for dental procedures, etc) I've noticed that I don't get "high" but I have had a better sense of well-being and the music was back and singing loudly. Now I'm on Desipramine and I basically have side effects and no good effects.
I don't know if any of this can help you - remember they are just MY experiences. But, I at least wanted to tell you - musician to musician - that you aren't alone. Hopefully some day soon we'll hear -- and feel the music again.....
Good luck
Jerry
> I was diagnosed with depression a year ago
> and have since been sustained with varying ammounts of celexa. I am currently on 10 mg.
> I am in a delema and want help from anyone who can help. I play the piano and am going to try my grade 10 in 2 months. Without celexa my anxiety would be to great for me to practice. On the celexa I can practice I just seem to loose musical motivation. It is very hard to explain I think It may have something to do with dopamine.
> I am happy, I enjoy Seinfeld more than ever, I just don't enjoy the piano like I used to. The notes just don't envoke the same emotion. I find my mind just drifts right in the middle of practicing. I can concentrate on math and even reading but just not music. I was wondering if Remeron would be a better alternative. Music lovers out there, which AD's affect your appreciation of music the most. The music doesn't go through my mind like it did. Without Celexa I stay up all night with Mozart going through my mind. Don't get me wrong - It is not a stupifying effect of the Celexa - lingusitically I am faster than ever - jokes and humour come much more easily to me just not music. I know I've been bableing but help me out here anybody.
>
> Linkadge
Posted by wcfrench on July 2, 2002, at 21:54:50
In reply to Re: moclobemide maybe? Kate Kite, posted by Roo on July 2, 2002, at 15:25:45
I took Geodon for a little while and the music was loud and amazing. I felt it more than I had felt it in a long time, -- it seemed to be the med for me. But after a while and after increasing it, it gave me terrible pain and took away all my energy. Just sitting in a chair fully mentally and physically exhausted me, and I went to the hospital thinking I had cancer or some other deathly disease. I can tell you, though, that that fairly strong medicine (Geodon) worked for me. Some people, however, don't require a med as strong as Geodon, but if you get into the anti-psychotics, it definitely is a med that has positive effects on music listening and feeling. I was writing song lyrics and everything. Good luck to you.
-Charlie
Posted by katekite on July 2, 2002, at 23:01:08
In reply to Re: moclobemide maybe? Kate Kite, posted by Roo on July 2, 2002, at 15:25:45
For me, after 4 or 5 days I felt too sedated on it. I tried two different dose levels, 75 mg/day and 150 mg/day and was actually more sedated on the lower dose. My response to it might be abnormal since I have some hormone problem going on at the moment.
The first couple days were great. For a while I also used it just on days where I was particularly depressed and I would reliably turn around and have a good day. I've never heard of anyone else using it 'as needed' and can't say I'd recommend that as that's not how it was intended to be used, but it really did seem to work that way.
Sexual side effects: as far as I know moclobemide is supposed to improve sex, not hurt it. I think I read a paper saying the incidence of sexual side effects was 3%, the lowest of any AD so far. And that some of the normal control group reported improved sex. That was just one study, of course. At the time I took it I had a normal libido, and moclobemide seemed to increase it slightly, as well as make sex more enjoyable (like a slight touch became erotic).
There's a policy on this website that says that it's not allowed to discuss any details on importing drugs that are not marketed in the US.
I think it cost 50 or 60 for the first month or six weeks supply, not cheap. I was pretty desperate for a new class of drugs at the time having exhausted most everything else, and it seemed worth it. It was made by (I can't recall which) a major drug company, was blister packed, and was manufactured in New Zealand (I figure new zealand probably has pretty good drug manufacturing standards).
I hope I am not going too far in discussing this. One should be careful about taking anything that may not be made to the standards that are enforced in the US.
Since it is an maoi one would have to be careful with drug interactions. The sex enhancing feature is mild, it's not like viagra I don't think, so I doubt anyone would get it just for that aspect.
I talked to my psychiatrist about it, he had read about it: for a while many docs thought it would be marketed in the US. He did not want to prescribe it (which perhaps some pdocs would, in some cases) but was interested in my response and was 'there' in the background. I think pdocs are more open to being sued if they prescribe something that is not FDA approved. He had not heard anything bad about it, other than that it was perhaps weaker in fighting hard core depression than the old maois (with food interactions and more side effects) that are available in the US.
kate
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