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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by sedona on March 4, 2003, at 14:10:38
Has anyone else had a problem with lack of motivation and apathy on an SSRI? I have been taking Prozac for over a year now, and it has worked well for my anxiety, but I have no motivation whatsoever. Any suggestions?
Thanks
Posted by zeliva on March 4, 2003, at 15:30:26
In reply to SSRIs and apathy, posted by sedona on March 4, 2003, at 14:10:38
I totally know what you mean! I have been on Prozac since Nov. and it also has helped with my anxiety but I always feel like I can never get going. My pdoc gave me Provigil which is for narcolepsy. I haven't tried it yet. I think I am scared I will be too wired. I started taking Gingko for the sexual side effects from the Prozac and that has seemed to make me more motivated. I take 60mg per day. How many mg of Prozac are you taking? I take 40mg.
Posted by janejj on March 4, 2003, at 17:29:55
In reply to Re: SSRIs and apathy, posted by zeliva on March 4, 2003, at 15:30:26
Yes I had this problem with Prozac also. I stopped taking it and my motivation has come back. My doctor suggested lowering my dose, ask your doc about it, it may help a little.
Posted by sedona on March 4, 2003, at 19:19:16
In reply to Re: SSRIs and apathy, posted by zeliva on March 4, 2003, at 15:30:26
I only take 20mg of Prozac. It's great to be rid of the anxiety and the worry(I had a lot of social anxiety), but instead I just sit on my couch all day carelessly avoiding any responsibilities. Maybe I will look into the Provigil.
> I totally know what you mean! I have been on
Prozac since Nov. and it also has helped with my anxiety but I always feel like I can never get going. My pdoc gave me Provigil which is for narcolepsy. I haven't tried it yet. I think I am scared I will be too wired. I started taking Gingko for the sexual side effects from the Prozac and that has seemed to make me more motivated. I take 60mg per day. How many mg of Prozac are you taking? I take 40mg.
Posted by noa on March 4, 2003, at 20:04:44
In reply to Re: SSRIs and apathy, posted by sedona on March 4, 2003, at 19:19:16
I suspect I may have a problem with this, too. My pdoc and I have been discussing it. First we want to see how I continue to improve with an increased dose of fish oil. Then, we are going to try lowering the dose of one of my antidepressants just a little. My therapist and I have also been discussing this. On the one hand, I do wonder if the motivation problems are due to the medications. The pdoc says it is plausible. But my therapist and I have agreed that it is also plausible that it is due to psychological reasons, because my motivation in certain realms of my life, under certain conditions (when structure comes from the outside) is much better than in others (in less structured situations). Of course, I think getting motivated is harder in unstructure situations--requires more initiative, etc., so the problem could be some of each--psychological and medicaiton. In any event it is fairly clear to all of us that my meds do cause some ADD-like symptoms--mostly in realm of organizing time and space, keeping track of things in memory, etc. So, therefore the plan to try lowering the dose somewhat.
Posted by male34 on March 4, 2003, at 22:02:26
In reply to SSRIs and apathy, posted by sedona on March 4, 2003, at 14:10:38
ive done paxil and LEX ,with all do respect ,its up to you dont let it get you lathargic, beat the system stay motivated,good luck
Posted by viridis on March 5, 2003, at 0:33:38
In reply to SSRIs and apathy, posted by sedona on March 4, 2003, at 14:10:38
Prozac made me very anxious at first, then sort of wired but apathetic -- not a good combination (I've taken it for months at a time, at various doses). Zoloft made me feel completely bizarre, with wild mood swings.
SSRIs aren't for everyone. I do best with low-dose Klonopin, Adderall, and 1200 mg/day Neurontin, plus a bit of Xanax now and then. I now avoid SSRIs, and my pdoc agrees that they aren't appropriate for me (although they're very good for some people).
Posted by jesus on March 5, 2003, at 6:53:40
In reply to Re: SSRIs and apathy, posted by noa on March 4, 2003, at 20:04:44
i experience apathy and fatigue on lex...I used to freak out if i missed a day @ the gym but now i only go about 4 days a week...I found that stimulants like adderall and ritalin can counter this to some degree. maybe you should look into combining adderall XR w/ your ssri so that way the stimulant will be in effect nearly all day...this is what i do and it works for me.
Posted by sedona on March 5, 2003, at 12:54:42
In reply to Re: SSRIs and apathy, posted by jesus on March 5, 2003, at 6:53:40
May I ask if you take Adderall for ADHD or just to counteract the SSRIs?
Thanks> i experience apathy and fatigue on lex...I used to freak out if i missed a day @ the gym but now i only go about 4 days a week...I found that stimulants like adderall and ritalin can counter this to some degree. maybe you should look into combining adderall XR w/ your ssri so that way the stimulant will be in effect nearly all day...this is what i do and it works for me.
Posted by Jack Smith on March 5, 2003, at 13:29:25
In reply to Re: SSRIs and apathy, posted by noa on March 4, 2003, at 20:04:44
Just curious as I have read a lot of your posts in the archives, especially about effexor.
Posted by Ron Hill on March 5, 2003, at 17:00:48
In reply to SSRIs and apathy, posted by sedona on March 4, 2003, at 14:10:38
Hi Sedona,
> Has anyone else had a problem with lack of motivation and apathy on an SSRI? I have been taking Prozac for over a year now, and it has worked well for my anxiety, but I have no motivation whatsoever. Any suggestions?
I have tried almost all of the SSRIs and they all do the same thing to me. For me, of all the SSRIs, Prozac is the least offensive and Paxil is the worst when it comes to apathy and low motivation. I attribute these adverse SSRI side effects to the fact that:
“Chief among the brain’s reactions to artificially elevated serotonin levels is a compensatory drop in dopamine.”
I took this quote from page 20 of the introduction in a book entitled "Prozac Backlash" by Joseph Glenmullen, M.D. He is a clinical instructor in psychiatry at Harvard Medical School, is on the staff of Harvard University Health Services, and is in private practice in Harvard Square. His credentials look impressive, but he appears to be somewhat extreme in his views regarding the dangers of SSRIs. If you want, you can read the Introduction and Chapter 1 in their entirety for free at the Amazon link provided. I thought it was worth the time I spent scanning the available portions of his book.
There have been numerous discussions on this board regarding the issue of SSRIs adversely affecting dopaminergic pathways and, thereby, inducing the types of symptoms you describe. However, this is the first time that I personally have seen a doctor state in print that SSRIs cause a reduction in dopamine levels. However, I'm sure there are other doctors that have addressed this issue in print and that I have merely not come across those documents.
I have found something that is currently working well for me. However, everyone is unique so it may or may not benefit you. Let me know if you to hear about it. Also, what is your dx? In addition to the one year of Prozac, have you been on other medications? If so, which ones, for how long, and how did they affect you?
-- Ron
Posted by noa on March 5, 2003, at 17:05:03
In reply to What meds are you on now? » noa, posted by Jack Smith on March 5, 2003, at 13:29:25
Here is the run-down:
Morning:
Adderall Xr 30 mg
Effexor Xr 262.5
Cytomel 12.5 mcg
Synthroid 50 mcg
folic acid 400 mcg
chromium picolinate 400 mcg.
multivitamin ('the works', btw also includes additional 400 mcg of folic acid)
Alesse 28 (bc for hormone regulation)
fish oil a few grams of EPA per day (try to take some with each meal)
I also take 2000 mg of metformin for insulin resistance, and tetracycline for skin.Late afternoon:
Cytomel 12.5 mcg
Night:
Serzone 500
Lorazepam .25 mgAs far as SSRI apathy, I know I'm not taking an SSRI perse, but the effexor does, at least partly, act as an SSRI.
Posted by linkadge on March 5, 2003, at 18:23:36
In reply to Re: What meds are you on now? » Jack Smith, posted by noa on March 5, 2003, at 17:05:03
Try chromium. A few studies and my own experience
sugeest suplemental chromium helps the ssri apathy. Might give it a try.Linkadge
Posted by exbenzouser on March 5, 2003, at 22:28:37
In reply to Re: SSRIs and apathy » sedona, posted by Ron Hill on March 5, 2003, at 17:00:48
> Hi Sedona,
>
> > Has anyone else had a problem with lack of motivation and apathy on an SSRI? I have been taking Prozac for over a year now, and it has worked well for my anxiety, but I have no motivation whatsoever. Any suggestions?
>
> I have tried almost all of the SSRIs and they all do the same thing to me. For me, of all the SSRIs, Prozac is the least offensive and Paxil is the worst when it comes to apathy and low motivation. I attribute these adverse SSRI side effects to the fact that:
>
> “Chief among the brain’s reactions to artificially elevated serotonin levels is a compensatory drop in dopamine.”
-------------------------------------------Yes Paxil also turned me into an apathetic zombie. I think this is where MAOI's have an advantage over SSRI's because they are not selective. They raise serotonin, norepinephrine, and dopamine levels which produces a more balanced effect. At least this has been my experience.
Larry
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