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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by SFY on March 12, 2006, at 18:11:45
I have long-standing dysthymia/anhedonia: constant low mood, disinterest, little motivation, as well as a history of major depressive episodes. The lingering depression also manifests itself as chronic insomnia of the early morning awakening type. The major depression has been well-treated over the years with antidepressants but the dysthymia has proved harder to treat.
I also have Social Anxiety (but more of an avoidant variety than a seriously anxious one) with severe rejection sensitivity. Cognitive-behavioral therapy has helped over the years but then I seem to run up against the low motivation factor and reach a plateau. A course of Nardil did help but after a time I started suffering severe insomnia and went off it.
Right now, I am taking Nortryptiline which keeps my major depression at bay (or at least provides a floor for it) but does nothing for my dysthymia. My current thinking is to get my blood levels for Nortryptiline checked & see if they fall within the therapeutic window and to ask my pdoc to add some type of dopamine augmentation for the dysthymia. I've been looking at Mirapex and Requip but am wondering about the other options and which (if any) might be best for me.
(And if that doesn't do the trick then I'm looking at Emsam, and then Parnate, if I can get beyond the fears about exacerbating my insomnia.)
Posted by psychopharmacon on March 13, 2006, at 2:53:02
In reply to Dopamine Augmentation for Dysthymia/SA, posted by SFY on March 12, 2006, at 18:11:45
Some people report good results with Dostinex (cabergoline). It is the DA with the least side effects. Personally I take amisulpride, which is an antipsychotic, but in contrast to other AP's it is a dopamine agonist at low doses (12.5-100 mg).
Posted by Caedmon on March 14, 2006, at 22:54:45
In reply to Dopamine Augmentation for Dysthymia/SA, posted by SFY on March 12, 2006, at 18:11:45
It's a worthwhile idea. Have you tried Provigil [modafinil]? I have bipolar (mostly depressed) as well as social anxiety. I found modafinil remarkably helpful on both counts, and it kept me awake to boot. Too expensive though. *fingers crossed for generic this June!*
Posted by kingcolon on March 19, 2006, at 11:12:13
In reply to Re: Dopamine Augmentation for Dysthymia/SA » SFY, posted by Caedmon on March 14, 2006, at 22:54:45
I'm using Requip (ropinirole)with good effects on depression, amotivation, anhedonia, and social phobia. There is one study on this drug using a dose of 1.5 mg daily (mean). Some people get sedated with it, but this is uncommon at doses of 1.5 mg.
It works specifically on the D2 and D3 receptors which are most likely involved with mood and motivation.
It has only been studied as an augmenting agent, however. I'm also on Cymbalta, and Lamictal.
This is the end of the thread.
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