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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by pseudoname on April 4, 2006, at 12:58:47
Deep brain stimulation sounds so promising to me, I almost (almost!) wish my current med weren't working as modestly well as it is: maybe DBS would work better. Sheece, some people are never satisfied! LOL!
The TRD woman who got remission through DBS had trouble re-adjusting to “normal” life. By my standards, she hadn't been severely depressed for very long (3 or 4 years, I think).
Now that I seem to be *gradually* coming out of my 24-year depression thanks to buprenorphine, I'm having to sort out what was directly due to the biological depression, what's just personal preference, what's just habitual after all these years, what's still untreated depression, etc. I have to “make” myself do things I still don't want to do but am now “able” to do, whatever that means.
For example, I'm recovered enough from the depression that I “can”, say, fix my leaky tub (which has been costing me $10/month for 6 years). But I feel like I still have no *reason* to fix it — a lack of motivation that looks to me a lot like depression. But then I can tell myself (like in CBT or REBT etc), “I don't like feeling amotivational,” and voilá I don't have to have a reason: I can fix the sink even though I don't *feel* like I have a good motivating reason to do so.
Those little cognitive tricks never worked before this med.
Hard to explain.
When you're really depressed, you have to really want something and expect to get a lot out of it in order to drag yourself to do it. Maybe I'm just expecting everything now to have the sort of exceptional motivation or high reward that depressives must have to be able to do anything?
I think I'm still missing a little dopaminergic improvement as far as reward or expectation of reward. Maybe with a little time & effort, that will change on its own? Maybe even if I got DBS, I'd still be in the same boat. ;-)
I'm not depressed, but I only minimally want to do anything. That hasn't changed even as I've gotten out and done things. The CBT gurus predict that doing things makes you more motivated. Hasn't helped me much, but maybe I'm making a centimeter-a-day progress....
Antipsychotics treat amotivational syndrome, don't they? (I've never tried one except a few days on Haldol.)
Posted by Declan on April 4, 2006, at 13:42:43
In reply to Recovery is complicated, posted by pseudoname on April 4, 2006, at 12:58:47
Hi PN
I managed to lose those little search thingos here, so I can't check, but I had thought, and must be wrong I guess, that you had stopped bupe, because it wasn't helpful. Must have been someone else.
What you said about motivation (being able to do something, but having no reason to) makes me think of procrastination. Is it just like having no enthusiasm?
My passive/angry/negative response to the world has been such as to preclude enthusiastic competance. Some kind of protest, maybe.
I wish I had something more coherant to say about this relevant thing. I am though quite sure that the old APs would be worse than useless for you. I've sometimes wondered about low dose amisulpiride, but I probably won't try that either.
Declan
Posted by pseudoname on April 4, 2006, at 15:02:20
In reply to Re: Recovery is complicated, posted by Declan on April 4, 2006, at 13:42:43
Hey, Declan!
> but I had thought, and must be wrong I guess, that you had stopped bupe...
You're remembering pretty good. I developed anxiety attacks / trouble breathing in January and my GP told me to stop taking the buprenorphine. He thought it might be the cause. But the breathing problems were purely psychological, related to the reduced depression. Sort of like “Yikes! NOW what should I do?!” After almost 2 weeks off bupe, I went back on it, although at a reduced dose, now about 0.5mg 2x / day. Bupe has worked remarkably for me, where nothing else has, but it doesn't seem to hit every aspect of my depression.
> I am though quite sure that the old APs would be worse than useless for you.
That's sort of a relief to read. I thought I read that APs combat “amotivational syndrome” in pot smokers, but Googling for that just now I think I must've mis-read it.
> Is it just like having no enthusiasm?
There's no enthusiasm, which is okay… I'm a little wary of enthusiasm sometimes. But there's also zero reward feeling when I'm done. No expectation of satisfaction or feeling, “Ah, that's better now.” My pdoc thinks I'm hyper-afraid of criticism (which would make sense, given my upbringing).
I must really want to do this stuff, or why would not-doing it bother me so?
I hope that I'm just struggling here with the mental/behavioral barnacles of more than 20 years of depression and social withdrawal and that an additional med won't be needed.
> Some kind of protest, maybe.
I think resentment plays a huge role in my life. I'm prone to hold grudges forever. NOT very productive.
Even when I'm getting better, it's all so complicated to sort through. Thanks, Dec.
Posted by krystee on April 5, 2006, at 0:17:12
In reply to Re: Recovery is complicated » Declan, posted by pseudoname on April 4, 2006, at 15:02:20
Personally, I have to say that my two weeks on Risperdal (an atypical AP) made me want to do things. I never want to do anything, kinda like you were talking about, but on the Risperdal I got up, cleaned my house, did normal stuff. Didn't feel great by any standard but was slightly productive. However, after the Risperdal made me lactate and made my hands shake I stopped it. I am supposed to try Abilify and it is coming in the mail. I just wanna be able to do normal chores, ya know? Hope you sort it out!
Posted by Declan on April 5, 2006, at 1:03:02
In reply to Re: Recovery is complicated, posted by krystee on April 5, 2006, at 0:17:12
Low dose amisulpride is suppose to put your prolactin up too (I think). But maybe you could take a dopamine agonist for that? Apparently Hydergine 10mg/d or cabergoline would do it. What about deprenyl? You might end up too zappy.
Declan
Posted by Meri-Tuuli on April 5, 2006, at 7:26:15
In reply to Re: Recovery is complicated » Declan, posted by pseudoname on April 4, 2006, at 15:02:20
Poo, I wrote a long post but somehow managed to lose it!! I hate it when that happens!!
Anyway the crux of it was that I am in a similar position to you. I have always had problems being motivated, it takes me ages to do anything, and I always leave everything to the last minute and use the stress and panic to get something done which isn't good.
Its like we have lost the capcity to experience satisfaction from doing something. Something that doesn't light up in our brains. Its interesting to say that you might be hypersensitive to criticism and its related to your upbringing. I know for me, it is defintately related to upbringing -- my mother would never be happy with my actions, if I like cleaned the house to try and please her, she would never appreciate it, she expected it ("you missed abit over there, why can't you do anything properly?"). Maybe this alters our brain chemistry or our reward pathways or something, because we have come to learn not to expect anything good to happen if we do something, so when we do something, the bits in the brain that light up and give us satisfaction don't bother anymore. So we become unmotivated, because we don't *expect* anything good to happen, and then, even if we do somehthing, anyway, nothing will happen because our reward pathways are alterned. So it enforces itself.....and we become completely unmotivated and it spirals down.
And then possibly we become involved in drugs/alcohol/over eating etc, because thats an artifical way to stimulant our reward pathways.....I know I only drink wine in the evenings because it makes me feel better!!!
Phew! I hope that makes sense.....who knows anyway!! Kind regards
Meri
> Hey, Declan!
>
> > but I had thought, and must be wrong I guess, that you had stopped bupe...
>
> You're remembering pretty good. I developed anxiety attacks / trouble breathing in January and my GP told me to stop taking the buprenorphine. He thought it might be the cause. But the breathing problems were purely psychological, related to the reduced depression. Sort of like “Yikes! NOW what should I do?!” After almost 2 weeks off bupe, I went back on it, although at a reduced dose, now about 0.5mg 2x / day. Bupe has worked remarkably for me, where nothing else has, but it doesn't seem to hit every aspect of my depression.
>
> > I am though quite sure that the old APs would be worse than useless for you.
>
> That's sort of a relief to read. I thought I read that APs combat “amotivational syndrome” in pot smokers, but Googling for that just now I think I must've mis-read it.
>
> > Is it just like having no enthusiasm?
>
> There's no enthusiasm, which is okay… I'm a little wary of enthusiasm sometimes. But there's also zero reward feeling when I'm done. No expectation of satisfaction or feeling, “Ah, that's better now.” My pdoc thinks I'm hyper-afraid of criticism (which would make sense, given my upbringing).
>
> I must really want to do this stuff, or why would not-doing it bother me so?
>
> I hope that I'm just struggling here with the mental/behavioral barnacles of more than 20 years of depression and social withdrawal and that an additional med won't be needed.
>
> > Some kind of protest, maybe.
>
> I think resentment plays a huge role in my life. I'm prone to hold grudges forever. NOT very productive.
>
> Even when I'm getting better, it's all so complicated to sort through. Thanks, Dec.
Posted by pseudoname on April 5, 2006, at 8:38:53
In reply to Reward pathways and motivation.... » pseudoname, posted by Meri-Tuuli on April 5, 2006, at 7:26:15
Hey, Meri
> I wrote a long post but somehow managed to lose it!! I hate it when that happens!!
I'm glad you re-wrote it; I appreciate that. It's happened to me so much (lately from computer crashes) that I now save drafts of my long posts as I write them, either in a dummy email or in a Notepad file I keep in my Start Menu for just that purpose.
I realized last night (so I dunno yet if it's a reliable insight) that the criticism I fear is not of the job I'm about to do, but of my entire life up to that point. It's like by doing X I'll open myself up to deep, wide-ranging eviscerations of everything I've ever done or not done. Always by comparison to others, which was my dad's vicious style.
And I agree about physiology. The reward pathways in my brain are abnormal somehow. I was probably sensititve to begin with, and then the upbringing was a bad combo with that.
Posted by pseudoname on April 5, 2006, at 8:54:14
In reply to Re: Recovery is complicated, posted by krystee on April 5, 2006, at 0:17:12
Thanks for your story. I was sure I read that antipsychotics can help amotivational syndrome, but maybe not. I'm too depressed this morning to look for it, LOL! (My bupe hasn't kicked in yet.)
My pdoc suggested trying Risperdal…
But APs have such side effects! As you show.
I wondered about a low dose, on top of my buprenorphine. Maybe low-dose amisulpride (Solian), like Declan said?
If I can't get better at this motivational stuff through further cognitive-type work, I may have to try something like that. The low-dose amisulpride abstract said it works quickly.
Good luck with the Abilify! Please post how it goes.
Posted by Meri-Tuuli on April 5, 2006, at 10:52:34
In reply to Reward pathways and motivation » Meri-Tuuli, posted by pseudoname on April 5, 2006, at 8:38:53
Hi again!
> I realized last night (so I dunno yet if it's a reliable insight) that the criticism I fear is not of the job I'm about to do, but of my entire life up to that point. It's like by doing X I'll open myself up to deep, wide-ranging eviscerations of everything I've ever done or not done. Always by comparison to others, which was my dad's vicious style.
Tell me about it! I constantly compare myself to others (which is obviously not a healthy thing to do) -- I compare myself to the other gradutes in my class and I'm like, 'they're working at such a such a company in a good position' and I'm unemployed!! The thing is, I know I was just as clever etc as them, and then I get frustrated because I had to take a semester out due to severe depression and I also dropped out of teacher training as well because of it, and then I just took a low level admin job because I didn't have the confidence to get a job more suited to my educational background. And then I see my fellow classmates and friends from uni doing these 'good' jobs that I wouldn't even have the confidence to apply for......
and I get super frustrated with myself, my situation and my mental health problems. I feel trapped by my inability to have any confidence in myself. SIgh. Any advice?? CBT?
I'm trying to view my mental disorders like a physical illness, it somehow makes it abit more acceptable that I've not accomplished as much as I would have liked to. That and a quote from that Baz Luhrman song 'class of 98 wear sunscreen' ... I think its like 'sometimes we're ahead, and sometimes we're behind, but in the end the race is only with ourselves'.
Posted by pseudoname on April 5, 2006, at 12:13:39
In reply to Re: Reward pathways and motivation, posted by Meri-Tuuli on April 5, 2006, at 10:52:34
> I feel trapped by my inability to have any confidence in myself. SIgh. Any advice?? CBT?
Well, you could compare yourself to *me*, that should make you feel better. ;-) LOL!
I started getting breathing attacks last night in bed when I was thinking about exactly the sort of stuff (classmates' jobs) you just described!
I've found that the buprenorphine, the first drug that ever had a lasting effect against my depression, opened up new insights and some cognitive techniques that didn't work much before are now having some enduring good effects for me.
Right now I'm trying the most to apply principles from "Acceptance and Commitment Therapy", which now has a self-help book out called "Get Out of Your Mind". It's similar to CBT and DBT, but with sorta lower expectations, in a way. They advocate not-fighting against the bad thoughts and feelings that automatically arise in us. So I try to accept that I feel rotten about the criticisms everyone could (or will) make about me. That's different from either accepting the criticisms or challenging the criticisms: I'm just trying to live with my own emotional reactions, not even trying to change them.
But a lot of these feelings are just below the surface, not quite obvious. So I'm not sure what thoughts or feelings I'm struggling against, because I'm so good at immediately avoiding them!
This sort of work is a lot easier and more effective for me on the bupe, but it's far from a slam-dunk, and progress is slow. The gains I've made so far seem secure, but I don't know if I can make any more. So I'm still considering other options, like maybe APs. — Although I just remembered that Solian isn't available in the U.S. Oh well. :-(
I should add that the Acceptance and Commitment people are preachy and messianic and have some tiresome linguistic ideas that confuse their overall case. Their leader is consummately arrogant and doesn't realize his own sometimes embarrassing intellectual limitations. And he (therefore they) are somewhat anti-med, an attitude that is ALWAYS a problem for patients. But the acceptance techniques, I think, are very promising and otherwise overlooked in therapy.
Posted by Meri-Tuuli on April 5, 2006, at 12:58:20
In reply to Re: criticism » Meri-Tuuli, posted by pseudoname on April 5, 2006, at 12:13:39
Hi again!!
Thanks for the advice - I'm actually struggling to even open David Burn's ' ten days to self esteem'. I haven't ever seen a therapist and er, I find the whole thing quite daunting to be honest. Here in the UK we don't have such a 'therapy' culture and I wouldn't even know where to begin to find a decent one. Plus we would have to pay for it, something I'm not used to, I mean we get healthcare here in the UK completely free. So..... but I would love to give it a go! But then, I'm afraid I would find it too painful.......... argh!
> Right now I'm trying the most to apply principles from "Acceptance and Commitment Therapy", which now has a self-help book out called "Get Out of Your Mind". It's similar to CBT and DBT, but with sorta lower expectations, in a way. They advocate not-fighting against the bad thoughts and feelings that automatically arise in us. So I try to accept that I feel rotten about the criticisms everyone could (or will) make about me. That's different from either accepting the criticisms or challenging the criticisms: I'm just trying to live with my own emotional reactions, not even trying to change them.Acceptance techniques sound quite useful actually, I mean everyone must at some stage, for example, compare themselves with others, its just that we somehow don't make allowances or excuses for ourselves. I know some of my other friends from my low level admin job were just as frustrated by it as me - the difference was they just brushed it off with 'excuses' ("its only for a short while", its not so bad here") but with me, for some reason, these things stick. Its like I use it to reinforce my negetive ideas about myself. Hmm.... And if anything good actually happened to me, I would do kind of brush it off with excuses like the 'happy' people do with negative things. Its like I don't think I *deserve* good things to happen to me or that I believe that i am capable of things. So its sort of a negetive downward spiral....I think I am rubbish -> don't apply for good jobs/have good experiences/don't bother to attend interviews because I think I won't be any good, and I'm completely scared of failure -> I stay unemployed/low level admin -> get more depressed, think I'm rubbish blah blah. oh dear, thats a scary thought!!!!!!!!!! EEEK!
Meri
x
>
> But a lot of these feelings are just below the surface, not quite obvious. So I'm not sure what thoughts or feelings I'm struggling against, because I'm so good at immediately avoiding them!
>
> This sort of work is a lot easier and more effective for me on the bupe, but it's far from a slam-dunk, and progress is slow. The gains I've made so far seem secure, but I don't know if I can make any more. So I'm still considering other options, like maybe APs. — Although I just remembered that Solian isn't available in the U.S. Oh well. :-(
>
> I should add that the Acceptance and Commitment people are preachy and messianic and have some tiresome linguistic ideas that confuse their overall case. Their leader is consummately arrogant and doesn't realize his own sometimes embarrassing intellectual limitations. And he (therefore they) are somewhat anti-med, an attitude that is ALWAYS a problem for patients. But the acceptance techniques, I think, are very promising and otherwise overlooked in therapy.
Posted by pseudoname on April 5, 2006, at 13:19:29
In reply to Re: criticism, posted by Meri-Tuuli on April 5, 2006, at 12:58:20
Posted by pseudoname on April 5, 2006, at 13:59:29
In reply to Re: Recovery is complicated, posted by Declan on April 4, 2006, at 13:42:43
Hey, Declan.
> I am though quite sure that the old APs would be worse than useless for you. I've sometimes wondered about low dose amisulpiride, but I probably won't try that either.
The old antipsychotics would be bad because of their huge side effects? Or because they're dopamine antagonists?
And amisulpiride (Solian) isn't a real option in the U.S., unfortunately.
What about the newer APs? What do you think they would do for “motivation” (whatever that is)? I've never really considered APs much before.
Thanks for any thoughts. (I'm not sure you're still following this thread.)
Posted by Declan on April 5, 2006, at 14:48:33
In reply to APs: could you say more? » Declan, posted by pseudoname on April 5, 2006, at 13:59:29
Hi PN
'You have been weighed in the balance and are found wanting'? That sort of criticism? Where part of your mind has to take account of some unfolding horrible perspective? Yes, well. Someone was talking about Geodon above, saying that it was activating. Not the only thing said about Geodon. I wouldn't take that. The old APs just made me feel restless and dead. Except for Mellarill, which just made me feel a bit dead. I certainly feel that opiates are a better solution than APs. So there's Abilify and amisulpride. Now I've forgotten what else you take. When you are happy to completely give up on sex there's always Nardil.
Declan
Posted by pseudoname on April 5, 2006, at 15:14:27
In reply to Re: APs: could you say more?, posted by Declan on April 5, 2006, at 14:48:33
You clever writer, Declan. I snorted so hard laughing at your post just now that I hurt my throat! LOL.
I tried Mellaril / thioridazine back in 1989. I didn't realize it was an antipsychotic. How dumb is that.
Buprenorphine is all I'm taking now.
Thanks for your comments. I'm not sure what to do next. Going with no change may be best.
Posted by ed_uk on April 6, 2006, at 15:09:14
In reply to Re: APs: Thanks » Declan, posted by pseudoname on April 5, 2006, at 15:14:27
Hi PN!
How did you find Mellaril?
Ed
Posted by pseudoname on April 6, 2006, at 16:01:41
In reply to Re: APs: Thanks, posted by ed_uk on April 6, 2006, at 15:09:14
Heyo, Ed.
> How did you find Mellaril?
It had no effect on the depression. The side effects were tolerable. It was about 14 years ago, and I don't have any notes from that time about it, so details are a little fuzzy.
This is the end of the thread.
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