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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Garnet71 on January 12, 2009, at 18:50:04
Hello Mexperts (mental health experts)
I have no motivation or energy. I was a very ambitious person most of my life, always busy too. But lately, I turned into this null existence.
I don't feel depresssed/sad, or miserable. Just null. Can anyone relate? What is it?
Posted by Phillipa on January 12, 2009, at 21:46:58
In reply to No Motivation/Energy - What is wrong with me?, posted by Garnet71 on January 12, 2009, at 18:50:04
Me too seriously and hoping it's my thyroid. Love Phillipa
Posted by Garnet71 on January 12, 2009, at 21:59:20
In reply to No Motivation/Energy - What is wrong with me?, posted by Garnet71 on January 12, 2009, at 18:50:04
Someone's personal story:
http://paxilprogress.org/forums/showpost.php?p=528943&postcount=316
Has anyone heard of this? This sounds like me too..
Posted by Garnet71 on January 12, 2009, at 22:00:44
In reply to Antidepressant withdrawal syndrome, posted by Garnet71 on January 12, 2009, at 21:59:20
"What exactly is antidepressant withdrawal syndrome? is a question that comes up over and over on paxilprogress and, I imagine, similar boards all over the world. I've done 4 years of research on it, finally found a doctor who understands it, and, while I'm not a medical expert, I believe I can describe the ballpark.
The initial issue in antidepressant withdrawal syndrome is rebound of other systems (with Paxil, including the cholinergic) while the serotonin system is still downregulated. For some people, it takes a long time for the serotonin receptors to correct. In the meantime, other systems take over and establish a dysfunctional homeostasis without adequate serotonergic participation.
This dysfunctional homeostasis leaves some people, such as myself, with a hyper-reactive glutamatergic system. (This is part of the limbic system deep within the brain and the body-wide autonomic system.) Reacting with "fight or flight" to the least stimulation, the glutamatergic system signals the adrenals to create excessive cortisol. The cortisol level may be elevated enough to show up in conventional testing, but since it is not related to adrenal or pituitary tumor, medicine doesn't know what to do with that information.
Theories of serotonin or dopamine deficiency etc. are particularly stubborn red herrings. The mythology of neurotransmitter imbalance is not relevant in withdrawal. The issue has moved to the glutamatergic system, norepinephrine, noradrenaline, and cortisol. Interventions that reduce cortisol are helpful. Noradrenergic medications such as buproprion (Wellbutrin) and mirtazapine (Remeron) are not. Celexa and other SSRIs may be noradrenergically activating.
Spurts of elevated cortisol causes many symptoms, from muscle stiffness and pain to waves of anxiety and despair. CNS instability causes symptoms my doctor calls "autonomic dumping," with fast heartbeat and waves of othe unpleasant sensations. Excessive glutamatergic activity and inappropriately raised cortisol at night causes the awful withdrawal insomnia.
This is not a relapse or emergence of depression, etc. It is a neurological syndrome all on its own.
In chronic withdrawal insomnia like mine, because of damage from withdrawal, the alerting setpoint of the glutamatergic system has been set too low -- hyper-vigilance. My doctor calls this a meta-homeostasis. The brain wants to keep us alert to respond to (non-existent) threats, and wakes us up when we become too inattentive. Tragically, the alerting response is triggered by the relaxation of sleep. In sleep medicine terms, this is called alpha intrusion. It is not a circadian rhythm disorder.
To re-establish the brain's natural ability to sleep, the glutamatergic system has to be gradually tamed. Too strong an intervention, even deep sleep, will cause the meta-homeostasis to increase glutamatergic activity. This paradoxical aspect of the condition is particularly hard to understand.
I am being treated with very low-dose Lamictal (now 1.07mg) to reduce glutamatergic activity and, at night, 2mg of melatonin at 7pm and low-dose Lyrica at 9pm to induce sleep. It's taken 10 months but I now believe I am about 85% on the way to recovery. I am now sleeping at least 4 hours a night and haven't had a sleepless night in a month. (Since January, I have had at least one or two sleepless nights a week and maybe 3-4 hours of sleep the other nights.)
According to my doctor, the signal from endogenous melatonin recruits the brain's ancient sleep system, which eventually will overcome the hyper-vigilance of the disorder glutamatergic system. He says his gradual approach with very low doses of drugs is all they have for now.
I have had no problems with Lyrica and expect to be able to taper off without a problem.
When I am all done with this (cross fingers), I am going to stay far, far away from psychiatric drugs. I expect my nervous system would still be susceptible to damage from them. I suggest anyone who has experienced a bad drug withdrawal avoid any neurologically active drugs in the future if you are at all able to do so."
Posted by Garnet71 on January 12, 2009, at 22:01:56
In reply to Re: No Motivation/Energy - What is wrong with me? » Garnet71, posted by Phillipa on January 12, 2009, at 21:46:58
Wanting to do nothing but stay in bed all day too Phillipa???
It's rough being an ambitious person who cannot get yourself to do anything. I feel horrible
Posted by Phillipa on January 13, 2009, at 18:56:40
In reply to Re: No Motivation/Energy - What is wrong with me?, posted by Garnet71 on January 12, 2009, at 22:01:56
So are you saying your're in paxil withdrawal as took l0mg of it for about two years. By taking tinier pieces of the med daily avoided withdrawl symtoms and the benzos. No don't want to stay in bed all day force myself to be out of the house and bike riding at night. More info please? Love Phillipa
Posted by Garnet71 on January 14, 2009, at 11:50:39
In reply to Re: No Motivation/Energy - What is wrong with me? » Garnet71, posted by Phillipa on January 13, 2009, at 18:56:40
Hi Phillipa, you are always so kind to respond. I haven't been taking Paxil,but the website, PaxilProgress, has great ancidontal information.
My last meds were WEllbutrin and Zoloft. Zoloft for anxiety and Wellbutrin for the constant fatigue I feel from Zoloft. They made me worse this time. Wellbutrin worked great in the past, but now does nothing. I keep reading about others' experiences with the generic types, and when I took it int he past, it was the brand. I have never had a bad experience from generic medication before.
My body has energy, but my mind is so unmotivated. It takes everything out of me to do anything and I don't know why. I am now tapering off the Zoloft and Wellbutrin--why should I take them if they do nothing but give me side effects?
I'm in school. I don't do any of my homework until the very last minute becaue I jsut can't get myself to do anything unless I absolutely have to.
I wish I knew what was wrong with me. I'm so angry about his. Thanks so much for askng.
Posted by Phillipa on January 14, 2009, at 19:22:45
In reply to Re: No Motivation/Energy - What is wrong with me? » Phillipa, posted by Garnet71 on January 14, 2009, at 11:50:39
I agree with your decision and seems common for second time round meds not to work. happened to me with paxil. Love Phillipa
Posted by desolationrower on January 16, 2009, at 1:34:11
In reply to No Motivation/Energy - What is wrong with me?, posted by Garnet71 on January 12, 2009, at 18:50:04
Its bipolar.
Of course, two lines isn't enough for anyone to actually have a good idea whats going on. So, you might disagree.
-d/r
Posted by Vincent_QC on January 17, 2009, at 8:50:06
In reply to Re: No Motivation/Energy - What is wrong with me? » Phillipa, posted by Garnet71 on January 14, 2009, at 11:50:39
> Hi Phillipa, you are always so kind to respond. I haven't been taking Paxil,but the website, PaxilProgress, has great ancidontal information.
>
> My last meds were WEllbutrin and Zoloft. Zoloft for anxiety and Wellbutrin for the constant fatigue I feel from Zoloft. They made me worse this time. Wellbutrin worked great in the past, but now does nothing. I keep reading about others' experiences with the generic types, and when I took it int he past, it was the brand. I have never had a bad experience from generic medication before.
>
> My body has energy, but my mind is so unmotivated. It takes everything out of me to do anything and I don't know why. I am now tapering off the Zoloft and Wellbutrin--why should I take them if they do nothing but give me side effects?
>
> I'm in school. I don't do any of my homework until the very last minute becaue I jsut can't get myself to do anything unless I absolutely have to.
>
> I wish I knew what was wrong with me. I'm so angry about his. Thanks so much for askng.Hi Garnet71,
Well...you're not alone in the same boat. Last fall, I withdraw from Lexapro (Second try also) because I was always tired as hell, more than before I begin it, and the Wellbutrin, who was supposed to improve my fatigue and make me more energic fail to do anything this time...as well as the Ritalin...it's like I was on a placebo or something else...The first time I take the Wellbutrin-Xr, it was the true thing...not the generic one...last fall it was the generic version...anyway...I also had the Zoloft (Generic version) for a second try last winter and it did nothing for my anxiety and my social phobia...it was worse for my energy level and my weight also...I don't know a lot of things about the difference between generics and patented drugs...but I know that second tries is often a fail, in my case...What is your diagnostic exactly? Did you feel a lack of motivation and energy since a lot of time?...Normally, are you someone who like to move or just to sit and watch TV? ...
I'm like you since more than 1 1/2 years...mean that I don't have any energy to do anything...In fact, I have to lie in my bed several hours at daytime to be able to do something in the evening with my friends...It's a mental fatigue more than physical...even if on my last drug trail (Parnate) it was more physical fatigue...
I have to save my little (to non existent) energy level for the night. I have tons of things to do but I have no energy so I always say to myself, I will do this and this tomorrow...Before becoming completely invalid and unable to do anything of my life, I was studying at the university...I was not able to do my big works and respect the date of delivery of the works, so I had to walk to my doctor office and ask for a medical paper to have additional time to make my works...it was crazy as hell.
Now it's worse...each time I try a new drug...it's like my problems increased to a new level...I feel a lot like I will never be able to return to my "normal" energy level...Mentally, I fell like my cognitives faculties are completly gone...I was the type of guy who was able to do 30 things at the same time and keep the same focus and level of success...now I can only do one thing at the time and it take me severals times to be able to achieve it...(like writing messages here...)...
What make me feeling worse in that whole process it's the fact that i'm not a depressive person, so the lack of energy is not suppose to affect me like someone who have a major depression as a main problem... My main problem is "untreat" social anxiety and social phobia with too much comorbidities (General anxiety, panic disorder with agoraphobia, and depression because of my untreat state...). Also, I feel like the more time it will take before I will be able to make something good again of my life, and the lesser chances I have to healing or to achieve a complete remission and a return to my normal energy level...
Anyway, I hope that you will find the good solution soon and that the withdraw of the Zoloft and Wellbutrin is not too much hard on you... Keep the faith and I wish you're feeling ok ;-)
Take care!
Vince ;-)
Posted by ihatedrugs on January 18, 2009, at 2:40:14
In reply to No Motivation/Energy - What is wrong with me?, posted by Garnet71 on January 12, 2009, at 18:50:04
Hi
I had been feeling just like you for the last few years. I am usually a very optimistic and happy person but years of battling this disease had left me without motivation and just down tired. I have been taking several meds to see if I find th e right cocktail but some work for a bit and then poop out. I have also been hoping that all my maladies were thyroid related but tests always come out right. Lately I decided to stop wellbutrin which honestly I never felt did anything, quit Cymbalta because of the brain zaps and went back to Prozac augmented with Abilify. I don't want to jinx it but I have felt better in the past two weeks than the last ten years. I really hope this is it. It feels good to want to do things other than sleep and watch tv.
I don't know what your RX is but mine is Major depressive disorder and GAD (no bipolar, adhd or other conditions). Perhaps you have already tried this combo but if not it may not be a bad idea to check it out.
Wishing you the best
Ihatedrugs
Posted by Garnet71 on January 18, 2009, at 9:31:35
In reply to Re: No Motivation/Energy - What is wrong with me?, posted by ihatedrugs on January 18, 2009, at 2:40:14
Hey thanks for sharing. No, no more drugs for me. Its been 4 days since i quit everything. I need to go to a neurologist and try other things before I would ever take another psychiatric drug agian. I guess I have to be a bitch and demand some tests. Every doctor I've been to over the past several years attributes any and all symptoms to anxiety.
I never get my diagnosis and they are never explained. When I had askedin the past, I was told I had depression and anxiety. duh.
Great to hear you are doing well. Please keep us posted!
Posted by ihatedrugs on January 19, 2009, at 21:08:26
In reply to Re: No Motivation/Energy - What is wrong with me? » ihatedrugs, posted by Garnet71 on January 18, 2009, at 9:31:35
Well good for you. We must be proactive in voicing our own grievances and making our desisions.. Dr.s normally mean well just don{t have the patience or time to deal with the nuances of our conditions.
E> Hey thanks for sharing. No, no more drugs for me. Its been 4 days since i quit everything. I need to go to a neurologist and try other things before I would ever take another psychiatric drug agian. I guess I have to be a bitch and demand some tests. Every doctor I've been to over the past several years attributes any and all symptoms to anxiety.
>
> I never get my diagnosis and they are never explained. When I had askedin the past, I was told I had depression and anxiety. duh.
>
> Great to hear you are doing well. Please keep us posted!
This is the end of the thread.
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