Which Medication for my Depression?

[Eisi]

First my story in short:
I have to tell that I´m German and do live in Germany (therefore it could be that my English sounds a bit strange).
I`m suffering from heavy depression since 1998.
What do I mean by heavy depression? I mean a depression that leads to inability to work. In the meantime I´m in premature pension.
The first 4 years I tried it on my own to fight depression, because classical Medication like SSRI made the depression worse (which is typical for people with ADD as I found out later).
The next 4 years I was misdiagnosed with Schizophrenia simplex and treated mainly with NL. Now you haven`t to be a genius to tell that treating a Schizophrenia (which isn`t there) does not lift depression.
In 2007 a miracle happened and I was diagnosed ADD (without the "H"). I was put on Concerta, which ****** me terrible up. BUT was lifting the depression as long as it was working. In the so called Rebound I was more depressed than before.
I quit medication until 2008 and got more and more depressed. In 2009 I startet again.
I have to shorten up the story, before it becomes a novel.
The development in short since 2009:
The anxiety disorder with regular daily panick attacks got less and less over the years.
I was the DL-Ampehtamin that did that. Although I had to admit that in the first place Amphetamin did trigger the anxiety, only after a year getting used to it, it got better.
The Depression however remained, only did it change its charakter completely. Before and in the first time of the ADHD medication it was a depression with anxiety, a agitatet depression, a depression with high restlessness. The main question in those times was: how to calm down.
No its the opposite:
The depression became a static one with the main problems, no motivasion at all, no work drive, no sex drive, no drive whatsoever, apathy, lethargy.
The former main problem insomnia got in the opposite, too. Now it`s hypersomnia. So whereas in the old days I couldn`t sleep at all, now it`s the opposite I could sleep all day long.

After the long story now comes the question:

Is there an antidepressant medication out their that increases drive?

My current medication is:

4o mg MPH of what you call extended release in the morning combined with 1o mg what you call Lexapro. Followed by 15 mg DL-Amphetamin at noon and in the early evening (optional what you call Dexedrine 2 x 1o mg).

The SSRI does lift depression a bit, BUT only cognitive, less negative thoughts, less frowning...

It does NOT increase drive. On the contrary if I would rise the dose of Lexapro, I would become more and more tired and driveless.

To make it very short: I need an antidepressant that works drive-enhancing.

We tried the following (in combination with the stimulants):

3oo mg Wellbutrin - did not work at all.
9oo mg Moclobemide - did not work at all.
12o mg Tranylcypromine - did not work at all.
12 mg Reboxetine - made me even more tired.
6oo mg Venlafaxine - did not work at all.
5o mg Desipramine - made me even more tired.

others:
8oo - 24oo mg Piracetam - worked a bit causing headaches.

As you can see we focussed on ADs being known for working drive-enhcancing and not workind sedating.

We also tried a few alternative things with nutrional supplements as there were:

5oo - 2ooo mg L-Thyrosine - did not work at all.
2 x 8oo mg SAMe - did work a bit, but was too expensive to be further pursued.
5oo - 2ooo mg DLPA/LPA - did not work at all.
1oo mg DHEA - did nort work at all.
5oo - 2ooo mg DMAE - did not work at all.
5oo mg Rhodiola - did work a bit causing nausea.
2 - 5 gr Omega-3-Fatties - did not work at all.
1 gr St. John`s Wort - did not work at all.
5oo - 2ooo mg Yohimbine - did not work at all causing nausea.

As you can see with the supplements we also concentratet on substances that are known for having a positive effect on drive.

The most easy way off course to increase drive would be increasing the dose of the stimulants.

Or in other words: overdosing (= going over the dose which is required to treat ADHD) with stimulants is NOT the solution I`m lookin for.

There are two main reasons:

- taking more MPH would indeed boost the drive, but alongside with negative side-effect as feeling nervous and overstimulated (like drinking too much coffee) and becoming even more depressed with the drop down/Rebound. That means in the longterm it worsens depression.

- taking more Amphetamine would have basically the same negative side-effects. Allthough (overdosed) Amphetamines do not increase my depression that much as it does MPH it increases on the other Hand my anxiety level.

So for you all the good people out there: The answer on my question: Is there an antidepressant that works drive enhancing? is NOT: yeah, off course, stimulants.

Another question of yours could be: Why do you take MPH AND Amphetamine?
That`s a technical reason. In Germany the doctors are by law not allowed to prescribe more than 6oo - 9oo mg Amphetamine per mounth. Off course that`s too little . Thus I have to work additionally with the MPH in the morning. Generally spoken Amphetamine does work better with me (smoother set on/set off, less side-effects) than MPH. If I would be an American I would probably take Adderall XR. (We only have Vyvanse as a extended release form of amphetamine in Germany and only for the children. If you want to have Vyvanse as an adult you have to pay it by yourself, it isn`t paid by health inssurance. The same story it is with Attentin (that you would call Dexedrine).

So I`m looking forward to any of your suggestions.

[Little Nut]

Hi Eisi, These are only some quick comments that are no better than my understanding of your issues/questions and my own knowledge and intelligence. Let me begin that the info from you is somewhat lacking and my knowledge/intelligence in this area is not up to the task. My hope is to spark a new idea on your end to make progress for you.

Are there drugs that can adequately enhance motivation, of course. I have no ideas which ones will work with your current particular brain chemistry. Are there drug(s) that will provide "you" with adequately enhanced motivation, of course, but I have no idea what they are. Is the solution to your issues a drug to improve motivation, I haven't read anything to indicate that or preclude it.

Let me try to make my point. You seem to agree with your diagnosis of ADHD (AFAIK this is the name covering the disorder as a whole whether you have symptoms of hyperactivity or not). You also mention depression with these symptoms which seem to indicate melancholia (*hides from thunderbolts thrown by DSM gods );

The depression became a static one with the main problems, no motivasion at all, no work drive, no sex drive, no drive whatsoever, apathy, lethargy.

I also note you had no (not little, no) effect from the TCA's, So I would knee jerk and suggest you investigate ECT and then follow up w/ treatment for whatever is left over after the majority of these symptoms are addressed. The problem is if your symptoms are truly as you describe, I would expect you to barely martial the will to get out of bed to go to the toilet, let alone bathe yourself, feed yourself, nor seek out a forum and write a detailed post looking for help.

On the other hand, a way to do this initially is for you to do a thorough job identifying your symptoms and then diagnosing yourself. This would require an ability to OBJECTIVELY evaluate yourself for symptoms, research in the area and considerable reading and study. Then near the end, find a very good clinician and have him/her do a comprehensive diagnosis. You having done a good diagnosis of yourself including all the necessary reading/studying/analysis would allow you to to critically review your Docs diagnosis and give him/her feedback. Of course the Doc would do the same for your rationale, but in the end you would have a good diagnosis to start with. Also you and your Doc would have a good understanding of your symptoms and evaluating your treatment.

Just a suggestion. HTH, LN

[Twiggy]

Maybe try Prozac (Fluoxetine).

[sarahsweets]

Wellburtrin an help in a stimulant like way and with depression.

[20thcenturyfox]

Although my history is much simpler than yours (1. long-term poor-focus type depression with some ADHD symptoms well controlled with Adderal XR + anti-depressants, desipramine, later venlafaxine during very demanding career; 2. AD's suddenly stopped working, depression changed to extreme lack of motivation, fatigue; 3. Feeling I was not so much depressed as unmotivated, I quit antidepressants and demanded different treatment; currently trying Vyvanse + Strattera which MAY ACTUALLY be helping, still too soon to say for sure how much), there are some parallels. In my case, I believe my depressive symptoms are mostly or entirely secondary to my dangerously low drive, which I personally attribute to a shortage of dopamine in my pre-frontal cortex.

So I was struck by your description of a drastic change in the character of your depression from agitation to extreme low motivation, though I'm not clear whether this was after being treated with an SSRI class of antidepressant.

FYI, there is a growing literature on the development of apathy as a result, or side effect, of SSRI medication: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2989833/ So is it possible your low drive is actually a result of treatment with SSRI's? If this is a possibility, the first step would be to make sure you stop taking SSRI's, and see if that helps.

Could it also be possible that you are not depressed at all, except as part of your response to suffering from low drive (which is very depressing, right?)? So can you go off anti-depressants and just concentrate on raising your dopamine levels by any and all means (not just medications or supplements)?

[Eisi]

Today i found my post of 2016, that I have forgot having written.



Im struggled by the point, that I didn`t seem to have made any progress. Accept for one.


I realized that the no motivation point of the depression is only increased by depression, otherwise it IS ADHD in it`s core. "They can not create internal motivation. So ADD is MDD, Motivation Deficit Disorder."
Russell A. Barkley

I found out another thing.

Amphetamine to a certain point has antidepressive effects.

Now here comes the problem. Has depression passed a certain point in severeness Amphetamine works the opposite way, as an depressant.

The main problem persists: No AD is really working on depression.

[Emre22]

Originally Posted by Eisi

Today i found my post of 2016, that I have forgot having written.



Im struggled by the point, that I didn`t seem to have made any progress. Accept for one.


I realized that the no motivation point of the depression is only increased by depression, otherwise it IS ADHD in it`s core. "They can not create internal motivation. So ADD is MDD, Motivation Deficit Disorder."
Russell A. Barkley

I found out another thing.

Amphetamine to a certain point has antidepressive effects.

Now here comes the problem. Has depression passed a certain point in severeness Amphetamine works the opposite way, as an depressant.

The main problem persists: No AD is really working on depression.

When i had depression , most severe or annoying thing was motivation deficiancy , everything was a challenge . I have BipolarI i am not sure my depression is same with a normal person's depression(i mean withiout bipolar)
but i heard about these thing a lot , adhd people's depression isn't mainly about mood sadness etc.
lack of motivation was at the center for me

I found 2 anti-depressant helpful in my life. Wellbutrin and stablon(it's withdrawal was horrible for me)

I am on wellbutrin , 2 years passed almost
i used it for 2 years in a past period

I think it is about dopamine mechanism

"They can not create internal motivation. So ADD is MDD, Motivation Deficit Disorder." i really liked his definition , my inner locomotive must work otherwise i am paralyzed

I see that you didnt benefit from wellbutrin

I can suggest antidepressants work by affecting norepinephrine or/and dopamine levels.

[Eisi]

Yes, I agree. Motivation deficiany is the key point. What`s most frustrating stimulances don`t work on that.


Nope, Stablon didn`t work either.

[Emre22]

Originally Posted by Eisi

Yes, I agree. Motivation deficiany is the key point. What`s most frustrating stimulances don`t work on that.


Nope, Stablon didn`t work either.

Did you try any noradrenaline reuptake inhibitor or any medicine works by noradrenaline mechanism.

As i know last resort is MAOIs