8 replies to this topic

[t0rp3d0]

Hi I'm considering taking a stack of amino acids, vitamins, and herbs to combat my mild depression and lack of motivation recently.
I have a history of OCD, which I think should be noted... and I'm currently still on 20mg of fluoxetine hydrochloride. Although I think this is relevant, I'm not suffering from OCD symptoms at the moment.
In addition to the 20mg of prozac (fluoxetine hydrochloride), I plan on taking the following (in the following amounts too):


5-HTP:
240mg daily (taken in two doses, morning and lunch)


nodoz (Caffeine):
200mg daily (taken in two doses, morning and lunch)


Ginkgo Biloba Extract:
240mg (taken in two doses, morning and lunch)

Multi-vitamin: I'll take recommended dosage.

And an EFA (undecided on which to go for).

_______________________________

And that's it. Any critique, ideas, or suggestions would be hugely helpful. Thanks!


Edit: decided I should actually talk some about my current mental condition.
I feel unmotivated a lot of the time. And when I do feel motivated it is normally quite extreme motivation, and temporary (a matter of hours). Once it's over I feel little desire to do anything. Let me point out I have a good self esteem (I like myself :P ) but I just feel like there is no point in attempting things, and therefore often don't, when I'm in this mindset I feel like the reward (of exercise etc) isn't worth it. but when I'm more positive and motivated I feel like achieving these things... but the motivation never lasts long enough.

Edited by t0rp3d0, 02 June 2013 - 09:10 AM.

[nupi]

Why 5HTP AND an SSRI?

[t0rp3d0]

I continue to take the SSRI (prozac/fluoxetine) cause I was under the impression from my psychiatrist that it's probably keeping my OCD at bay.
I thought 5HTP acted similarly to SSRI's, not the same way and would therefore be beneficial to me. Just read some on it, sounds dangerous taking both at once :O
Previously just read about the benefits, not possible interactions. Given I'll be taking one or the other now, not both, which of the two should I choose?
Thanks for help!
Edit: after reading more on 5-HTP I think I'll actually remove it completely from consideration, because of it's potential effects on dopamine.

Edited by t0rp3d0, 02 June 2013 - 01:44 PM.

[Tom_]

Everything that follows is on the basis that you do in fact have a depressive disorder of irrelevent severity. Mind if I ask you a few questions?

How do you sleep? Would you describe yourself as sleeping normally or To much, to little, at the wrong times, enough but still tired...other something else?
How is your mood the majority of the time? Is it normal (are you happy), low, irritable...? Is your mood reactive (i.e. you still laugh at jokes or get exited).
How long have you had the problems?
How is your apetite/weight? Have you lost or gained much weight? Is your apetite to low or high? Do you have any cravings?
Do you have any thoughts of suicide or deliberate self harm?
Are you taking any other drugs, supplements, health foods...etc? What dose, how long etc
Have you tried anything else for your symptoms and how did it work?
What are you doing with your life at the moment? At work, school, unempolyed (if so why? can't find a job or unable to work)?
Any physical health problems? Pain problems?
How old are you?
What Sex?

Can you fill in this and give me the number?
http://www.ibogaine..../3639b1c_23.pdf

Depressive disorder is almost certainly the reason for your cognitive problems (to much Ach, dsyregulated noradrenaline and buggered serotonin) there for if you want to improve this the best way is to cure it rather than mask symptoms as best you can. In the absence of tic or schizoid disorders OCD appears to be primarily a disease of Sertonergic neurotransmission. Disorders of hyper neurotransmission in dopamine are commonly comorbid to OCD so I would recommend you stay away from traditional stimulants.

While 5HTP isn't the best option, slightly worse side effect profile less BBB crossing, addition of a precuser to Serotonin in concomitant SRI therapy is an accepted and very safe treatment option. The best evidence for an antidepressant and Tryptophan is along side a TCA (even more so with the more potent NRI TCA's). This treatment option does actually make a lot of sense. If your illness is cause by a general deficiency of serotonin then all the RI effects in the world won't make any difference. (how is your body meant to inhibit the reuptake of something that isn't there).

L-Tryptophan in doses of 2-5Grams have been shown effective. Side effects are mild at worst. It should be combined with B6 and Vit C to enable it to cross the BBB more effectively. L-tryptophan non-responsive individuals may have a tryptophan-hydrolase polymorphism (enzyme is the rate limiting factor) slowing conversion to 5HTP. In this case 5HTP is a good idea (it needs to be taken with a few things for BBB crossing). L-Tryptohan is sedating and I would advise you take it at night.

One major factor in your cognitive/motivational impairment might be your choice of antidepressant. Prozac at doses of 20mg plus function as a very noticeable 5HT2c antagonist otherwise known as a dopamine and noradrenaline disinhibitor. While associated with antidepressive effects it could certainly explain why your motivation fuctuates between from the way you described it as problomatically high to pathologically low. If you notice the change a few hours after you take the antidepressant would mean this is very likely, however simply because this isn't happening soon after you take it doesn't rule it out. I would seriously recommend you switch antidepressants (actually indicated due to lack of remission anyway) to another SSRI. This is not to mention Fluoxatine is a dirty drug. It can cause a lot of unpleasnt side effects and isn't patiually effective. Sertraline is the best evidenced (arguably) of all of them for OCD and depression. You should aim for a dose of around 100-200mg. You may want to reduce the fluoxatine as you increase the sertraline, that way you are less likely to suffer any deteriation or SSRI withdrawal syndrome or on iniation of sertraline increased axiety that is so common with SSRI's.

Drop to 10mg Fluoxatine and 50mg sertraline. After a week, 100mg of sertraline and no fluoxatine

Depending on how you answer the above it might be advisable you try another antidepressant rather than sertraline like venlafaxine or mirtazapine.

I would strongly recommend against using choline sups, racetams or anything else that increases Ach activity (anthing that decreases it is great) as this is heavily implicated in depression. Racetams other mechanisms of action might improve depression more than choline effects worsen it but its not a risk i would take.

Ginko is fine but the actual evidence base for it is apalling incomparison for antidepressants. I understand all the arguments about "Oh, Tom its just no pharm companies will pay for studies that they can't eventually make cash out of!". Sure thats true but you can't show it actually works. Its method of action is very interesting

I would also avoid caffeine, even more so after you describe these brief increases in activity before you become less interested again, its a major cause of anxiety and can induce anxiety disorders with long enough use at high enough doses, espially in people already suspectable (you have OCD). You need stability rather than ups and downs. Venlafaxine might help here or even trying atomoxetine. Atomoxetine as a monotherapy antidepressant is dismal. However with SSRI therapy it improved cognition, mood and lead to total remission in lots of case studies (no RTC's I'm afriad). It also acts as a NMDA antagonist (while I've venomenly oposed to using just NMDA antagonists for OCD until the evidence comes in) its a happy coincidence and worth a shot.

The lack of indication that you have tried any psychotherapy (just like most people on hear) is disturbing. Some don't use it because they don't think they can afford it, others because they think they have a 'biological problem', others because they don't want to have to talk to someone...

Online CBT (moodGYM) and by book are both easily accesible and the first is free. CBT is equally effective as SSRIs and impacts different symptoms. Mindfulness is free and often quite fun. It improves attention and mood as well as reducing anxiety. It can also be used to reduce sleep latency. Start with a small amount 5-10 minutes a day and increase.

[t0rp3d0]

A huge thanks Tom, for the extremely detailed reply! :D

I sleep irregularly (with no apparent pattern), and take melatonin for this. I sleep for around 7 hours most nights. Although 7 hours I think should be enough, I still feel tired.
A lot of the time (more so recently, last month or so) I feel unmotivated, and for some of the time I feel neutral, and for the smallest part of the time I feel extremely motivated.
I'm still reactive to jokes etc, unless I'm VERY tired.
My appetite is pretty normal, I eat similar portions to my athletic-type friends... I have however gained around 7Kg since I came back from a mental institution/hospital for OCD treatment (I was there for 6 months~ and got back around a year ago).
I do not have thoughts of suicide, but I do have some self-destructive tendencies; like drinking alcohol in reasonably large amounts (infrequently) when I'm feeling low.
The only other thing that I take that fits into the drug/supplement category would be melatonin (5mg).
I haven't tried anything else for my symptoms (of depression, and lack of energy/motivation.).
I'm currently a Highschool student in New Zealand.
I'm a 17 year old male.
I completed the form. My result was: 14.

I should make it apparent I see a psychologist, though, I don't talk to him about these symptoms. The reason I don't is because I have been hospitalized because of my OCD before, and underwent CBT and I now feel that it requires a certain type of psychologist to carry out CBT successfully with me. my current psychologist is okay, but doesn't fully "get it", even with my OCD, so I'm reluctant to tell him about new issues - and have him want to meet with me even more often (boring as hell, and annoying as is.)


Thanks again, Tom. I really appreciate the help!

[Tom_]

You were admitted for 6 months for OCD! Bloody hell. I'm assuming if I was in new Zealand I would never see the light of day again (you do mean inpatient, right?).

Unless you tried to commit suicide, were actively psychotic (with risk factors) or the OCD was taking up 8 plus hours of your day I can't think of any good reason to admit you. Maybe you won't want to talk about it (which is more than fine, after all I am a stranger)

For a 17 year old 7 hours isn't enough. You should be looking more towards 9. Although you are right in expecting to be able to function ok on 7.

I find myself quite hesitant to suggest you make any changes other than perhaps an increase in dose spread across the day. I'm also utterly astounded that you say you are symptom free from OCD. No more rituals? What about obsessions? Generally its accepted that inpatient treatment is rarely effective for OCD, let alone a full remission.

There are other treatment options however and I think you should certainly consider them.

SSRI/Vanlafaxine/Mirtazapine
SSRI + Tryptophan + b6 + vit c
SSRI + Mirtazapine
SSRI + Venlafaxine
Mirtazapine + Venlafaxine
SSRI/Vanlafaxine/Mirtazapine + Agomelatine
Clomipramine
SSRI/Venlafaxine + buspirone

However because your presentation is so unusual I want more information...a lot more before I could suggest an option. Some of them you have already answered but I C/P them in when ever I want the whole shebang.

What age where you when this first became a problem?
Has anything helped? What?
How old are you?
What sex?
What medical (including psychiatric) disorders have you been diagnosed with?
When was your last blood test and what were the results?
How tall are you and how much do you weigh?
How much physical activity do you get?
Are you employed? Not employed? What do you spend most of your day doing?
Do you have any pain problems?
How is your apetite? Do you like Carbs, fats, salty food...?
Is there any major or chronic stressors? This would include stuff like rape, war but equally important and just as bad are things 'everybody' gets. Over critical perants, going into care, lost job...paticually important are things that started within a few months either way of when you started getting these panic attacks.
What phamacological treatments have you tried in what order and what combinations? How did you respond to them?
Any history (including family history) of drug abuse(not just to get high but it causing a genuine impact on there life)/dependance, suicide or major mental disorder?
Anything else you have to add?
What psychosoical and behavioural interventions have you tried?
Do you have thoughts of suicide or deliberate self harm? If yes have you ever acted on them? How often? Was the intent to end your life and (you believed the attempt would kill you, you took steps to avoid detection etc)
How would you describe your psychomotor activity? Exessive, normal decreased?
Would you describe your anxiety as generlised, panic (attacks), obessive or phobic (or which ones?)
Do you/have you abused regually any substances? what type/s? was there addiction?

I also want to ask you some sleep questions.
What do you do the two hours before you go to bed?
What time do you go to bed? Whats your enviroment like? Any lights, sounds, etc? (do you go to bed and then use a laptop)? After 'lights out' how long does it take you to get to sleep?
Do you fall asleep at socially inapprioate times? Like in the middle of the day? If so does it happen within 5 minutes? can you fight it off/delay it signifcantly? How many times a day? Do you wake up to find you can't move for a short time?
Do you sleep walk? move abnormally while in bed or snore/gasp a lot in bed?

Can you fill in these questionnaires.
epthworth sleepiness http://consultgerirn...ry_this_6_2.pdf

Sorry about all the questions but we aren't face to face and I want to know everything. There is a good chance you are going to get more.

[t0rp3d0]

Thanks again for the replies, Tom. And yep, 6 months inpatient for OCD. Even included being put in seclusion a few times (only for around 20 hours). The reason was that they (my main doc) thought I was violent/had violent tendencies. This was because I tried to escape several times (I was there involuntarily, under the mental health act), and when they tried to restrain me I tried to escape their clasps... but I was careful not to harm, or even lay a hand on them lol. My escape attempts (one of them was successful, but got caught) also involved breaking a door to get out.. I guess that could be somehow interpreted in a way in which I appear as dangerous :/.
After reading your comment on sleep and researching it, I've decided I'll try to get 8+, hopefully 9 most nights.
Also, about OCD: I do still have weak obsessions, and desires to act on them (do a ritual), but they (the obsessions) are at a point where I can easily (most of the time) resist them. Most of the progress was made in my last 2 months in hospital, I think it was primarily driven by me wanting to get the hell out of there (gets pretty repetitious, after some time). After I've posted this, I plan on researching the alternative medications you mention.

Answers to questions:

I have had mild OCD symptoms for as long as I can remember, but when I was 14 they become a whole lot worse (Fueled by the uncleanliness of highschool, I think.
As for the symptoms I'm experience now, I've experienced these since I left the hospital, and they've been gradually getting worse for the year that has passed since then.
I should note that I have since then lowered my dose of fluoxetine from 60mg to 20mg.

Main thing that has helped with OCD was my determination, and antipsychotics worked really well at suppressing the symptoms.
So far nothing has improved the depression symptoms that I now have. But I haven't done a whole lot to combat this, I also haven't mentioned it to any medical/psychologist person (don't really want to).

I'm Male.

The only medical disorder I have been diagnosed with (not including self diagnosis) is the psychiatric disorder OCD.
My last blood test was 2 and a half weeks ago, the results were fine apparently (they tested for the usual stuff, plus prolactin levels because I used to be on rispiredone).
I am 5'11" tall, and weight around 94Kg.

I don't do much intense physical activity, but I do most days go for a walk (around 2km distance). I was up until recently going to the gym 2 times a week as well.

I'm an unemployed Highschool student, and I spend all day on premises at school.

I do now have any pain problems.

My appetite is normal, imo. I eat similar food, and portions to most other healthy (in appearance) kids my age at school.
I don't have any particular craving.

I haven't suffered from any major stressing events.

I haven't tried any pharmacological treatments.

There is no history (that I'm aware of) of mental illness in my family.

I haven't tried any psychosoical/ behavioural interventions.
No thoughts of suicide, or self harm.

my psychomotor activity is normal, unless I'm very tired.

I describe my anxiety as obsessive (phobic).

Substances: does alcohol counts? if so, then yes... it gives me temporary euphoria, when I'm down. There's not an addiction.

I'm normally on my computer programming, or learning stuff until I'm too tired to continue (11pm~).

When I go to bed I get rid of any light, even from chargers, or alarms, or watches... I can't sleep well if there's any of this.

socially inappropriate times when I've fallen asleep: In class on my desk (once this year).

I do not sleep walk, or do anything else abnormal in bed.

Completed the sleepiness test and got a result of 7.

Thanks :D

[Tom_]

Good news is...no primary sleep disorder by the look of things - certainly not surprising.

The small amount of sleep may be all that you need although its an hour and a half less than I would expect someone your age to be getting.

The most important thing I can recommend for this is sleep hygine. You have actually already started - removing annoying ticking stuff out of your room. Your bed shouldn't be used for anything more than to sleep and have sex (if you are lucky enough to be getting any) - that means not using your laptop/computer in your bed under any circamstances, preferably not in your room. Your room needs to be as comptable as possible (no or as little light as humanly possible), quite, nice temprature etc...

You should go to bed when you feel tired, the only things you should be doing are the Masonic secret self handshake and relaxing in bed. If you aren't asleep after 30 minutes get out of bed and go do something until you are tired, before retuning to bed. rince and repeat.

Other than that, I would recommend your doctor switches you to Sertraline or ups the dose to 30/40mg and you tell your doctor about the symptoms - don't stress the mildness. Let them do there own assessment and answer the questions as you have to me/truthfully - if your depression is like this they wouldn't dream of admitting you.

Getting out and doing stuff is important - maybe start playing a sport.

If you wont do CBT with your psychologist (although there is no reason he can't help - but I really do understand what you mean) buy a book on the subject or use moodGYM. Getting into mindfulness and meditation (doesn't have be very long - can start at 10 mins a day) can be really helpful.

[socialpiranha]

Tom's suggestions are very thorough so not much i can add, except maybe if you could list the top five things that bother you about your life, I.e (physical appearance, social life, unanswered existential questions, family or relationships problems, or whatever they might be)

Also phobias, whether its germs or what have you. If you could post the thoughts you have when your obsessing this could really help me/us get a better picture of the underlying problem(if there is one). phobias are often just healthy survival thoughts wrongly associated unconsciously, the problem is the brain likes to keep the associations unconscious to retain homeostasis, so you might not see them.

Lastly i would recommend against everything in that stack, none of them are actually supportive for optimal function other than vitamins and possibly efa's which you get in decent food anyway.

Your symptoms are fairly minor and most likely result from boredom and lack of exercise. Society is sort of geared to make people bored, scared and apathetic . Nobody designed it that way, its just sort of the best way to tame the primal instincts. Find something worth dying/living for and persue it and your phobias and depressive thoughts will be no more than a slight distraction if anything.