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Not Quite Depression?
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moskierko posted:
Hello All,

I'd first like to thank you for reading my post. This may be pretty long but I have not been able to get anything out of MY doctor that has helped. I've been patient, followed their directions and did what I was told.

I have a bit of a problem with overall "happiness," "desire," and "productivity." Even since about half way through college I would consider myself in an "enjoyment rut." I do still get pleasure out of life, but in general it is very rare for me to look forward to things, find something that just grabs my attention even for a little while, and find the motivation to do anything whole heartedly. Most of the time I feel like "this is just what I'm supposed to do." Granted, I do a good job at work, I play with my daughter (2 yrs) and I do things with my wife; just not like I used to.

I remember when I got my first computer (it was about 10 years ago.) I would do so many things with it. I would play games and become engrosed in them yet not to the point where it was an obsession. I would surf just to find random things that interested me and then study and learn about those things. In the first three years I taught myself graphic design, programming in a dozen languages, very specific details about the inner workings of my computer TONS of stuff. I used to spend hours a week just tweaking systems, devices, getting everything out of my computer that I could. This is just an example, I also did the same with playing trombone, relationships with girlfriends, my car, etc. the point is I had PASSION for something that lasted more than 5 minutes!

Now to the exact question. During college and subsequent years I have talked to medical professionals about this issue. I've taken the written tests and they say I am borderline depressed. I've taken a number of antidepressants such as Welbutrin, Effexor, Zoloft (sorry for the misspellings.) I did not see much difference with these antidepressants except with the zoloft. In fact, the world was GREAT, everything would "work it way out"... don't worry about studying because "i've got this covered"... it made me lazy and a procrastinator because the world was great and there was always a backup plan kind of thing... I failed Chemistry that semester miserably due to the fact that a 10 minute review 10 minutes prior to the final would be "more than enough"... so I thought. I've even tried a medication for Adult ADHD strattera which helped a little with a very low dose, the introductory week dose, but as the dose went higher the side effects became worse and the "help" stayed at the same "sort of helped" level. I became edgy, jittery, couldn't sit still type thing. (The tests for ADHD typically put me in the upper category in severity)

The two things that actually do what I need (and I hate to admit this) is cocaine and hydrocodone. I do not use elicit drugs, even "recreationally", but the couple times I did back in college I remember how productive, sociable, and down right happy I was with life. I enjoyed studying and learning again, I was truely excited about something, whether it was playing on the computer, studying, or hanging out. I would use some, then leave the party to do something "i've been meaning to do and have been putting off way to long." The problem with cocaine is it's just as harmful as helpful, illegal, and WAY TO MUCH! The Hydrocodone is the best example of the help that I need. Most people say it makes them sleepy or the equivalent of a potato on the couch. Not for me, it makes me interested, eager, productive, and it feels like it brings me OUT of my slump or rut.

What does hydrocodone do that it makes me feel this way? Is there a 'none liver destroying' alternative that I can use on a regular basis? Perhaps a class of antidepressants or ADHD medications that act similar to hydrocodone?
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Betty Ford Center
Sean Barlow, MD responded:
You ask why hydrocodone makes you feel goal-directed and productive. Many people have that response to opioids, i.e. hydrocodone, but some don't. The easiest answer is that it affects many areas of the brain but specifically the pleasure center. Hence the dramatic change in your life perception/motivation. However, over time, tolerance often develops, possibly leading to higher doses and misuse/abuse of the medication.
In response to your second question: Hydrocodone itself doesn't cause liver problems, but the Tylenol often combined with it does, with prolonged and/or high dose usage.
There are no antidepressants that work like opioids do, i.e. on specific opioid receptors, and conversely there are no opioids that work as clear antidepressants. If you do have ADHD, there are medications similar to cocaine - such as methylphenidate (Ritalin) and amphetamine (Adderall) — that are used to treat this condition. If a person does not have a substance use disorder and does have ADHD, these are medications your physician might consider. It is possible for some people with low-grade depression from ADHD to feel improvement of mood/motivation with these medications.
That being said, if your mood is unrelated to ADHD and you have a low-grade depression, other medications might help if you work with a psychiatrist. However, other treatments can also help and should not be forgotten, including psychotherapy, exercise and various forms of meditation/relaxation therapy.
 
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donniecarvin; replied to Sean Barlow, MD's response:
I am in a very similar situation. My doctor has diagnosed me with depression, but I feel that this is incorrect. My wife is currently taking hydrocodone for a back injury. I am constantly sneaking pills to help me feel productive and creative. I also take adipex and provigil which provide me with the energy and interest that I desire. I also aquire Adderall and Vivance whenever I can find them. Without this added stimulation, I feel constantly tired and lack the desire to complete even the smallest of daily tasts. I would be extremely interested in how to find the correct diagnosis of my problem as my doctor refuses to listen to me and keeps insisting that I have depression. Any advice would be greatly appreciated.

carvin.don@hotmail.com
 
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Betty Ford Center
Sean Barlow, MD replied to donniecarvin;'s response:
Given your symptoms and reaction to the medications, I would recommend the following. If you haven't already done so, you should get a thorough physical exam and labs as your family doctor feels are appropriate. If this finds you to be without evidence of a cause for your fatigue/apathy, then an evaluation by a psychiatrist experienced in the ways of depression, poor attention, and medications of potential misuse, i.e. an addiction psychiatrist, is probably warranted. If your doctor does not know of one, contacting the local county medical society should find you one.
Also a word of caution: The medications you report taking are strong medications that need a doctor's guidance. Also, obtaining scheduled medications (the ones you report taking) without a prescription from a properly licensed MD is a crime in the United States. I'm just throwing this out there so you don't find yourself in a worse situation.


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