Posted by Dave001 on August 22, 2004, at 21:33:47
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI--DAVE, posted by alesta on August 21, 2004, at 17:32:26
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> Hi, dave, :)
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> good to hear from you! Excellent job! There is so much quality information in your post that I still need to sort through. I was looking for which medications they were using in the study, but didn’t see them; guess I didn’t look hard enough.:) I checked on mirapex and it didn’t look that great from a side-effect point-of-view (e.g. hair loss!) lexapro, I don’t know too much about. I’m definitely going to check on that.
>It certainly does seem like a lot of people have difficulty tolerating the side-effects from Mirapex. I'm even having second thoughts. I may try Amantadine or another dopaminergic before Mirapex. I sure wish amineptine were available.
> Question: you said you wanted to quit Dexedrine due to neurotoxicity. Do you feel that all stimulants are neurotoxic? I ask because I am considering augmenting prozac with low-dose Ritalin for dopamine and to combat the ssri-related fatigue.
>Unfortunately, we have no well-controlled, long-term studies evaluating the potential neurotoxicity of amphetamines or methylphenidate in humans, so it would be presumptuous of me to say that either one is toxic in humans at any specific dose range. They have been used for many years by a lot of patients, especially those with narcolepsy, and I don't believe there have been any overt manifestations of neurological damage linked to them. Whether either of them are likely to induce subtle, cognitive deficits from chronic use at doses consistent with their use in medicine is anyone's guess. The oft cited maxim, "the dose makes the poison," is no doubt applicable here. So the real question is "at which dose does *x* become toxic?" And the answer to that no doubt depends on a lot of factors and varies from person to person. From my reading of the scientific literature that we do have available on the subject (again, all based on animal studies), I'm inclined to believe that Ritalin is probably less toxic than Dexedrine at equipotent doses. However, two things to bear in mind: 1) That still doesn't mean either are toxic at typical doses used in medicine, and 2) I could be wrong.
Here is one abstract that supports this view:
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Brain Res. 1997 Aug 29;767(1):172-5.Methylphenidate and brain dopamine neurotoxicity.
Yuan J, McCann U, Ricaurte G.
Department of Neurology, Johns Hopkins Medical Institutions, Baltimore, MD 21224, USA.
To further evaluate the dopamine (DA) neurotoxic potential of the widely prescribed psychostimulant, methylphenidate, mice were treated with various doses (range: 10-120 mg/kg) and treatment schedules of methylphenidate (every 2 h x 4 or twice daily x 4). Higher doses of methylphenidate produced intense stereotypy, as well as short- (5-day), but not long- (2-week), term depletions of striatal DA axonal markers. By contrast, amphetamine caused not only intense stereotypy, but also profound, long-lasting, dose-related DA deficits. These findings indicate that results of studies of amphetamine neurotoxicity using short (5-day) post-drug survival periods are potentially misleading. Further, the present findings confirm and extend previous results indicating that methylphenidate, unlike amphetamine, lacks DA neurotoxic potential, and strongly suggest that DA efflux, although perhaps necessary, is not sufficient for the expression of amphetamine-induced DA neurotoxicity.
PMID: 9365033
---------------------------------------------For what it's worth, I really wouldn't worry about adding Ritalin to augment your current approach. In fact, I'm going to try switching from Dexedrine to Focalin (dexmethylphenidate -- a stereoisomer of Ritalin), rather than ceasing stimulant use altogether.
> Thank you again for your wealth of pertinent information. You’re really helpful.:)
>You're more than welcome, Amy. In fact, you've helped me rethink some aspects of my own treatment (particularly WRT Mirapex, which is really a coin toss at this point), so I ought to be thanking you really.
Be sure to keep me posted on your progress, and good luck!
Dave
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poster:Dave001
thread:378302
URL: http://www.dr-bob.org/babble/20040821/msgs/381044.html