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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 12 of 12. This is the beginning of the thread.
Posted by jerrympls on January 20, 2004, at 21:29:24
HI all-
After 13 years of SSRIs, tricyclics, ECT, VNS, etc,etc - I'm convinced that it's my dopamine system that is out of whack - not my serotonin system. I always get a partial repsonse to all the AD's. When a stimulant is added I'm much much better. Even opiates - after researching I found out they interact with the dopamine system. When I have been on an opiate, I'm creative, motivated, listen to music, etc....same with a stimulant.
Problem with stimulants is there's too much ups and downs and edginess....problem with opiates is when they wear off I get more depressed...
So, what out there can help augment a traditional AD (I'm on effexor XR now) to stimulate my dopamine system? I've heard of Mirapex - is there anything else?Thanks in advance!
Jerry
Posted by Karen Moore on January 20, 2004, at 22:51:23
In reply to Dopamine system out of whack?, posted by jerrympls on January 20, 2004, at 21:29:24
Jerry,
Have you tried MAOI's? Parnate seems to be the most dopaminergic. I also have the same suspicion about my own "atypical" treatment resistant depression being dopamine based. I feel terrible on serotonergics and only feel better with stimulants. Right now I'm getting by on Adderall but I have to alternate days, 3 on 2 off, because by day three my blood pressure drops and I feel absolutely wasted. But at least I have 2 or 3 days a week when I can function.
Endocrine abnormalities can also effect dopamine, if you haven't already gone down that route...
I'm also very curious about the opiates, which one's have you tried?
KM
Posted by jerrympls on January 20, 2004, at 23:21:03
In reply to Dopamine system out of whack? » jerrympls, posted by Karen Moore on January 20, 2004, at 22:51:23
> Jerry,
> Have you tried MAOI's? Parnate seems to be the most dopaminergic. I also have the same suspicion about my own "atypical" treatment resistant depression being dopamine based. I feel terrible on serotonergics and only feel better with stimulants. Right now I'm getting by on Adderall but I have to alternate days, 3 on 2 off, because by day three my blood pressure drops and I feel absolutely wasted. But at least I have 2 or 3 days a week when I can function.
> Endocrine abnormalities can also effect dopamine, if you haven't already gone down that route...
> I'm also very curious about the opiates, which one's have you tried?
> KMHello!
Yes, I've been on Nardil and it worked really well for about a month - but then everything went downhill and the side effects were horrible. I've also had a full endocrine work-up. As far as opiates - I've only been on hydrocodone and Propoxyphene. I was on Dilauded for about a week in the hospital during a bout of encephalitis and was given a short supply of Percocet (oxycontin) after being released.
Recently my pdoc agreed to put me on Vicodin (hydrocodone) 4 tabs/day. However, it was causing anxiety more than anything - which is odd because it has always gotten me out of the most severe depressions. I stopped it for a while and now it's working a little. I've heard a little about bromocriptine and buphenorine - but I am unsure my doc will want to try those...
I'm just at the end of my rope with SSRIs/SNRIs...it's my dopamine system I'm sure of. I'm so apathetic, lethargic and without pleasure it's killing me...I see my doc on Thursday so we'll see...
Posted by Karen Moore on January 20, 2004, at 23:49:18
In reply to Re: Dopamine system out of whack? » Karen Moore, posted by jerrympls on January 20, 2004, at 23:21:03
Well, hang in there, there are many options to try. I've tried over 30 meds in the last two years but I still haven't lost my determination to find something that will harness this monster.
Depending on which side-effects you had with the Nardil you might still want to consider giving Parnate a shot. I know the diet can be a pain in the arse but it's much easier to adapt to than depression. It was the first drug that pulled me out of my most severe bout, it took some heavy convincing to get me to try anything at that point, my depression was so wretched. So, though I couldn't stay on it, I am particularly fond of it.
Best of luck,
K.
P.S. I'm heading to Denver next week to see a researcher/pdoc who specializes in treatment resistance. If I find out anything more relating to the dopamine issues I'll let you know.
Also, I don't know how much you like doing research online but there are some decent resources out there. Let me know if you want any direct links.
Posted by epiphany on January 21, 2004, at 3:43:15
In reply to Dopamine system out of whack?, posted by jerrympls on January 20, 2004, at 21:29:24
Have you tried one of the newer antipsychotics taken at low dose? They sometimes help people with those symptoms of apathy, anhedonia. A lot of people here like Amisulpride. Zyprexa or Abilify can be good too if you are unable to obtain Amisulpride. I know they have an effect on dopamine, but I am not one to explain how or why. I'm sure you could find a lot of information about it on a search here.
Here is a pubmed article on Amisulpride used for depression, just to give you an idea.
Hope this helps
Posted by scott-d-o on January 21, 2004, at 4:35:36
In reply to Re: Dopamine system out of whack?, posted by epiphany on January 21, 2004, at 3:43:15
> Have you tried one of the newer antipsychotics taken at low dose? They sometimes help people with those symptoms of apathy, anhedonia. A lot of people here like Amisulpride. Zyprexa or Abilify can be good too if you are unable to obtain Amisulpride. I know they have an effect on dopamine, but I am not one to explain how or why. I'm sure you could find a lot of information about it on a search here.
>
> Here is a pubmed article on Amisulpride used for depression, just to give you an idea.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12685917&dopt=Abstract
>
> Hope this helps
>Okay, I recently wrote a long post explaining the neurological difference between high and low dose amisulpride and it should apply to most antipsychotics as well. The post seemed to go unnoticed for the most part, so I will provide the link here:
http://www.dr-bob.org/babble/20040109/msgs/300303.html
Also, to the original poster who was complaining of the "ups and downs" of stimulants, I am wondering if you tried the extended-release formulations (Adderall XR, Concerta, etc.), or if you had only tried the immediate-release versions of stimulants?
I have dysthymic depression and have also been unresponsive to all the common antidepressants. Over the past two weeks I have trialed both Adderall and Ritalin and seemed to have a very positive response to Ritalin. The Adderall improved my focus, however, I still felt fatigued and unmotivated. I think this is because of amphetamines action at the dopamine transporter where it actually causes it to reverse its action and transport dopamine out of the presynaptic neuron, as opposed to Ritalin which just blocks the dopamine transporter altogether, preventing the reuptake of dopamine back into the neuron.
I plan to switch to the extended-release formulation of Ritalin, Concerta, starting next week. I also had a positive response to low-dose sulpiride, however it doesn't seem to work well in conjunction with a stimulant and seems to block much of their effects. I think I need the stimulant since I have comorbid inattentive ADD and the sulpiride just doesn't get it done in that area.
I am wondering if anyone who has had a positive response to Ritalin has tried Concerta and still could not deal with the come-downs?
scott
Posted by jerrympls on January 21, 2004, at 18:44:02
In reply to Re: Dopamine system out of whack?, posted by Karen Moore on January 20, 2004, at 23:49:18
> Well, hang in there, there are many options to try. I've tried over 30 meds in the last two years but I still haven't lost my determination to find something that will harness this monster.
> Depending on which side-effects you had with the Nardil you might still want to consider giving Parnate a shot. I know the diet can be a pain in the arse but it's much easier to adapt to than depression. It was the first drug that pulled me out of my most severe bout, it took some heavy convincing to get me to try anything at that point, my depression was so wretched. So, though I couldn't stay on it, I am particularly fond of it.
> Best of luck,
> K.
> P.S. I'm heading to Denver next week to see a researcher/pdoc who specializes in treatment resistance. If I find out anything more relating to the dopamine issues I'll let you know.
> Also, I don't know how much you like doing research online but there are some decent resources out there. Let me know if you want any direct links.Hi Karen!
I do research on the web all the time - so any direct links you can send me would be much appreciated. Feel free to email me directly at jerrympls@mn.rr.com. As for questions for the doc you will be seeing - I am most interested in the use of opiates and dopamine antagonists like Mirapex, etc.
As for Parnate - I guess that is an option. I'm not sure why my doc choose Nardil over that. He's actually a researcher himself and has delt with many treatment-resistant patients. Apparently he's had the most success with Nardil. Going off the Nardil was the most horrible experience in my life - I've never had such horrible withdrawl from any med - and we even did a slow taper. Oh well- that's a whole other post.
Anyway, thanks in advance for any info you can send my way!
Jerry
Posted by jerrympls on January 21, 2004, at 18:47:56
In reply to Re: Dopamine system out of whack?, posted by epiphany on January 21, 2004, at 3:43:15
> Have you tried one of the newer antipsychotics taken at low dose? They sometimes help people with those symptoms of apathy, anhedonia. A lot of people here like Amisulpride. Zyprexa or Abilify can be good too if you are unable to obtain Amisulpride. I know they have an effect on dopamine, but I am not one to explain how or why. I'm sure you could find a lot of information about it on a search here.
>
> Here is a pubmed article on Amisulpride used for depression, just to give you an idea.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12685917&dopt=Abstract
>
> Hope this helps
>Hi Epiphany
I'm on 200mg of Seroquel. It hasn't done much for my depression - I mainly take it for insomnia and it also helps a little with anxiety. BUt I think it actually makes me more lethargic. Thanks for the link tho!
Jerry
Posted by jerrympls on January 21, 2004, at 18:53:45
In reply to Re: Dopamine system out of whack?, posted by scott-d-o on January 21, 2004, at 4:35:36
> > Have you tried one of the newer antipsychotics taken at low dose? They sometimes help people with those symptoms of apathy, anhedonia. A lot of people here like Amisulpride. Zyprexa or Abilify can be good too if you are unable to obtain Amisulpride. I know they have an effect on dopamine, but I am not one to explain how or why. I'm sure you could find a lot of information about it on a search here.
> >
> > Here is a pubmed article on Amisulpride used for depression, just to give you an idea.
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12685917&dopt=Abstract
> >
> > Hope this helps
> >
>
> Okay, I recently wrote a long post explaining the neurological difference between high and low dose amisulpride and it should apply to most antipsychotics as well. The post seemed to go unnoticed for the most part, so I will provide the link here:
>
> http://www.dr-bob.org/babble/20040109/msgs/300303.html
>
> Also, to the original poster who was complaining of the "ups and downs" of stimulants, I am wondering if you tried the extended-release formulations (Adderall XR, Concerta, etc.), or if you had only tried the immediate-release versions of stimulants?
>
> I have dysthymic depression and have also been unresponsive to all the common antidepressants. Over the past two weeks I have trialed both Adderall and Ritalin and seemed to have a very positive response to Ritalin. The Adderall improved my focus, however, I still felt fatigued and unmotivated. I think this is because of amphetamines action at the dopamine transporter where it actually causes it to reverse its action and transport dopamine out of the presynaptic neuron, as opposed to Ritalin which just blocks the dopamine transporter altogether, preventing the reuptake of dopamine back into the neuron.
>
> I plan to switch to the extended-release formulation of Ritalin, Concerta, starting next week. I also had a positive response to low-dose sulpiride, however it doesn't seem to work well in conjunction with a stimulant and seems to block much of their effects. I think I need the stimulant since I have comorbid inattentive ADD and the sulpiride just doesn't get it done in that area.
>
> I am wondering if anyone who has had a positive response to Ritalin has tried Concerta and still could not deal with the come-downs?
>
> scottHey Scott
I've been on immediate release Ritalin (each dose only lasted a couple hours) and the SR version (wasn't much difference compared to the immediate release). I've also been on Adderall immediate release - which wasn't too bad but still ups and downs AND it eventually made me more apathetic even tho it helped with concentration - so it's interesting you bring up the differences between the mechanisms of action and the dopamine transport system! The Dexedrine Spansules (extended release) have always worked well. I've wanted to try Concerta because I've heard it lasts all day and doesn't give you so much of a "crash." I hope you share your experiences if you eventually go on it!
Thanks for your reply!
Jerryy
Posted by scott-d-o on January 21, 2004, at 21:15:49
In reply to Re: Dopamine system out of whack? » scott-d-o, posted by jerrympls on January 21, 2004, at 18:53:45
>
> Hey Scott
>
> I've been on immediate release Ritalin (each dose only lasted a couple hours) and the SR version (wasn't much difference compared to the immediate release). I've also been on Adderall immediate release - which wasn't too bad but still ups and downs AND it eventually made me more apathetic even tho it helped with concentration - so it's interesting you bring up the differences between the mechanisms of action and the dopamine transport system! The Dexedrine Spansules (extended release) have always worked well. I've wanted to try Concerta because I've heard it lasts all day and doesn't give you so much of a "crash." I hope you share your experiences if you eventually go on it!
>
> Thanks for your reply!
>
> JerryyI have heard that Ritalin SR doesn't last much longer than the immediate release version, which only lasts about 3 hours for me. Adderall immediate-release lasted a bit longer for me, maybe like 5 hours. I am hopeful that Concerta will be the ultimate solution for me; it lasts for about 12 hours.
The pharmacokinetics of Concerta look very promising. It reaches it's peak plasma concentration 6.8 hrs after dosing. If you are interested you can go to this link:
http://www.fda.gov/cder/foi/nda/2000/21-121_Concerta_prntlbl.pdf
Scroll down to page 4 to see a graph of Concerta 18mg vs. Ritalin 5mg TID (4 hrs between doses). Notice how much smoother the Concerta line is in comparison; the Concerta line looks like a bell curve, while the Ritalin IR line is all over the place. Not to mention the convienence of not having to carry your meds w/you all the time.
I should be starting on the med next Monday, most likely starting at 18mg.. I'll let you know how it goes.
scott
Posted by Karen Moore on January 24, 2004, at 20:36:42
In reply to Re: Dopamine system out of whack? » Karen Moore, posted by jerrympls on January 21, 2004, at 18:44:02
Jerry,
One other reason to try Parnate: it's metabolized differently from Nardil...
When I get frustrated and feel like I've run out of options I usually find something new to research and try at http://www.biopsychiatry.com. Specifically for dopamine, start at: http://www.biopsychiatry.com/dopaug.htm
Then I surf the links for new ideas/strategies. Careful though, I've noticed that some of the abstracts are pretty old. Also, as a site they have an interesting (I find it very amusing) agenda...
Hope this is helpful. I'll keep you in mind if I find any other sites for dopamine...chrs,
km
Posted by Shane M on January 27, 2004, at 1:33:50
In reply to Re: Dopamine system out of whack? » Karen Moore, posted by jerrympls on January 20, 2004, at 23:21:03
Hi Jerry,
I have the same symptoms as you, apathy, anhedonia, no feelings of pleasure ect.. You are on the right track with dopamine being the chemical you need to focus on, with a little having to do with norepinephrine as well. I achieved full remission while taking 300mg Effexor XR and the antipsychotic Geodon 40mg and Buspar 10mg. This worked great and I had my life back until one day I was around some marijuana smoke, and the Geodon stopped working. I would definately give it a shot, just watch your surroundings!
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