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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by blueberry on December 4, 2005, at 15:23:37
My symptoms are apathetic anhedonic depression. Antidepressants keep me an inch above the suicidal range or make me worse. I respond real well to dopamine enhancers, but alas, only for a very short time. Ritalin, adderall, the little bit of dopamine reuptake in zoloft, cymbalta, or wellbutrin, only provides benefits for a couple days before tolerance sets in. Same with amisulpride. Probably the most effective might be ritalin or adderall, but I know where that road leads...tolerance, increased doses, increased side effects, eventual ineffectiveness.
So I'm wondering...amantadine, pramipexole, bromocriptine. If..and I understand that is a big if...a dopamine agonist works for someone, would it keep working for a long time? Or would it poop out quickly like other dopamine meds?
Any thoughts?
Posted by linkadge on December 4, 2005, at 18:10:16
In reply to Tell me about dopamine agonists for depression, posted by blueberry on December 4, 2005, at 15:23:37
I don't know how well they work on their own. Some studies show effectiveness when they are combined with other drugs.
They are not mood brighteners, I don't think, but they may tackel some aspects of depression.
I always thought a combination of the serotonin agonist buspar, plus a dopamine agonist would be interesting.
Linkadge
Posted by lunesta on December 4, 2005, at 18:26:42
In reply to Re: Tell me about dopamine agonists for depression, posted by linkadge on December 4, 2005, at 18:10:16
you may want to look into higher dose provigil, works as a dopamine enhancer. Dopamine is linked to endorphins, so you might want to look into endorpin enhancers. Do you respond well to opiates? If so, your dopamine problems could be related to low endorphins. low dose naltrexone could be of some help there.
Posted by med_empowered on December 5, 2005, at 6:51:40
In reply to Re: Tell me about dopamine agonists for depression, posted by linkadge on December 4, 2005, at 18:10:16
my take on the situation is the same as linkadges--used alone, you probably wont see much (or any) mood-lifting effect. In combo with other drugs, you may see a response--perhaps turning a partial response into a more robust one, or non-response into a noticeable, significant one. I think Provigil could be interesting; it might also be worthwhile to go with something that doesn't do your usual serotonin reuptake inhibition...maybe Surmontil? Stablon (I dont know where you live..this may or may not be an option)? Buspar+antidepressant of choice+dopamine agonist might be cool. It would seem that low-dose Abilify plus an antidepressant could do some dopamine agonism that could be pretty significant.
Also...have you tried sleep deprivation? I dont know if its appropriate for you, but you might want to talk to a doc about it...*some* people get very nice results; the problem is maintaining them....I imagine an experienced doc could work out a med plan that would help maintain your results. Some surprising meds have action on dopamine...Trileptal, for instance, may have an antidepressant action due in part to some sort of dopamine-enhancing activity. Another poster mentioned opiates...that might be worth pursuing. Ultram, Temgesic, and others have proven useful in some cases of depression; some of it may have to do with the usual (ex: Ultram inhibits reuptake of some neurotransmitters), but some of it is probably due to as-yet unknown actions specific to the opiates.
Good luck!
Posted by Meri-Tuuli on December 5, 2005, at 10:46:56
In reply to Re: Tell me about dopamine agonists for depression, posted by med_empowered on December 5, 2005, at 6:51:40
Hey folks,
Can someone tell me what an agonist is? Whats the difference between an antagonist and agonist? I'm trying to get myself educated!! I understand what reuptake inhibitators do, but not the others.
Thanks!
Meri
Posted by TenMan on December 5, 2005, at 10:58:35
In reply to Tell me about dopamine agonists for depression, posted by blueberry on December 4, 2005, at 15:23:37
There is a study on PubMed that shows bromocriptine producing a clinically significant antidepressant effect all by itself. I can personally vouch for this as bromocriptine at 5mgs. in the morning every day did work well for me as an antidepressant but I could not tolerate the side effects which were mainly a terrible stuffy nose and somnolence. I am doing well now on a combination of selegiline and forskolin.
Hope that helps.
Posted by Schess81 on December 5, 2005, at 11:14:16
In reply to Re: Tell me about dopamine agonists for depression, posted by Meri-Tuuli on December 5, 2005, at 10:46:56
an agonist is a drug that facilitates the effects or action of a certain neurotransmitter, while an antagonist drug inhibits a neurotransmitters effects.
Posted by blueberry on December 5, 2005, at 14:13:12
In reply to Tell me about dopamine agonists for depression, posted by blueberry on December 4, 2005, at 15:23:37
Thank you all for your posts. Interesting stuff.
Yeah, if I used a dopamine agonist it would be in combo with an ssri.
The opioid connection is interesting. Buspar is out...increases tinnitus unbelievable.
The mention of Stablon was especially interesting. I feel the best shortly after I decrease a dose of an antidepressant, but it only lasts a couple days. Pretty predictable pattern though. It's like an ssri is a dam that produces a large stationary pool of neuros, but with little flow...drop the dose and it's like opening up the dam a little bit creating some flow. Tianeptine could work that way. No prob getting a precription for it.
For now, just on day two of switching from lexapro which was aweful to zoloft, I'm kind of liking it. Zoloft feels more dopaminergic to me than serotonergic. We'll see where it goes.
Great ideas and I appreciate it. Thanks all.
Posted by Paulbwell on December 6, 2005, at 5:16:04
In reply to Re: Tell me about dopamine agonists...to all here, posted by blueberry on December 5, 2005, at 14:13:12
> Thank you all for your posts. Interesting stuff.
>
> Yeah, if I used a dopamine agonist it would be in combo with an ssri.
>
> The opioid connection is interesting. Buspar is out...increases tinnitus unbelievable.
>
> The mention of Stablon was especially interesting. I feel the best shortly after I decrease a dose of an antidepressant, but it only lasts a couple days. Pretty predictable pattern though. It's like an ssri is a dam that produces a large stationary pool of neuros, but with little flow...drop the dose and it's like opening up the dam a little bit creating some flow. Tianeptine could work that way. No prob getting a precription for it.
>
> For now, just on day two of switching from lexapro which was aweful to zoloft, I'm kind of liking it. Zoloft feels more dopaminergic to me than serotonergic. We'll see where it goes.
>
> Great ideas and I appreciate it. Thanks all.I am on Ritalin 80mgs +Nicotine+Caffeine, and find it very usefull, especially in the get up and go dept.
I just aborted a 2 week combo with Prozac as the SEs were intolerable, and it greatly lessoned the ADD/HD effects of the Ritalin, as MANY on SSRIs+stims report.
I seem to feel better with higher levels of Dopamine.
I hope to try Dextroamphetamine next, as it seems to be preferred by most adults.
Cheers
Posted by cache-monkey on December 6, 2005, at 21:31:14
In reply to Tell me about dopamine agonists for depression, posted by blueberry on December 4, 2005, at 15:23:37
I've also been thinking about a dopaminergic antidepressant. Based on what I've dug up (based on abstracts and people's posts here on pbabble), I haven't seen any reports on actual long-term efficacy for any of the drugs you mention. This could, however, be a matter of people not reporting back when something actually works. In any case, here's a summary of what I've gathered:
* Amantadine - Mostly studied as adjunctive for treatment-resistant depression, SSRI sexual dysfunction, and Zyprexa weight gain. I can't seem to find much in terms of its monotherapeutic antidepressant/anhedonic properties. Based on what I've read on pbabble, I think that most people find this somewhat of a dud as monotherapy, and a minority ended up feeling worse.
* Mirapex - The only one that has been really clinically studied (mostly for BP depression) out of the list you give. Some people on pbabble have reported a great initial response. For those who have posted about their long-term experience, most seem to report getting really tired after a while on the med. So this might be evidence of poop-out, but I'm wondering this is just a matter of who's reporting back.
* Bromocriptine - I've found at least one study indicating a strong AD profile for bromo monotherapy (it was = to imipramine). There are also some studies showing it beneficial for stopping smoking. (For me nicotine has been a way of self-medicating anhedonia, as well as anxiety.) I've read about a handful of people with postive reponses, but most (like TenMan) have gone off of it due to some side effect, usually rhinitis. I have no idea about long-term efficacy.
I've been running through the dopamine options with my pdoc, who I respect a lot. He was actually most hip about low-dose selegiline... (well, actually with the option of heading up to non-MAO-B-selective doses). Have you thought about that as an option? I know that patch is delayed until late Feb, but there's still the old-fashioned oral route.
The limiting side effect here seems to be insomnia, but this is dose dependent. I have read posts by a number of people who have stayed on selegiline at some dose that they could tolerate for quite a while, maintaining a positive response. Many have had to go up to higher standard-AD doses, but a few seem to get something positive out of the low MAO-B selective dose range.
I actually have a scrip for selegiline (up to 10 mg/day, which is pretty low) that I'm about to fill. I don't know if I'm going to start right away because I'm trying to adjust my benzo downward. But if/when I do, I will keep the group posted.
Good luck with your search for a dopaminergic. I'll look forward to reading about which direction you end up heading.
Best,
cache-monkey> My symptoms are apathetic anhedonic depression. Antidepressants keep me an inch above the suicidal range or make me worse. I respond real well to dopamine enhancers, but alas, only for a very short time. Ritalin, adderall, the little bit of dopamine reuptake in zoloft, cymbalta, or wellbutrin, only provides benefits for a couple days before tolerance sets in. Same with amisulpride. Probably the most effective might be ritalin or adderall, but I know where that road leads...tolerance, increased doses, increased side effects, eventual ineffectiveness.
>
> So I'm wondering...amantadine, pramipexole, bromocriptine. If..and I understand that is a big if...a dopamine agonist works for someone, would it keep working for a long time? Or would it poop out quickly like other dopamine meds?
>
> Any thoughts?
This is the end of the thread.
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