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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Chinaboy on March 27, 2015, at 23:22:02
I've read it somewhere that low dose antipsychotics increase dopamine. Is this true? How come? Aren't antipsychotics always inhibit some of the dopamines like D2 regardless of the dose?
a provincially renowned p-doc randomly threw me a script which says "5mg of Olanzapine+20mg of Prozac+300mg of Wellbutrine", when he knew that I've schizoid personality disorder. I dared not take it coz he appeared so careless.
Hi, everybody, what can you infer from this combo? Is it a rational one?
Posted by Chinaboy on March 28, 2015, at 4:28:13
In reply to Low dose antipsychotics increase dopamine?, posted by Chinaboy on March 27, 2015, at 23:22:02
Back to the question about if I'm schizoid or schizotypal, I think that p-doc might be actually refering to schizotypal as these two words have only one Chinese expression.( He once said "I just know you are different the moment you entered the door from your rigid facial expression.")
Yes, I'm a recluse, unemployed (coz work environment freaks me out), cannot socialize and show little interest in most of the social scenes, cannot organize myself well (like being unhygenic and caring little about it), still dependent on parents for lots of things, etc.
He thinks those are mainly symptoms mimicing negative psychotic symptoms and that there is a deficiency of dopamine in me, so he uses symbyax for that.
What do you guys think? I'm really expecting an answer from you guys coz this question has been bothering me for a long time, the answer to which will decide my future treatment combo. THank you again!
Posted by SLS on March 28, 2015, at 8:33:34
In reply to Low dose antipsychotics increase dopamine?, posted by Chinaboy on March 27, 2015, at 23:22:02
I'm not sure I agree with your conclusions regarding dopamine as being the primary site of pathology, but antpsychotics do increase the rate of manufacture and release of dopamine at synapses by blocking presynaptic autoreceptors. However, these same drugs block postsynaptic autoreceptors, which prevents the extra dopamine from increasing postsynaptic neural excitation.
There are a few antipsychotics that are preferential for presynaptic autoreceptors at low dosages. Drugs like amisulpride and sulpiride will increase dopamine activity at a low dosage and reduce it at high doaages.
Abilify is an interesting drug. As a partial DA receptor agonist, it seems to act as an antidepressant or antimanic / antipsychotic, depending on synaptic dopamine levels.
- Scott
Posted by linkadge on March 28, 2015, at 16:23:30
In reply to Re: Low dose antipsychotics increase dopamine? » Chinaboy, posted by SLS on March 28, 2015, at 8:33:34
Hi Chinaboy:
This seems like a bit of an overkill prescription if you are not currently on these meds.
For instance, it would seem reasonable to start with Prozac OR Wellbutrin first and see what happens. I would not add the others unless needed.
The logic here might be that Prozac and wellbutrin would be too stimulating and thus the olanzapine could help offset this.
As mentioned by SLS, olanzapine can increase dopamine release to some extent through blockade of dopamine receptors. Additionally, olanzapine blocks serotonin and acetylcholine receptors which can inhibit dopamine release. Lower doses may preferentially block 5-ht2a / 5-ht2c receptors which can increase dopamine release in certain brain regions.
Linkadge
Posted by rjlockhart37 on March 29, 2015, at 13:08:27
In reply to Re: Low dose antipsychotics increase dopamine?, posted by linkadge on March 28, 2015, at 16:23:30
i think some AP's reduce dopamine in certain regions of the brain that cause abnormalies in manic depressive disorders, yet it modifies it to make the mood a bit better, less irrtible thinking, and maybe it does slightly increase it in some sections even though most AP's are dopamine blockers.....
Posted by Christ_empowered on March 30, 2015, at 9:07:32
In reply to Low dose antipsychotics increase dopamine?, posted by Chinaboy on March 27, 2015, at 23:22:02
Low doses of some antipsychotics (even old ones, weirdly enough) can be somewhat stimulating. Problem is...that effect is often short-lived. Some people on amisulpride, for instance, notice that it kind of "poops out" after a while.
Anyway, the Prozac+Zyprexa combo (symbyax here in the US) has been studied, since it is/was patented. You can google it if you want..I think that at some doses it can increase dopamine concentration in some parts of the brain.
In the US, symbyax comes in several different combos/ratios, all the way up to 12/50 (12 zyprexa, 50 Prozac). The lower doses are comparable to what you've been prescribed...3/25 or something like that.
Anyway, varying doses of neuroleptics can be used with more stimulating AD drugs for a while to keep people from freaking out. They can also be used w/ psychotic depression for a time and then tapered when the psychosis and agitation subside. So....my best guess is that with both wellbutrin AND Prozac on board, the zyprexa will, if nothing else, keep you calm(er) while you adjust to the meds (which, btw, are full dose...I guess your doc doesn't do slow titration?).
I'd do a drug interactions check if you're worried. I go to community health and to save time and money, they'll pull stuff like your doc did...put somebody on a little cocktail w/ full dose meds right off the bat, then its "see you in 8-12 weeks!," and they're done. I just find it a bit unusual that a private practice doc would do that, but...whatever.
Good luck!
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