Posted by med_empowered on August 14, 2005, at 13:21:28
In reply to Is psychosis the opposite of depression?, posted by pretty_paints on August 14, 2005, at 11:56:07
hey! The dopamine theory of psychosis is a little bit oversimplified and hasn't really been proven...its true that anti-psychotics all block some dopamine, especially at D2...but it also appears that some people with psychosis, especially schizophrenia, may often have *less* dopamine than the average person, which is now believed to be responsible for some of the "negative" symptoms associated with schizophrenia...its why Abilify is so popular (theoretically, it could "adjust" dopamine levels, upwards or downwards, as needed). Anyway, psychotic depression is also a tricky condition. Usually, it indicates either that someone currently has bipolar disorder, and they are now in an extremely depressed state OR it can indicate that someone with no bipolar history may well develop a bipolar disorder after the psychotic depression resolves...there are also some people who remain unipolar depressives, but after a psychotic episode the odds of severe, recurrent depression jumps considerably. Anyway, standard therapy for psychotic depression used to be an old-school antipsychotic and a Tricyclic antidepressant, with ECT and possibly add-on meds, such as Lithium, if needed. Interestingly, unlike in schizophrenia, stimulants have a place in treating psychotic depression; some doctors have tried a antidepressant+mood-stabilizer and/or antipsychotic+ stimulant (especially Ritalin) combo with a bit more success than combos not using a stimulant. These days, the treatment is usually a newer antidepressant, an atypical antipsychotic, and then any as-needed meds...especially things for anxiety and sleep. Also, there's some indication that the psychosis in depression isn't dopamine related; it may be related to a huge surge in cortisol levels....that's why there have been some studies using RU-486, the medication used to chemically-induce early-term abortions, as a treatment for psychotic depression...it dramatically lowers cortisol levels immediately. The results have apparently been impressive....this sort of treatment would have obvious advantages over using an antipsychotic and/or ECT.
poster:med_empowered
thread:541507
URL: http://www.dr-bob.org/babble/20050811/msgs/541536.html