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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 43. This is the beginning of the thread.
Posted by alesta on August 16, 2004, at 14:38:41
I really need some dopamine in my system. i'm starting to feel happy with the prozac, but i know i've got to replace the depleted dopamine (due to no motivation, anhedonia, etc.). i don't want to add wellbutrin because i suffer from anxiety and don't need anything anxiogenic. i really want to try l-theanine with it (it increases dopamine *and* GABA, the effect on serotonin is debatable). i just wonder if this is safe. i don't like not knowing how they will interact, and i can't find any info on this combo. does anyone know how these might interact or have any suggestions on how i can *safely* increase my dopamine levels with prozac besides adding wellbutrin? if not, and no one responds, that's ok, then i'll at least have closure and then can move on to parnate (or nardil + provigil) with certainty.
you can skip this part..just venting..(And I’m used to being on the prozac now, and like its prosocial aspects, it’s how I used to be, and don’t know what’s going to happen on the next drug, or when I go off this one. I don’t even know if I would’ve posted on this board if I hadn’t started the prozac. I don’t know...maybe I’ll be okay on the parnate...I don’t know why I’m freaking out.... I just needed to vent that. I have my rare negative moments.:))
amy
Posted by Sad Panda on August 16, 2004, at 22:51:12
In reply to Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by alesta on August 16, 2004, at 14:38:41
Hi Amy,
It's more likely that you need a NE boost. Nortriptyline or Desipramine would be good to add on, you would only need a tiny dose.
Cheers,
Panda.
Posted by KaraS on August 17, 2004, at 1:03:08
In reply to Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by alesta on August 16, 2004, at 14:38:41
You might want to post on the alternative board and ask Larry about l-theanine. He'll probaby know whether it's a good idea to take it with Prozac.
Posted by alesta on August 17, 2004, at 1:21:51
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin » alesta, posted by Sad Panda on August 16, 2004, at 22:51:12
Thanks, panda. Appreciate it. I really want to keep this as simple as possible on my body though, and replace the dopamine that the prozac has depleted, rather than try to compensate with norepinephrine. (I really don’t like the idea of having depleted dopamine levels.) I don’t know. I think I’ll just take the plunge and make the switch to parnate. Although I have to wait a couple months. Do you think I’ll still get as much of a serotonin boost on parnate as I do on prozac?
Thanks,
amy
Posted by alesta on August 17, 2004, at 1:26:43
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin » alesta, posted by KaraS on August 17, 2004, at 1:03:08
thank you, kara! great suggestion.
amy:)
Posted by Sad Panda on August 17, 2004, at 1:51:16
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin » Sad Panda, posted by alesta on August 17, 2004, at 1:21:51
Hi Amy,
Norepinephrine is the motivating one. Dopamine is the reward. Getting dopamine in a tablet is often seen as the Holy Grail, but it's a trap. If you get it in a pill, you end up with even less motivation to do things.
> Do you think I’ll still get as much of a serotonin boost on parnate as I do on prozac?
>Yes & it raises NE & Dopamine levels higher.
Cheers,
Panda.
Posted by alesta on August 17, 2004, at 2:00:57
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin » alesta, posted by Sad Panda on August 17, 2004, at 1:51:16
hey, panda,
interesting. why does supplementing with dopamine have the opposite effect? do you know of a web site that i can read about this? then why do people even bother taking wellbutrin, which boosts dopamine? sorry for all the questions. thank you.amy
Posted by alesta on August 17, 2004, at 2:03:28
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin » alesta, posted by Sad Panda on August 17, 2004, at 1:51:16
oops, sorry, i just realized that that is not what you said/meant. please disregard the last post.:)
amy
Posted by KaraS on August 17, 2004, at 6:03:56
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by alesta on August 17, 2004, at 2:03:28
I have read different things about the action of Wellbutrin. I had heard originally that it was dopaminergic but later started reading that it's action is more on norepinephrine and has a much smaller effect on dopamine. Is this the general consensus here?
Posted by alesta on August 17, 2004, at 7:04:08
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by KaraS on August 17, 2004, at 6:03:56
> I have read different things about the action of Wellbutrin. I had heard originally that it was dopaminergic but later started reading that it's action is more on norepinephrine and has a much smaller effect on dopamine. Is this the general consensus here?
kara,
i was trying to find that out myself. that's funny, the last source i read said that its action was much more on dopamine and that it had a smaller effect on norepinephrine, lol. go figure!! does anyone know?
amy :0)
Posted by SLS on August 17, 2004, at 7:04:16
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by KaraS on August 17, 2004, at 6:03:56
> I have read different things about the action of Wellbutrin. I had heard originally that it was dopaminergic but later started reading that it's action is more on norepinephrine and has a much smaller effect on dopamine. Is this the general consensus here?
I don't know. Generally, I have not considered Wellbutrin to be a directly acting dopaminergic drug. Although there is far from being a consensus on how it works, there was a period of time several years ago when the focus was on norepinephrine. Promoting NE activity probably does represent an important net effect.
Bromocriptine, Dexedrine, and nomifensine all produced significant, albeit transient antidepressant effects for me. All three are direct acting pro-dopaminergic drugs, with additional NE promoting effects to be found in the latter two. Wellbutrin consistently worsens my depression. If pro-dopaminergic activity was sufficient to improve my condition, the selective DA agonist bromocriptine would provide support for this and tend to call into question the significance of the DA properties of Wellbutrin.
On the other hand, Sheldon H. Preskorn, MD on his website, presents a thoughtful argument for why he believes that both NE and DA reuptake inhibition are significant contributors to its clinical effect.
http://www.preskorn.com/columns/0001.html
What might make for a more complete appraisal of the physiological effects of Wellbutrin would be to provide information as to where in the brain these effects dominate and the drug concentrates. Function is dependent on not only what happens, but where it happens. A little dopamine here, and you chase yourself around in circles; a little dopamine there, and you chase members of the opposite sex in straight lines.
- Scott
Posted by alesta on August 17, 2004, at 7:29:04
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by SLS on August 17, 2004, at 7:04:16
no wonder we don't know the answer. no one else does, either!:) so, scott, you agree with panda that dopaminergic drugs are not the answer in the long run? did wellbutrin even work for you in the beginning?
> A little dopamine here, and you chase yourself around in circles; a little dopamine there, and you chase members of the opposite sex in straight lines.
interesting way of putting it.:)amy
Posted by SLS on August 17, 2004, at 8:27:35
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by alesta on August 17, 2004, at 7:29:04
> no wonder we don't know the answer. no one else does, either!:)
I know. Somehow, I find this reassuring. If they did understand everything, AND STILL COULD NOT GET US WELL, we would be pretty much well doomed. It's that uncertainty that keeps hope alive for me.
> so, scott, you agree with panda that dopaminergic drugs are not the answer in the long run?
At this point in time, for the average sufferer of depression, I would say that I agree. Regulation of DA circuits might be one of the final pathways to remission, but it might be that it is those regulatory processes upstream that is necessary for long-term stable improvements. If you fine tune the inputs and interactions between the NE locus ceruleus and 5-HT raphe, perhaps you can re-regulate the activities of DA circuits in the mesolimbic cortex and watch depression disappear.
> did wellbutrin even work for you in the beginning?
No, not at all. I found nothing dopaminergic about it. But then again, a nosefull of cocaine did little for me when I experimented with it at my bachelor's party. It did do something positive, though. Or maybe it was the way the dancing girl... Never mind.
- Scott
Posted by alesta on August 17, 2004, at 9:24:39
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by SLS on August 17, 2004, at 8:27:35
thank you, scott! i appreciate it. take it easy with those bachelor parties......
amy :)
Posted by Emme on August 17, 2004, at 9:43:52
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by SLS on August 17, 2004, at 7:04:16
Hi Scott,
> A little dopamine here, and you chase yourself around in circles; a little dopamine there, and you chase members of the opposite sex in straight lines.
I'll be happy to be able to chase anything! :) Where do you find the time, energy, mental focus, to develop your knowledge of pharmacology? Impressive considering the severity of your depression.
Okay, got any thoughts? I had not thought about pursuing drugs with NE promoting effects. Maybe that would be helpful in keeping me motivated and out of sluggishness? Or would it make anxiety worse...? Wellbutrin was great when I first used it with Serzone. After a while that combo stopped working and I found Wellbutrin to be intolerably stimulating. A retrial didn't pan out - I couldn't control the stimulation and it didn't help depression. I can't tolerate Effexor.
BTW, aricept is probably out. My liver enzymes are a little elevated and my pdoc thinks that's the culprit. Now we're trying Mirapex. I think it's helping. I'm getting a little more done. But I'm still having a hard time having any optimistic thoughts like I had a few weeks back. It's probably worth continuing the Mirapex trial though.
But anyway, I'm wondering if I shouldn't ask my pdoc about a microdose of a tricyclic as mentioned above. I think she's leery of ADs since so many have pooped out on me, not helped, caused some cycling, or been intolerable. But I've never tried a tricyclc.
The L-theanine suggestion sounds interesting.
Sometimes I can't help but feel that we're feeling our way in the dark trying to match symptoms to neurotransmitters.
Emme
Posted by Sad Panda on August 17, 2004, at 9:58:20
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin, posted by alesta on August 17, 2004, at 2:00:57
> hey, panda,
> interesting. why does supplementing with dopamine have the opposite effect? do you know of a web site that i can read about this? then why do people even bother taking wellbutrin, which boosts dopamine? sorry for all the questions. thank you.
>
> amy
>Wellbutrin is one of the drugs that people really don't know how it works. It is an average NRI & a weak DRI, mg for mg I think Zoloft is a stronger DRI than Wellbutrin is. I have seen written somewhere(can't remember) that Wellbutrin is a nicotinic acetylcholine antagonist which is said to be the reason that you are twice as likely to quit smoking using Wellbutrin(as Zyban) than using nicotine gums & patches. It also may have activity at NMDA receptors.
Cheers,
Panda.
Posted by alesta on August 17, 2004, at 10:46:22
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbutrin » alesta, posted by Sad Panda on August 17, 2004, at 9:58:20
hi, panda,
thanks for the info. and it's nice to finally know how it helps smokers to quit. i wonder how it takes away the sexual side effects of SSRIs. (don't answer that <g>)
well, in conclusion:), i have decided not to augment the prozac. here's something interesting: linkadge told me that the lowering of the dopamine is part of the mechanism of action of the SSRIs, and that raising dopamine levels would probably make it less effective. strange. so maybe i could go with the norepinephrine-raising meds, but i don't know if that's a good idea, either. i think i'll just forget the augmentation for now. thanks for working through this with me. :0)
appreciate it,
amy
> > hey, panda,
> > interesting. why does supplementing with dopamine have the opposite effect? do you know of a web site that i can read about this? then why do people even bother taking wellbutrin, which boosts dopamine? sorry for all the questions. thank you.
> >
> > amy
> >
>
> Wellbutrin is one of the drugs that people really don't know how it works. It is an average NRI & a weak DRI, mg for mg I think Zoloft is a stronger DRI than Wellbutrin is. I have seen written somewhere(can't remember) that Wellbutrin is a nicotinic acetylcholine antagonist which is said to be the reason that you are twice as likely to quit smoking using Wellbutrin(as Zyban) than using nicotine gums & patches. It also may have activity at NMDA receptors.
>
> Cheers,
> Panda.
>
>
Posted by SLS on August 17, 2004, at 10:52:52
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbut » SLS, posted by Emme on August 17, 2004, at 9:43:52
> Where do you find the time, energy, mental focus, to develop your knowledge of pharmacology? Impressive considering the severity of your depression.
That's flattering.
Most of what I learned about psychopharmacology came during a 3 week burst in 1983 when I responded to a combination of Nardil + amitriptyline. (all the ipsilateral and contralateral stuff) Since then, I've enjoyed a handful of opportunities to be able to read, learn, and remember, but they are rare and short lived. For everything else, it is
POUND POUND POUND POUND POUND POUND POUND
with very little reward, but it is better than nothing. I feel so very, very, stupid. Reading anything is a difficult enough chore that it produces anticipitory anxiety at the mere thought of it.
Thanks for the ego boost.
:-)
- Scott
Posted by alesta on August 17, 2004, at 11:38:50
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI-Not Wellbut, posted by SLS on August 17, 2004, at 10:52:52
scott,
i can't believe you feel stupid. this is very upsetting to me (i am an empathetic person--feel others emotions *very* easily). and if there's little reward, why pursue it? you don't need to. you know plenty to help people on this board with the experiences you've already had with meds. it's your charm, your presence that people are drawn to. why not just pursue happiness instead? sorry--don't mean to tell you how to live your life--i can never stop being an amateur counselor. i think i've finally overstepped my bounds on this site....i think that rejection sensitivity is setting in right about now...be gentle, people....
amy
Posted by SLS on August 17, 2004, at 12:12:40
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI---SLS, posted by alesta on August 17, 2004, at 11:38:50
Hi Amy.
You have me smiling and enjoying the warm fuzzies that effervesce from your kind words.
Thanks.
:-)
- Scott
> scott,
>
> i can't believe you feel stupid. this is very upsetting to me (i am an empathetic person--feel others emotions *very* easily). and if there's little reward, why pursue it? you don't need to. you know plenty to help people on this board with the experiences you've already had with meds. it's your charm, your presence that people are drawn to. why not just pursue happiness instead? sorry--don't mean to tell you how to live your life--i can never stop being an amateur counselor. i think i've finally overstepped my bounds on this site....i think that rejection sensitivity is setting in right about now...be gentle, people....
>
> amy
>
>
Posted by alesta on August 17, 2004, at 12:29:26
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI---SLS » alesta, posted by SLS on August 17, 2004, at 12:12:40
your welcome, scott. same here. i loved that post!!! now *that* is interesting to read...
amy :)
> Hi Amy.
>
> You have me smiling and enjoying the warm fuzzies that effervesce from your kind words.
>
> Thanks.
>
> :-)
>
>
> - Scott
>
>
> > scott,
> >
> > i can't believe you feel stupid. this is very upsetting to me (i am an empathetic person--feel others emotions *very* easily). and if there's little reward, why pursue it? you don't need to. you know plenty to help people on this board with the experiences you've already had with meds. it's your charm, your presence that people are drawn to. why not just pursue happiness instead? sorry--don't mean to tell you how to live your life--i can never stop being an amateur counselor. i think i've finally overstepped my bounds on this site....i think that rejection sensitivity is setting in right about now...be gentle, people....
> >
> > amy
> >
> >
>
>
Posted by zeugma on August 17, 2004, at 14:15:50
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI---SLS, posted by alesta on August 17, 2004, at 12:29:26
hi all. last week, when i started Ritalin, and had combined it with about 50 mg Provigil, I had mydriasis (enlarged pupils). The last time I had this side effect was on Wellbutrin, which makes me think all three drugs are dopaminergic. LSD also had this effect, and I think it also affects dopamine function, although I am less familiar with its pharmacology (I know it also functions as a serotonin agonist).
About DA and depression, I really shouldn't say, as I know for sure that I have ADHD, and that is a dopaminergic disorder beyond doubt. Attempts to correlate noradrenergic function to ADHD via genetics have been politically driven and unsuccessful, while abnormalities in dopaminergic function have been established for some years now. But there is a link, I am convinced, between ADHD severity and depression. I used to think that the ADHD caused depression as a secondary matter, i.e. by producing multiple failures in school, socially, etc., leading finally to a reactive depression. I don't believe this any more, because I think that abnormalities of DA expression strain the balance of the other amines, and that if, e.g. the dopamine transporter is overexpressed, leading to a chronically low level of synaptic dopamine, one is going to be in a constant state of hypoarousal that the brain is going to try to compensate for somehow, and this could well lead to other amines becoming hyperfunctional to the point where they themselves break down and depression results.
I think a similar thing may happen on long-term SSRI therapy, but in reverse. The hyperfunction of the serotonin system causes the dopamine system to break down to some extent. I think that it is unfortunate that so many with comorbid ADHD are treated with SSRI's, as they appear capable of creating ADHD-like symptoms in those without the disorder.Btw, someone made a suggestion a while ago that AD poop-out was so frequent on SSRI's because of a mild serotonin syndrome induced by unnecessarily high dosages. Recovery from depression requires all aminergic systems to function properly, and doctors have become so fixated on serotonin that they have been utilizing the pharmacopeia very unwisely, in my opinion. This is especially unfortunate given that the official catecholinergic alternative since the TCA's and MAOI's have fallen from favor is Wellbutrin. In my experience and in the experience of those I know, it is an extremely unpredictable drug, has an ambiguous effect on symptoms, and appears far more prone than any other AD to induce serious allergic reactions.
Posted by jrbecker on August 17, 2004, at 21:14:26
In reply to Wellbutrin DA? and digression on ADHD, posted by zeugma on August 17, 2004, at 14:15:50
Combining a Dopamine Agonist and Selective Serotonin Reuptake Inhibitor for Treatment of Depression: A Double-Blind, Randomized Study
Posted by alesta on August 18, 2004, at 1:15:58
In reply to Re: Dopaminergic Drug/Supp to Aug SSRI, posted by jrbecker on August 17, 2004, at 21:14:26
jrbecker, you're a lifesaver! Wow. So now we’re back to square one. They are proposing that you *can* augment with something to raise dopamine levels and that it is a good idea to augment an ssri with a dopamine antagonist! so now we’re back to my original question. larry or chemist, i know this is a long series of posts, but if you could at least read my first one i would be most grateful. i won't ask another one for a loooong time.....:)...:).....please?
Amy
Posted by alesta on August 18, 2004, at 6:05:31
In reply to Re: Dopaminergic Drug/Supp.LARRY or CHEMIST help!, posted by alesta on August 18, 2004, at 1:15:58
OOPS....i meant to say dopamine agonist, not antagonist....sorry!
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