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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by whitmore on September 28, 2012, at 15:39:04
For the last few years, I have been suffering from severe depression, anhedonia and anxiety.
I have recently been injured(broken ankle) and while off work have started zoloft, 100 mg. It worked for a while, but now I seem to be back to square one.I asked my psychiatrist to prescribe adderall, as another doctor had suspected ADD. The previous doctor had given me a few stimulant medications to try, but since I was working, the side-effects were too much for me to deal with and I only tried each once.
This time I tried the Adderall(5 mg) for a few days and it was remarkable for mood and relaxation. Initially, I took 1/2 in the am, per doctor's orders, but increased it to 1/2 twice a day. Side-effects were bad(dizziness, lack of focus--go figure!) and it was an emotional roller-coaster, with severe insomnia by day 3, which resulted in my stopping it.
However, it does lead me to think that dopamine may be what's lacking.
I know there are various dopamine enhancing medications out there that are used for Parkinson's, but does anyone know if these are useful in depression and if they can be dosed to provide a steady level of dopamine without insomnia? And if so, if there's any chance of a psychiatrist prescribing it?
I should also mention that I am a 59 year old woman, have been diagnosed with lyme disease and babesia(2 years now) and made little progress with antibiotic treatement. I am now seeing a naturopath and attempting to treat these infections holistically.
One more thing: I have craved cigarettes for the last couple of years, having given them up 30 years ago and not missing them until recently. I've thought of a nicotine patch, but don't know if that would be enough of a boost.
Any input would be gratefully received.
Regards.
Sue
Posted by phidippus on September 28, 2012, at 17:02:51
In reply to Medication to increase levels of dopamine, posted by whitmore on September 28, 2012, at 15:39:04
>I know there are various dopamine enhancing >medications out there that are used for Parkinson's, but does anyone know if these are useful in depression and if they can be dosed to provide a steady level of dopamine without insomnia?
Both Mirapex and Requip have been studied in the treatment of depression, with good results.
>And if so, if there's any chance of a psychiatrist prescribing it?
Yes.
> lyme disease and babesia(2 years now) and made little progress with antibiotic treatement.
Has the Lyme disease been treated with doxycycline and ceftriaxone?
Has the Babesia been treated with atovaquone with oral azithromycin?
You really need to treat these diseases in a standard fashion. A holistic approach could be detrimental.
>I've thought of a nicotine patch, but don't know if that would be enough of a boost.
If you're trying to kick the habit and want a boost at the same time, try Wellbutrin-it is prescribed to lower cravings f or nicotineand is a dopamine reuptake inhibitor which gives this med a boost.
Eric
Posted by whitmore on September 28, 2012, at 17:21:24
In reply to Re: Medication to increase levels of dopamine » whitmore, posted by phidippus on September 28, 2012, at 17:02:51
Thanks for the reply Phillipidus.
I have treated these infections with all sorts of antibiotics including the ones you mention for the last 2 years and as soon as I come off them, I'm back to square one.If you follow older people with these illnesses there is very little cure or even remission with standard protocols. Some people have been on antibiotics for years and years. The only success I'm aware of in cases like mine is an alternative approach using herbs, since the bacteria are less likely to become resistant and they(herbs) are less likely to cause the patient long term problems.
I do not smoke and have not done so for 30 years. However, since the Lyme disease, I have been craving cigarettes and it seems to fit into the dopamine deficiency theory.
Regards.
Sue
Posted by jono_in_adelaide on September 28, 2012, at 18:16:59
In reply to Re: Medication to increase levels of dopamine, posted by whitmore on September 28, 2012, at 17:21:24
It might be worth trying Welbutrin (bupropion) 300-450mg per day, this boosts noradrenalin and dopamine
Posted by phillipa on September 28, 2012, at 18:55:40
In reply to Re: Medication to increase levels of dopamine, posted by whitmore on September 28, 2012, at 17:21:24
I also had lymes disease. Still test positive. But not taking antibiotics. When first discovered I had it routine blood test with Western blot. I ended up in hospital as all of a sudden my anxiety was through the roof, same time menopause, and thyroid became hypo. Spent l month inpatient. Had pic line and given rocephin IV for only a few days as couldn't stand the pic line near my heart. So the infection control doc put me on biaxin xl for two years. At first daily forget for how long. Then it was three month on and then three months off. I then lost taste and smell. That's another story. But during the acute episode for lymes since no idea when had contracted it. I also could no longer handle ad's in any normal amount. Was put then on a mere 12.5mg of luvox & 2.5mg of paxil, and lots of benzos. Two years ago when last saw the infection doc as still had three positive bands or could have been 6 he gave me doxycycline as didn't know what to do. I only took a few weeks. Then due to a small surgery dicontinued. So I now take 50mg of luvox & 2.5mg of lexapro. Strange thing is that benzos now need less to fall asleep. No rheumatoid arthritis osteo, stuff like this. I'm also 66 so arthritis is to be expected. Have you recently had a lymes titer done from the lab in California? Phillipa
Posted by rjlockhart37 on September 28, 2012, at 21:27:09
In reply to Medication to increase levels of dopamine, posted by whitmore on September 28, 2012, at 15:39:04
Focalin XR or Concerta...those increase dopamine without the release of it from an amphetamine.
Posted by Christ_empowered on September 28, 2012, at 22:00:20
In reply to Re: Medication to increase levels of dopamine » whitmore, posted by phillipa on September 28, 2012, at 18:55:40
If you have good insurance, Provigil or Nuvigil might help...just throwing that out there (not traditional stimulants, but they do help depression and fatigue).
Someone mentioned methylphenidate (Ritalin, etc.) products. If you go this route, I'd strongly recommend a sustained release product AM and a tablet in the afternoon. Even if the dose is very low, this approach (in my experience as a patient--NOT a professional here by any means) helps keep blood levels more even, so you don't go crazy. Unless you just can't tolerate stims at all, in which case any dose might make you crazy, no matter the formulation.
Wellbutrin is a possibility. Works well with SRI drugs. My sneaking suspicion--again, as a patient, not a pro--is that the Zoloft is making matters worse. By boosting serotonin, you're dampening dopamine, which can flatten mood. Long-term, SRI drugs are a lot like taking very low-dose antipsychotics in terms of the way they can blunt mood and reduce motivation. They can also (rarely) cause tardive dyskinesia after prolonged exposure.
If you want to ditch the zoloft, there's EMSAM patch (again: you'll need good insurance for this one). Varying doses of an MAOI that lifts mood, helps Parkinson's, and has a mild stimulating effect. Initially, the patch was designed to avoid the (often difficult) "MAOI diet." Now, I think the official stance is that you have to do the diet with the patch, no matter the dose. Your doc will advise you on this.
Simply switching out the zoloft might help. Sorry...I just can't handle long-term SRIs myself, because they tend to be too dulling after an extended period. You could talk about starting another AD (again, wellbutrin comes to mind. If you have more severe depression, a stimulating TCA, such as Pamelor, might be appropriate, if you can handle the side effects) and taper off the SRI. Some people need temporary meds to help with an SRI taper, many don't (and many shrinks just shrug it off and expect the patient to deal with whatever happens).
Since you're into alternative health, I'd seriously suggest (again: because it worked for me, not because I'm some super-educated pro) an Orthomolecular approach. High dose niacinamide, C, E (or tocotrienols), B-complex, etc. Can be customized to work with your meds and maybe get a little more "oomph" out of your pharmaceuticals, while also improving mood and overall health. Just a suggestion.
Good luck!
Posted by bleauberry on September 29, 2012, at 5:44:16
In reply to Medication to increase levels of dopamine, posted by whitmore on September 28, 2012, at 15:39:04
Based on your very informative description, the first thing that popped into my head was Savella. I say this for several reasons. Long story short, I have the same things happen to me with stimulants as you. And I respond well to savella but not any other ADs.
Another option, add nortriptyline to zoloft. Excellent combo that does a lot more than either alone.
In a Stahl book he explains how norepinephrine reuptake inhibition increases dopamine. That's because in parts of the brain, the NE pumps take up not just NE but also dopamine.
While I totally understand how much stimulants can help me on the first day or two, despite the side effects, I also understand that is a road that usually leads to bad places. Whether it is used as a street drug, an illegal drug, or a prescription medicine, it's still the same molecule, and outcomes from longterm usage are predominantly bad. I use ritalin as a life preserver for particularly bad days, but never 2 days in a row and never more than twice in week. My own rules. That way at least I can get some benefit when I need it the most, but avoid the slippery slope.
The herb rhodiola rosea could be helpful to you as well, can be added to zoloft or any other AD except maois.
Personally I have found NE far more correlated to depression, anhedonia, pleasure, drive, etc, than dopamine. But they work in concert, so it isn't an either/or situation. I just think the focus should be more on NE, not DA, despite all the internet talk of dopamine. My own experiences and listening to stories of others leads me to believe that.
Posted by SLS on September 29, 2012, at 6:24:10
In reply to Medication to increase levels of dopamine, posted by whitmore on September 28, 2012, at 15:39:04
> Based on your very informative description, the first thing that popped into my head was Savella. I say this for several reasons. Long story short, I have the same things happen to me with stimulants as you. And I respond well to savella but not any other ADs.
>
> Another option, add nortriptyline to zoloft. Excellent combo that does a lot more than either alone.
>
> In a Stahl book he explains how norepinephrine reuptake inhibition increases dopamine. That's because in parts of the brain, the NE pumps take up not just NE but also dopamine.
>
> While I totally understand how much stimulants can help me on the first day or two, despite the side effects, I also understand that is a road that usually leads to bad places. Whether it is used as a street drug, an illegal drug, or a prescription medicine, it's still the same molecule, and outcomes from longterm usage are predominantly bad. I use ritalin as a life preserver for particularly bad days, but never 2 days in a row and never more than twice in week. My own rules. That way at least I can get some benefit when I need it the most, but avoid the slippery slope.
>
> The herb rhodiola rosea could be helpful to you as well, can be added to zoloft or any other AD except maois.
>
> Personally I have found NE far more correlated to depression, anhedonia, pleasure, drive, etc, than dopamine. But they work in concert, so it isn't an either/or situation. I just think the focus should be more on NE, not DA, despite all the internet talk of dopamine. My own experiences and listening to stories of others leads me to believe that.
I agree with Bleauberry.Questions:
1. In what brain structures would you like to increase dopamine activity?
2. Why do you think that low dopamine levels are involved with depression?
3. How did you establish that your dopamine levels are low?
Excessive dopamine in certain areas can increase rather than decrease depression.http://www.webmd.com/depression/news/20050728/dopamine-may-play-new-role-in-depression
Even Prozac can produce increases in dopamine (DA) and norepinephrine (NE) activity in regions of the brain that are downstream from the serotonin neurons Prozac affects directly.Here is an interesting study that demonstrates how Prozac can amplify the increases in DA and NE that Wellbutrin produces in several brain structures. It gives a rationale for combining SRIs with Wellbutrin.
- Scott
Posted by 4WD on September 29, 2012, at 9:56:46
In reply to Re: Medication to increase levels of dopamine » whitmore, posted by phidippus on September 28, 2012, at 17:02:51
For the nicotine cravings, have you thought if trying an e-cig? I quit smoking in December and my electronic cigarettes have been a lifesaver-especially since my husband still smokes. It covers that oral gratification need and you can get them with nicotine levels from 0mg to 24 mg per ml of e-liquid.
Marsha
Posted by jono_in_adelaide on September 30, 2012, at 0:55:51
In reply to Re: Medication to increase levels of dopamine, posted by 4WD on September 29, 2012, at 9:56:46
L-Dopa would ncrease dopamine
Has it ever been used with any sucsess in depression?
Posted by SLS on September 30, 2012, at 4:12:12
In reply to Re: Medication to increase levels of dopamine, posted by jono_in_adelaide on September 30, 2012, at 0:55:51
> L-Dopa would ncrease dopamine
>
> Has it ever been used with any sucsess in depression?Interest in using L-dopa as a treatment for depression emerged in the 1960s. It was abandoned in the early 1980s. The effects of L-dopa on mood in depressive disorders are unpredictable. I could never get a doctor to prescribe it to me.
- Scott
Posted by jono_in_adelaide on September 30, 2012, at 5:47:40
In reply to Re: Medication to increase levels of dopamine » jono_in_adelaide, posted by SLS on September 30, 2012, at 4:12:12
Thats what I thought, if it had achived any widespread sucsess, it would have been in use today.
I guess the monoamine theory gives as many questions as it gives answers
Posted by whitmore on September 30, 2012, at 14:51:26
In reply to Re: Medication to increase levels of dopamine, posted by jono_in_adelaide on September 30, 2012, at 5:47:40
Thanks to all who replied.
I have no idea if I am actually low in dopamine. Just that I never had anhedonia until 2 years ago(coinciding with the Lyme/Babesia diagnosis). Was always busy and interested in stuff, though have become more socially withdrawn with each passing decade. Have tried Wellbutrin in the past but it seemed way too activating and I gave up before giving it a real trial. On occasion, I have restless legs at night and in general sleep appallingly. And the Adderall instantly lifted mood and made me feel 'normal'.
Have tried some Vyvanse today. Feels much less intense than the Adderall, even though, per the equivalence tables, I am taking much more(20 mg at 9 am, then another 20 mg at 3 pm, compared to only about 7.5 mg of Adderall), since it was wearing off and I could feel myself getting weepy. I suspect I would need much more of it to get the increased focus benefit. I might just pursue the Vyvanse option with my psychiatrist and hope that it won't interfere with sleep--or that she can give me something that will knock me out. Not ideal, but I really, really need to be able to function...
Again many thanks for everyone's input.
Regards.
Sue
Posted by jono_in_adelaide on September 30, 2012, at 18:08:47
In reply to Re: Medication to increase levels of dopamine, posted by whitmore on September 30, 2012, at 14:51:26
I'd give Welbutrin another chance before starting long term amphetamines, start of with 150mg of SR in the morning for 2-3 weeks or so, then increase to 150mg SR twice a day or 300mg XL once a day
If you are now able to tolorate amphetamines, its likely that you'll be able to tolorate the activating effects of Welbutrin.
Posted by whitmore on September 30, 2012, at 20:14:15
In reply to Medication to increase levels of dopamine, posted by whitmore on September 28, 2012, at 15:39:04
A couple of people are advising me not to go the amphetamine route. Could anyone elaborate on whether the outcomes are inevitably bad?
So far, they just make me feel normal mood-wise. I have never had a drug problem, don't drink or smoke. I know that addiction problems can develop on dopamine enhancing meds., but it can't possibly happen all the time considering it seems most of the nation's male adoloescents are taking them for years on end.
What I do like about them is that they work immediately and the dose if easily controlled.I am concerned about the resulting worsening insomnia. Any ideas on what I can take to fix that? Would need to be heavy duty, but with no hangover. Traz. no good. Ambien and co. only give me about 4 hours. If I can get over this final hurdle, I might, dare I say it, be good to go!
Regards.
Sue
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