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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 1 to 24 of 24. This is the beginning of the thread.
Posted by floatingbridge on January 9, 2011, at 15:12:13
I know I've asked this before in some form or another.
My depression is worsening. I ran across information that stated emsam at 6mg affects dopamine levels more than other transmittors. (Maybe true?)
The last time I repeated what two docs said to me, I was (kinda) ridiculed. They said I was a dopamine responder. I didn't and don't understand enough to know why this could be considered absurd.
Can one be low in dopamine? Not processing it efficiently?
Is it related to endorphines?
Thanks for any clarification or for pointing me towards some reading.
fb
Posted by ed_uk2010 on January 9, 2011, at 15:47:17
In reply to can anyone explain dopamine's role in depression?, posted by floatingbridge on January 9, 2011, at 15:12:13
>The last time I repeated what two docs said to me, I was (kinda) ridiculed. They said I was a dopamine responder. I didn't and don't understand enough to know why this could be considered absurd.
I think they would be saying that you had previously responded to certain medications which are believed to affect dopamine function in the brain. Unfortunately, it's not possible to prove or disprove any ideas about whether an individual may be low on a particular neurotransmitter, or whether it is functioning abnormally in some way.
>Is it related to endorphins?
There are many different neurotransmitters in the brain, but they do not work in isolation. Dopamine and the endorphins are two different types of neurotransmitter, but the endorphins are believed to affect dopamine neurotransmission in certain parts of the brain, particularly those which are responsible for feelings of reward and pleasure.
Posted by Phillipa on January 9, 2011, at 21:59:54
In reply to Re: can anyone explain dopamine's role in depression? » floatingbridge, posted by ed_uk2010 on January 9, 2011, at 15:47:17
Pain meds are one. Phillipa
Posted by floatingbridge on January 10, 2011, at 2:12:11
In reply to Re: can anyone explain dopamine's role in depression? » ed_uk2010, posted by Phillipa on January 9, 2011, at 21:59:54
Did I really post this twice? :( Outsmarted by my smart phone again.
Ed & Phillipa, thank you both. And yes, Ed, that is what I think my doctors meant. Thank you for proper phrasing ;)
Posted by creepy on January 13, 2011, at 15:45:49
In reply to can anyone explain dopamine's role in depression?, posted by floatingbridge on January 9, 2011, at 15:12:13
Emsam hits MAO-B at lower doses and MAO-A at higher doses. MAO-A is responsible for breaking down serotonin. So at a lower dose youll get mostly its effect on dopamine and phenethylamine. It may act like a stimulant. May or may not have AD effects that last until you raise the dose and thus serotonin.
Every drug Ive taken that works on dopamine seems to offer fleeting relief from depression. Im not sure that it works in quite the way serotonin does for depression. Its really complex.. boosting levels of these transmitters is probably not even what causes depression relief, its some secondary action like maybe neuroprotection or levels of BDNF.
Wikipedia has lots of articles on this stuff that are a good start if you have questions. Then there is google books, tons of psych and biology texts there.
If you wind up on parnate or nardil (probably more effective than emsam) there are a lot of people here taking those, this board has a lot of good info on those meds.
Posted by floatingbridge on January 13, 2011, at 17:21:56
In reply to Re: can anyone explain dopamine's role in depression?, posted by creepy on January 13, 2011, at 15:45:49
Thanks, Creepy. I'm still working on a link Conundrum posted. Have you seen that? (Seems I posted this question twice accidentally.)
Based on my experience, the amount of relief is fleeting. Seems I do best with some sort of dopamine agonist on board--at least so far. That I had a disastrous trial of Abilify also suggests to me that dopamine is part of my treatment.
I did read that 6mg of emsam is heavier on the dopamine and the ratio diminishes at 9 and up. (I was also told by one of the mentioned docs that emsam might work, and if not, then maoi. Obviously I'm balking, and my own pdoc isn't supportive--he'd want a complete washout, I have a dependent child.... My experience of discontinuation syndrome can be disabling.)
O.K. TMI :)
How have you been?
fb
Posted by creepy on January 13, 2011, at 20:38:09
In reply to Re: can anyone explain dopamine's role in depression? » creepy, posted by floatingbridge on January 13, 2011, at 17:21:56
I am doing much better on 50mg sertraline and 150mg wellbutrin xl. the wellbutrin is nice.. when it works. currently its pooping out and switching from one mfr to another seems to get me a couple days of relief until I get used to it again. weird. I wish there was an NDRI or DRI that remained consistent, this is frustrating.
Sertraline is hard to put a finger on.. but the AD effect is certainly there. I am going slow since I had a previous dysphoric reaction.
So far it has helped the rage I get from PTSD immensely.
Posted by floatingbridge on January 13, 2011, at 21:24:11
In reply to Re: can anyone explain dopamine's role in depression?, posted by creepy on January 13, 2011, at 20:38:09
Creepy,
How do you think setraline works on rage? I mean, is that what emotion is forefront when you are triggered?
I usually have fear, panic, maybe rage (if I'm 'lucky' enough to tap it). If something would smooth out the trigger response....
I am glad you're getting some relief. (((Yay))).
Wellbutrin worked once for me amazingly well about ten years ago (why did I stop?!). Two years ago, nothing :(
Thanks, Creepy.
fb
Posted by Phillipa on January 13, 2011, at 21:49:19
In reply to Re: can anyone explain dopamine's role in depression? » creepy, posted by floatingbridge on January 13, 2011, at 21:24:11
FB still taking the cymbalta? How's the pain? What is next? Love Phillipa
Posted by floatingbridge on January 14, 2011, at 1:00:17
In reply to Re: can anyone explain dopamine's role in depression? » floatingbridge, posted by Phillipa on January 13, 2011, at 21:49:19
Hi Phillipa,
The cymbalta continues. I've gone this far, will take it to 90mg and see. Have a GP appt. Monday for GI issues.
thanks for asking,
fb
Posted by creepy on January 14, 2011, at 8:54:19
In reply to Re: can anyone explain dopamine's role in depression? » creepy, posted by floatingbridge on January 13, 2011, at 21:24:11
I think it works pretty good on anxiety and anger at 50mg. On dpression, not so much. Im depending on the wellbutrin for that and its really hit or miss. It poops out on me and I cant escalate the dose this time since I get bad anxiety.
I wouldnt have said this about sertraline 10 years ago, at that time it sent me into dysphoria.
but you folks all know its not which drug is best, but rather which is best suited to your illness and individual brain.
Posted by Phillipa on January 14, 2011, at 20:08:39
In reply to Re: can anyone explain dopamine's role in depression?, posted by creepy on January 14, 2011, at 8:54:19
That is so true and since body chemistry also changes what didn't work once could work now and vis versa. Phillipa
Posted by floatingbridge on January 15, 2011, at 1:54:53
In reply to Re: can anyone explain dopamine's role in depression?, posted by creepy on January 14, 2011, at 8:54:19
Creepy, a long shot, but there is strattera. I think it's a nri. Used for add. I tried it as an add-on w/ terrible results. (I had one of the rare, obscure side effects --not life threatening.) Maybe to back up the Wellbutrin. I don't know....
fb
Posted by creepy on January 17, 2011, at 12:34:30
In reply to Re: can anyone explain dopamine's role in depression? » creepy, posted by floatingbridge on January 15, 2011, at 1:54:53
It sure feels like the NRI effect is whats causing the anxiety. I also got a little of that on desipramine. I thought it was better since its half-life was longer and I could get out of bed in the morning versus wellbutrin which drops off after 10 hours.
I notice I definitely have more motivation on wellbutrin than I did with desipramine. It may be that once the depression is in remission I dont need it to motivate me and an NRI alone will help the fatigue.
Posted by floatingbridge on January 17, 2011, at 13:17:36
In reply to Re: can anyone explain dopamine's role in depression?, posted by creepy on January 17, 2011, at 12:34:30
Best with this, creepy. I do know two people who have been doing well on Wellbutrin alone.
Isn't there Wellbutrin xr? (It's been awhile for me.)
fb
Posted by creepy on January 19, 2011, at 12:43:47
In reply to Re: can anyone explain dopamine's role in depression? » creepy, posted by floatingbridge on January 17, 2011, at 13:17:36
I am on wellbutrin XL 150mg.. the sertraline Im on is a mild inhibitor at CYP2B6 I think, which wellbutrin uses. So Im effectively taking a little more than 150.
What Im having problems with is the hit-or-miss nature of taking this drug, its a lot like what amphetamine does to me. Some days its like taking speed, others its like a sugar pill.
Also just the fact that for 10 hours a day Im under its effects, and the other 14 Im not. Its hard to get out of bed in the morning. This is where desipramine really helped.
I have a lot of physical anxiety too. Im shakey and have butterflies in stomach feeling. Im sure it doesnt do my PTSD much good, but the depression is the big problem right now.
I have tried taking it with food, water. have tried making sure my heartburn isnt bad when I take it (acidity). Dunno what to try next. Doc wants to go back to the SR form but I worry about the mood / energy rollercoaster from that.
Wellbutrin certainly helps my depression but a pure NRI did about as much. The real difference is motivation which can feedback into depression relief. Im sure this is different for everyone though.
Posted by floatingbridge on January 19, 2011, at 14:02:51
In reply to Re: can anyone explain dopamine's role in depression?, posted by creepy on January 19, 2011, at 12:43:47
This sounds like where I'm at :( I feel very debilitated.... I'm in bed a majority of the time. I can't quite believe it.
I'm sorry to hear this, creepy.
Are you saying the Wellbutrin bothers your stomach?
SR vs. XR. I know that the XR of xanax isn't the same. I'm trying to recall my Wellbutrin days (back when it worked). SR was best for me.
Most days dex is a sugar pill :( and the cymbalta is really painful (GI). I think I need to drop back to 30mg.
You have tried cymbalta? (Sorry to have forgotten.)
> What Im having problems with is the hit-or-miss nature of taking this drug, its a lot like what amphetamine does to me.? Some days its like taking speed, others its like a sugar pill.
> Also just the fact that for 10 hours a day Im under its effects, and the other 14 Im not. Its hard to get out of bed in the morning. This is where desipramine really helped.
> I have a lot of physical anxiety too. Im shakey and have butterflies in stomach feeling. Im sure it doesnt do my PTSD much good, but the depression is the big problem right now.
> I have tried taking it with food, water. have tried making sure my heartburn isnt bad when I take it (acidity). Dunno
what to try next. Doc wants to go back to the SR form but I worry about the mood / energy rollercoaster from that.
> Wellbutrin certainly helps my depression but a pure NRI did about as much. The real difference is motivation which can feedback into depression relief. Im sure this is different for everyone though.
>
Posted by Phillipa on January 19, 2011, at 21:08:37
In reply to Re: can anyone explain dopamine's role in depression?, posted by floatingbridge on January 19, 2011, at 14:02:51
FB what's wrong with dropping back down to 30mg? More isn't always better. Love Phillipa
Posted by floatingbridge on January 19, 2011, at 22:15:52
In reply to Re: can anyone explain dopamine's role in depression? » floatingbridge, posted by Phillipa on January 19, 2011, at 21:08:37
I came to that same conclusion, Phillipa just a few hours ago. Cymbalta is providing the same pain coverage (so far) at 30mg with waaay less sides. Thank you for suggesting it :)
I am thinking about Lyrica, as you know. I wiki'd it. Didn't know it was used to treat GAD. Maybe will help with ptsd?
Took 60 cymbalta and lost a few hours :( I wonder if I can drop back to 30mg tomorrow. Will try. Maybe two doses of a split capsule?
Thanks!
Posted by Phillipa on January 20, 2011, at 0:08:49
In reply to Re: can anyone explain dopamine's role in depression? » Phillipa, posted by floatingbridge on January 19, 2011, at 22:15:52
FB really in bed cause of pain. Try what seriously worked for me for avoiding root canal the dentist had me take ibuphrphen sp? 600mg every four hours for 24 hours and not the day I took it but day after felt normal? Link said he's had same think happen on a post here. Then someone Ron suggested NAC. I did a lot of googling first and believe it or not came back to lymes. And still positive. Off to googleland now for a bit. let me know what's going on with you. Love Phillipa
Posted by floatingbridge on January 20, 2011, at 0:18:10
In reply to Re: can anyone explain dopamine's role in depression? » floatingbridge, posted by Phillipa on January 20, 2011, at 0:08:49
Phillipa, positive lymes again? How often do you test? Can you feel a flare? (If they call it that.) Like hashimoto's--it remits then randomly progresses?
My pdoc told me that hashimoto's patients need their antibodies checked at least once a year. Twice a year or more preferable. He's really on it.
You've had a positive Ana? I thought that article you posted was interesting. No one wants to repeat my testing.... Maybe there isn't any reason to.
fb
Posted by Phillipa on January 20, 2011, at 19:46:47
In reply to Re: can anyone explain dopamine's role in depression? » Phillipa, posted by floatingbridge on January 20, 2011, at 0:18:10
Last ANA was negative wierd? But good. Love Phillipa
Posted by linkadge on January 21, 2011, at 20:12:22
In reply to Re: can anyone explain dopamine's role in depression? » floatingbridge, posted by Phillipa on January 20, 2011, at 19:46:47
Posted by floatingbridge on January 22, 2011, at 0:52:41
In reply to Re: No (nm), posted by linkadge on January 21, 2011, at 20:12:22
This is the end of the thread.
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