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Dr. Bob is Robert Hsiung, MD,
[email protected]Shown: posts 36 to 60 of 77. Go back in thread:
Posted by Brainbeard on July 28, 2009, at 14:39:27
In reply to Re: Do SSRI's cause dopamine depletion » SLS, posted by morganpmiller on June 5, 2009, at 23:17:28
> Hi I'm new to this board. You guys know that Zoloft is a Serotonin and Dopamine reuptake inhibitor, especially at doses of 100 and more?
> It has far more dopamine reuptake inhibition than Wellbutrin.
Yeah, but the gap between a drug's receptor affinities is what matters. Although sertraline's (Zoloft's) affinity for the dopamine reuptake pump is greater than that of bupropion (Wellbutrin), it is still 100 to 250 times smaller than sertraline's affinity for the serotonin reuptake pump. This means, as Dr. Preskorn argues, that 'the physician would have to increase the dose (ie, the concentration) of sertraline 100 times higher than that needed to inhibit the serotonin uptake pump before a comparable effect would be achieved on the dopamine uptake pump.' (Quoting from his online book: http://www.preskorn.com/books/ssri_s3.html)
Affinity ratios thus have to be seen 'within the context of the actual affinity of the drug for a secondary SOA [Site Of Action] relative to its affinity for its primary SOA and relative to the clinically relevant concentration needed to produce the desired clinical effect.'
Preskorn has also written a column with a subheading titled: 'Is sertraline an inhibitor of dopamine uptake?' Discussing this question, Preskorn concludes that 'it is quite doubtful that sertraline has any meaningful effect on dopamine uptake at concentrations typically achieved at its recommended dosing range, 50-200 mg/day.' (http://www.preskorn.com/columns/9909.html, scroll down)
Discussing other pharmacological data that support this view, he further concludes that 'While this does not absolutely rule out an effect of sertraline on dopamine uptake at concentrations usually achieved on its recommended dosing range, it places the burden of proof on the proponent of such a theory.'
Interestingly, Preskorn mentions a patient who used sertraline 300-400mg several times a day to achieve a stimulant high.
I do think that Preskorn underestimates the effects that even mild inhibition of the dopamine reuptake pump apparently has for many people. Alternatively, if Preskorn is entirely right, the stimulating effects of (higher doses of) Zoloft may be due to a different, yet unknown mechanism.
It is interesting that Zoloft is a derivative of tametraline, a norepinephrine and dopamine reuptake inhibitor. Quoting from the (excellent) Wikipedia article on sertraline (http://en.wikipedia.org/wiki/Sertraline):'in 1977, pharmacologist Kenneth Koe, after comparing the structural features of a variety of reuptake inhibitors, became interested in the tametraline series. He asked another Pfizer chemist, Willard Welch, to synthesize some previously unexplored tametraline derivatives. Welch generated a number of potent norepinephrine and triple reuptake inhibitors, but to the surprise of the scientists, one representative of the generally inactive cis-analogs was a serotonin reuptake inhibitor. Welch then prepared stereoisomers of this compound, which were tested in vivo by animal behavioral scientist Albert Weissman. The most potent and selective (+)-isomer was taken into further development and eventually named sertraline.'
I like to think that this chemical origin might contribute to Zoloft's stimulant profile in some intangible way.
Posted by morganpmiller on July 30, 2009, at 22:45:35
In reply to Re: Do SSRI's cause dopamine depletion, posted by Brainbeard on July 28, 2009, at 14:39:27
Gotchya..I also think he underestimates the small effect of dopmamine reuptake inihibition. He's just one of those doctor's taking an extreme view and making a name for himself. Well, maybe not but it just seems many doctors do this, Dr. Peter Breggin being one of them.
Posted by Brainbeard on July 31, 2009, at 3:23:48
In reply to Re: Do SSRI's cause dopamine depletion, posted by morganpmiller on July 30, 2009, at 22:45:35
Yeah, Breggin has this complete tunnel vision that makes him such an unscientific whiner and a waste for the in itself noble cause of fighting Big Pharma.
Posted by SLS on July 31, 2009, at 7:01:57
In reply to Re: Do SSRI's cause dopamine depletion, posted by Brainbeard on July 31, 2009, at 3:23:48
> Yeah, Breggin has this complete tunnel vision that makes him such an unscientific whiner and a waste for the in itself noble cause of fighting Big Pharma.
Book sales and speaking engagements.
- Scott
Posted by Wanderer123 on August 30, 2009, at 19:15:06
In reply to Re: Do SSRI's cause dopamine depletion, posted by SLS on July 31, 2009, at 7:01:57
So Prozac has caused me apathy which I suspect is Dopamine-related. I don't know why but it became permanent. The question is, can I take some supplements and herbs to re-boost my Dopamine if its been damaged by an SSRI? Please help.
Posted by Alexanderfromdenmark on September 7, 2009, at 9:57:54
In reply to Is there a way to naturally increase Dopamine?, posted by Wanderer123 on August 30, 2009, at 19:15:06
> So Prozac has caused me apathy which I suspect is Dopamine-related. I don't know why but it became permanent. The question is, can I take some supplements and herbs to re-boost my Dopamine if its been damaged by an SSRI? Please help.
How long time since you went off Prozac?
Posted by Wanderer123 on September 7, 2009, at 10:40:31
In reply to Re: Is there a way to naturally increase Dopamine?, posted by Alexanderfromdenmark on September 7, 2009, at 9:57:54
> > So Prozac has caused me apathy which I suspect is Dopamine-related. I don't know why but it became permanent. The question is, can I take some supplements and herbs to re-boost my Dopamine if its been damaged by an SSRI? Please help.
>
> How long time since you went off Prozac?Over 6 years.
Posted by Wanderer123 on September 7, 2009, at 10:40:48
In reply to Re: Is there a way to naturally increase Dopamine?, posted by Alexanderfromdenmark on September 7, 2009, at 9:57:54
> > So Prozac has caused me apathy which I suspect is Dopamine-related. I don't know why but it became permanent. The question is, can I take some supplements and herbs to re-boost my Dopamine if its been damaged by an SSRI? Please help.
>
> How long time since you went off Prozac?Over 6 years.
Posted by Brainbeard on September 7, 2009, at 10:48:31
In reply to Re: Is there a way to naturally increase Dopamine?, posted by Wanderer123 on September 7, 2009, at 10:40:48
One solution is: get back on Prozac. But: low dose this time, say 2.5-5mg. That way, Prozac's 5HT2C-antagonism will boost your dopamine and noradrenaline without touching your serotonin too much. You will be stimulated without being apathized.
Posted by metafunj on September 12, 2009, at 10:47:26
In reply to Re: Is there a way to naturally increase Dopamine?, posted by Brainbeard on September 7, 2009, at 10:48:31
Hey Wanderer123,
I just wanted to say I'm in the same boat as you. I have been off Prozac for 6 years and have low dopaminergic symptoms ie, anhedonia, poor concentration, poor memory, low motivation, feeling tired during the day.
I am also looking at ways to boost dopamine. I've tried natural methods(L-tyrosine, mucana puriens, NADH, ginseng) but none of them worked very well. Even exercise is starting to fail me.
I may try the low dose prozac as brainbeard suggested. I just recently took Lexapro though and even at a low dose of 5mgs it made me kinda spacey and slightly out of it. Hopefully low dose prozac wouldn't do this. Maybe I could take the 5 mg half tablet every other day?
If that doesn't work I'll try a stimulant or both, if I can get a script.
Posted by metafunj on September 12, 2009, at 11:23:47
In reply to Do SSRI's cause dopamine depletion, posted by Alexanderfromdenmark on March 3, 2009, at 10:46:37
Just thought I'd throw this in here. I posted it in the tread about dopamine depletion on SSRIs being a myth. I hope this helps to answer the initial question.
Abstract
Serotonin and dopamine transporter (SERT, DAT) availabilities have prospectively been investigated using [123I]β-CIT and single photon emission computed tomography in subjects with obsessive–compulsive disorder under treatment with the selective serotonin reuptake inhibitor citalopram. SERT availability decreased by a mean 36.5%, whereas DAT availability increased by about 40%. The data point at a citalopram induced modulation of both serotonergic and dopaminergic activity and support the notion of functional interactions of monoaminergic systems in the human brain.
Keywords: Serotonin and dopamine transporters; Single photon emission computed tomography; β-CIT; Serotonin reuptake inhibitor; Obsessive–compulsive disorder
Posted by Wanderer123 on September 12, 2009, at 11:51:17
In reply to Re: Is there a way to naturally increase Dopamine?, posted by metafunj on September 12, 2009, at 10:47:26
> Hey Wanderer123,
>
> I just wanted to say I'm in the same boat as you. I have been off Prozac for 6 years and have low dopaminergic symptoms ie, anhedonia, poor concentration, poor memory, low motivation, feeling tired during the day.
>
> I am also looking at ways to boost dopamine. I've tried natural methods(L-tyrosine, mucana puriens, NADH, ginseng) but none of them worked very well. Even exercise is starting to fail me.
>
> I may try the low dose prozac as brainbeard suggested. I just recently took Lexapro though and even at a low dose of 5mgs it made me kinda spacey and slightly out of it. Hopefully low dose prozac wouldn't do this. Maybe I could take the 5 mg half tablet every other day?
>
> If that doesn't work I'll try a stimulant or both, if I can get a script.
>What do you think about this website? http://www.integrativepsychiatry.net/neurotransmitter_tests.html . I want to take a Neurotransmitters Test there and wanted to know if thoseproducts could help me. Maybe they can know what I will need and give me potent products to heal me? You too actually.
Posted by Alexanderfromdenmark on September 12, 2009, at 13:00:30
In reply to Re: Do SSRI's cause dopamine depletion, posted by metafunj on September 12, 2009, at 11:23:47
> Just thought I'd throw this in here. I posted it in the tread about dopamine depletion on SSRIs being a myth. I hope this helps to answer the initial question.
>
> http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T26-4FNW4KX-2&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1009313094&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=bf1894ef55db5d4f4c51a0e41f6c6514
>
> Abstract
>
> Serotonin and dopamine transporter (SERT, DAT) availabilities have prospectively been investigated using [123I]β-CIT and single photon emission computed tomography in subjects with obsessivecompulsive disorder under treatment with the selective serotonin reuptake inhibitor citalopram. SERT availability decreased by a mean 36.5%, whereas DAT availability increased by about 40%. The data point at a citalopram induced modulation of both serotonergic and dopaminergic activity and support the notion of functional interactions of monoaminergic systems in the human brain.
>
> Keywords: Serotonin and dopamine transporters; Single photon emission computed tomography; β-CIT; Serotonin reuptake inhibitor; Obsessivecompulsive disorderWhy do SSRIs' cause hyperprolactin´, akathsia, apathy, sexual dysfunction if not trough low dopamine. A lot of psychiatrists, I have written with say that quite simply. When you raise serotonin significantly, you significantly lowers dopamine.
Posted by metafunj on September 12, 2009, at 19:12:52
In reply to Re: Is there a way to naturally increase Dopamine?, posted by Wanderer123 on September 12, 2009, at 11:51:17
I'm all for natural remedies but sometimes it hard to find objective data on them. I've tried lots of stuff chinese medicine, meditation, exercise, neurotransmitter precursors and nothing has really done much.
I think its worth a shot to get a urine test its should show the metabolites of the neurotransmitters and help you figure out what you need more of. If you have low dopamine they will probably tell you to take L-tyrosine w/ B6. It didn't do anything for me but some people find it helpful.
This may be a good sign post for your wonderer. (no pun intended), but I've found that the natural stuff isn't strong enough to counter what prozac has done to me.
Posted by metafunj on September 12, 2009, at 19:18:17
In reply to Re: Do SSRI's cause dopamine depletion, posted by Alexanderfromdenmark on September 12, 2009, at 13:00:30
I think there is some confusion. This abstract is saying that SSRIs decrease dopaminergic function.
It says that taking an SSRI decreases SERT. SERT is the serotonin transporter. With less transporters more serotonin is left in the synapse and serotonergic transmittion is enhanced.
It also says that taking an SSRI increases DAT, which is the dopamine transporter. This means that your brain on (and probably after) an SSRI is taking more dopamine up out of the synapse and decreasing dopaminergic transmittion.
I hope this helps.
Posted by Wanderer123 on September 12, 2009, at 19:25:21
In reply to Re: Is there a way to naturally increase Dopamine?, posted by metafunj on September 12, 2009, at 19:12:52
I think if there's a will, there's a way!
Posted by metafunj on September 15, 2009, at 19:42:35
In reply to Re: Is there a way to naturally increase Dopamine?, posted by Wanderer123 on September 12, 2009, at 19:25:21
One thing to try is to eat high quality protein meats and dairy products. You want to try to use proteins that don't have very much tryptophan because tryptophan will be converted to serotonin in the body. Whey and yogurt seem to be low in tryptophan and eggs and milk are high in tyrosine.
This is a link comparing tyrosine:tryptophan in foods.
http://www.nutritiondata.com/foods-000087000000079000000-2w.html?
This is a search based on tryptophan content in dairy products
http://www.nutritiondata.com/foods-001079000000000000000-4w.html?This is a search based on tyrosine content in dairy products.
http://www.nutritiondata.com/foods-001990600700000000000.html?maxCount=33
Also you should cut back on carbohydrates as much as possible, especially while eating protein because carbs make it so tryptophan gets converted into serotonin and competes with the other amino acids. Basically Protein and carbohydrates will compete and carbs will cause serotonin to dominate. So if you can try to eat more leafy vegetables and less starchy vegetables. Eating complex carbohydrates may help too.
Don't forget exercise and gingko biloba to decrease serotonin release!
Posted by GuardiAngel on November 7, 2009, at 13:15:01
In reply to Re: Do SSRI's cause dopamine depletion, posted by Alexanderfromdenmark on March 4, 2009, at 16:20:32
I have been taking Celexa for ten years. For the last three or so years I have been _extremely_ tired and sleepy (which was not my baseline pattern). This made me lose the will to live (though I was not suicidal---just waiting to die). Now, Wellbutrin has been added and I feel "normal". That made me think: maybe SSRI's somehow reduce dopamine levels/sensitivity...and so a google search brought me to this site and thread.This is very scary and tragic if true and must be added on top of severe withdrawal symptoms (panic attacks and more) I had two years ago when I was off celexa (in an attempt to switch to cymbalta).
I wish I had never been on SSRI's for such a long time. And I wish that both doctors and patients would realize that taking any anti-depressant is not a matter that should be taken lightly.
Posted by Deneb on November 7, 2009, at 16:13:02
In reply to Very sleepy and tired after long term celexa use, posted by GuardiAngel on November 7, 2009, at 13:15:01
Hello GuardiAngel
Welcome to Psycho-Babble! Sorry to hear the Celexa made you tired. That is scary because I've been on an SSRI close to 10 years too. I hope I don't get serious side effects from it. Right now I am finding I have a lot of lack of motivation. I don't know if it is from my meds.
Deneb
Posted by metafunj on November 7, 2009, at 16:29:24
In reply to Very sleepy and tired after long term celexa use, posted by GuardiAngel on November 7, 2009, at 13:15:01
Everything you say is true.
Posted by creepy on November 13, 2009, at 12:01:03
In reply to Very sleepy and tired after long term celexa use, posted by GuardiAngel on November 7, 2009, at 13:15:01
wow, I just posted a message exactly like this one.
same deal, sedation on celexa. No ideas so far =(
Posted by mtdewcmu on November 26, 2009, at 0:22:53
In reply to Very sleepy and tired after long term celexa use, posted by GuardiAngel on November 7, 2009, at 13:15:01
>
> I have been taking Celexa for ten years. For the last three or so years I have been _extremely_ tired and sleepy (which was not my baseline pattern). This made me lose the will to live (though I was not suicidal---just waiting to die). Now, Wellbutrin has been added and I feel "normal". That made me think: maybe SSRI's somehow reduce dopamine levels/sensitivity...and so a google search brought me to this site and thread.
>I think you may be awfulizing. A more straightforward explanation for what happened is that the Celexa pooped out on you and your depression returned. The same thing happened to me (poop out), and rather than continue to take Celexa, I have switched to all new meds and I am feeling better (after a grueling 3 months of trial and error).
Posted by mtdewcmu on November 26, 2009, at 0:39:06
In reply to Very sleepy and tired after long term celexa use, posted by GuardiAngel on November 7, 2009, at 13:15:01
>
> I have been taking Celexa for ten years. For the last three or so years I have been _extremely_ tired and sleepy (which was not my baseline pattern). This made me lose the will to live (though I was not suicidal---just waiting to die). Now, Wellbutrin has been added and I feel "normal". That made me think: maybe SSRI's somehow reduce dopamine levels/sensitivity...and so a google search brought me to this site and thread.
>
> This is very scary and tragic if true and must be added on top of severe withdrawal symptoms (panic attacks and more) I had two years ago when I was off celexa (in an attempt to switch to cymbalta).
>
> I wish I had never been on SSRI's for such a long time. And I wish that both doctors and patients would realize that taking any anti-depressant is not a matter that should be taken lightly.I do agree that the decision to take an antidepressant should not be taken lightly. Although, I don't see why anyone would continue to take the pills for an extended period if they didn't really need them. Case in point, my sister was having some issues of anxiety and low mood around the time she graduated college. This is a challenging time for anyone, I am sure. She saw a psychiatrist, who started her on Cymbalta, which she couldn't tolerate. Then she switched to Prozac, from which she derived some benefit. After seeing a therapist and psychiatrist for a number of months, and taking Ritalin and Concerta for a time (I don't know how she scored that one), she eventually quit taking all the meds of her own accord. My feeling is that she doesn't need medication, and she eventually realized this.
I, on the other hand, don't care to imagine life without meds. I guess I have to accept whatever long-term consequences there may be, because there is no alternative.
I am sure that occasionally it happens, but I can't see why someone would go on taking them for years if they could get along without them.
Posted by conundrum on November 26, 2009, at 6:15:55
In reply to Re: Very sleepy and tired after long term celexa use, posted by mtdewcmu on November 26, 2009, at 0:39:06
Some docs prescribe ritalin for SSRI induced anhedonia. THat could be how she got that script to counter prozac's side effects.
Posted by mtdewcmu on November 26, 2009, at 10:12:07
In reply to Re: Very sleepy and tired after long term celexa use » mtdewcmu, posted by conundrum on November 26, 2009, at 6:15:55
> Some docs prescribe ritalin for SSRI induced anhedonia. THat could be how she got that script to counter prozac's side effects.
That could be true, although she didn't describe any side effects to me, and we were in close contact during that time. I was under the impression that it was more related to attention problems, but who can really know what's in the mind of a pdoc?
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Dr. Bob is Robert Hsiung, MD,
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