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Re: Amphetamine Treatment of Mania

Posted by PeterJ on May 13, 2000, at 4:20:26

In reply to Re: Amphetamine Treatment of Mania, posted by SLS on May 10, 2000, at 15:37:17

> > > I forgot to respond to your part about stimulants. Of course, we are all different, but I found stimulants either prevented or decreased my mania. I'm not positive, but I believe they would more often than not prevent rather than induce mania (for me anyway). Janice
>
> > Your observation is backed up by several studies and case reports showing that amphetamine reduces manic symptoms On the other hand there are reports of amphetamine inducing mania as well and certainly the effects of amphetamine can mimic manic symptoms. It would seem that many bipolar individuals react to amphetamine in a ways similar to people with ADHD and find the stimulant calming. Here are some references.
>
> Other than in those cases of brain-injury patients, have all the instances of amphetamine-induced improvement of manic symptoms you encountered been extremely transient?
>
> I guess I just like to brainstorm this stuff, but couldn't the acute pouring-out of dopamine effected by amphetamine produce a temporary state of accommodation (continual depolarization) of dopaminergic neurons, thereby decreasing neural activity in the culprit regions and temporarily ameliorating manic symptoms, this phenomenon only to diminish once presynaptic stores are partially depleted or postsynaptic receptor sensitivity reduced?
>
> (I must catch my breath)
>
> Perhaps the consequence of these changes at the synapse is a prophylactic effect against mania in certain individuals.
>
> I feel like I'm reaching.

"Oh that a man's reach should exceed his grasp,or what's a Heaven for?" --Robert Browning

Not that I'm implying you don't grasp the subject, but I thought the quote was apropos :-)

I don't know what the literature says about the duration of the effect. I do know that the effectiveness of stimulants against Attention Deficit Disorder (ADD) does not wear off after time. Occam's razor suggests to me that since ADHD and mania share many symptoms that the mechanism of stimulants in treating both may be similar. On the other hand the refractory, kindling-like aspects of mania suggest the possibilty that some treatments may lose effectiveness.

It is often assumed that stimualants are inherently...well, stimulating. This is not necessarily so. A 1974 Science article by Joseph Tecce and Jonothan Cole showed that 13 of 20 adults were less alert the first hour after amphetamine, although all subjects were more alert at 2 and 3 hours.

With hyperactive individuals the initial de-activating effect is prolonged and their is usually no stimulant effect.

Their are a lot of theoretical explanations for the effectiveness of stimulants in AD(H)D. Some suggest a reduced dopamine activity due to some kind of auto-inhibition. Other theories suggest DA inhbition of NE. Still others suggest a focusing effect of DA on the frontal lobes. Any of these could potentially apply to mania.

My own personal observations is that amphetamine initially sedates me, with delayed stimulation after a few hours. Other dopaminergic drugs are almost invariably sedating and de-activating to me. These include ritalin, pemoline, bromocriptine, diethylpropion, bupropion, l-dopa, and isocarboxazid. For example, if I take ritalin, I have to lie down, and am virtual immobile for several hours. All the other drugs in the list produce similar effects.

This sedating effect of DA drugs may have something to do with the fact that I have several relatives with ADD. I don't have it myself, but may have some neurochemical similarities.

But then you can't judge much by my personal drug responses. I seem to have odd or paradoxical responses to many drugs. Dr. McCoy would blame it on my green vulcan blood I'm sure :-)

Peter


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poster:PeterJ thread:32741
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