Posted by BekkaH on August 7, 2002, at 0:35:10
In reply to DOPAMINE-AD's, posted by Mischief on August 7, 2002, at 0:02:01
Wellbutrin, which you said you tried, is supposed to have some slight effect on dopamine, but I think it affects norepinephrine much more.
Effexor, at very high doses, supposedly blocks the reuptake of dopamine, and at the lower doses it acts as a serotonin reuptake inhibitor, I believe.
Parnate, a monoamine oxidase inhibitor (MAOI), is one of the most dopaminergic medicines available. If you take an MAOI, you have to be careful not to eat aged or fermented foods, like cheese,etc. Another dopaminergic MAOI is Eldepryl/Selegiline.
Then, there are the psychostimulants, like dexedrine (dextroamphetamine), Adderall (a mixture of amphetamine salts) and Ritalin/Concerta (methylphenidate). Sometimes, in severe, difficult-to-treat depressions, doctors will use stimulants alone, but stimulants are usually more effective over the long term when they are used to "augment" another antidepressant.
In recent years, some doctors are prescribing dopamine agonists, like Mirapex (Pramipexole) to augment other antidepressants. Dopamine agonists like Mirapex are actually used for the treatment of Parkinson's disease, but they are also helpful in some antidepressant combinations.
How is your psychopharmacologist? Is he/she creative and willing to try out some medication combinations? It takes a certain amount of imagination, creativity, time and patience for a doctor to work closely with you to come up with a combo that works for you. Some doctors are too conservative or too scared to try augmentation with psychostimulants. Perhaps some of those meds you've tried are not lost causes. If you could find one that could be combined with something else, like a dopamine agonist or a psychostimulant, perhaps you'd feel better.
There are some other possibilities for antidepressant augmentation that do NOT involve the use of meds that affect dopamine. For example, many patients here have been helped by augmenting their antidepressants with lithium, lamictal/lamotrigine, topamax, thyroid supplementation, among others. Lamictal (lamotrigine) appears to be one of the best meds for antidepressant augmentation; however, the dose must be raised VERY gradually, over many weeks, to avoid some rare, but dangerous, side effects.
Perhaps you can discuss some medication combinations and augmentation strategies with your pdoc on Thursday. I hope your appointment goes well!
poster:BekkaH
thread:115489
URL: http://www.dr-bob.org/babble/20020731/msgs/115496.html