Posted by Ivo_M on January 14, 2010, at 15:52:56
In reply to How to defeat Atypical Depression?, posted by Petrucci914 on January 27, 2009, at 17:04:34
I have unipolar atypical depression/dysthymia for over 20 years with symptoms similar to yours. I can exactly remember the time when i noticed my mood switch from normal to depressed/dysthymic and how different I was before that.
So far I have tried clomipramine, maprotiline, two kinds of SSRI-s, amitriptyline, wellbutrin + T3 hormone, and venlafaxine. Clomipramine wast the first I got and it was some effect. I had better, but only partial, success with amitriptyline and took it for 4-5 years. All others were either ineffective or had too bad side effects - mostly decreased libido. Most SSSR-is made me just feeling blunt and had disastrous effect on my already decreased libido. I got chest pain from wellbutrin and it also made me nervous so I had to stop using it.
I think that problem lies in the fact that almost all antidepressants increase neurotransmiters serotonin or norepinephrine. There is no effective antidepressant that increases dopamine. Dopamine is the neurotransmitter which influences motivation and reward, sleep, mood, attention, learning, sex drive, and other functions. It's possible that downregulation of dapaminergic pathways might be the cause of unipolar atypical depression/dysthymia. For instance, after overstimulation of dopamine receptors with stimulants like amphetamine a withdrawal crisis develops with symptoms similar to depression.
The only effective antidepressant that stimulated dopeminergic pathways was amineptine. It was a French drug, and it was very effective in large percent of patients. In contrast to most antidepressants it didn't decrease sex drive, but did the opposite. As a dopamine stimulant it had some potential of abuse but it was rather mild. However, under the pressure of FDA it was declared as potentially abusive and it was withdrawn from the markets all around the world. The fact is it was simply too effective and cheap and as such it was a strong competition for the US big pharma industry which spent hundreds of millions for the development and marketing of SSRIs. There are many other drugs with much higher abuse potential but they are manufactured by the US big pharma and they never got withdrawn from the market.
There is one drug with action similar to amineptine but it's not antidepressant, its an antipsychotic. Amisulpride (Solian) is used for treatment of schizophrenia in doses of a few hundreds mg per day. In such doses it works as dopamine antagonist (schizophrenia is caused by excess of dopamine). But in small doses (up to 50 mg per day) it has the opposite effect - it works as dopamine agonist (i.e. stimulant). It's been proven to be effective for depression/dysthymia in 50-60% of cases in doses of up to 50 mg/day. However, it has a serious drawback - in some patients it can increase hormone prolactin, which in turn decreases sex drive, and can be harmful over prolonged period of time. Prolactin increase happens more often in female patients than in men. It might also cause other serious side effects, like tardive dyskinesia, but as far as I understand it's more likely to happen with doses used for schizophrenia.
Some users of this forum have been using it for two or more years with good results. I still haven't tried it myself but I'm considering it.
Here are some links:
http://www.dr-bob.org/babble/20010515/msgs/63723.html
http://www.ncbi.nlm.nih.gov/pubmed/9892856
http://www.ncbi.nlm.nih.gov/pubmed/9495601
http://www.ncbi.nlm.nih.gov/pubmed/10512080
http://www.ncbi.nlm.nih.gov/pubmed/11712619
poster:Ivo_M
thread:876608
URL: http://www.dr-bob.org/babble/neuro/20091104/msgs/933630.html