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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by den2 on April 16, 2003, at 7:34:22
Will adding remeron to an ssri stop the dopamine depletion from long term use? (since the depletion is caused by 5ht2 and 5ht3 stimulation) I have used paxil before and I it gave me dystonia, parkinsonism etc. after long term use)
Posted by linkadge on April 16, 2003, at 8:10:12
In reply to how to stop ssris from depleting dopamine?, posted by den2 on April 16, 2003, at 7:34:22
The key to this is getting the right dose.
You will know if your dopamine becomes imballenced. You will experience what we call 'ssri apathy', where your motivation is
low and your range of emotion becomes very restricted. This is not a sign of depression (which would require a higher dose) but rather of too much serotonin which can downregulate dopamine circuts. When you find the right dose where you are not depressed and not apathetic, this is when your dopamine and serotonin are most likely in harmony.
But if you believe you have a fundemental dopamine problem (you were apathetic and emotionless to begin with) you can try adding or switching to a dopamanergic, ie.Wellbutrin,
Deprynyl
Parkinson Meds ie permax
Fish Oil
Stimulants
MAOIGood Luck
Linkadge
Posted by den2 on April 16, 2003, at 9:35:50
In reply to Re: how to stop ssris from depleting dopamine?, posted by linkadge on April 16, 2003, at 8:10:12
I am apathetic to begin with. It is probably because I have ptsd and melencholic major depression. 20 mgs of paxil works great for me and my emotions come back. I am taking fish oil, ginkgo biloba, vitamin e and vitamin b12 also. How does fish oil affect dopamine levels?
Posted by linkadge on April 16, 2003, at 12:21:32
In reply to Re: how to stop ssris from depleting dopamine?, posted by den2 on April 16, 2003, at 9:35:50
Fish oil is a polyunsaturated fat that positivly effects dopaminergic neurotrasmission.
http://www.biopsychiatry.com/unsatfatdop.html
I think you're right in taking the B12. It is relativly non toxic, even in very high doses.
It affects monoamine oxidase B activity. (An enzyme that depletes dopamine). I recomend 100-250 mcg of it.Good Luck
Linkadge
Posted by chad_3 on April 16, 2003, at 12:43:48
In reply to Re: how to stop ssris from depleting dopamine?, posted by linkadge on April 16, 2003, at 12:21:32
Hello there -
You are right on. SSRI's deplete dopamine in general. You can add ritalin which is safe in long term use, usually does not "wear off" or require endlessly increasing doses - and downregulates d2 receptors .... but ... the results of ssri + ritalin may not be as good - or *nearly* as good ... as an maoi - nardil, or parnate.
Nardil (to a small extent) - and Parnate (to a greater extent) - globablly increase dopamine levels.
Chad
http://www.socialfear.com/
> Fish oil is a polyunsaturated fat that positivly effects dopaminergic neurotrasmission.
>
> http://www.biopsychiatry.com/unsatfatdop.html
>
> I think you're right in taking the B12. It is relativly non toxic, even in very high doses.
> It affects monoamine oxidase B activity. (An enzyme that depletes dopamine). I recomend 100-250 mcg of it.
>
> Good Luck
>
> Linkadge
>
>
>
>
>
>
>
>
Posted by Caleb462 on April 16, 2003, at 22:27:25
In reply to ssri dopamine depletion - maoi or +ritalin, posted by chad_3 on April 16, 2003, at 12:43:48
Yes, remeron, by blocking the 5-HT2c receptor, will prevent dopamine downregulation. In turn, however, you'd have to deal with sedation and possibly weight gain.
If you feel that SRRI-induced dopamine dysfunction is really causing you problems, you could consider a different antidepressant. You could also consider adding a very low dose of an atypical anti-psychotic, which work in the same way as Remeron by blocking the 5-HT2c receptor. Of course, you may not be comfortable with this, due to the risk of tardive dyskenia. And that's understandable.
Adding something that positively affects dopamine, is obviously a good option with less risks than an atypical. Wellbutrin, Ritalin, Dexedrine, Mirapex, and so on.
Posted by jemma on April 17, 2003, at 10:53:19
In reply to how to stop ssris from depleting dopamine?, posted by den2 on April 16, 2003, at 7:34:22
What about adding modafinil (provigil, alertec)? It doesn't appear to act directly on neurotransmitters, but it does seem to boost catecholamine (dopamine and norepinephrine) levels by some unknown mechanism. And it's terrific for giving energy and motivation without taking away emotions. In fact, I'm coming to the conclusion that, for us low-energy types, modafinil with any other medication makes it more effective.
- Jemma
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