![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by g_g_g_unit on September 23, 2009, at 6:08:10
i was just curious whether it's productive to consider executive function issues apart from depression in terms of etiology - i.e. whether they require some specific kind of treatment, or if depression itself can cause prefrontal hypofunction, and its relief (by whatever means - SSRI's, etc.) should help functioning?
most of my issues look like the negative symptoms of schizophrenia - no real affect unless faked, a general slowness that makes conversation hard, the desire to avoid people (and feeling quite content being alone), an empty-minded feeling, concentration difficulties. but i don't really get any psychomotor retardation - in fact, i often feel really fidgety and restless.
i was wondering if it's pointless to think of this as a 'low dopamine' depression? if it's just a shade of depression that can be caused by anything, or if there's some path i should be taking? i guess i'm just wondering if Parnate is the right way to go, or if i should be looking at something more receptor specific like the atypical AP's.
my EF issues seem to get more severe with time, and make it hard to stick with a treatment, since i can't really 'plan' or commit to a decision. there were some days on Memantine where i felt completely normal - calm and able to make decisions that 'felt right', but it wasn't very consistent in effect. i often feel like if my executive + social function improved, my depression would lift, but again is that just a chicken/egg thing?
Posted by linkadge on September 23, 2009, at 6:53:41
In reply to depression + executive function, posted by g_g_g_unit on September 23, 2009, at 6:08:10
Depression can be associated with both hypo and hyper prefrontal cortex activitiy.
Anhedonia is a core symptom of depression and both psychomotor agitation and retardation can be smypoms of depression.
In one of the studies phillipa posted above, response to citalopram an SSRI, was associated with early activation of the prefrontal cortex.
So, even though SSRI's don't typically induce dopamine release there, there appeared to be an indirect effect.
Inability to process emotions (flat affect) could be due to hyper or hypoactive limbic function as well.
Sometimes when you tickle deeper brain regions and the brain likes it, it starts to perk up then this starts a chain reaction to other regions like the PFC.
What does a strong cup of coffee do for you - anything? SSRI's can be effective for a broad range of depression symtpoms -so they're worth a try regardless of the purported mechanism.
If this does't work, drugs with a different mechanism are worth a try.
While I experience many of the same symptoms as you, parnate made my depression much worse. It made my mood very dark and serious.
Linkadge
Posted by SLS on September 23, 2009, at 7:03:15
In reply to Re: depression + executive function, posted by linkadge on September 23, 2009, at 6:53:41
Hi.
I like Linkadge's explanations.
Here are a few of mine that doesn't take all of his into consideration:
> i was just curious whether it's productive to consider executive function issues apart from depression in terms of etiology
Probably not. Much of the hypofunction you allude to is reversed upon recovery from depression. That is, of course, unless there is comorbid ADD. To add a stimulant might help if the response to antidepressants is incomplete.
As seen through a PET Scan, most of my cerebral cortex, including prefrontal areas, were hypofunctioning during depression. This is corroborated by the observation of cognitive deficits and slow-thinking with me. I do not have ADD. As I have recovered from depression in the past. During times of remission, all of my cognitive powers seem to return along with an improvement in memory.
> most of my issues look like the negative symptoms of schizophreniaYes. This is what is often seen in bipolar depression. What you experience is sometimes described as the "deficit syndrome". Although more often used to characterize schizophrenia, this term has been used from time to time with depression.
> i was wondering if it's pointless to think of this as a 'low dopamine' depression?
Yes and no. It is too simplistic an idea if one sets out to try dopaminergic drugs exclusively. With depression (especially bipolar depression), deficits in the function of dopaminergic pathways may be the final step in a series of biological anomolies. As an example, SSRIs, drugs without direct dopaminergic effects, are capable of precipitating mania, presumed to be a hyperdopaminergic state.
> if it's just a shade of depression that can be caused by anything, or if there's some path i should be taking? i guess i'm just wondering if Parnate is the right way to go, or if i should be looking at something more receptor specific like the atypical AP's.
Parnate is a good choice of drug simply because it works. This is an empirical observation that is independent of whatever theories we would like to apply to its effectiveness. Parnate is one of the more effective treatments for bipolar depression. Interestingly, the application of high-dose Parnate (120mg and above) downregulates serotonin 5-HT2a receptors. This might be be a reaction to the accumulation of 5-HT in the synaptic cleft, but that doesn't explain why such is not seen as readily at lower dosages. Parnate almost certainly does things other than inhibit the MAO enzume.
> my EF issues
What are EF issues?
> seem to get more severe with time, and make it hard to stick with a treatment, since i can't really 'plan' or commit to a decision. there were some days on Memantine where i felt completely normal - calm and able to make decisions that 'felt right', but it wasn't very consistent in effect.
Have you tried Lamictal? It also works to reduce glutamate activity.
> i often feel like if my executive + social function improved, my depression would lift,
It has been my observation that executive + social function improve only upon the recovery from depression, and not before. It also seems be proportional to the degree of antidepressant response. With more severe depressions, I don't think it is likely that one can budge the biology very much by working on the psychology. This has been my experience, anyway.
> but again is that just a chicken/egg thing?
Off topic: The egg has my vote. I think the egg came first, as it is from the genetic mutations in germ cells that new phenotypes are expressed.
- Scott
Posted by Phillipa on September 23, 2009, at 11:03:56
In reply to Re: depression + executive function, posted by SLS on September 23, 2009, at 7:03:15
What's executive functioning seriously? Phillipa
Posted by uncouth on September 23, 2009, at 11:42:32
In reply to Re: depression + executive function, posted by Phillipa on September 23, 2009, at 11:03:56
I'm not sure what the dictionary definition of 'executive function' is, but in my opinion, the term is probably used a bit too broadly. For the past two and half years I have been dealing with an acute, crippling bipolar-esque depression. During that time, I've been on a variety of meds and med combinations, including MAOIs, TCAs, SNRIs, APs -- the whole shebang. And 22 sessions of ECT.
My experience has been that during certain treatments, parts of executive function seem to be working fine, although mood is suicidally low. For example, my ability to solve analytical problems, read complex material, cogitate can be fine. My intellectual capacity has in fact improved over the past year despite my depression maintaining, if not worsening.
Other aspects of 'executive function', like decision-making, ability to talk back to negative thoughts, ability to notice, latch on, and depend on the objective positives in one's life, social intelligence, etc. however can be very much weakened by depression. To say nothing of sustained attention and motivation.
My own understanding, and it is very superficial, is that the prefrontal cortex serves as the locus for the more integrative, high-level, dare I say most human aspects of personality. A dysfunction of the PFC, and/or it's connections to the limbic region, I imagine as truly a 'dehumanizing' disorder. To me, that's what depression feels like. As though I'm losing those things that make humans most human.
-uncouth
Posted by SLS on September 23, 2009, at 12:10:44
In reply to Re: depression + executive function, posted by uncouth on September 23, 2009, at 11:42:32
> My own understanding, and it is very superficial, is that the prefrontal cortex serves as the locus for the more integrative, high-level, dare I say most human aspects of personality. A dysfunction of the PFC, and/or it's connections to the limbic region, I imagine as truly a 'dehumanizing' disorder. To me, that's what depression feels like. As though I'm losing those things that make humans most human.
Yes.
For years, I have commented to others that I felt sub-human. My level of function certainly was. Unfortunately, most people don't get it.
- Scott
Posted by Alexanderfromdenmark on September 23, 2009, at 12:29:44
In reply to depression + executive function, posted by g_g_g_unit on September 23, 2009, at 6:08:10
If you are willing to look beyond monoamines
I would get a full hormonal workup includingThyroid panel
Sex hormone panel
IGF-1
Adrenal panel
Ferritin
B12
Vitamin D
Posted by g_g_g_unit on September 23, 2009, at 18:44:31
In reply to Re: depression + executive function, posted by linkadge on September 23, 2009, at 6:53:41
> What does a strong cup of coffee do for you - anything? SSRI's can be effective for a broad range of depression symtpoms -so they're worth a try regardless of the purported mechanism.
since falling depressed, coffee doesn't do a thing for me - just makes me more tired and apathetic. i've been wondering why actually. what does that indicate?
>
> If this does't work, drugs with a different mechanism are worth a try.
>
> While I experience many of the same symptoms as you, parnate made my depression much worse. It made my mood very dark and serious.
>
> Linkadgeyeah i feel worse on Parnate - more agitated, and even scared to be alone at times.
still, i can't think of anything else i'd rather be on, so i'm holding out in the hopes it works. my preference is for drugs that are clean cognitively.
Posted by g_g_g_unit on September 23, 2009, at 18:52:21
In reply to Re: depression + executive function, posted by SLS on September 23, 2009, at 7:03:15
>> Parnate is a good choice of drug simply because it works.i'm taking 30mg now. i asked my pdoc if he could augment with a TCA for sleep and he said he'd be willing to look at any papers i have on the matter since he's never tried. would a low dose of notriptyline work for sleep, or might amitriptyline be better?
>
> > my EF issues
>
> What are EF issues?
>
sorry executive function issues. i guess i've always had slight issues with attention span, but that's probably a given with OCD; my follow through, etc. on projects was all intact. still, even though atypical AP's can help with executive function, don't they have anti-depressant properties in and of themselves anyway?
>
> Have you tried Lamictal? It also works to reduce glutamate activity.no i've never been on a mood stabilizer. i'll keep lamictal in mind
Posted by g_g_g_unit on September 23, 2009, at 18:59:31
In reply to Re: depression + executive function, posted by uncouth on September 23, 2009, at 11:42:32
> I'm not sure what the dictionary definition of 'executive function' is, but in my opinion, the term is probably used a bit too broadly.
i guess i'm referring to things like attention span, concentration, and ability for abstract thought. what i find cruelest about depression is that given the presence of executive function issues combined with psychomotor agitation, i can't even do things like read for long periods or watch TV to keep me busy or entertained. i have all this restless energy but it's completely unproductive. i just walk around the house eating.
Posted by g_g_g_unit on September 23, 2009, at 19:01:39
In reply to Re: depression + executive function, posted by SLS on September 23, 2009, at 12:10:44
> For years, I have commented to others that I felt sub-human. My level of function certainly was. Unfortunately, most people don't get it.
>
>
> - Scottyeah i find it sad that i can't even take solace in my own presence/thoughts. my mom finds this part hard to understand - she keeps imagining i'm in some kind of state of emotional torture, whereas the opposite is true: i feel like an alien.
Posted by g_g_g_unit on September 23, 2009, at 19:03:27
In reply to Re: depression + executive function, posted by Alexanderfromdenmark on September 23, 2009, at 12:29:44
>
> Thyroid panel
> Sex hormone panel
> IGF-1
> Adrenal panel
> Ferritin
> B12
> Vitamin DVit D and B12 were low; correcting them helped my brain fog, but not much else.
Ferritin was too high.
Thyroid was fine.
i haven't had the others checked though. what's IGF-1?
Posted by Phillipa on September 23, 2009, at 20:53:04
In reply to Re: depression + executive function, posted by uncouth on September 23, 2009, at 11:42:32
Uncouth thank you sincerely for taking the time to give a great very easy definition to understand. Appreciate it and hopefully soon you will be feeling better. I do feel for you. Love Phillipa
Posted by Monica L on September 24, 2009, at 17:07:21
In reply to depression + executive function, posted by g_g_g_unit on September 23, 2009, at 6:08:10
> i was just curious whether it's productive to consider executive function issues apart from depression in terms of etiology - i.e. whether they require some specific kind of treatment, or if depression itself can cause prefrontal hypofunction, and its relief (by whatever means - SSRI's, etc.) should help functioning?
>
> most of my issues look like the negative symptoms of schizophrenia - no real affect unlessfaked, a general slowness that makes conversation hard, the desire to avoid people (and feeling quite content being alone), an empty-minded feeling, concentration difficulties. but i don't really get any psychomotor retardation - in fact, i often feel really fidgety and restless.
>
> i was wondering if it's pointless to think of this as a 'low dopamine' depression? if it's just a shade of depression that can be caused by anything, or if there's some path i should be taking? i guess i'm just wondering if Parnate is the right way to go, or if i should be looking at something more receptor specific like the atypical AP's.
>
> my EF issues seem to get more severe with time, and make it hard to stick with a treatment, since i can't really 'plan' or commit to a decision. there were some days on Memantine where i felt completely normal - calm and able to make decisions that 'felt right', but it wasn't very consistent in effect. i often feel like if my executive + social function improved, my depression would lift, but again is that just a chicken/egg thing?
>
>
A lot of the symptoms you mention sound just like what I'm dealing with. I feel like I'm capable of so much more but can never get there.
Posted by g_g_g_unit on September 25, 2009, at 3:04:28
In reply to Re: depression + executive function, posted by Monica L on September 24, 2009, at 17:07:21
> >
> A lot of the symptoms you mention sound just like what I'm dealing with. I feel like I'm capable of so much more but can never get there.
>
i'm sorry to hear that. are you currently on anything?
Posted by g_g_g_unit on September 25, 2009, at 3:06:27
In reply to Re: depression + executive function, posted by SLS on September 23, 2009, at 7:03:15
> Yes. This is what is often seen in bipolar depression. What you experience is sometimes described as the "deficit syndrome". Although more often used to characterize schizophrenia, this term has been used from time to time with depression.is it seen in unipolar depression as well? For what it's worth, i've never been diagnosed as bipolar.
Posted by SLS on September 25, 2009, at 3:37:02
In reply to Re: depression + executive function » SLS, posted by g_g_g_unit on September 25, 2009, at 3:06:27
>
> > Yes. This is what is often seen in bipolar depression. What you experience is sometimes described as the "deficit syndrome". Although more often used to characterize schizophrenia, this term has been used from time to time with depression.
>
> is it seen in unipolar depression as well? For what it's worth, i've never been diagnosed as bipolar.I think much of what is described as the deficit syndrome occurs with more severe anergic atypical depressions with anhedonia as a primary symptom.
For now, I guess the term "deficit syndrome" is best reserved for use in schizophrenia.
- Scott
Posted by linkadge on September 26, 2009, at 12:04:00
In reply to Re: depression + executive function, posted by g_g_g_unit on September 23, 2009, at 18:44:31
Dopamine isn't the magic pleasure chemical. Pleasure is regulated by a balance of all sorts of chemicals in the neucleus accumbens - dopamine, serotonin, norpinephrine, PEA, opiates etc. Too much dopamine in the neucleus accumbens can actually produce depression. Stress can elevate dopamine in the prefrontal cortex and limbic system, making things feel more serious and more real. SSRI's may work by resetting the balance of dopamine/serotonin in these regions.
When SSRI's make people apathetic, sometimes the answer is less SSRI not dopaminergic augmentation.
Too much dopamine can cause apathy too.
Linkadge
Posted by SLS on September 26, 2009, at 13:08:00
In reply to Re: depression + executive function, posted by linkadge on September 26, 2009, at 12:04:00
Great information.
Thanks.
- Scott
> Dopamine isn't the magic pleasure chemical. Pleasure is regulated by a balance of all sorts of chemicals in the neucleus accumbens - dopamine, serotonin, norpinephrine, PEA, opiates etc. Too much dopamine in the neucleus accumbens can actually produce depression. Stress can elevate dopamine in the prefrontal cortex and limbic system, making things feel more serious and more real. SSRI's may work by resetting the balance of dopamine/serotonin in these regions.
>
> When SSRI's make people apathetic, sometimes the answer is less SSRI not dopaminergic augmentation.
>
> Too much dopamine can cause apathy too.
>
> Linkadge
>
Posted by g_g_g_unit on September 26, 2009, at 22:30:48
In reply to Re: depression + executive function, posted by linkadge on September 26, 2009, at 12:04:00
> Dopamine isn't the magic pleasure chemical. Pleasure is regulated by a balance of all sorts of chemicals in the neucleus accumbens - dopamine, serotonin, norpinephrine, PEA, opiates etc. Too much dopamine in the neucleus accumbens can actually produce depression. Stress can elevate dopamine in the prefrontal cortex and limbic system, making things feel more serious and more real. SSRI's may work by resetting the balance of dopamine/serotonin in these regions.
>
> When SSRI's make people apathetic, sometimes the answer is less SSRI not dopaminergic augmentation.
>
> Too much dopamine can cause apathy too.
>
> Linkadge
>for what it's worth, i'm not searching for pleasure; just a return to baseline functioning.
at the moment, like i say, i get the worst ADD-like symptoms - i can barely drive without looking at everything that catches my attention; when watching movies my attention seems to shut out every 5 seconds so i have to direct it back to the movie constantly and can barely follow plots; i have no self-control over addictive behaviours (browsing doctor bob, for example) or tics. most of this stuff began to appear after a really bad experience on REmeron, so either the drug triggered depression via the intense stress it caused (worsened OCD), or had some withdrawal i should've waited out. i remember complaining about brain fog after coming off the drug, which low dose prozac fixed instantly, but i couldn't sleep on prozac.
nothing seems to help now - SSRI's make me more withdrawn and ruin sleep; Nardil helped the depression but made me hypomanic and seemed to worsen OCD; the insomnia on Parnate is becoming unbearable, and i just feel more dysphoric and anxious. CBT helps me cope with the symptoms, but no amount of inner will power can help them.
the only thing that helped attention and social issues was a low dose Memantine, when it acted as a stimulant, but that worsened compulsive behaviours. i'm really at a loss about what to do now.
Posted by Alexanderfromdenmark on September 27, 2009, at 8:07:08
In reply to Re: depression + executive function » Alexanderfromdenmark, posted by g_g_g_unit on September 23, 2009, at 19:03:27
IGF-1 is a marker for the activity of growth hormone.
What's causing the elevated ferritin?
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.