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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 29. This is the beginning of the thread.
Posted by Phillipa on February 28, 2011, at 19:30:55
Seems amphetamines are being linked to the development of Parkinson's disease both involve dopamine. Phillipa
From Medscape Medical News > Neurology
Amphetamine Use Linked to Increased Parkinson's Risk
Kate JohnsonAuthors and Disclosures
February 25, 2011 Exposure to the amphetamines Benzedrine (Amedra Pharmaceuticals) and Dexedrine (GlaxoSmithKline) is associated with a roughly 60% boost in the risk of developing Parkinsons disease (PD), a new study suggests.
The preliminary findings were released February 20 and will be presented in April at the American Academy of Neurology's 63rd Annual Meeting in Honolulu, Hawaii.
The results could have important clinical implications if they are confirmed by other studies, said principal investigator Stephen K. Van Den Eeden, PhD, a research scientist with Kaiser Permanente Northern California in Oakland.
Amphetamines are prescribed for the treatment of attention-deficit/hyperactivity disorder, narcolepsy, and traumatic brain injuries, and there is also growing interest in their use as cognitive enhancers.
"If this is a true association and someone has a family history of Parkinson's disease, that would weigh in a clinical decision," Dr. Van Den Eeden told Medscape Medical News.
"In prescribing amphetamines we need to weigh the benefits and risks, and [PD family history] could be one risk to consider, though small, as the absolute risk does not appear to be large at this point."
Amphetamine Exposure
The study involved 66,438 people who participated in the Multiphasic Health Checkup Cohort Exam between 1964 and 1973 and were followed for a mean of 38.8 years. The mean age of the participants at baseline was 36 years, and none of them had PD at that time; however, family history of the disease was not recorded.
By the end of the study, a total of 1154 participants had been diagnosed with PD, most of them at approximately 70 years of age.
All cases were diagnosed by a neurologist and identified by a review of electronic clinical records.
Amphetamine exposure was determined by 2 questions: 1 about the use Benzedrine or Dexedrine, and 1 about the use of weight-loss drugs. At the time of the study, amphetamines were commonly used for weight loss.
Cox proportional hazards models showed that participants with PD were much more likely to have been exposed to amphetamines than were participants who were free of the disease.
Compared with participants who had no exposure to amphetamines, those who reported using Benzedrine or Dexedrine "often" had an increased risk of developing PD (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.01 - 2.40). The effect was similar in women (HR, 1.55) and men (HR, 1.60).
In contrast, individuals who reported taking weight-loss medication did not have an increased risk (HR, 0.95; 95% CI, 0.75 - 1.21).
The reasons for no increased risk among those exposed to weight-loss medication deserve further study, said Dr. Van Den Eeden.
"We are looking into this a bit further as we speak to see if the association varied by other factors," such as obesity, or age, he said.
"The most obvious reason would likely be that the weight-loss question was about any drug for weight loss, some of which was certainly amphetamines, but other drugs were used at this time," he speculated. "In other words, the question was less specific and the participants likely responded thinking about a wide range of drugs, some of which may have been over-the-counter drugs."
Amphetamines affect the release and uptake of dopamine, which is the key neurotransmitter involved in PD, he said.
Novel Association
The preliminary findings suggest a "novel association," although further prospective research is needed to confirm the results, said Anna Hohler, MD, assistant professor of neurology at Boston University Medical College, when reached for comment on the study.
"I will alert my patients about this preliminary finding when counseling them about these medications," Dr. Hohler added.
She said in addition to a family history of PD, other factors that might contribute to increased risk when combined with amphetamines include a history of head trauma and exposure to heavy metals or pesticides.
The study was supported by Kaiser Permanente Northern California. Dr. Van Den Eeden and Dr. Hohler disclosed no relevant financial relationships.
American Academy of Neurology 63rd Annual Meeting. Released February 20, 2011, ahead of presentation.
Posted by floatingbridge on March 1, 2011, at 4:31:00
In reply to Amphetamine Use Linked To Parkinson's Disease, posted by Phillipa on February 28, 2011, at 19:30:55
Sigh. My pdoc called to tell me.
Posted by linkadge on March 1, 2011, at 10:36:46
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by floatingbridge on March 1, 2011, at 4:31:00
I would consider this research very preliminary.
Also note, the study only found an increased risk of parkinsons when the amphetamines were used in ADHD, not in obesity.
Perhaps in ADHD, there is an increased risk of parkinsons to begin with (due to some sort of fundamental dopaminergic system deficiancy / damage). I.e. is ADHD an independant risk factor for parkinsons?
If the amphetamine does cause parkinsons, does this extend to methylphenidate?
Posted by Phillipa on March 1, 2011, at 11:18:38
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by floatingbridge on March 1, 2011, at 4:31:00
He did? So it's true? OMG. Love Phillipa
Posted by floatingbridge on March 1, 2011, at 11:46:06
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » floatingbridge, posted by Phillipa on March 1, 2011, at 11:18:38
Phillipa,
He called, maybe because he expected I might panic if I stumbled across it. He said it's all over. We have a history: he's either horrified or delighted by my readings.
And Link, darn good question of yours.
Posted by floatingbridge on March 1, 2011, at 11:46:57
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » floatingbridge, posted by Phillipa on March 1, 2011, at 11:18:38
Phillipa,
He called, maybe because he expected I might panic if I stumbled across it. He said it's all over. We have a history: he's either horrified or delighted by my readings.
And Link, darn good question of yours.
Posted by Phillipa on March 1, 2011, at 12:46:09
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by floatingbridge on March 1, 2011, at 11:46:57
FB seriously it's all over? I have to see dermatologist possible nose skin cancer so was kind of preoccupied with fear. But I will give this search are you planning on continuing with the med? If what Link says it correct it really doesn't matter does it. I don't know. He's a great doc to call you I've not heard of any doing this before physical or pdoc. You have a great doc. Love Phillipa
Posted by Phillipa on March 1, 2011, at 12:52:00
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » floatingbridge, posted by Phillipa on March 1, 2011, at 12:46:09
Quick google confirms above. So many people could be affected if true. Love Phillipa
Posted by former poster on March 2, 2011, at 23:54:59
In reply to Amphetamine Use Linked To Parkinson's Disease, posted by Phillipa on February 28, 2011, at 19:30:55
I wonder why it took 60 years to come out with this info? Benzidrine was used by many in the 40's. Maybe its back to Methylphenidate (Ritalin) for me? It's one of the most extensively researched drugs in history. Thanks FDA for doing a great job..
Posted by floatingbridge on March 3, 2011, at 2:40:54
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by former poster on March 2, 2011, at 23:54:59
FP
Ritalin? What's it like?
I'm now down to 30mg today.
Posted by Phillipa on March 3, 2011, at 19:35:58
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by former poster on March 2, 2011, at 23:54:59
FP more to come as now motrin or something haven't read newsletter yet is supposed to protect from Parkinson's so maybe take that and dexadrine? Phillipa
Posted by former poster on March 3, 2011, at 21:37:51
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » former poster, posted by floatingbridge on March 3, 2011, at 2:40:54
Ritalin made me drive fast, talk fast and have a short temper. Also relieved some depression, made me able to focus but usually caused more anxiety. I felt like it made me more outgoing, but in a nerdy way. Dextroamphetamine is a smoother, calmer stimulant and more effective on social anxiety.
Posted by former poster on March 3, 2011, at 21:47:23
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » former poster, posted by Phillipa on March 3, 2011, at 19:35:58
I read that about Motrin (Ibuprofin) too. Along with several other substances. Strange as it may seem, nicotine can prevent the dopamine depleting diseases. Parkinsons scares me because my Grandmother died from it.
Posted by floatingbridge on March 3, 2011, at 22:11:48
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by former poster on March 3, 2011, at 21:47:23
So Motrin? Will Google. Interesting.
Took last dexedrine today; my 15mg spansule.
Pdoc says 3 day wash for dex. I see him on Tuesday, and he'll give me emsam then.
He asked me if I was sure I knew what I was doing. Absolutely not, I said, --are you serious? He had to laugh at that.
Motrin, yeah?
What about emsam (segilene, sp?)?
Posted by former poster on March 3, 2011, at 22:35:39
In reply to Re: Amphetamine Use Linked To Parkinson's Disease, posted by floatingbridge on March 3, 2011, at 22:11:48
Emsam is part of my cocktail. I am looking for a study that might indicate Emsam have neuroprotective / anti-parkinsons property's like most of the MAOI's. Emsam feels almost the same as Dextro. Supposedly its metabolized into amphetamine. But causes me a lot of side effects I never got with Dex.
Posted by floatingbridge on March 3, 2011, at 23:52:32
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » floatingbridge, posted by former poster on March 3, 2011, at 22:35:39
Hi FP,
Your experience is interesting. Dexedrine 'stopped' working a while back.
I had heard somewhere that maoi's were broken down into metabolites (right word) with amphetamine-like qualities. Not being scientific-minded, I couldn't
recall the references, nor explain that to docs.That maoi's could provide some neuroprotection and some stimulation
would be grand. Dex was what had helped me the most to date.Thanks.
Hope you find that study.
Posted by Phillipa on March 4, 2011, at 0:31:30
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » former poster, posted by floatingbridge on March 3, 2011, at 23:52:32
FB so ensam it is I do think it will work for you. The motrin a mystery to me posted a link bottom of page and since Linkage also go a good response he posted to motrin like I did that time hoping he will respond been googling and can't find what I want on it. Love Phillipa
Posted by former poster on March 4, 2011, at 12:06:55
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » former poster, posted by floatingbridge on March 3, 2011, at 23:52:32
Yeah Dex helped me the most too.
Posted by floatingbridge on March 4, 2011, at 12:45:51
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » floatingbridge, posted by Phillipa on March 4, 2011, at 0:31:30
Phillipa,
This may be irrelevant, but motrin has been the only nsaid that I could 'feel' enter my system. That could be separate from analgesic quality, and I say that because it does not help my back pain (bone on bone?)
So a motrin a day?
Dad took aspirin a day; then docs said, oh. Take baby aspirin. By then he was almost deaf. (Could have been his age.)
Minimum dosage suggested in that link?
Posted by linkadge on March 4, 2011, at 15:29:19
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by floatingbridge on March 4, 2011, at 12:45:51
dopamine depletion is not what causes parkinsons, its destruction to the dopamine produicing and recieving neurons.
Coffee can deplete dopamine but actually reduces the risk of parkinsons.
Linkadge
Posted by floatingbridge on March 4, 2011, at 15:36:48
In reply to Re: Amphetamine Use Linked To Parkinson's Disease, posted by linkadge on March 4, 2011, at 15:29:19
So is that what study hypothesizes? Destruction?
Posted by Phillipa on March 4, 2011, at 19:58:17
In reply to Re: Amphetamine Use Linked To Parkinson's Disease » Phillipa, posted by floatingbridge on March 4, 2011, at 12:45:51
Floatingbridge strange isn't it as same here. It was 600mg for 24 hours that for me felt so different and I felt good mentally. Love Phillipa
Posted by iforgotmypassword on March 8, 2011, at 14:38:01
In reply to Amphetamine Use Linked To Parkinson's Disease, posted by Phillipa on February 28, 2011, at 19:30:55
AMP interferes with VMAT2, and reverses the safe storage of DA in vesicles, and this is how AMP increases DA; but DAT is left mostly unchecked and begins transporting elevated amounts of DA back into the unguarded intracellular environment where its breakdown is quite toxic and creates reactive oxygen species, killing cells. it is theorised that this is what causes the intractable apathy, and blown executive function, proper inhibition/disinhibition in those having dealt with sufficient AMP and meth-AMP addiction; but that somehow functioning of mesocortical and mesolimbic pathways go first, rather than what is assumed in parkinson's where nigrostriatal pathway degeneration is what's focused on.
seemingly out of place but important: while indeed i am saying there may be a "level of priority" in how the damage takes place in differing situations, an extreme black and white form of this thinking i think is improperly taken for granted due to professional ignorance of certain types of symptoms in medicine and our right-wing-libertarian-slanted culture that sees certain problems as moral before neurological; the reality that many of us personally may be subject to here on this forum is that this thinking perpetually dooms people with potential dopaminergic dysfunction OF ANY TYPE that should be explored, and neglects the humanitarian goals we associate with medicine. if medicine is to be credibly humanitarian, that is, i guess.
so to clarify, i don't think it can be seen as having a very selective effect on the mesocortical and mesolimbic pathwayss, it still could not in anyway be healthy for the nigrostriatal pathway, and i think this is what they may be seeing, also consider the extreme movement effects of AMP overuse short term and long term, "meth-mouth", etc.
controlling intracellular DA by interfering with DAT is why MPH, despite often feeling more agitating and thus making a subject sometimes feel that it is more unhealthy and 'dirtier' at effective doses, MPH is proposed to be neuroprotective and certainly seems to be in animal models, including as a preventative against AMP related damage.
(i apoligise for the total lack of order. as usual i have too much trouble with this, and if i am going to send anything at all i have to keep as is.)
Posted by iforgotmypassword on March 8, 2011, at 15:24:33
In reply to relevant diff betw MPH and AMP is the transporter, posted by iforgotmypassword on March 8, 2011, at 14:38:01
> " the reality that many of us personally may be subject to here on this forum is that this thinking perpetually dooms people with potential dopaminergic dysfunction OF ANY TYPE that should be explored, and neglects the humanitarian goals we associate with medicine. if medicine is to be credibly humanitarian, that is, i guess."
bad editing in parts of sentences, i don't mean to say that people are subject to this philosophy here, but rather that people here are subject to it in society, i edited in what i was saying incorrectly, and in the wrong place. there are probably other things that sound off, i am really not doing well.
Posted by linkadge on March 8, 2011, at 15:33:37
In reply to relevant diff betw MPH and AMP is the transporter, posted by iforgotmypassword on March 8, 2011, at 14:38:01
First of all, this is simply one study, and it is by no way conclusive. Like mentioned, the study did not find a unanimous increase in parkinsons in amphetamine users (i.e. no increased incidence was found in those using the drugs for weight loss). I would like to see more studies confirming this finding, and which drugs, at which doses.
>is theorised that this is what causes the >intractable apathy, and blown executive >function, proper inhibition/disinhibition in >those having dealt with sufficient AMP and meth->AMP addiction
There is no evidence that use of amphetamine in theraputic doses causes these problems.
>but that somehow functioning of mesocortical and >mesolimbic pathways go first, rather than what >is assumed in parkinson's where nigrostriatal >pathway degeneration is what's focused on.Says who?
Also keep in mind, the brain has its own version of amphetamine (PEA). PEA acts identically to amphetamine in terms of transporter reversal and monoamine release. High doses of PEA can cause neurotoxicity and psychosis just like with amphetamines. Obviously there is a theraputic, physiological level of PEA. PEA has been shown (in many studies) to be low in ADHD.
My personal thoughts are that amphetamine also has a window of theraputic effect. The study posted does not really focus on the theraputic use of amphetamines in ADHD. By not specifically studying ADHD, there really is no good control. I.e. in which cases was amphetamine abused vs. used? Also, isn't it possible that an individual with dopamine system dysfunction might be more prone to use amphetamines in the first place?
Some studies show that theraptic use of amphetamines can actually *enhance* motor recovery in stroke. Also, in animal models of ADHD, amphetamines are trophic to dopaminergic pathways in the prefrontal cortex.
I would still be cautious about implicating theraptic use of amphetamines in parkinsons development. I don't really think we have the data to suggest that yet.
Linkadge
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