![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by Peter on March 29, 2003, at 20:11:41
Hi all:
Well, it's been about 2-3 weeks on Prozac. I'm now up to 10mg. It has helped me get out of the horrid, deep depression I was in, but I still have specific, negative mood tendencies.
What seems to be happening often is that I get very socially withdrawn and dull-feeling. At least I can get myself to go out to a restaurant with a friend, which I couldn't even do before out of social anxiety and depression. But, once I'm there, I feel like getting out and isolating - not so much out of social anxiety like before; now, it's more that dull, withdrawn feeling that causes me to feel like I can't carry on a conversation, and I'm just disinterested in everything. Also, I'm noticing that I very easily and quickly get a feeling of 'sensory overload,' like I just want to be alone in silence and close my eyes.
I discussed this with my pdoc, and he said it's indicative of a dopamine-deficiency. I already take 40 mg adderall daily, which I would have thought would make up for any dopamine deficiency. But my doc said that stimulants like adderall 'mimic' temporary surges in dopamine, while a drug like Wellbutrin has been known to actually permanently and consistently raise the base level of dopamine in the brain.
I've tried Wellbutrin before, but only for a few weeks, and it made me feel jittery and anxious. But the wierd thing is that the adderall does benefit me, but only for a very short time - like at the onset of its action - and then it leaves me even more socially withdrawn. That very short period when it seems to help is characterized not by euphoria, but by a temporary lifting of depression and an increase in focus and social interest.
But I wonder why it's beneficial effects are so short-lived for me (like under 1 hour)? Is this a possible attestment to my need for a dopamine-inducing med more along the lines of wellbutrin? BTW, my pdoc in the past tried a few dopamine agonists on me - mirapex, etc. I don't recall them helping my mood much, but I guess they work on a different receptor?
I don't even know for sure if my problem boils down to a dopamine deficiency. As time goes by, we're going to see if the Prozac helps me - my doc says it raises dopamine in some people, but lowers it in others; the whole serotonin-dopamine relationship isn't so predictable and linear.
But I just wonder: even though the adderall helps me get going in the morning, helps me work, and decreases depression, does the fact that it only helps me for such a short time mean that it might be ultimately LOWERING my dopamine to below-normal levels in the long run? I'd appreciate anyone's opinions and/or suggestions.
thanks,
Peter
Posted by paxvox on March 29, 2003, at 20:44:49
In reply to question about dopamine, posted by Peter on March 29, 2003, at 20:11:41
Been on wellbutrin for 6 years now. It has been the only AD to work for me for that long a time period. Amphetamines have shorter half-lives, and thus would be flushed out of your system fairly quickly. There is a time-released version of Adderal that might work differently for you, but WB is not addictive, nor will you develop a tolerance to it. It does, however, take a while to get used to, and yes, jitters and chest tightening can be one negative side effect. There are more dosing options now that a 100mg SR is also available.
PAX
Posted by Ron Hill on March 29, 2003, at 20:57:37
In reply to question about dopamine, posted by Peter on March 29, 2003, at 20:11:41
Peter,
What you describe sounds similar to the emotional blunting I experience from all of the SSRIs. Even with a good functioning moodstabilizer in place, the slightest pinch of an SSRI gives me a couple days of hypomania (euphoric type), followed by a couple days of normal non-depressive state, and then it turns me into what my wife affectionately calls her "do nothing boy". In the latter state, I'm not really depressed and I'm not irritable. But I have no motivation, my energy is low, and I'm completely numb emotionally. By contrast, when I'm healthy (i.e.; not depressed and not on an SSRI), I am an emotional person.
I attribute these adverse SSRI side effects to the fact that; “Chief among the brain’s reactions to artificially elevated serotonin levels is a compensatory drop in dopamine.” I took this quote from page 20 of the introduction in a book entitled "Prozac Backlash" by Joseph Glenmullen, M.D. He is a clinical instructor in psychiatry at Harvard Medical School, is on the staff of Harvard University Health Services, and is in private practice in Harvard Square. His credentials look impressive, but he appears to be somewhat extreme in his views regarding the dangers of SSRIs. If you want, you can read the Introduction and Chapter 1 in their entirety for free at the Amazon.com hyperlink provided above. I thought it was worth the time I spent scanning the available portions of his book.
If I sent this information to you a few months ago, please excuse the duplication.
-- Ron
--------------------------------------------
> Hi all:
> Well, it's been about 2-3 weeks on Prozac. I'm now up to 10mg. It has helped me get out of the horrid, deep depression I was in, but I still have specific, negative mood tendencies.
> What seems to be happening often is that I get very socially withdrawn and dull-feeling. At least I can get myself to go out to a restaurant with a friend, which I couldn't even do before out of social anxiety and depression. But, once I'm there, I feel like getting out and isolating - not so much out of social anxiety like before; now, it's more that dull, withdrawn feeling that causes me to feel like I can't carry on a conversation, and I'm just disinterested in everything. Also, I'm noticing that I very easily and quickly get a feeling of 'sensory overload,' like I just want to be alone in silence and close my eyes.
> I discussed this with my pdoc, and he said it's indicative of a dopamine-deficiency. I already take 40 mg adderall daily, which I would have thought would make up for any dopamine deficiency. But my doc said that stimulants like adderall 'mimic' temporary surges in dopamine, while a drug like Wellbutrin has been known to actually permanently and consistently raise the base level of dopamine in the brain.
> I've tried Wellbutrin before, but only for a few weeks, and it made me feel jittery and anxious. But the wierd thing is that the adderall does benefit me, but only for a very short time - like at the onset of its action - and then it leaves me even more socially withdrawn. That very short period when it seems to help is characterized not by euphoria, but by a temporary lifting of depression and an increase in focus and social interest.
> But I wonder why it's beneficial effects are so short-lived for me (like under 1 hour)? Is this a possible attestment to my need for a dopamine-inducing med more along the lines of wellbutrin? BTW, my pdoc in the past tried a few dopamine agonists on me - mirapex, etc. I don't recall them helping my mood much, but I guess they work on a different receptor?
> I don't even know for sure if my problem boils down to a dopamine deficiency. As time goes by, we're going to see if the Prozac helps me - my doc says it raises dopamine in some people, but lowers it in others; the whole serotonin-dopamine relationship isn't so predictable and linear.
> But I just wonder: even though the adderall helps me get going in the morning, helps me work, and decreases depression, does the fact that it only helps me for such a short time mean that it might be ultimately LOWERING my dopamine to below-normal levels in the long run? I'd appreciate anyone's opinions and/or suggestions.
> thanks,
> Peter
Posted by Ron Hill on March 29, 2003, at 21:09:12
In reply to question about dopamine, posted by Peter on March 29, 2003, at 20:11:41
Here's the Amazon.com hyperlink:
Posted by Mama Bear on March 30, 2003, at 0:13:08
In reply to question about dopamine, posted by Peter on March 29, 2003, at 20:11:41
You need to check out and see if one of the neuroleptics is actually doing damage to your brain rather than helping it. You should check out a book by Dr Peter Breggin. The name of the book is Your Drug May Be Your Problem. Alot of these psychiatric medications can cause you to have more problems than before you went on this medication. My daughter was on prozac for a short while and it totally screwed her up. She was spun on this stuff. Before Prozac she was on Respirdal which is an anti-psychotic that caused her to have permanent brain damage. If you have had a long term use of a Neuroleptic or other drugs like this then you too could have permanent brain damage. My daughter is only 5 years old and she is suffering from a movement disorder called Tardive Dyskinesia. It is caused from long term use of a neuroleptic. Do some research and go see the doctor. If the doctor refuses to tell you the truth about these medications then you may need to find a doctor that does. You can also check out Dr. Breggins own website at www.breggin.com He has testified as an expert witness for the plaintiff(s) damaged from the use of neuroleptics and has not lost a case that he has testified in. Hope this will offer you some hope and help. Tammy. Don't stop your meds. See and consult with your doctor before making any tough decisions like these.
Posted by Peter on March 30, 2003, at 2:35:30
In reply to Re: SSRI Induced Drop in Dopamine » Peter, posted by Ron Hill on March 29, 2003, at 20:57:37
?Chief among the brain?s reactions to artificially elevated serotonin levels is a compensatory drop in dopamine.?
> I've heard this as well. In fact, when I used to take SSRI's alone or with a mood stabilizer, the emotional blunting would always occur. But my pdoc and I discovered that I also usually developed a craving for alcohol, I suppose to stimulate the numbness. This is all indicative of the 'seratonin/dopamine see-saw.' And this is a primary reason for why I now take a dopamine-acting drug along with an SSRI. Each time I've taken the stimulant/SSRI combo, my numbness and alcohol craving no longer occur.
Though this combo has worked in the past, as my doc said, the seratonin/dopamine relationship isn't always so clear-cut. Sometimes dopamine can be indirectly INCREASED, as opposed to decreased, by an SSRI. This is what we're hoping for as I continue the prozac. I'm quite sure the adderall is to some extent compensating for a possible serotonin-induced dopamine deficiency, but obviously it isn't doing it in a consistent, sufficient way. Thus my consideration of wellbutrin add-on. But we'll see how the latest prozac increase works. Thanks for your input,
Peter
Posted by Peter on March 30, 2003, at 2:37:28
In reply to Re: question about dopamine, posted by paxvox on March 29, 2003, at 20:44:49
> Been on wellbutrin for 6 years now. It has been the only AD to work for me for that long a time period. Amphetamines have shorter half-lives, and thus would be flushed out of your system fairly quickly. There is a time-released version of Adderal that might work differently for you, but WB is not addictive, nor will you develop a tolerance to it. It does, however, take a while to get used to, and yes, jitters and chest tightening can be one negative side effect. There are more dosing options now that a 100mg SR is also available.
>>Have you ever taken Wellbutrin in combination with an SSRI?
> Peter
Posted by KRM123 on March 30, 2003, at 10:29:09
In reply to question about dopamine, posted by Peter on March 29, 2003, at 20:11:41
What about Effexor? Is this going to mess up my dopamine chemical since effexor boosts the other two serotonin and norephrinine? I haven't tried Effexor yet...but what should I be looking for if I have dopamine deficiency?
Posted by Peter on March 30, 2003, at 12:32:50
In reply to Re: question about dopamine, posted by KRM123 on March 30, 2003, at 10:29:09
> What about Effexor? Is this going to mess up my dopamine chemical since effexor boosts the other two serotonin and norephrinine? I haven't tried Effexor yet...but what should I be looking for if I have dopamine deficiency?
> I'm sorry if I sounded like the SSRI's or SNRI's ALWAYS lower dopamine. They don't. All of these meds, including effexor, are very good, succesful anti-depressants that have helped many, many people with depression and anxiety. They also have a benign side-effect profile compared to many other psychiatric drugs. So don't worry; even if effexor ends up lowering your dopamine levels, it's not a side-effect that is permanent, irreversible, or dangerous.
The mention of Tardive dyskinesia, in an earlier thread, 'is the only known long-standing, potentially irreversible side effect from any psychiatric med, and only comes from taking neuroleptic (aka, antipsychotic) meds.' This is a direct quote from my doctor's recent email to me. Effexor is not a neuroleptic.
I would say one way to be aware of the possibility of the med lowering your dopamine in the way that AD's can do with some people, is to see if you start feeling very 'dampened' and dulled and in need of excessive stimulation. If that happens, discuss it with your doctor, and you don't feel well from the med after a significant trial, you can always wean off of it under the supervision of your doctor and discuss another route of treatment. If dopamine decrease occurs while on the med and you end up coming off the med, your dopamine levels will return to their natural equilibrium. Don't worry (-:
Peter
Posted by Ron Hill on March 30, 2003, at 12:42:20
In reply to Re: question about dopamine, posted by KRM123 on March 30, 2003, at 10:29:09
> What about Effexor? Is this going to mess up my dopamine chemical since effexor boosts the other two serotonin and norephrinine?
It did for me, but YMMV.
-- Ron
Posted by jonh kimble on March 30, 2003, at 13:43:13
In reply to Re: question about dopamine » KRM123, posted by Ron Hill on March 30, 2003, at 12:42:20
Hi Peter. What you describe is so similar to what ive been dealing with for five years. not really social anxiety but more like what you describe. it sucks so very much. amisulpride is an ap that at low doses selectivly blocks presynaptic dopamine receptors incresing dopamine tranmission, helping some with what you desrcibe (not me however). there have been times when all of this simply vanished for me, which is part of why ive been diagnosed bpII. im starting on lamictal and will tell you how that goes.
Posted by Caleb462 on March 30, 2003, at 15:51:23
In reply to Re: question about dopamine, posted by jonh kimble on March 30, 2003, at 13:43:13
What happens when one takes SSRIs, SNRIs, or other meds that increase serotonin transmission, is that the brain's 5-HT2c receptors are being overactivated. One of the functions of the 5-HT2c receptor is to reduce dopamine transmission in some areas of the brain.
So, basically, serotonergic meds cause extensive 5-HT2c activation and therefore decrease dopamine transmission.
However, this should be less of an issue with Prozac, as Prozac is a 5-HT2c antagonist.
Posted by Dr. Bob on March 30, 2003, at 17:18:49
In reply to Re: Oops, I forgot the double quotes for book link » Peter, posted by Ron Hill on March 29, 2003, at 21:09:12
Posted by KRM123 on March 30, 2003, at 19:10:03
In reply to Re: question about dopamine » KRM123, posted by Peter on March 30, 2003, at 12:32:50
Thanks for clarifying that Peter, I feel much better now =) I guess I should have read more into what this thread was talking about. Thanks again.
Posted by paxvox on April 1, 2003, at 16:36:44
In reply to Re: question about dopamine » paxvox, posted by Peter on March 30, 2003, at 2:37:28
No, I have not.
Posted by stjames on April 1, 2003, at 18:44:26
In reply to Re: question about dopamine, posted by Mama Bear on March 30, 2003, at 0:13:08
http://www.quackwatch.org/04ConsumerEducation/NegativeBR/breggin.html
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.