Posted by JohnL on January 29, 2003, at 4:08:55
In reply to Is Wellbutrin effective for dysthymia?, posted by btnd on January 28, 2003, at 12:55:49
Dysthymia is often unresponsive to serotonin meds. It's just my opinion from observations over the years, but I believe dysthymia is actually a stand-alone condition that should be treated differently than major depression. It looks a lot like depression, but is uniquely different at the same time. It actually looks more like the negative symptoms of schizophrenia than it does major depression. Dysthymia tends to be a reward deficiency syndrome, which is usually not directly related to serotonin, but instead related to dopamine D2 receptors.
In my opinion, what makes dysthymia different from depression is that it involves an irregularity in the dopamine/norepinephrine system. It doesn't usually directly involve the serotonin circuitry.
For example, someone with dysthymia who takes an SSRI may likely complain of emotions being dulled even more than they were to begin with.
Dopamine meds seem better for dysthymia. That being said, Wellbutrin doesn't seem to do a very good job. Its dopamine action is either too weak or in the wrong area of the brain. And often a good response fades to non-response with Wellbutrin.
Natural things to consider for dysthymia: SAMe and/or Rhodiola Rosea (4% Rosavin minimum).
Meds to consider, in no particular order: Zyprexa, Desipramine, stimulants, Adrafinil, Mirapex, or any meds that work on dopamine and/or norepinephrine primarily.
I hate to be in a position where I told you so. But if you go the antidepressant/mood stabilizer route for dysthymia, you will likely be disappointed and waste years of your life. Again though, just observations.
JohnL
poster:JohnL
thread:137958
URL: http://www.dr-bob.org/babble/20030125/msgs/138092.html