Posted by Quintal on February 22, 2007, at 20:15:34
In reply to Re: opiates for depression, posted by linkadge on February 21, 2007, at 20:58:11
>Caffiene is an example of a stimulant drug which increases dopamine release much more in the frontal cortex than in the neucleus accumbens. While caffine is not patentable, it is probably the number one choice for ADHD for a number of undiagnosed.
Caffeine seems to mostly increase alertness and still isn't as effective as amphetamines though and it is less well tolerated at doses needed to have the desired effects; most people with ADHD seem to prefer amphetamines. Caffeine doesn't seem to be an impressive treatment for ADHD in spiders(!): http://en.wikipedia.org/wiki/Image:Caffeinated_spiderwebs.jpg
>Thats probably because straterra doesn't increase frontal cortex dopamine as much as it does frontal cortex noradrenaline. This drug doesn't make a lot of sense for ADHD since a number of studies indicate noradrenaline is hyperactive compared to dopamine in ADHD. (but thats beside the point)
That is the point I'm getting at link. This drug does make sense in theory because there have also been a number of studies that indicate a deficit in the nordrenergic systems of people with ADHD. Just as with dopamine, according to my textbook, there has been a noradrenaline deficit hypothesis in ADHD (it seems) whenever it has been convenient to market a new drug that operates via that mechanism.
>For starters we only really have Straterra, which as I mentioned above doesn't really increase frontal cortex dopamine so I wouldn't even use it as a comparitor.
That's the whole point I'm getting at link; you can increase attention span with drugs that act on neurotransmitters other than dopamine, yet they don't seem to be as good for treating the overall problem.
>Another consideration is that ADHD drugs can continue to work, long after the subjective high has subsided. Kids who take ritalin for years, are unlikely to be getting any buzz from it, but it still helps their attention.
You can say the same thing about benzos and point to people who have been taking them for decades and feel they are helping their anxiety long after the initial sedation and euphoria have faded. That might be true for some, but as studies suggest (in benzos for example), most are receiving little real benefit from the drugs at that point (hard though it is for them to believe). They have little more than placebo brought on by conditioning. I think a lot depends on the rate at which each person develops tolerance. For some it's rapid and the anxiety slaps them in the face and they have no choice but to admit the drug is no longer working. For others I suspect it's more insidious, creeping up over the years so gradually that they have time to adjust and develop coping mechanisms. In effect they've gradually withdrawn from the drug in the therapeutic sense, in that it is doing little to help the original problem, yet they are still dependent on it, but mostly to maintain equilibrium.
>Another argument that I would make is that many people who are trying drugs like strattera have already been primed to the reward of ritalin. As such, they are unlikely to find other drugs as effective.
Why would such drugs be any less effective for ADHD if the reward systems played no part in the therapeutic response? I seem to have put myself in the position of defending the 'ADHD drugs get you high' camp, which wasn't the intention I began with. I posted those comments about amphetamines because here in the UK you would certainly not be prescribed a stimulant for depression because tolerance to those effects develop quickly and they are notorious for precipitating particularly severe depressions on withdrawal. For those reasons amphetimes are considered inappropriate for treating depression here, and I'm inclined to agree. It seems unwise to give such drugs to people already prone to depression and mood swings for the risk of exacerbating the problem in the long run, whatever the temporary gain.
I was hoping to add some perspective on flmm's comments about opiates by highlighting the fact that some people here have been prescribed amphetamines for this purpose and no such objections are raised to this as they are with opiates. I've also noticed some people with chronic depression deciding that because they have poor concentration and trouble organising themselves they must have ADHD, and therefore need stims to treat this newly discovered co-morbid disorder. That seems a little dubious to me, hence my comments.
Q
poster:Quintal
thread:734151
URL: http://www.dr-bob.org/babble/20070219/msgs/735204.html