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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by blueberry on February 20, 2006, at 19:37:23
Your thoughts please Scott on some brain mechanistics? ...
If I flood my brain with dopamine/norepinephrine neurotransmitters, from precursors, I get a pattern. First, I feel good for a couple hours, and then I start feeling more depressed than I had been. Also, I have tinnitus...but when my brain is flooded, that tinnitus quiets down dramatically to where I can hardly hear it. It's as if all the extra dopamine/norepinephrine floating around in there dampens everything down, slows down or shuts down release, puts receptors to rest, or something. Dunno. I wondered if you might know what mechanisms are at play here, so that when there is more than ample norepinephrine and dopamine floating around, it dramatically quiets tinnitus but also causes a worsening of depression. The same pattern holds true with serotonin precursors as well.
Posted by SLS on February 20, 2006, at 21:17:59
In reply to Question for SLS, posted by blueberry on February 20, 2006, at 19:37:23
Hi Blueberry.
First of all, I really do enjoy following your posts. You are very well informed and I respect your opinions.
> Your thoughts please Scott on some brain mechanistics? ...
I'm afraid that I don't have an immediately obvious answer for you regarding your experiences with precursor loading. I'll need to give it some more thought and a few peeks at Google. For now, I would say that *if* precursor loading resulted in an increase of synaptic neurotransmitter, there might be a lag time between the disappearance of neurotransmitter and the turning-off of presynaptic autoreceptors. This lag time might be responsible for the depression that follows as synthesis and release neurotransmitter remain inhibited.
How does Wellbutrin affect you?
Remeron and nortriptyline are other drugs that come to mind.
- Scott
Posted by blueberry on February 21, 2006, at 5:13:29
In reply to Re: Question for SLS, posted by SLS on February 20, 2006, at 21:17:59
Hi Scott,
Thanks for your thoughts. I will look forward to more followup if you think of something to add.
I get the hunch that with precursor loading the receptors sense so much concentration of neurotransmitters floating around that the release just slows way down. Not good for my mood, but great for silencing tinnitus.
How does wellbutrin effect me? Poorly. Worsened depression and a total loss of any motivation, just want to hide in a cave. And worsened tinnitus.
Remeron also depresses me. And increases tinnitus.
I tried nortriptyline a long time ago for just one week and don't remember much about it other than the drugged feeling and dry mouth.
> Hi Blueberry.
>
> First of all, I really do enjoy following your posts. You are very well informed and I respect your opinions.
>
> > Your thoughts please Scott on some brain mechanistics? ...
>
> I'm afraid that I don't have an immediately obvious answer for you regarding your experiences with precursor loading. I'll need to give it some more thought and a few peeks at Google. For now, I would say that *if* precursor loading resulted in an increase of synaptic neurotransmitter, there might be a lag time between the disappearance of neurotransmitter and the turning-off of presynaptic autoreceptors. This lag time might be responsible for the depression that follows as synthesis and release neurotransmitter remain inhibited.
>
> How does Wellbutrin affect you?
>
> Remeron and nortriptyline are other drugs that come to mind.
>
>
> - Scott
Posted by SLS on February 21, 2006, at 7:45:03
In reply to Re: Question for SLS » SLS, posted by blueberry on February 21, 2006, at 5:13:29
> Thanks for your thoughts. I will look forward to more followup if you think of something to add.
> How does wellbutrin effect me? Poorly. Worsened depression and a total loss of any motivation, just want to hide in a cave. And worsened tinnitus.I would have expected it to exacerbate the tinnitus, but was hoping there was an antagonistic relationship between it and depression.
> Remeron also depresses me. And increases tinnitus.Both Remeron and Wellbutrin seem to work by ultimately increasing NE neurotransmission. However, I'm not sure either drug can be titrated in such a way as to locate a window of increased NE function that might be right for you. You could possibly have a better chance of doing this with a reuptake inhibitor or an MAOI.
> I tried nortriptyline a long time ago for just one week and don't remember much about it other than the drugged feeling and dry mouth.
I'm guessing you have already tried the SSRIs.
Nortriptyline or desipramine might be a good place to start. Many people feel a great somnolence or sedation with nortriptyline when they first start taking it. This more often than not disappears, leaving an energizing effect once it becomes effective for depression. The dry mouth might persist, but probably will not be as significant as time passes.
What were your responses to Effexor and Cymbalta?
What are the most burdensome features of your depression?Sadness?
Depressed mood?
Melancholia?
Dysphoria?
Loss of interest?
Loss of Energy?
Loss of Motivation?
Concentration or memory impairments?
Early morning awakenings?
Having the morning be the time of greatest severity?
Loss of appetite?
Loss of libido?
Irritability?
Social inhibition?
Anxiety?
- Scott
Posted by Larry Hoover on February 21, 2006, at 12:56:24
In reply to Question for SLS, posted by blueberry on February 20, 2006, at 19:37:23
> Your thoughts please Scott on some brain mechanistics? ...
>
> If I flood my brain with dopamine/norepinephrine neurotransmitters, from precursors, I get a pattern. First, I feel good for a couple hours, and then I start feeling more depressed than I had been. Also, I have tinnitus...but when my brain is flooded, that tinnitus quiets down dramatically to where I can hardly hear it. It's as if all the extra dopamine/norepinephrine floating around in there dampens everything down, slows down or shuts down release, puts receptors to rest, or something. Dunno. I wondered if you might know what mechanisms are at play here, so that when there is more than ample norepinephrine and dopamine floating around, it dramatically quiets tinnitus but also causes a worsening of depression. The same pattern holds true with serotonin precursors as well.I think you're describing the peripheral effects of dopamine on blood flow. Dopamine is given to treat shock, for example. It has opposing effects, though, at different concentrations, depending on whether or not there is substantial beta-adrenergic binding.
You're going to see greater perfusion with slight increases in serum dopamine. The correlation with tinnitus may indicate that you have poor circulation in your middle ear.
I'm just throwing ideas around. What do you think?
Lar
Posted by blueberry on February 21, 2006, at 16:09:40
In reply to Re: Question for SLS, posted by SLS on February 21, 2006, at 7:45:03
>
> I'm guessing you have already tried the SSRIs.Yeah, all except luvox and effexor.
>
> Nortriptyline or desipramine might be a good place to start. Many people feel a great somnolence or sedation with nortriptyline when they first start taking it. This more often than not disappears, leaving an energizing effect once it becomes effective for depression. The dry mouth might persist, but probably will not be as significant as time passes.
>
>
> What were your responses to Effexor and Cymbalta?Cymbalta very nice almost right away. But after 3 days the same pattern kicked in...getting a lot more depressed that I was to start. I wanted to ride it out and give the receptors a chance to adjust, but it was just too severe to hang in there.
>
>
> What are the most burdensome features of your depression?
>
> Sadness?
Not much.
>
> Depressed mood?
Sort of.
>
> Melancholia?
Yeah.
>
> Dysphoria?
Yeah.
>
> Loss of interest?
Big time.
>
> Loss of Energy?
No not really.
>
> Loss of Motivation?
Big time.
>
> Concentration or memory impairments?
Not really.
>
> Early morning awakenings?
Always.
>
> Having the morning be the time of greatest severity?
Actually morning is fair, usually with more free floating fear than depression. 2pm to 6pm is the worst in terms of depression, and then after 6pm is sporadically pretty decent.
>
> Loss of appetite?
Not usually.
>
> Loss of libido?
Usually.
>
> Irritability?
Never.
>
> Social inhibition?
Always.
>
> Anxiety?
Yeah, the free floating kind not directed at anything in particular.On top of depression, I have a recent diagnosis of adrenal fatigue with extremely low cortisol and dhea levels. If I ever am to feel half decent, it is ALWAYS in the evening after 6pm. And no coincidence, that is a primary symptom of adrenal fatigue.
Doc has just started me on a mix of different ginsengs for adrenal support, and rhodiola rosea for adrenal support and depression. I am on day 4 of the rhodiola alone. Immediate antidepressant effect, instant energy, but can now feel things getting worse instead. Tinnitus has quieted down somewhat. I see the same pattern happening here.
Honestly I think the ginseng method of adrenal support is not good. The stimulation might just wear out my adrenals even more and worsen my mood even worse because of it.
To be quite frank about it, I personally think I should be on xanax for about 3 months because it makes me calm, serene, tranquil, and paradoxically elevates my mood and restores interest and motivation, but without stimulating me to overdrive the adrenals. A benzo for a few months to recover, and then go from there. I don't know.
I do appreciate very much the time and thought you are putting into my situation.
>
>
> - Scott
>
Posted by Cairo on February 22, 2006, at 21:30:12
In reply to Re: Question for SLS » blueberry, posted by Larry Hoover on February 21, 2006, at 12:56:24
Myofascial trigger points in neck and jaw muscles can cause tinnitus, especially the splenius capitis muscle. Medications that relax muscles decrease my tinnitus (at least the part that is not caused by high frequency hearing loss; it has a different pitch).
Cairo
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