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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 Jay2112 on July 5, 2023, at 19:08:21
I have been using bromocriptine with good sucess. It is a potent dopamine agonist, and has mild serotonin agonist properties. For about 30 years, I have been hammering my dopamine system with large doses of serotonin drugs, and antipsychotics. I have developed severe akathisia, and wake up angry, agitated...just nasty. This went on and off during the day. I thought amphetamines were the answer, as they are dopamine agonists. But, somehow, I have responded to bromocriptine, and found numerous reports on pubmed of akathisia being treated with bromocriptine.I still use smaller doses of risperidone, prozac, and effexor, with much better results WITH the bromocriptine. Akathisia, gone...anxiety attacks, gone. Oh, and I use 300mg of lithium at bedtime, as I found plenty of research on pubmed that show that lithium is good for nightmares and bad dreams. It works amazing on those things for me.
We heavily dampen the dopamine system with a lot of drugs, and large quantities of serotonin dampen the dopamine system. For those with akathisia, dopamine agonists are a huge relief. I thought I was turning into some kind of monster, as I was so agitated and miserable all the time. Plus, I am a bit more "perky", and much more motivated.
Just something to think about if you have such problems.
Jay
Posted by SLS on July 6, 2023, at 11:52:32
In reply to Many drugs likely cause changes to dopamine system, posted by Jay2112 on July 5, 2023, at 19:08:21
In 1983, I began researching affective disorders at the Rutgers medical school library. After poking around there for a few weeks, I proposed to the clinical research division of psychiatry at Columbia Presbyterian (now Coumbia-Cornell) a theory that I had devised suggesting a role for dopamine in the pathogenesis of depression - especially in bipolar disorder. After failing 7 or 8 antidepressant trials, I asked them for Wellbutrin, which was not yet available. Compassionate use? Harrison and Quitkin said that they would consider it if I were to go for 6 months of psychotherapy. So, I asked about bromocriptine. Harrison said to me, "That's fine if you want to throw up all day", and laughed at me. I left and found someone who was working with Wellbutrin on an open-label basis.
https://pubmed.ncbi.nlm.nih.gov/408861/
Today:
https://pubmed.ncbi.nlm.nih.gov/?term=dopamine+hypothesis+depression&size=50
In 1983, I could find only one author who proposed a role for dopamine in depression. I felt vindicated. Considering that a role for dopamine had been proposed in the medical literature by 1977, I really should not have been dismissed so quickly. I had my eye on a drug called nomifensine. It was described as a potent dopamine reuptake inhibitors in addition to being a norepinephrine reuptake inhibitor. Amineptine was another DA reuptake inhibitor available in France, but was withdrawn from the market when the Olympic committee banned it as a performance-enhancing drug. Eventually, nomifensine was approved by the FDA in 1984 and named Merital. I had to beg Baron Shopsin to prescribe it for me. He said that the drug was a piece of sh*t, but acquiesced. People who were treatment resistant to all other antidepressants responded robustly to nomifensine. Unfortunately, reports of hemolytic anemia were emerging in association with nomifensine. In 1992, the FDA withdrew its approval, and nomifensine was withdrawn from the market worldwide. That was the decision of Hoechst-Roussell.
- Scott
Posted by Jay2112 on July 6, 2023, at 13:24:59
In reply to Re: Many drugs likely cause changes to dopamine system, posted by SLS on July 6, 2023, at 11:52:32
Hi Scott,
I hope all is well with you. Interesting how all of these meds come and go in our lives. You seem to have some great, and lucky experiences. (Experiments...really.) I take a very small quantity of bromocriptine, and my body seems to have gotten used of it, so I don't have much nausea anymore.(knock on wood!). I don't think it is an ideal drug, but I seem to have fit it into my drug therapy well. We will have to see. Dopamine agonists seem to need to be switched around once in awhile. I don't respond to Wellbutrin very well...it's norepinephrine agonism turns me into a big hot mess. All's I do is sweat on it...and feel unease and horrible.
Nortriptyline works for me at times, but I seem to develop bad nightmares on it, though that might change with my lithium. I seem to be fine with this current drug regimen.
I guess I am hoping to protect my dopamine system, since I use amphetamines for both depression and regular add. Also, for any blemishes caused by both antipsychotics and heavy serotonin based drugs. I feel asymptomatic, not always, but most often. But I feel if we are going to take drugs, we should be reaching for the best, but just by human nature, we are always going to get days where we feel not so good. I take my meds consistently, and only tinker once in awhile, meaning rarely, and with my pdoc's approval.
I often think of how important dopamine is when I get dystonia, and all of the other antipsychotic side effects. Not nice....not fun....just hell!
So, I have learnt the need to not constantly harm my dopamine system.Best,
Jay> In 1983, I began researching affective disorders at the Rutgers medical school library. After poking around there for a few weeks, I proposed to the clinical research division of psychiatry at Columbia Presbyterian (now Coumbia-Cornell) a theory that I had devised suggesting a role for dopamine in the pathogenesis of depression - especially in bipolar disorder. After failing 7 or 8 antidepressant trials, I asked them for Wellbutrin, which was not yet available. Compassionate use? Harrison and Quitkin said that they would consider it if I were to go for 6 months of psychotherapy. So, I asked about bromocriptine. Harrison said to me, "That's fine if you want to throw up all day", and laughed at me. I left and found someone who was working with Wellbutrin on an open-label basis.
>
> https://pubmed.ncbi.nlm.nih.gov/408861/
>
> Today:
>
> https://pubmed.ncbi.nlm.nih.gov/?term=dopamine+hypothesis+depression&size=50
>
> In 1983, I could find only one author who proposed a role for dopamine in depression. I felt vindicated. Considering that a role for dopamine had been proposed in the medical literature by 1977, I really should not have been dismissed so quickly. I had my eye on a drug called nomifensine. It was described as a potent dopamine reuptake inhibitors in addition to being a norepinephrine reuptake inhibitor. Amineptine was another DA reuptake inhibitor available in France, but was withdrawn from the market when the Olympic committee banned it as a performance-enhancing drug. Eventually, nomifensine was approved by the FDA in 1984 and named Merital. I had to beg Baron Shopsin to prescribe it for me. He said that the drug was a piece of sh*t, but acquiesced. People who were treatment resistant to all other antidepressants responded robustly to nomifensine. Unfortunately, reports of hemolytic anemia were emerging in association with nomifensine. In 1992, the FDA withdrew its approval, and nomifensine was withdrawn from the market worldwide. That was the decision of Hoechst-Roussell.
>
>
> - Scott
Posted by SLS on July 6, 2023, at 22:33:44
In reply to Re: Many drugs likely cause changes to dopamine system, posted by Jay2112 on July 6, 2023, at 13:24:59
Hi, Jay.
You reported:
"Dopamine agonists seem to need to be switched around once in awhile."
I had never heard this, but this would be a critical understanding regarding the optimal use of DA receptor agonists. All I can say is, "Wow". Big-time insight. I will keep that in mind.
As for me, just this past week, I discovered that lithium has *destablized* me rather than stabilized me. Somehow, it was acting as an agent to prevent the establishment of a functional homeostasis. I stumbled upon this discovery with information supplied to me by my pharmacist. To make a short story long, I would not have identified lithium as the culprit for episodic mood shifts. Anyway, I discontinued lithium a few days ago. I went through hell with the emergence of severe psychic pain. Interestingly, although what I was experiencing was a return to a severe depressive state, there remained a certain cognitive clarity that is absent when I have a true relapse. Recognizing this subtle difference allowed me do continue to go through hell because I felt very optimistic that this depressive state would resolve once my system accommodated to the new drug environment.
I'm still one incredibly lucky person to have been able to find a treatment that works so well. Logic can be effective, but usually, it also takes a willingness to take risks and paying very close attention to your reaction to every drug you try. But in my estimation, it takes a hell of a lot of luck to hit the one effective combination among myriad permutations. Patience is not so much an inherited virtue as it is an acquired skill. My patience became shorter and shorter with each treatment failure. I would say that this is particularly true when one remembers how great it was to be in a mental state in the absence of depression. This makes the depression that much more torturous. I'll write more about this at some point in the future.
Jay, you display both the logic found in critical thinking and a great deal of patience. That's a winning combination, especially when a little bit of intuition enters the equation.
- Scott
Posted by SLS on July 7, 2023, at 9:45:07
In reply to Many drugs likely cause changes to dopamine system, posted by Jay2112 on July 5, 2023, at 19:08:21
I forgot to add that I had never heard of nortriptyline causing nightmares, vivid dreaming, and acting out my dream in bed with unrestrained movement. Many times, I wake up to the sheets on the floor. I can't do without nortriptyline, so, if I decide to do anything about it, I would first try adding prazosin, which is often used to quell nightmares in PTSD. I actually tried it about 10 years ago for my depression, the genesis of which included childhood adversity in the form of physical and emotional abuse. Prazosin, to my surprise, had a moderate antidepressant effect such that I continued to take it for about a year. For me, prazosin had no side effects at all. My doctor's rationale for choosing it is that childhood adversity resulted in what had been called "developmental PTSD", which I found to be a great term to use. Now, it has been replaced with "Complex post-traumatic stress disorder" or CPTSD. Since prazosin at higher dosages effectively treats daytime depressive and anxiety, and the possibility that there was a PTSD component to the environment I grew up in, prazosin made sense to him to try. He was good with coming up with ideas that were outside the box.
For PTSD related nightmares, one dose of 1-3 mg just before bedtime works extremely well for many people. More recently, doctors have found that 30-40 mg/day t.i.d. also works to reduce daytime aspects to the disorder. I forgot. I think prazosin reduces sex-drive to some extent, but, for me, did not abolish it.
- Scott
Posted by Jay2112 on July 7, 2023, at 19:13:12
In reply to Re: Many drugs likely cause changes to dopamine system » Jay2112, posted by SLS on July 7, 2023, at 9:45:07
Hey Scott,
Well, nortriptyline affects everyone different, and does cause vivid dreaming and nightmares for some.(https://www.forhims.com/blog/nortriptyline-side-effects)
In one study (involving cannnabis and nitrazapam) only nightmares were suppressed by lithium. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582056/) For me, lithium is better than any other conventional nightmare treatment (including prazosin and clonidine) Lithium just also gives me better subjective sleep. I think the overall improvement in sleep architecture brought on by lithium is a part of this. Plus all of it's other benefits.
Jay
Posted by SLS on July 7, 2023, at 22:22:15
In reply to Re: Many drugs likely cause changes to dopamine system, posted by Jay2112 on July 7, 2023, at 19:13:12
> Hey Scott,
>
> Well, nortriptyline affects everyone different, and does cause vivid dreaming and nightmares for some.(https://www.forhims.com/blog/nortriptyline-side-effects)
>
> In one study (involving cannnabis and nitrazapam) only nightmares were suppressed by lithium. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582056/) For me, lithium is better than any other conventional nightmare treatment (including prazosin and clonidine) Lithium just also gives me better subjective sleep. I think the overall improvement in sleep architecture brought on by lithium is a part of this. Plus all of it's other benefits.
>
> JayThis is another thing you taught me. Obviously, lithium was not mitigating my acting out dreams, but I was only taking 300 mg/day. Lithium is kinda sorta like aspirin for the brain. It produces a plethora of biological and clinical activities that I doubt are well-understood. So, it is not surprising that it should help with your dreaming condition. I think my dream anomalies are due to MAOIs, possibly in conjunction with nortriptyline as you described.
I appreciate your input.
- Scott
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