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Dr. Bob is Robert Hsiung, MD,
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Posted by deprime82 on July 29, 2009, at 7:54:43
hey!
i have nearly no experience with dopamine agonists. i've been on wellbutrin for a year, along with lexapro 10 mg, but i ended up being quite aggressive, a little anxious and nervous and hostile because of the irritability.
the lexapro mellowed out a lot of the irritability, but unfortunately didn't remove it totally.so i returned to selegiline 5mg in pill form along with 10mg lexapro. this worked too for about a year, but then i couldn't take it any more, because of anxiety and future worries (i think the amphetamine metabolites in the selegiline were the culprit). for a year it was okay, but just as the next big change in my life was imminent (the final exams at the university), the anxiety overwhelmed me again.
wellbutrin and selegiline both exacerbated anxiety in me, even when i took it along with lexapro (which is a common approach).
a few days ago, i've tried requip (ropinirole) and took 0.5mg (adjunctive to the lex). that was probably too much all at once, but i immediately began too feel very sleepy and dizzy.
that reminded me of when i took levodopa, which was also a singular attempt to raise dopamine levels.
it seems that real l-dopa or dopamine agonists make me tired or nauseous and the ones which act stimulating like selegiline oder wellbutrin seem to raise anxiety.
i would be really glad, respectively i'd be looking forward to hear from someone who has experienced a similar situation or who has taken the mentioned drugs too.
I'd really like to find the one drug for me which isn't causing too much anxiety or nervousness but gives me some motivation and energy (without pushing me too much in the amphetamine direction).
yours, deprime82
Posted by Brainbeard on July 29, 2009, at 15:13:18
In reply to any success with dopaminergic meds?, posted by deprime82 on July 29, 2009, at 7:54:43
Hi,
I have been experimenting with selegiline too, in doses from 2.5 to 10mg. As a stand-alone drug, it sure worsened my obsessive fears. Taking it together with tianeptine, the unique French antidepressant by Servier, really mellowed out the anxiety. Unfortunately, tianeptine isn't prescribed in Holland (nor in the US) and is rather expensive.
I haven't tried a dopamine agonist yet, but I've just received a pack of piribedil tablets - another drug by the French Servier. Piribedil seems to be the most benign dopamine agonist around, but it may be a wild card.
I have theorized my *ss off elsewhere on this forum (http://www.dr-bob.org/babble/neuro/20090701/msgs/904542.html) about 5HT2A-blockade as a way of raising dopamine firing. I'm experimenting with low dose Geodon (5-40mg) right now for this particular effect. I have used Risperdal before on a very low dose, just 0.5mg, and that had a very pronounced dopaminergic effect. Risperdal raises prolactin levels wildly, though, which I don't particularly like.
I do think that 5HT2A-blockade may be one of the milder and more benign ways of stimulating dopamine. It is associated with anxiety relief, after all. Geodon feels a lot harsher than Risperdal, though.
Oh yeah, I've also tried low dose (12.5-50mg) amisulpride, another, lesser known atypical antipsychotic, that in the doserange mentioned 'preferentially blocks dopamine autoreceptors' which for me means a very enjoyable, motivating, libido-raising experience. From what I've read on this forum, this initial effect wanes after several days, while with continued use a milder anti-anxiety and antidepressant effect kicks in after some weeks. I use amisulpride once a week, nowadays (together with modafinil, 50mg and sometimes 2.5-10mg of selegiline, although with the selegiline added my libido begins to take hypomanic forms), because it raises prolactin levels even more wildly than Risperdal.
Theoretically, a dopamine agonist would counter at least some of an atypical antipsychotic's (especially amisulpride and Risperdal) prolactin raising effect.
Hm, and 5HT1A-agonism helps 5HT2A-mediated dopamine boosting, according to Dr. Stahl. That's why I take Buspar along with my Geodon.
Somebody stop me.
Posted by deprime82 on July 30, 2009, at 11:29:13
In reply to Re: any success with dopaminergic meds?, posted by Brainbeard on July 29, 2009, at 15:13:18
hey!
i too have thought of using amisulpride, but then i've read about the clinical tests that it raises prolactine at ten-fold already at doses of 50mg -> i really don't want to get female breasts etc. because of hyperprolactinamea.
piribedil sounds like an option, but i don't know if it's prescribed in europe. i just would like to have the benefits of dopaminergic stimulation, such as mood elevation, having motivation and energy, pursuit of goals, having aims in life and so on, WITHOUT ending up as a nervous wreck with signs of social phobia.
i mean this was partially the case with wellbutrin, even when i took it with lexapro.
i have read too, that especially the non-ergoline dopamine agonists like requip or mirapex tend to make people tired, sleepy and nauseous. this is also something I don't want to achieve.. but on the other hand, the ergoline-dopamine-agonists make people more active and awake but are likely to cause some kind of heart disease (valvular heart disease, i think that's the english word).
even another health risk i don't want to take a chance.in addition, most dopamine agonists (except pergolide or cabergoline) must be taken 2-3 times a day, which is too much for me. a dosage of one time a day would be ideal.
then there are of course the APs like the mentioned amisulpride and also ABILIFY. but the abilify is way too expensive, i don't think insurance will cover a med of 450 euro per month only because i want to get a little more motivated;)
an interesting option would be AZILECT, which is basically very similar to SELEGILINE - also a MAO-B-inhibitor, but without the amphetamine metabolites that SELEGILINE possesses.
i'd be curious if someone has already tried AZILECT (rasagiline), which is normally used for parkinson's and which is thought to provide a "cleaner" and smoother feeling of motivation and dopamine flow than selegiline...
dep82
Posted by Brainbeard on July 30, 2009, at 14:12:45
In reply to Re: any success with dopaminergic meds?, posted by deprime82 on July 30, 2009, at 11:29:13
> piribedil sounds like an option, but i don't know if it's prescribed in europe.
I just bought some from a Greece pharmacy, so yes, it is prescribed in Europe.
Wellbutrin probably doesn't work through dopamine activation at all. See elsewhere on the forum.
Also, dopamine agonist don't activate dopamine, but mimick dopamine at the D2 and sometimes also the D3-receptor. That's a huge difference. If you want pure dopaminergic activation, you should stay clear from the DA-agonists.
Piribedil causes the least sleepiness of the not-ergot-DA-agonists, while it comes in an XR-formulation that lasts 24 hours.
Abilify is a wildcard since it can (and most probably will) also antagonize dopamine extremely potently. It isn't extremely expensive when bought online, though. You should of course buy the generic, unless you collect brand name pill boxes or something.
I don't think AZILECT is very interesting. In doses of 10mg or less, the amphetamine metabolites of selegiline are probably barely noticeable. Azilect is way too expensive, too. Dave Pearce has tried Azilect and found it to be inferior to selegiline.
Posted by Sigismund on July 30, 2009, at 16:03:00
In reply to any success with dopaminergic meds?, posted by deprime82 on July 29, 2009, at 7:54:43
Trivastal?
Posted by Brainbeard on July 30, 2009, at 16:09:14
In reply to Re: any success with dopaminergic meds?, posted by Sigismund on July 30, 2009, at 16:03:00
> Trivastal?
Trivastal = piribedil.
Posted by deprime82 on July 31, 2009, at 8:24:31
In reply to Re: any success with dopaminergic meds?, posted by Brainbeard on July 30, 2009, at 14:12:45
of course wellbutrin is a dopamine reuptake inhibitor.. (also a partial agonist) - when I say dopamine activation then I mean that it's boosting the availability of dopamine between the neurons.
can you tell me then what you mean by the difference between that what the agonists do (mimicking dopamine) and what you mean by activating? do you mean that dopaminergic activation is a stronger release of dopamine or so..? like the stimulants do...?
for me abilify is much to expensive, I can't afford it (the cheapest source I found is still about 3-400 euro)..
for me selegiline was indeed causing anxiety and I think it was because of the few amphetamine metabolites.. as for me I have read a few posts, which say that the activating and pushing effect of selegiline is mostly due to the amph-metabolites..
Posted by Brainbeard on July 31, 2009, at 8:34:31
In reply to Re: any success with dopaminergic meds? » Brainbeard, posted by deprime82 on July 31, 2009, at 8:24:31
> of course wellbutrin is a dopamine reuptake inhibitor.. (also a partial agonist) - when I say dopamine activation then I mean that it's boosting the availability of dopamine between the neurons.
I don't think so. Its dopamine reuptake inhibition is way too weak to account for its stimulating effects. This has been discussed elsewhere on the forum.
> can you tell me then what you mean by the difference between that what the agonists do (mimicking dopamine) and what you mean by activating? do you mean that dopaminergic activation is a stronger release of dopamine or so..? like the stimulants do...?
Well, by dopaminergic activation I think of increasing dopamine concentrations and/or firing. That's what dopaminergic stimulants do. DA-agonists don't increase dopamine or dopamine firing itself, but act on dopamine receptors - fooling the brain, as it were, into thinking there's more dopamine around. According to some, this is the reason that the DA-agonists can actually have anti-dopaminergic side-effects (sedation).
> for me selegiline was indeed causing anxiety and I think it was because of the few amphetamine metabolites.. as for me I have read a few posts, which say that the activating and pushing effect of selegiline is mostly due to the amph-metabolites..Hm, I don't really buy that, but it's a matter of opinion perhaps. Selegiline's main mode of action (catecholamine boosting and MAO-B inhibition) is well enough to increase anxiety. MAO-B inhibition is itself activating, so IMNSHO it is nonsense to say that this effect is due mainly to that tiny amount of wrong-enantiomer (= not very effective) amphetamines.
With the EMSAM-patch, you got selegiline without the amphetamines, and people on Emsam get activated and pushed and anxious just the same.
Posted by deprime82 on July 31, 2009, at 11:24:51
In reply to Re: any success with dopaminergic meds?, posted by Brainbeard on July 31, 2009, at 8:34:31
This is the end of the thread.
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