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dopamine levels and depression


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#1 citabriapilot

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Posted 17 February 2013 - 08:46 AM

I have suffered from PD (8 yrs) and depression for most of my life. Antidepressants are no help. I understand that the lack of dopamine in PD can cause depression and since most antidepressant effect either seritonin or norepinephrine not dopamine could this be why none have worked for me? Is there a antidepressant that works on dopamine levels or should sinemet help with that?

#2 MComes RPH

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Posted 05 March 2013 - 04:06 PM

Great question. Hopefully I can give you an understandable great answer. The short answer is "YES," with an explanation. It is not the actual dopamine levels themselves, but rather dopamine fibers. So, here comes the reasoning.
I guess most people would say,"You have PD, of course you are depressed." It is not that simple because not all people with PD experience long-lasting depression. When you get depression, it is not necessarily related to the severity of your symptoms or how long you have had PD.When the brain activity patterns of PD patients with depression versus PD patients without depression who are at equal disease severity levels, we find that the PD patients with depression exhibit lower brain activity levels in a portion of the brain known as the orbitofrontal cortex. This pattern of low activity in the orbitofrontal cortex was strongly related to the degree of depression experienced by patients with depression. Now the orbitofrontal cortex is that area in the brain where we experience and evaluate pleasurable rewards of various kinds from the mundane rewards of a good meal to the highly abstract rewards of prestige and influence. Dopamine fibers normally regulate operations in the orbitofrontal cortex. When these dopamine fibers degenerate, as they do in some, but not all, persons with PD, the ability to normally experience pleasure and the ability to anticipate future rewards becomes difficult. It also appears that the Young Onset group of PD patients seem to have the longer-duration type depression.
Now for the good news. It does appear that certain types of PD medications can help with the issue. They are known as MAO inhibitors. There are 2 specific MAO inhibitors recommended: selegiline and rasegaline(Azilect). Both of these seem to be more effective at increasing the mood without using an anti-depressant. It also appears that the selegiline is more effective than rasegaline at elevating the mood. This is probably due to the fact that selegiline is a non-selective MAO inhibitor, so it will work on the dopamine fibers. Whereas rasegaline, is a MAO-B inhibir, which will specifically target MAO-B cells (the MAO non-selective and MAO-B is a whole other topic for another day).
Also, the dopamine agonists (pergolide and Requip especially), seem to work for this also, but not as well as the selegiline.
Hope it helped and keep me updated.
Best of health,
Mark R. Comes R.Ph.
Board Certified Pharmacist,
Medical Board Member, & Consultant.
National Parkinson Foundation
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www.parkinson.org

#3 Beau's Mom

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Posted 05 March 2013 - 06:26 PM

Dear Mark,

You have just given me an explanation that explains why my depression prior to diagnosis (which was delayed for many years) was increasingly difficult to treat and why it is even worse now 2+ years after diagnosis. Thank you!

I am not on Selegiline, but Seroquel. I have never been able to tolerate agonists. Is Selegiline an agonist or likely to produce the same side effects? Do you recommend me discussing it with my care team?

I am not a human being trying to have a spiritual experience; I am a spiritual being having a (sometimes difficult) human experience.

 

First symptoms: right-hand tremor, constipation and restless arms 1978 (age 25). Depression and anxiety (non-motor symptoms) began in 1989 and worsened through the years. Last inpatient episode June 2013.

Diagnosed December, 2010 by a regular neurologist (age 57). After negative reactions to Requip, Mirapex and selegiline began Sinemet 25/100 3x/day. First MDS visit in Houston in February of 2011 was inconclusive. Second MDS visit at Baylor Fort Worth in May/June 2011 diagnosis changed to Parkinsonism, Sinemet stopped. Third MDS visit in August 2011 in WA State: received a confirmed diagnosis of idiopathic PD which had started on the right side and had now crossed to the left side as well. Restarted on Sinemet 25/100 4x/day. A short trial of Amantadine caused audio hallucinations in September 2011.

 

Current medications at age 62: Sinemet 25/100 ODT every 2.5 hours while awake (7/day). One Sinemet 25/100 CR between midnight and 4 AM. Trazodone 200 mg at bedtime, Fluvoxamine 300 mg at bedtime. Clonazepam 0.5 mg morning and afternoon, 1 mg at bedtime. Vit D3 2x/day, Calcium Carbonate Susp. 5 cc daily, Baclofen 10 mg 3x/day, Flonase two sprays 2x/day, Calcitonin-Salmon nasal spray once daily (for osteoporosis). Gel eye drops as needed throughout the day, Restasis Eye drops 2x/day, Nighttime eye ointment at bedtime. 02 2L per nasal cannula while asleep. Walker, electric wheelchair, moist and soft or pureed foods and 115 caregiver hours/month keep me sane.

 

All of the above subject to change based on progression, stress level, and dyskinesia. Whew! I'm glad I finally wrote that all out.


#4 MComes RPH

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Posted 12 March 2013 - 11:06 AM

Selegiline is not an agonist, but rather an MAO INHIBITOR. So, i may try it if I were you. A little can go a long way in your situation.
Tonly downfall if diet restrictions. You must stay away from tyramine foods.
Keep me posted.
Best of health,
Mark R. Comes R.Ph.
Board Certified Pharmacist,
Medical Board Member, & Consultant.
National Parkinson Foundation
"Ask The Pharmacist"
www.parkinson.org

#5 citabriapilot

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Posted 24 August 2013 - 09:52 AM

I have finally found a way I can afford selegiline I hope and want to try it however I am also taking Tramadol which I see is contraindicated. I suffer from bad pain but percoset or dan , oxecodone have no effect. Mscontin did but would prefer to stay away from it since it is so addictive. methodone does not work. Is there a pain killer similar to Tramadol you can suggest?

#6 MComes RPH

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Posted 13 September 2013 - 11:23 AM

Since theblast post, I see you triedbmy suggestions. The MS Contin is just as addictive as the oxycodone. I think that at a low dose, that might be it. It is hard to find an alternative for tramadol, when you do, you should start at a low dose and increase slowly until thebpain subsides.
I think this would be the best option for you at a low dose. Talk to yoir dr about it, because it is in the same class as oxycodone, methadone.
Please keep me updated.
Best of health,
Mark R. Comes R.Ph.
Board Certified Pharmacist,
Medical Board Member, & Consultant.
National Parkinson Foundation
"Ask The Pharmacist"
www.parkinson.org




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