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citabriapilot

dopamine levels and depression

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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?

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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.

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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?

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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.

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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?

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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.

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