T Nation

For More Pain: Dopamine Deficiency/Apathy

I could be wrong, but I think the ‘release of dopamine’ and the production of it are mutually exclusive.

For instance, it could be possible to create a lot of dopamine but not efficiently release it (either at the appropriate time or not release enough of it). It could also be possible to release it efficiently but not have it in sufficient amounts “in the tank.”

Again, I could be really off.

From my understanding, belligerent’s comment “Apathy is an ideological issue like almost everything else” and PonceDeLeon’s post go hand-in-hand. Your friend may have sufficient dopamine to be released; that may not necessarily be the problem. The problem, in my opinion, likely relates to your friend’s perspective on his life and the world. Your friend may not see the point or the reward in a particular action; thus the dopamine never releases from performing the action. I’m purely theorizing here, but I believe every individual will receive dopamine from a particular action based on their perspective of said action. You may believe strongly in the purpose of lifting at the gym, which results in a large dopamine release for you and consequently deep satisfaction. On the other hand, your friend doesn’t see the same purpose from lifting at the gym (merely the difference in perspective between the two of you), so there’s no dopamine release from lifting and therefore no satisfaction. For him going to the gym is just another lifeless activity which has no meaning.

I’m not quite sure how you relay to another person there IS meaning to life, and based on your statements about your friend it appears he’s lacked meaning in his life for quite some time and possibly since his early childhood. I suggest you read Viktor Frankl’s “Man’s Search for Meaning”. It’s a very powerful book, albeit short, and while it’s unlikely you will be able to get your friend to read the book in his current condition, maybe you can relay some of the messages in the book to him. For instance, if one can endure the life of a concentration camp victim in WWII and still prevail through the horrific conditions and live a happy life after the fact, any ONE, particularly in the Industrialized/Western world where opportunities are bountiful, can be happy and find meaning in life. It’s essentially a matter of willing meaning upon life and the world. Your friend needs to believe there is meaning to lifting at the gym, working a job, hanging out with you, his friend, starting new hobbies, dating a girl, etc. If your friend believes there is meaning to all these different aspects of life, then the dopamine will follow and so will the satisfaction of being alive, well, and happy.

And it’s not just the amount of dopamine, or even the reuptake, but also lack of receptors. Humans and animals that easily become addicted to certain drugs, for example, have few dopamine receptors in the amygdala (I think, don’t always bother to try to remember specific regions).

It’s interesting that exercise can increase the number of receptors. There are people who exercise regularly, almost religiously, and become depressed after 2 weeks of not exercising. So it’s possible that there is a population of people with suboptimal dopamine receptors that self-medicate with exercise rather than drugs.

The problem with a guy like 300’s mate is obvious, that if he is in such a bad state that he cares about nothing, gets no pleasure from anything, it’s hard to start with any behavior modification, including exercise, because he won’t be motivated to do it. It’s kind of like trying to boot a computer with a crashed hard drive. That’s where you would hope that a drug like Wellbutrin, which has been helpful for some people with these symptoms, could help him somewhat, and then he might have enough motivation to exercise, which might help further. . .

It’s a hard problem, and it’s definitely a bad sign to me that he used to work out but doesn’t any more.

[quote]andersons wrote:
Defekt wrote:
andersons wrote:
No, behavior and emotion (or lack thereof) are biological. Dopamine insufficiency in the amygdala is thought to cause these symptoms of depression.

…dont these two statements contradict each other?

How?

(Not that I think that my statement was anywhere close to an explanation of the cause of the symptoms…)

[/quote]

To me a dopamine deficiency is in fact biological? I may be misunderstanding something though.

[quote]kylec72 wrote:
From my understanding, belligerent’s comment “Apathy is an ideological issue like almost everything else” and PonceDeLeon’s post go hand-in-hand. Your friend may have sufficient dopamine to be released; that may not necessarily be the problem. The problem, in my opinion, likely relates to your friend’s perspective on his life and the world. Your friend may not see the point or the reward in a particular action; thus the dopamine never releases from performing the action. I’m purely theorizing here, but I believe every individual will receive dopamine from a particular action based on their perspective of said action. You may believe strongly in the purpose of lifting at the gym, which results in a large dopamine release for you and consequently deep satisfaction. On the other hand, your friend doesn’t see the same purpose from lifting at the gym (merely the difference in perspective between the two of you), so there’s no dopamine release from lifting and therefore no satisfaction. For him going to the gym is just another lifeless activity which has no meaning.

I’m not quite sure how you relay to another person there IS meaning to life, and based on your statements about your friend it appears he’s lacked meaning in his life for quite some time and possibly since his early childhood. I suggest you read Viktor Frankl’s “Man’s Search for Meaning”. It’s a very powerful book, albeit short, and while it’s unlikely you will be able to get your friend to read the book in his current condition, maybe you can relay some of the messages in the book to him. For instance, if one can endure the life of a concentration camp victim in WWII and still prevail through the horrific conditions and live a happy life after the fact, any ONE, particularly in the Industrialized/Western world where opportunities are bountiful, can be happy and find meaning in life. It’s essentially a matter of willing meaning upon life and the world. Your friend needs to believe there is meaning to lifting at the gym, working a job, hanging out with you, his friend, starting new hobbies, dating a girl, etc. If your friend believes there is meaning to all these different aspects of life, then the dopamine will follow and so will the satisfaction of being alive, well, and happy. [/quote]

Well said, I couldn’t have explained it any better myself.

(in response to andersons comment about there being nothing to enjoy)

It is my belief that as a conscious being, we control what matters to us, and we have control (of varying degrees) over our state of mind, and consequently neurotransmitters.

My last post hasnt showed up yet, so I can’t edit it.

I’ve witnessed good results in the short term use of antidepressants, complemented by a lifestyle change, and the eventual cessation of the drug.

You brought up a good point in saying that someone with this mindset may in fact have a lot of trouble being motivated to change in the first place, and that is where I believe drugs should be used.

I do not however agree with long term use of such drugs, in most cases. Long term use to me signifies a masking of the deeper issue at hand. Its like putting a bandaid on a cut and pretending it is healed.

Of course you need to stop the bleeding though :]

So who does one go to, to get this prescribed ?

As you can guess, i literally will have to have everything done before i knock on his door as he won’t be assed doing anything himself.

Can a doctor prescribe it ?

Is Wellbutrin the one he should be asking for.

Again i really do appreciate all the help/answers very kind of ye.

Regards.

[quote]300andabove wrote:
So who does one go to, to get this prescribed ?

As you can guess, i literally will have to have everything done before i knock on his door as he won’t be assed doing anything himself.

Can a doctor prescribe it ?

Is Wellbutrin the one he should be asking for.

Again i really do appreciate all the help/answers very kind of ye.

Regards.[/quote]

Doctors can prescribe it.

Wellbutrin would be a good option to ask for, yes.

I’d be more concerned with lack of serotonin than dopamine.

If you think he has problems or he worsens, get him to someone who can diagnose him properly. You can get suggestions from people in this thread as to what to do, but we don’t witness his behavior or interact with him so we’re largely in the dark.

Starve your friend and then stick him in the wild. Maybe his instincts will “reboot” his brain, per se.

:stuck_out_tongue:

whatsup bro,

There’s lots of things that can increase dopamine levels. Browsing around wikipedia should yield lots of information. There’s dopamine agonists, dopamine reuptake inhibitors, dopaminergenic analogues & precursors, etc.

Wellbutrin has a very slight dopamine reuptake inhibition. More so than other antidepressants, yet research shows its dopamine reuptake inhibition is FAR less significant than we think. Like someone else said, people respond differently to it. So even if your bro has a dopamine deficiency, Wellbutrin may not be not be key. Other pharmas that work on dopamine: methylphenidate, dextroamphetamine, selignine, pramixepole, etc. The first two you may know as ritalin and adderall, which are used for ADHD; the latter two are drugs given to patients with parkinson’s disease. All four are used (though not necessarily popularly) by docs for treatment resistant depression.

A good question to ask your friend is what sort of recreational drugs does he prefer: alcohol, mary jane, uppers, or downers. Uppers - cocaine, methamphetamine, amphetamine, mdma, etc - generally work by inhibiting dopamine reuptake and also pumping out “dormant” dopamine in your nervous system. So if he prefers uppers, it’s a pretty good indicator IMO that he maybe lacks the “normal” levels of dopamine.

There’s natural supplements that can help. Go to mindandmuscle.net and look at the nootropic forum and some of the articles. There’s stuff called PEA, L-Dopa, L-Tyrosine, and a bunch of others, all of which are used by the body during the synthesis of dopamine. Some people report great results with these substances. Also, it’s important although cliche that a good diet is being followed. The body needs its full spectrum of nutrients, vitamins, minerals, etc. for healthy neurotransmitter production.

I’d like to say something to the scientologists who have posted above saying “it’s all in his head:” unfortunately, it’s not. Millions of pages of scientific studies support the fact that as a result of genetics some people’s brains don’t function “regularly” in regards to the biochemistry. An analogy: some people suffer from hormone deficiency and require HRT to maintain stable testosterone levels. They were born this way. The same goes for people’s brain chemistry: some people are born with genes that tell the body to not do what is normal. For all of Big Pharma’s flaws, they do serve an important function: they help more people than they hurt.

That being said, his depression is very likely biochemically-originated, but because he’s been living with it so long it is also behavioral. The right prescription pharmaceutical will help, but it’s also imperative that he seeks counseling (likely cognitive behavioral therapy) to help him psychologically as well. These two go hand in hand: you need a healthy brain for counseling to work, and you need counseling to help you adjust to your “new” brain!

Probably the best thing you can do for your friend is sit him down tell him you hate seeing him like this (reminds me of Pantera’s song, Hollow) and that you want to help him to “be happy.” It’s a long process, but in the end, it may very well be the most generous, selfless thing anyone’s ever done for him!

Hope this helps!

[quote]Rape Weight wrote:
I’d be more concerned with lack of serotonin than dopamine.

[/quote]

Could be serotonin too. The thing is the three main neurotransmitters - serotonin, dopamine, and norepinephrine - are so intertwined that its never exclusively one thing or the other. From my experience interacting with depressed people - and mind you I’m not a doc I just ask lots of health questions - SSRIs have never been too effective for them as the sole medication. Don’t know why they are the first recommend from any psychiatrist though. Most times for them to be effective I’ve seen them augmented with an additional antidepressant or antipsychotic that works via a different mechanism.

This brings me round to the point of medical tests. Blood tests and brain scans can yield really significant results in targeting the essential biochemistry problem. Unfortunately, most pdocs have neither the training nor will to utilize these methods. Plus, unless your insurance covers it, they’re a hefty bill to foot. However, the save potentially years and years of uselessly trying new medications over and over again until you find the “right fit.” Best thing to do is check with the insurance to see whats covered and call your best nearby hospital’s psych dept to find if they have any specialists in reading those sorts of test results and then prognosticating a diagnosis from them!

[quote]skroohead wrote:
whatsup bro,

There’s lots of things that can increase dopamine levels. Browsing around wikipedia should yield lots of information. There’s dopamine agonists, dopamine reuptake inhibitors, dopaminergenic analogues & precursors, etc.

Wellbutrin has a very slight dopamine reuptake inhibition. More so than other antidepressants, yet research shows its dopamine reuptake inhibition is FAR less significant than we think. Like someone else said, people respond differently to it. So even if your bro has a dopamine deficiency, Wellbutrin may not be not be key. Other pharmas that work on dopamine: methylphenidate, dextroamphetamine, selignine, pramixepole, etc. The first two you may know as ritalin and adderall, which are used for ADHD; the latter two are drugs given to patients with parkinson’s disease. All four are used (though not necessarily popularly) by docs for treatment resistant depression.

A good question to ask your friend is what sort of recreational drugs does he prefer: alcohol, mary jane, uppers, or downers. Uppers - cocaine, methamphetamine, amphetamine, mdma, etc - generally work by inhibiting dopamine reuptake and also pumping out “dormant” dopamine in your nervous system. So if he prefers uppers, it’s a pretty good indicator IMO that he maybe lacks the “normal” levels of dopamine.

There’s natural supplements that can help. Go to mindandmuscle.net and look at the nootropic forum and some of the articles. There’s stuff called PEA, L-Dopa, L-Tyrosine, and a bunch of others, all of which are used by the body during the synthesis of dopamine. Some people report great results with these substances. Also, it’s important although cliche that a good diet is being followed. The body needs its full spectrum of nutrients, vitamins, minerals, etc. for healthy neurotransmitter production.

I’d like to say something to the scientologists who have posted above saying “it’s all in his head:” unfortunately, it’s not. Millions of pages of scientific studies support the fact that as a result of genetics some people’s brains don’t function “regularly” in regards to the biochemistry. An analogy: some people suffer from hormone deficiency and require HRT to maintain stable testosterone levels. They were born this way. The same goes for people’s brain chemistry: some people are born with genes that tell the body to not do what is normal. For all of Big Pharma’s flaws, they do serve an important function: they help more people than they hurt.

That being said, his depression is very likely biochemically-originated, but because he’s been living with it so long it is also behavioral. The right prescription pharmaceutical will help, but it’s also imperative that he seeks counseling (likely cognitive behavioral therapy) to help him psychologically as well. These two go hand in hand: you need a healthy brain for counseling to work, and you need counseling to help you adjust to your “new” brain!

Probably the best thing you can do for your friend is sit him down tell him you hate seeing him like this (reminds me of Pantera’s song, Hollow) and that you want to help him to “be happy.” It’s a long process, but in the end, it may very well be the most generous, selfless thing anyone’s ever done for him!

Hope this helps!
[/quote]

Cheers for typing that out man !

I got him to go to his Doctor yesterday he was prescribed Zyban European Wllbutrin ?

So on his 2nd day now, here’s hoping.

We can get can L-Tyrosine in the health shops is that good enough ?

I’ll look for the other 2, PEA, L-Dopa again cheers for the info from you and all, most appreciated,

[quote]300andabove wrote:
I got him to go to his Doctor yesterday he was prescribed Zyban European Wllbutrin ?

So on his 2nd day now, here’s hoping.

We can get can L-Tyrosine in the health shops is that good enough ?

I’ll look for the other 2, PEA, L-Dopa again cheers for the info from you and all, most appreciated,[/quote]

Don’t take any supps like L-tyrosine in conjunction with antidepressant drugs like Wellbutrin. One could try supps INSTEAD of drugs (for example, a stack of PowerDrive morning and afternoon plus Z12 at night may boost dopamine, norepinephrine, epinephrine, and serotonin, all of which have antidepressant effects).

The drugs, however, are thought to work by preventing the reuptake of neurotransmitters, keeping it “active” longer. If the amount of neurotransmitter is also increased, bad things can happen, such as serotonin syndrome. So don’t mix supps with drugs, especially in the first few months of adapting to the drugs.

Also be sure to let a single doctor, preferably a psychiatrist, oversee stacking any medications. Ideally, the psychiatrist would take a careful history of patient and choose a single med that has the best results for patients with those symptoms (there are different types of depression). Most meds take 6 weeks to work. And the patient may have unacceptable sides right away and therefore have to be immediately switched to something else. After 6 weeks, progress should be assessed, and if there are remaining symptoms (likely), a second med may be stacked. Good doctors use experience with their own patients as well as reading the literature to choose meds most likely to help.