Anyone know brain-based methods to treat exhaustion due to dopaminergic dysfunction?

[pocketsevens]

Hello bluelighters. I'm posting in the Neuroscience and Pharmacology section because I've browsed through a lot of the posts and you are all clearly intelligent people who know what you're talking about. I'm coming to you to ask for help. I have chronic exhaustion which causes other problems like depression. I wake up unable to sleep more, but there is this grogginess that follows me throughout the entire day and is impossible to shake. After about 10 minutes of being awake I can usually fall back asleep. And it doesn't matter how much sleep I get, I am always so tired. It's almost a type of pain... my body feels like a cage, a weight that I cannot escape from. I seem to fail at everything I do because I just can't keep up. It's sad because I used to be a very bright, ahead-of-the-game type of person. But now I feel almost disabled...

I saw a neuropsychologist who did tests on my brain and found that my brain exhibits some dopaminergic dsyfunction. It's mild, but I think it could be the reason I have such a hard time functioning. I wonder if this is because I was put on large doses of Adderall as a child. (Recent studies show that amphetamine causes damage to the dopaminergic system.) Whatever the reason is, I'm wondering what I can do to help manage my symptoms. Depression medication helps ever so slightly for the first few months I'm on it, then the effectiveness decreases. Caffeine doesn't work because of my tolerance from Adderall. Adderall helps but I'm staying away from that shit. Exercise is nearly impossible because I'm so tired. I can only run for a minute and then I have to walk. I have a heart problem (mitral valve regurgitation with a repaired valve) that most likely adds to my exhaustion, but my heart slowly healed after the valve was repaired and now exhibits near-normal function.

I even asked my doctor once if I could be put on a tiny dose of a drug for Parkinson's patients, like Levodopa, but they said no obviously. Oxycodone helps tremendously but it obviously cannot be a long-term solution due to dependence and tolerance. So I'm coming here to ask if anyone knows anything, ANYTHING I can do to improve my situation, even if it's only slightly. I have dreams and I want nothing more than to live a normal life... I would do anything. Thanks for reading and I look forward to hearing from you.

 

[serotonin2A]

How exactly did they determine that you have some type of dopamine dysfunction, and what was the specific diagnosis? Use of a MAO inhibitor might be something to consider but it is hard to know without having more info about your condition. Another medication that can be very effective is methylphenidate. Obviously L-DOPA is commonly used to treat low levels of dopamine but that will cause many other problems to develop, and should really be a last resort.

 

[sekio]

Caffeine doesn't work because of my tolerance from Adderall.

Caffeine works entirely differently than amphetamines to increase wakefulness, the two are not cross tolerant. Don't knock it til you've tried it, either, a lot of people seem disappointed because it has no direct euphoric effect even when overdosed (especially when overdosed IMO) but it does work to reduce fatigue and increase wakefulness quite well, and is sustainable for reasonably long periods of time if you moderate your use, too.

Exercise is nearly impossible because I'm so tired. I can only run for a minute and then I have to walk.

That's not an excuse to not attempt it though. You don't have to be excercising strenuously to see benefits. Nobody is expecting you to perform at a word class level starting from scratch. In fact, I would suggest against pushing yourself too hard in excercise sessions because at the least it can ruin the pace, leaving you winded. At worst you could hurt yourself in the worst case.

So run for a minute until you're just about to give out (don't go until you are totally winded), then walk it off until you can run for another minute, repeat the process for half an hour or so a day. And excercise doesn't just mean hard aerobics and running laps, either, any sort of stimulatory physical activity that allows you to push your limits in a reasonable fashion will help you. Or go swim around in a pool, practice diving and swimming. Get a cheap bicycle, ride it. Row a boat. Chop firewood. Take up shot put or javelin. Play Frisbee with your friends, children, or dogs. Go to a local gym, use the weight machines.

The important thing is you keep your body moving and you do so on a regular basis, every day. You can see improvements in your mood and physiology even from just increasing the amount of walking/standing as opposed to sitting that you do in a day. Listen to your body and know when to reduce intensity before you get fatigued.

I have a heart problem (mitral valve regurgitation with a repaired valve) that most likely adds to my exhaustion, but my heart slowly healed after the valve was repaired and now exhibits near-normal function.

So... you used to have a heart valve problem, but now you do not. Even if you did have a heart valve problem, it would not disqualify you for light to moderate physical activity.

If the only things that you've mentioned that seem to improve your situation are abusable drugs that promote dopamine release (amphetamines, oxycodone), it doesn't mean you have a "dopaminergic dysfunction", BTW, it means you are bored Of course, this makes a sort of sense: pleasurable activities (that are not associated with substance abuse) are, in playground myth, sources of elevated dopamine. I personally believe the evidence showing dopamine is not a "pleasure" chemical but rather is released when unexpected rewards happen in the brain as a means of reinforcing learned behaviours. Weltschmerz is often far more complex than a simple deficiency or excess of a single chemical in the brain, I'm afraid.

Anyways, some questions of my own, in addition to those posed by sero2A - namely, what sort of tests have you undergone and what the diagnosis was?

How is your day structured, may I ask? What are you eating and when? Are you consuming enough macronutrients (calories, protiens, fats)? enough micronutrients (vitamins, minerals)? (If you don't already, taking a daily multivitamin with B complex couldn't hurt.)

Are you taking any other drugs, alcohol, medication, or 'supplements'? Specifically, do you take anything for sleep, or any drugs or substaces close to bedtime?

Physiologically speaking, have you had full panel blood tests done to see if you are e.g. iron deficient or something?

 

[Nagelfar]

Ampakines are also not cross tolerant AFAIK. Though, not readily accessible to most.

 

[Cotcha Yankinov]

Hi there! I would be very curious to see how you do on a sleep study, specifically if you have a sleep breathing disorder (sleep apnea is VERY common, and a common complaint of sufferers is that no matter how much they sleep they are always tired) or very fragmented sleep/periodic limb movements etc. I am a sleep freak myself so I tend to chalk up most people's problems to sleep but sleep really is extremely important. I'm also very curious what your doctor meant specifically by dopaminergic dysfunction and whether that seemed to be on the spectrum of drug induced Parkinson's. It is very true that Adderall can harm dopamine brain cells. The thing about the Substantia Nigra is that there are really very few dopamine cell bodies there that project out to the rest of the brain's dopamine, but whether you're dopamine problem is at the source (Substantia Nigra) or lack of neurons elsewhere down the line (prefrontal cortex/mesolimbic pathway) is of significance. If you're lacking dopamine neurons outside the Substantia Nigra all the L-DOPA in the world can't truly help you, only if you're having a Parkinson's related dopamine depletion will you be helped by it. May I ask of your history of legal/illegal drug use? Ever MDMA use?

My friend I promise you that chronic deconditioning is a BITCH AND A HALF and that you seem to be suffering from it. Aerobic conditioning is EXTREMELY important with so many benefits not just related to your cardiovascular health. There are so many benefits to your entire body, especially brain, that comes with doing regular cardio. Cardio releases hormones to every part of your body, arteries/muscles/nerves/brain cells, telling them to grow and start to build new stuff. Cardio grows new brain cells especially in the center part of your brain and helps keep the ones you already have working optimally, humans are meant to run! Aerobic exercise also releases endorphins and DOPAMINEEEE Slow wave sleep where most of your growth hormone is released is increased by exercise, there are many benefits to increased slow wave sleep otherwise but getting on a routine of having done some regular cardio daily for a couple months will help your hormones. I'm sorry to hear your heart might not be doing the best But that seems to me to only make your cardio health more important and also your cardio health more likely a cause of your illness. So of course you'd want to take things easy but I would definitely ease into some elliptical/biking/treadmill whatever works for you, starting out around 2 minutes on then 1 minute walking and 2 minutes on again, but lower if you need to, this is typically how one starts to come back from chronic deconditioning. Until you can do 5 minutes straight, then over the weeks/months keep that up until you're up to 10 minutes then hopefully down the road 20-30 minutes 3-4 times a week. I hope you can get there in time man. It might take a couple years. But start as slow as you need to, the goal would be to go for a couple minutes of lighter exercise/fast walking than to go extremely hard for 1 minute. I don't know how exactly you got chronically deconditioned and if the valve was contributing but I think cardio will be essential to your rejuvenation.

TL;DR Sleep apnea could be an issue and a sleep study is in order regardless of history of snoring but aerobic conditioning will likely be the center piece of your recovery, it will be a lot easier to do once you a sleeping restfully though but just because you aren't sleeping restfully please try to do some light cardio regularly anyways

 

[dopamimetic]

I'm in the same boat as the OP. Chronic decondition is very probably very real and can become heavily disabling. I just don't know what to believe really. There are so many factors, possible origins etc ... I have a history of hyperactivity as a child, that changed into depression / avoiding personality / (social) anxiety / anhedonia etc. with puberty. More coincidentally than anything else at the age of 22 I got diagnosed with inattentive adult ADD (besides a bunch of other diagnoses where quite some are contradictory to others..)

Not much to add to the excellent posts here of course.

Dopamine really helps, if one's receptive to that. And there is a huge difference between amphetamine-like drugs (releasers) and methylphenidate (proposed DAT inverse agonist) at least depending on one's individual genetics. For me, MPH is sustainable. It works day after day, if dosed right and not combined with caffeine, the hangover is almost unnoticeable. With amphetamine just at 7.5mg/d the rebound depression became unbearable before the month was over. It literally locked me to bed.

Any pharmacologically induced motivation can become a one-way traffic quite fast though. But it can be a huge aid to get one's ass up and into life again. Sometimes it feels like with all willpower I can mobilize, I reach maybe 25% of what my brain 'on dopamine' is able to come up with - almost effortlessly (what might lead to conditioned decondition again...........)

L-dopa isn't that bad when used sparingly and in very low dosage. It's also available OTC as mucuna pruriens extract (don't use the pure L-dopa extracts, as the whole spectrum extract seems to protect against some of the side effects too).

Btw - how and why is L-dopa so different from 5-HTP in that it can lead to the brain/body stopping producing endogen dopamine and all that? Or is this just a matter of dose / concentration that is much higher when used together with a decarboxylase inhibitor and would be the same with 5-HTP? Usually it seems that the dopamine system recovers somewhat faster than the serotonergic (SSRI withdrawal..)

 

[The Monkey Mantra]

Maybe you've just got sleep apnea.