stratofortress
Bluelighter
- Joined
- May 16, 2012
- Messages
- 119
EDIT - I know i messed up on the thread title. Dopamine ReUptake Inhibitors........
In the UK, DRIs are not approved for treatment of depressive illnesses. The British National Formulary states that Methylphenidate, when being considered as a medication for use in patients with ADD/ADHD, is contraindicated in those with a history of, or suffering from depression. I'm making an assumption here, but I imagine this is the case in most countries. I've certainly never read about DRI's being prescribed for depression or any other mental illness.
So any ideas why this is the case? Antidepressants inhibiting the uptake of the other two main neurotransmitters are prescribed to patients presenting as depressed without a second thought. Why do pharmaceutical companies only focus on serotonin and norepinephrine activity in developing new antidepressant drugs? Why can't doctors and psychiatrists prescribe MPH as part of a patient's medication regimen?
You might argue that doctors are wary of prescribing more drugs with a high potential for abuse. Yet in the UK DRI's are the first choice of medication for the treatment of patients with Attention Deficit disorders. Chances are if you have ADD you'll be prescribed MPH; heck, my brother was on the stuff as a kid. And prescription rates are even higher in the US. Patients suffering depression often take a number of drugs before they find the one that is effective. If a patient has tried a number of drugs with no improvement in condition, psychiatrists may turn to less commonly prescribed drugs to give them a shot. DRI's would almost certainly be amongst these 'last resort' drugs, and so would rarely be prescribed in the treatment of mental illness. Such a change in prescribing rules would hardly lead to an epidemic of stimulant abuse.
Stimulant drugs taken by themselves can cause significant symptoms of anxiety and depression during the comedown. Speaking for myself, before I was forcibly made to stay in a psychiatric hospital, my use of Ethylphenidate caused some of the worst feelings of anxiety and dread that I'd ever felt. Every day I was a teary sobbing mucus faced mess. Surely evidence that those prone to depression should steer well clear of dopaminergic drugs? Perhaps if prescribed as the sole medicine a patient had to take. When I came out of hospital 6 months later I was being treated with an SNRI and Pregabalin. Unable to resist another go with the EPH i bought more, this time experiencing only a very mild and managable comedown. In combination with other psychiatric medications I believe those suffering mental illness would tolerate DRI's much better.
So using the example above, why not just say that the lack of comedown proved the efficacy of my SNRI and Pregabalin in the treatment of depression. Well depression comes with many symptoms, some of which are not always improved by currently licensed medicine. For example, I still found my motivation and enthusiasm for life were very low. Starting and finishing simple tasks was far more gruelling than it should have been. If you had to add another drug to this chemical cocktail, would you see a DRI as an obvious candidate? Improved motivation and concentration; the very same desired results from MPH prescribing in ADD/ADHD patients.
I don't know. Perhaps the governing bodies deciding prescribing rules are doing us a favour. Many more people suffer depression than ADD/ADHD. Maybe these dopaminergic drugs simply aren't as safe as the serotonin alternatives. It could be that the medical profession wishes to prevent more DRI prescriptions because the long term health effects of such drugs are more likely to be neurotoxic. But that sounds a bit tin foil hat to me.
Shit I've rambled on. Well you can't fault these drugs on their ability to increase productivity.
So any thoughts?
In the UK, DRIs are not approved for treatment of depressive illnesses. The British National Formulary states that Methylphenidate, when being considered as a medication for use in patients with ADD/ADHD, is contraindicated in those with a history of, or suffering from depression. I'm making an assumption here, but I imagine this is the case in most countries. I've certainly never read about DRI's being prescribed for depression or any other mental illness.
So any ideas why this is the case? Antidepressants inhibiting the uptake of the other two main neurotransmitters are prescribed to patients presenting as depressed without a second thought. Why do pharmaceutical companies only focus on serotonin and norepinephrine activity in developing new antidepressant drugs? Why can't doctors and psychiatrists prescribe MPH as part of a patient's medication regimen?
You might argue that doctors are wary of prescribing more drugs with a high potential for abuse. Yet in the UK DRI's are the first choice of medication for the treatment of patients with Attention Deficit disorders. Chances are if you have ADD you'll be prescribed MPH; heck, my brother was on the stuff as a kid. And prescription rates are even higher in the US. Patients suffering depression often take a number of drugs before they find the one that is effective. If a patient has tried a number of drugs with no improvement in condition, psychiatrists may turn to less commonly prescribed drugs to give them a shot. DRI's would almost certainly be amongst these 'last resort' drugs, and so would rarely be prescribed in the treatment of mental illness. Such a change in prescribing rules would hardly lead to an epidemic of stimulant abuse.
Stimulant drugs taken by themselves can cause significant symptoms of anxiety and depression during the comedown. Speaking for myself, before I was forcibly made to stay in a psychiatric hospital, my use of Ethylphenidate caused some of the worst feelings of anxiety and dread that I'd ever felt. Every day I was a teary sobbing mucus faced mess. Surely evidence that those prone to depression should steer well clear of dopaminergic drugs? Perhaps if prescribed as the sole medicine a patient had to take. When I came out of hospital 6 months later I was being treated with an SNRI and Pregabalin. Unable to resist another go with the EPH i bought more, this time experiencing only a very mild and managable comedown. In combination with other psychiatric medications I believe those suffering mental illness would tolerate DRI's much better.
So using the example above, why not just say that the lack of comedown proved the efficacy of my SNRI and Pregabalin in the treatment of depression. Well depression comes with many symptoms, some of which are not always improved by currently licensed medicine. For example, I still found my motivation and enthusiasm for life were very low. Starting and finishing simple tasks was far more gruelling than it should have been. If you had to add another drug to this chemical cocktail, would you see a DRI as an obvious candidate? Improved motivation and concentration; the very same desired results from MPH prescribing in ADD/ADHD patients.
I don't know. Perhaps the governing bodies deciding prescribing rules are doing us a favour. Many more people suffer depression than ADD/ADHD. Maybe these dopaminergic drugs simply aren't as safe as the serotonin alternatives. It could be that the medical profession wishes to prevent more DRI prescriptions because the long term health effects of such drugs are more likely to be neurotoxic. But that sounds a bit tin foil hat to me.
Shit I've rambled on. Well you can't fault these drugs on their ability to increase productivity.
So any thoughts?
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