[Atlantis]

Is there any major difference between the two? Obviously there would be, but how big and to what nature are their effects? Ever since bubropion has (in part) worked for me, I've learned about the effect of dopamine in my depression. But the doctor won't prescribe it anymore so the best I'm stuck with is the tricyclic clomipramine and the antipsychotic quetiapine, but now the doctor has suggested ziprasidone in place of the quetiapine, which appears to have good antagonism of the D receptors, but not of the DA transporter.

Will it be worth trying if quetiapine only works for a short while while I up the dose (thereby blocking dopamine receptors), or am I forced to stick to an up-down cycle of quetiapine (3-4 weeks) in order to achieve its dopamine effect?

[kindachaotic]

Here in the US we have the PDR (Physicians Desk Reference). They are in hospitals & probably pharmacy's. It's a thick manual that has pretty much every drug used here.
You should have the UK or Aus. equivalent.
That's about the only advice I have, over my head for sure.
The "Ask Doc Clyde" forum might be helpful.

[Atlantis]

Originally Posted by kindachaotic

Here in the US we have the PDR (Physicians Desk Reference). They are in hospitals & probably pharmacy's. It's a thick manual that has pretty much every drug used here.
You should have the UK or Aus. equivalent.
That's about the only advice I have, over my head for sure.
The "Ask Doc Clyde" forum might be helpful.

Thanks, I'm more after whether the function of dopamine is improved, but I hate to bring the word "dopamine" up to my psychiatrist as he disregards it, just as he does atypical depression. I will take your advice on asking "Doc Clyde".

[Atlantis]

Sorry, can you point me to that forum as I can't seem to find it?

[Squirrel1983]

Originally Posted by Atlantis

Sorry, can you point me to that forum as I can't seem to find it?

I think this is the forum the other poster was talking about.

http://forums.psychcentral.com/forumdisplay.php?f=50

[sunrise]

Bupropion increases the concentration of dopamine in the synapse by inhibiting the dopamine transporter. This INCREASES dopamine signaling. (Bupropion also inhibits the norepinephrine transporter.)

Antipsychotics such as ziprasidone are dopamine antagonists, which means they REDUCE dopamine signaling.

Buproprion and antipsychotics, therefore, have OPPOSITE effects on dopamine. If you want to achieve a similar effect to bupropion, you will not find it in antipsychotics.

Bupropion inhibits both the dopamine (DA) and norepinephrine (NE) transporters. Here are some meds with overlapping (but not identical by any means) functions:
Effexor (inhibits serotonin & NE transporters, but not DA)
Cymbalta (ditto)
Strattera (inhibits NE transporters)
Amphetamines such as Ritalin and Adderall also increase dopamine but by a different mechanism
Zoloft (inhibits serotonin transporters but also has lesser action as an inhibitor of dopamine transporters)

There are a couple of new meds with similar action to buproprion, but they are still in clinical trials.

A good combo for people with depression who suffer from low positive affect (anhedonia, lack of pleasure, blahness) as opposed to negativity, irrational negative thoughts, etc., is Zoloft + bupropion.

Atlantis, why won't your doc prescribe bupropion anymore? I take bupropion for ADHD, and also Vyvanse, an amphetamine stimulant. I need more dopamine for my ADHD and these help a lot. If you are taking the antipsychotics for psychotic symptoms, you probably would not want to take bupropion because you could make those symptoms worse by increasing your dopamine. In general, people with psychosis should not be trying to increase their dopamine. If you are taking the antipsychotics for depression (some of them are effective for this), then you might talk to your doc about switching back to bupropion. But if there are also psychotic symptoms, he is probably not going to want to do this.

[Atlantis]

Originally Posted by sunrise

Bupropion increases the concentration of dopamine in the synapse by inhibiting the dopamine transporter. This INCREASES dopamine signaling. (Bupropion also inhibits the norepinephrine transporter.)

Antipsychotics such as ziprasidone are dopamine antagonists, which means they REDUCE dopamine signaling.

Buproprion and antipsychotics, therefore, have OPPOSITE effects on dopamine. If you want to achieve a similar effect to bupropion, you will not find it in antipsychotics.

Wait a second, don't dopamine antagonists block the reuptake of dopamine, which in turn leads to increased extracellular concentrations of it? I'm confused by this, and why my doctor just isn't getting it.

Bupropion inhibits both the dopamine (DA) and norepinephrine (NE) transporters. Here are some meds with overlapping (but not identical by any means) functions:
Effexor (inhibits serotonin & NE transporters, but not DA)
Cymbalta (ditto)
Strattera (inhibits NE transporters)
Amphetamines such as Ritalin and Adderall also increase dopamine but by a different mechanism
Zoloft (inhibits serotonin transporters but also has lesser action as an inhibitor of dopamine transporters)

There are a couple of new meds with similar action to buproprion, but they are still in clinical trials.

A good combo for people with depression who suffer from low positive affect (anhedonia, lack of pleasure, blahness) as opposed to negativity, irrational negative thoughts, etc., is Zoloft + bupropion.

Atlantis, why won't your doc prescribe bupropion anymore? I take bupropion for ADHD, and also Vyvanse, an amphetamine stimulant. I need more dopamine for my ADHD and these help a lot. If you are taking the antipsychotics for psychotic symptoms, you probably would not want to take bupropion because you could make those symptoms worse by increasing your dopamine. In general, people with psychosis should not be trying to increase their dopamine. If you are taking the antipsychotics for depression (some of them are effective for this), then you might talk to your doc about switching back to bupropion. But if there are also psychotic symptoms, he is probably not going to want to do this.

Thanks so much for all the additional help you've given. Now why can't my doctor know all this? The reason he won't prescribe bupropion is because I had a bad case of withdrawal when I decreased my alcohol intake (from not much at all to practically nothing during a short space of time), which resulted in hallucinations and I guess seizure-like symptoms. I was on the drug for a few months and it was really helping and giving me the most positive effect I'd experienced in years, but then I ran out of repeats.

I don't have any psychotic symptoms, and the only reason I went on them is because nothing else seemed to work.

[Atlantis]

By the way, re the seizure threshold, I'm on 300 mg clomipramine (and 45 mg mirtazapine), and have not experienced anything since.

[sunrise]

Originally Posted by Atlantis

Wait a second, don't dopamine antagonists block the reuptake of dopamine, which in turn leads to increased extracellular concentrations of it?

No. Dopamine antagonists block the dopamine receptors on the neurons, not the dopamine transporters.

Originally Posted by Atlantis

The reason he won't prescribe bupropion is because I had a bad case of withdrawal when I decreased my alcohol intake (from not much at all to practically nothing during a short space of time), which resulted in hallucinations and I guess seizure-like symptoms.

Wellbutrin is contraindicated in someone at increased seizure risk, as it raises the risk for seizures itself, especially at higher doses. So in a person with no seizure history and no other seizure risk factors, 300 mg or less would be the recommended dose. In someone with a seizure history, the drug just usually isn't prescribed, so your history of seizures may be the reason he is not prescribing it to you anymore. This seems prudent.