For the Doc types of dopamine, norepinephrine & serotonin

I have been on the depression wagon for close to ten years with only limited success. I was initially diagnosed with dysthymia which was probably accurate as I was still functioning, work & etc. Things progressed to bouts of major depression as well as anxiety and panic attacks. I ran the gambit of SSRI's and tricyclics with no real help. I eventually started with Wellbutrin SA along with Xanax for the anxiety and panic attacks & Dexedrine spansules, later changed to Provigil which resulted in some improvement.(Provigil not as effective) My Pdoc did not like the "Elvis" aspects of Xanax and stimulants so I am no longer taking the stims.

My real question comes down to this: after reading a lot of the pharmacology on many drugs, if I understood them correctly, there are different types of dopamine, norepinephrine & serotonin in the brain. As Welbutrin works on dopamine & norepinephrine is there another antidepressant out there that might work on different types of dopamine & norepinephrine that could be used in conjunction with the Welburtun? Is my thinking on this completely in left field?

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so_it_goes said:
My real question comes down to this: after reading a lot of the pharmacology on many drugs, if I understood them correctly, there are different types of dopamine, norepinephrine & serotonin in the brain. As Welbutrin works on dopamine & norepinephrine is there another antidepressant out there that might work on different types of dopamine & norepinephrine that could be used in conjunction with the Welburtun? Is my thinking on this completely in left field?

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Your thinking isn't in left field, but there is a fundamental misunderstanding that needs to be cleared up.

It is not that there are different types of dopamine, norepinephrine, and serotonin, but instead, there are different types of receptors for these molecules. There is only one chemical structure that we know as dopamine, and so on. It is the binding site of the receptor, and the biochemistry associated with that binding site, that determines the influence of the individual neurotransmitter molecules. There are well over a dozen serotonin binding sites, as an example, each given an esoteric label such as 5-HT2a (5-hydroxy-tryptamine is another name for serotonin). There are fewer identified dopamine binding sites, but the effect of those different sites also varies depending on the brain structure within which they are found.

Now, back to the dopaminergic issue....your positive response to stimulants and Wellbutrin does lead you in the right direction. The trans-dermal delivery system for selegeline, called Emsam, might be very good for you, as it targets (predominantly) the B-form of the enzyme monoamine oxidase (MAO). It's an MAO-B inhibitor at lower doses, with some MAO-A activity at higher doses. MAO-B predominantly degrades dopamine, so inhibiting it increases the effect of dopamine that you already have within your brain. Unfortunately, the drug monograph clearly states that you can't take it with Wellbutrin.

If you want to read up Emsam, go to this link: http://www.rxlist.com/cgi/generic4/emsam.htm

Different tabs across the top of the page will take you to all the sections of the full drug monograph. The drug warnings are on the "Warnings and Precautions" page.

I hope you don't mind my replying to your inquiry.

Lar