One of the benefits of writing about my illness is that I get to bounce ideas off of very smart people. A few weeks ago, at a function in the
Here’s what has been playing around in my mind the past few weeks:
There are no “smart” dopamine meds. The ones we have are “dumb.” Dopamine is a neurotransmitter that plays a key role in pleasure and reward, as well as being involved in motivation and cognition. Too much dopamine in the brain can result in psychosis, manic behavior, and poor decision-making. Too little can result in dulled thinking, no sex drive, lack of motivation, no pleasure, and spastic muscular movement.
Here’s the catch: Researchers have mapped out five dopamine systems in the brain. As luck would have it, many of us may have too much dopamine in one brain system and not enough dopamine in the other.
And here’s the punch line: The meds we have are too stupid to figure this out.
First example: Amphetamines. These enhance dopamine. By cranking up energy levels, in some cases they may work on one’s depression better than an antidepressant. But because amphetamines are dumb dopamine meds, they may also ratchet up manic behavior and cause psychosis, plus result in no end of problems involving addiction.
Second example: Antipsychotics. These work by blocking out dopamine. These are your drugs of choice for knocking out psychosis and are a first option for treating mania. But antipsychotics happen to be as intellectually-challenged as amphetamines. Knocking out psychosis tends to come at the expense of taking out one’s sex drive, as well, not to mention causing significant collateral damage in the pleasure and reward and motivation departments.
Who wants to live like that? Granted, for a lot of individuals antipsychotics are life-savers, but let’s take the argument a bit further. Psychiatrists have identified three domains to schizophrenia: psychosis (what they call “positive” symptoms), impaired thinking, and flat affect (the latter two are referred together as “negative” symptoms).
By now, you see where this is going. An antipsychotic tends to clear up the psychosis while the rest of the schizophrenia gets worse. No wonder the illness has such a poor prognosis.
Bipolar is not schizophrenia, but there are a number of parallels. We can get psychotic. At the same time, our thinking may slow down, we may experience no joy, and we may not be motivated enough to get out of bed.
Don’t get me wrong, in a psychiatric emergency involving psychosis or mania or both, an antipsychotic is probably the best med to get you out of danger. Some of us with persistent psychosis or certain types of mania may have no choice but to stay on an antipsychotic, but unless all your dopamine systems happen to be in overdrive at the same time –
