Dopamine's Dirty Little Secret
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- Опубликовано: 8 фев 2025
- Dopamine's Dark Side: The Tyranny of Rage
In this video, I explore how dopamine affects mood and behavior, and the medical model's solution for managing irritability. Join me as we uncover the truth behind dopamine's dark side, and check my library for "Love/Hate: The Serotonin-Dopamine Relationship."
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0:19 the sound lmao 😂
Haha, glad you enjoyed that one! When I downloaded that sound byte I renamed it "Scary F@#%! Scream"
Bravo, that introduction perfectly encapsulated how I feel every morning.
Astounding editing as usual.
This one's sound bytes reverberate perfectly.
Illustration of the evolution of exemplery editing.
I recently turned 40, work long hours in the mental health field, and have young children.
Experiencing burnout and compassion fatigue as a result of challenging behaviours and S./H. ideations.
I have never had a psychiatric evaluation, and require a med review.
Medication manger by a GP that is reluctant to prescribe the medications I know will or do work for me.
Where I live down under Aus., I would love to meet someone as knowledgeable and experienced as you.
Querious as to your opinion.
Are Psychs. Ooen to letting patients take the steering wheel when it comes to prescribing?
Need to take the step, just cautious I may not be prescribed new medication I would like to try.
Thank you for noticing; I try to make these as fun and interesting and engaging as possible to watch. I could just recite the information and try to be quick about it (people have _very_ short attention spans, and I usually lose them around 10 minutes), and churn out a _lot_ more videos, but that's no fun. I spend hours and hours polishing them...thank goodness it's a hobby I love! Thank you again for the very kind words. Please stay tuned, and spread the word!
I love that my videos are playing down under!! There are hundreds of millions of people around the globe interested in mental health and my ambition is to reach as many as possible and to build a super-community on this channel, where people can help one another, guided by some really good, reliable information.
To answer your question: some are, yes, but most would probably balk at putting it that way (taking the wheel). Doctors like to stay in control, and they have a duty to guide therapy, but my philosophy is that psychotropic medication management is a collaboration. The expert and the subject must come together and form a therapeutic relationship, that is then the basis for exploring how best to annihilate target symptoms. Really, all of medicine should work this way. My advice to you would be to not have an agenda about specific medications you want to try, at least not too explicitly, because most providers would balk at that. It should certainly be okay to ask about specific classes of medications, and the provider should always give you options. Every practitioner is different, however, so you just have to hope you get someone you can work well with, and if not, know when to move on (without "doctor-shopping"). Good luck!
I do have a non-medical consultation service. For more information, you can e-mail me at drsilva@drsilva.com.
This was so enlightening. Thank you. I am curious how people with higher vs lower baseline dopamine levels tend to correlate with certain cognitive symptoms. Like being highly neurotic, for example. Makes one wonder how much of a person's outward reactions are personality based vs brain chemical levels. Thanks again.
You are most welcome, thanks for tuning in! Speaking as a highly neurotic person myself (I suffer from OCD and other interesting maladies of the mind), so-called neuroses have more to do with inadequate serotonergic neurotransmission, but at the end of the day it's really the _balance_ of neurotransmitters, and hormones, and exogenous compounds (like vitamins and caffeine and medicine and recreational drugs, etc.) that determines our mood, and our perspective, and our mental thresholds at any given moment. Hundreds, if not thousands, of molecular species, continuously impinge upon the mind, a vast quantum tide, dictated in large part by our genome, inducing emotion that scripts our thoughts, thoughts that consequently synthesize our subjective realities. Please see my "Primordiality of Mood" videos, parts 1-2 for more on how the chemical environment doesn't just determine how we respond to the outside world; it determines what aspects of it we are capable of sensing. ruclips.net/video/MMEPYla0OAo/видео.html
@@notonanemptymind Thanks for referring me to your videos. Quite a brew of factors involved. Maybe AI and bioanalytics could one day be synthesized to an individual level. Really enjoy your videos.
Thx Dr. Silva. You had mentioned similar observations in a reply to me a few weeks ago. I do take Vyvanse and dex and as a 59M, hv always had a disagreeable temperament, and naturally very hi total and free Testosterone (35.3 nmol/L & 420 pmol/L respectively). I am working with a psychiatrist and lately tried Trintellix as an adjunct for my irritability, but like all the SSRI's I've ever tried, the nausea is overwhelming and debilitating and not tolerable. Nardil was tolerable when I took it in university years ago, but is out of favor by most clinicians due to dietary dangers, and I'm not sure it would help for irritability? I may ask to try Qelbree next and see what happens.... or just try harder to live with it. Ugh
The dietary concern was probably over-stated, but always better safe than sorry, and if you are taking 2 separate stimulants, I would be very careful about blood pressure monitoring if you started an MAOI, and definitely stay away from charcuterie. I have a video on the MAOIs in which I review the dietary restrictions in detail, explain the pathophysiology underlying that food-drug interaction, and mention the fact that, even in your case, the dietetic perils are no reason not to try this class of very effective medications, especially if you did well in the past. However, the risk of serotonin syndrome in someone taking 2 different amphetamines must be carefully assessed.
It is always best to try to nip the source of the problem in the bud, rather than reaching for an antidote, if possible. You can't do anything about your temperament (your genes), and the nurture piece, your childhood and your prior experiences, likewise cannot be altered, but you can do a lot of good work in psychotherapy unpacking that baggage, figuring out your triggers, analyzing your reactions and aiming to modify your future behavior, although it's not easy if the anger is fast and intense (see also my "Controlling Anger: Emotional Analgesia" video for more on that). The easiest thing to do would be to stop pouring gasoline on that fire, so I would encourage you to re-evaluate the risk-benefit analysis of taking not one, but two, different amphetamines, an analysis which can change over time, by the way, as you age and your circumstances change, and the indication for that type of regimen varies. I would especially periodically review the dosages, because this side effect might be dose-dependent in some individuals (for others, I think it is more-or-less all-or-nothing, since very low doses let the genie out of the bottle every time, and lowering the dose doesn't help much). There are also roundabout ways stimulants can make you tense and snappy, such as not sleeping and forgetting to eat.
As far as Qelbree, remember that at the end of the day (metaphorically and literally, as I mention in this video), the final common pathway is mediated by the increase in dopamine and norepinephrine, so any stimulating, dopaminergic/noradrenergic agent would be expected to cause the same problem. Qelbree is most like Strattera (atomoxetine), if you have ever had that.
Finally, if you were my patient, I would delve deeply into this phenomenon of not being able to tolerate even low doses of a serotonergic agent due to intractable nausea. You only need _a little_ SSRI to help _a lot_ with anger, and nausea dissipates 100% for 99%+ of patients over a fairly short period of time (see my "3 Ways of Avoiding Side Effects" video for added strategies, but your body adapts on its own), such that if you are truly such a rare outlier, you might consider taking an anti-emetic agent like Zofran (or perhaps better yet, Remeron, which also blocks 5HT3 receptors but is a great sleeping pill/antidepressant agent as well, see "Remeron, an Almost Perfect Antidepressant"), at least for a few months. If you continue to experience severe, pervasive nausea on a tiny, starting dose of an SSRI taken with food and ondansetron, something is up. Meaning, that is not medically feasible and the nausea is almost certainly psychosomatic: genuinely experienced, but triggered by, and largely based upon, psychological factors. A directed psychotherapeutic program of desensitization (deconditioning) would then be in order. I can’t say whether this is the case with you, but have you tried combining with anti-emetics? If so, you might also explore this intolerance of serotonergic agents (which it is obvious you need, and from what you say, even if you weren't pouring gasoline) with a therapist. Therapy + medication is almost always better than either alone. (“How to Engage in Meaningful, Successful Psychotherapy”)
Those are my thoughts, that is how I would approach a case like yours...and I have seen a patient or two with your issue with intractable, medication-induced nausea. Whatever else is going on with your chemoreceptor trigger zone, by now you must have developed a certain psychological aversion to entire classes of serotonergic medications, such that we can't divorce you from the placebo effect. That is, initially; the whole point of therapy would be to do precisely that. I'm sure you must dread the thought of yet another such trial: "here we go again..." The thought is enough to make you...queasy.
@@notonanemptymind Wow, thx so much for such a comprehensive reply Dr. Silva. So much to think about. For whatever reason, I don't tolerate and/or like taking the adjunct meds and thx to your notes above I may seek via my physician to take only Vyvanse. That is to take my usual morning and try also early afternoon dose too. I didn't know that Vyvanse is considered a different stimulant per se and I have been taking 10mgs of dexedrine around 2pm because it's thought I'm a fast metabolizer, but the slower release of the afternoon Vyvanse could help ease me down at the end of the day and not interfere with sleep. I hv had periods when I was not taking any stimulants for months at a time in the last 20+ years, but unfortunately I hv a very heavy paperwork intense job and I work from home and found I was unable to function without the stims. Thx again Dr. Silva and I look forward to learning more about your out-of-state consult offering.
Both Dexedrine and Vyvanse are amphetamines. Careful with taking Vyvanse in the afternoon, because it is a long-acting agent that could definitely cause insomnia. I wouldn’t dose it after noon. To learn more about my non-medical consult service, you can contact me at drsilva@drsilva.com. Cheers.
What about SSRIs causing irritability early on? Does this necessarily mean bipolar or do some people require time to adjust?
That is a paradoxical reaction and it has nothing to do with bipolar disorder; the _sine qua non_ of manic depression is mania (see my videos in the bipolar playlist, especially "Be Skeptical," "Nowhere Near Mania" and "True Mania" for more information about that). It does mean you need to adjust, but if it was truly brought on by beginning an SSRI with absolutely no other concomitant medication changes, then you need to get to steady state before re-evaluating. That's usually around 5 days, except for Prozac, which can take 2-4 weeks. You may not be a good candidate for the PRN use of an SSRI if you are having this initial reaction.
@@notonanemptymind Thank you for the quick reply.
@@notonanemptymind Shame you are TX only.
Thank you, I do have a non-medical consultation service, where we could meet to discuss symptoms and treatments as they might pertain to you, but really more of a one-on-one, question-and-answer session that would not establish a doctor-patient relationship (since one cannot legally be established outside of Texas), and from which I would not make any formal diagnoses nor provide treatment. I am working on updating my website to reflect this service, and will make a general community announcement soon, but if that is something you might be interested in, you can contact me at drsilva@drsilva.com or text (432) 692-4525 for additional information. Thanks again for watching and please stay tuned for more great content!
@@notonanemptymind Thanks! I'll ponder it! Your videos are fantastic.