Posted by: Upping my meds | 2009-02-25

Confucious Reigns!

Dear CS, I have been on Cilift for 6yrs. Tried to go off a couple of times and with doc' s advice realise I am one of those that just needs to take it - period. That' s fine. On one tab (20mg I think) a day, but lately (past months) I am extremely sad, withdrawn, motionless, the usual. So he suggested either a change in meds, to something like Wellbutrin, or an increase in Cilift. He says Wellbutrin has dopamine in it which he called the " happy ingredient" . That sounded great until he mentioned dopamine' s side effect can be aggression and irritability. Having been on Lily Fluoxetine for a while, which made me more " mad"  in the head, I am scared to try new meds. For now I have chosen to up my Cilift to 2 tabs daily.
Please can you elaborate on the dopamine/Wellbutrin story.
Why can' t a blood be done to measure such neurotransmitter chemicals in the brain? Then we could easily adjust meds.
Feeling a bit lost here, please advise.

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Our expert says:
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Some ADs primarily affect the effective brain levels of a specific one o the neurotransmiters ( chemicals which in tiny amounts at the right places, keep us functioning ). Like Cilift, and Prozac. Some more significantly affect more than one at a time, like Wellbutrin. Sadly, the more we learn about it, the more complex it gets, affecting one neurotransmitter indirectly affects others, anyway. And we seem to vary in the profile of how our different relevant neurotransmiters are affected witnin our own Depression, so it is hard to predict exactly how we will reaspond to a particular AD, or which will suit us best. Thus generally there needs to be some experimentation to find which one suits you and your particular chemistry, best.
Now, there's a thing called the Blood-Brain Barier, which basically means that in various ways, the levels of chemicals in the bloodstream does not usually affect the levels of the same chemical in the barin --- some substances are effectively excluded from the brain, some enter it very easily. Generally, blood levels don't orrelate well with effective brain levels. And remember, the amounts that are relevant in the brain are, at any one nerve cell, truly micriscopic, and so variations in levels which would have a huge impact in brain would be too tiny to even measure in the blood. And obviously, taking brain samples to measure chemitry isn't thought to be a good idea !
The only psych drug where this actually does work quite well, for complex reasons, is Lithium, which can be quite easily measured in the blood, and we know the levels below which it will have no benefit, and above which it is likely to have severe side-effects. At one time they tried measurin blood levels of some of the ADs, but it did not prove to be practical or useful.

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