Anxiety, Dopamine and Serotonin

[Discopage]

I'm suffering from anxiety and panic attacks. Does anyone know if increasing dopamine levels would address these symptoms? My neurologist said he didn't think increasing the size of my Neupro patch to raise my dopamine levels would solve my anxiety. He thinks my anxiety and panic attacks are caused by low serotonin levels. But increasing the dosage of my SSRI Lexapro would likely worsen my RLS.

[Hidden]

Sorry, I can't recall anything you may have previously written about your experiences of RLS medications.

Here's my thoughts.

You're right to think that SSRIs can make RLS worse, so increasing the lexapro could make your RLS worse, but what's worse, the anxiety or the RLS?

Have we corresponded about anxiety coping strategies before?

Increasing dopamine levels may be more likely to increase anxiety than relieve it. It's also not a good idea anyway as it would increase your risk of suffering dopaminergic augmentation.

Hence I believe your neurologist is quite right in NOT increasing your neupro.

Bearing in mind that dopamine agonists are no longer preferred as a first treatment for RLS because of the high risk of augmentation, then you may wish to discuss with your neurologist either -

Adding an alpha 2 ligand and possibly reducing your neupro

OR

Adding an alpha 2 ligand and stopping the neupro.

The advantages of this are - -

The ligands can be effective for RLS and have a much lower risk of augmentation.

They are known to relieve anxiety and promote sleep.

They are pregabalin or gabapentin.

[Discopage in reply to Hidden]

Hi Manerva, I wrote the other day about having missed a weeks worth of the Neupro patch and how I was dealing with all sorts of anxiety and depression afterwards. We spoke about the potential of me having DAWS.

My neurologist said adamantly that I don't have DAWS, that my dosage of Neupro was too small and that my symptoms are tied to my psychiatric conditions. He said since I went back on the patch after just 6-7 days, if I had DAWS my symptoms would have gone away. My psychiatrist feels the same way, that the anxiety and depression I've experienced are linked to my anxiety disorder, bipolar, and life stressors. Personally I think the missed dosages of Neupro catalyzed my bipolar depression and heightened anxiety, so maybe I don't have DAWS but Neupro had an impact on me. The doctors are quick to discount this.

My big challenge now is anxiety and panic attacks. I wondered if increasing the dosage of Neupro would help raise my dopamine levels and calm my brain, hence the question above. Neurologist thinks my issues are all tied to low serotonin. I do know I have low serotonin levels from birth. I also know increasing the dosage of my SSRI would likely worsen my RLS so that's a no go. And increasing my Neupro patch could lead to augmentation which is also a bad move. All I know is this anxiety is brutal. Panic attacks are so hard to handle. Psychiatrist is prescribing Gabapentin when the attacks happen, and I raised the point of how the med can cause suicidality but the psychiatrist said she thought the benefits outweighed the costs.

[Discopage in reply to Discopage]

Just saw your full reply. Thanks. What dosage of Gabapentin is typical for RLS?

[Hidden in reply to Discopage]

The daily starting dose for RLS is 300mg. This is usually a single dose at night. This can be split into 2 or 3 times a day, if this helps more with daytime anxiety. However splitting it means it's less effective for RLS at night.

The dose can then be increased by 100mg a day or 300mg every three days, (capsules c ome in a 100mg and a 300mg size).

Be aware that it can take up to 3 to 4 wdeks to fully work and during that time you can exoect some side effects that usually wear off later. These are mainly drowsiness, dizziness and difficulty walking. Best ghen to take it only at night at first. You can't fall ovdr in bed!

The aim is to find the lowest dose that works. So once you find that dose don't increase it any more.

The typical minimum effective dose for RLS is 900mg. The maximum recommended is 2700mg.

In some respects pregabalin has some advantages over gabapentin. It's more potent and more consistently absorbed. Starting dose 50mg, typical minimum effective 150mg, maximum 450mg. Once absorbed pregabalin is turned into gabapentin - it has the same effects.

[Hidden in reply to Discopage]

I agree with your psychiatrist. But whether you had DAWS or not the neupro is an absolute time bomb! The week you missed is demonstration of that.

Definitely do not increase the neupro. The gabapentin may help you reduce it.

Have I mentioned psychological therapies before?

[Discopage in reply to Hidden]

Neupro really is a time bomb. Though I’m still taking the med, I personally despise it now.

Like what? Like CBT and DBT?

[Hidden in reply to Discopage]

CBT can be more effective long term than any drug. In my experience Mindfulness CBT is very good.

Taking drugs, although necessary at times may in fact disable you from developing strategies to deal with your problems, e.g. what to do when you have a panic attack.

At one time it was a theory that chronic anxiety/ depression may be due to a chemical imbalance in the brain. Since SSRIs work for anxiety/depression then maybe it's due to low serotinin.

Have you ever been tested for low serotonin?

This "chemical imbalance" theory is now thought to be a myth. Largely because it just isn't that simple.

In addition, if there are chemical imbalances, it's hard to really say that the imbalance has caused the anxiety, OR the anxiety has caused the imbalance.

There are some cases where depression or anxiety may have "organic" causes, but I don't believe there's a singular cause.

One problem is that it's easy to understand why somebody can become anxious or depressed as a reaction to an external event . It's not easy when there is no apparent external trigger.

[Discopage in reply to Hidden]

I got genetic testing done last year for mental health and I have a rare genetic variant that means very low serotonin levels.

This doctor recommends doing basically nothing to cure panic attacks. Ever heard of this? youtube.com/watch?v=8Un_Ykh...(Not working as expected?)

[involuntarydancer in reply to Discopage]

I attended a talk by Dr Harry Barry - he came to my son’s school to talk about the mental health of teenagers. I found him very convincing. By coincidence I have some of his books. Took me a while to realise it was the same guy. Apparently people come from all over the world to see him. As his methods are non-interventionist and he’s not selling any snake oil (other than the books), it’s probably worth trying. I would have to say, though, that I may be a bit of a sucker for these charismatic doctors with convincing sounding theories.

Whatever you end up doing, you sound like a measured, considered person going through a particularly hard time and I wish you the very best.

[Eryl]

One thing that can cause anxiety as well as cause rls is a high carb diet leading to inflammation of nerve cells. youtu.be/TXlVfwJ6RQU(Not working as expected?)