Sunday, August 9, 2009

Methylphenidate; Minaprine; Nomifensine

A SSRI can be combined ("augmented"; sounds more soothing to the official medical ear) with a dopaminergic such as methylphenidate. As "Ritalin", methylphenidate is prolifically dispensed to American schoolchildren for different purposes altogether. In spite of its structural relationship to amphetamine, methylphenidate resembles in many ways a benign version of cocaine, yet with a much longer half-life. It blocks the reuptake, but doesn't significantly release, the catecholamines noradrenaline and dopamine. If it is combined with an SSRI, all of which have anti-obsessive-compulsive properties too, the likelihood of dose-escalation is minimised.
Chewing coca leaves with a dash of powdered lime is a nutritious and energising way to sustain healthy mood.
Unfortunately, it is not very good for one's teeth.
A more cautious but still interesting option might be minaprine. Minaprine blocks the reuptake of both dopamine and serotonin. It is also in some degree cholinomimetic. Thus it may exhibit both mood-brightening and nootropic properties. Much more research is needed.
Nomifensine (Merital) showed great promise as a pleasantly stimulating dopaminergic which also inhibits the reuptake of noradrenaline and - to a much lesser extent - serotonin. It was withdrawn from licensed use after the discovery of its rare side-effect of precipitating a serious blood-disorder. For retarded melancholics, however, it was typically a very effective and well-tolerated mood-brightener with minimal side-effects. The risk/reward ratio of its carefully-monitored use may have been misjudged.

Dopamine function

What's missing, crucially, is vigorous and prolonged stimulation of meso(cortico-)limbic dopamine function.
This is really much more fun than it sounds. The currently available experimental evidence has persuaded many - but not all - researchers that the mesolimbic dopamine system serves as the final common pathway for pleasure in the brain. Enhanced responsiveness of post-synaptic dopamine D2/D3 receptors is crucial to long-term emotional well-being. The otherwise anomalous mood-brightening effects of the serotonin-reuptake accelerator tianeptine, for instance, are probably explained by its tendency to increase extracellular concentrations of dopamine in the nucleus accumbens. All "serotonergic" and "noradrenergic" mood-brighteners eventually act on the mesolimic dopamine pathway, albeit in differing degrees and with varying delay. And new anti-Parkinsonian and anti-Alzheimer's agents, notably roxindole and pramipexole, owe their exciting potential role as fast-acting antidepressants to their dopaminergic action.
The full story is inevitably complex. Dopamine isn't itself the magic pleasure-chemical, though its functional role is crucial. Researchers into affective disorders readily get over-attached to a particular neurotransmitter, its receptor sub-types and their signal transduction cascades. Traditionally, serotonin and noradrenaline have attracted the fiercest rival partisans. "Dopaminergic" (and opioid) agents, by contrast, are suspect. They are politically incorrect since they are both potentially "abusable". Moreover safe and sustainable empathogens are arguably as morally urgent as safe and sustainable mood-boosters. At any rate, mesolimbic activation, exclusively or otherwise, enhances the intensity of experience; increases pleasure and libido, and boosts cognitive performance. Even better, certain dopamine-enhancing drugs may have neuro-protective properties too.
So what are the other contemporary options for chemical life-enhancement?