Dear Dr. Gould,
First of all, thank you for the work you do here, for giving up your time to answer our questions. I apologize in advance for the length of this post, but I want to give you as much pertinent info as possible before asking my questions.
I have a 20-year history of atypical, treatment-resistant depresssion. Over the years I've tried many antidepressants: Prozac, Zoloft, Effexor, Celexa/Lexapro, Elavil, and Wellbutrin (or buproprion/budeprion). Through trial and error, I've learned that the SSRIs "drag me down" and sap my energy. Same with Effexor. Elavil simply tranquilized me. Of all these meds, Wellbutrin XL has worked the best for me and I've taken it (or generic equivalent) for about ten years. About 5 years ago I was also diagnosed with Adult ADD and prescribed Adderall XR, which I find helpful in low doses; anything above 20 mg/daily brings unpleasant side effects. I don't really think I have ADD but the Adderall helps me get off the couch and function, so I take it. Even with the Wellbutrin/Adderall combo, I still have bouts of breakthrough depression where I feel hopeless, sad, and cry easily for no reason.
Recently I consulted a new doctor who ordered neurotransmitter levels testing on me. The results: plasma Dopamine was "below reportable range"; serum Serotonin was low-normal range; and plasma Noripinephrine was normal.
At the time of the tests I was taking Budeprion XL 300mg/daily and Adderall XR 20 mg/daily. Considering that both of these meds affect dopamine, I was very surprised that the test showed a dopamine deficiency.
My questions for you are:
1) In your opinion, how reliable and accurate is this type of testing of neurotransmitter levels?
2) How can my levels of dopamine be undetectable while on these meds? (My doctor said it might mean that my body simply does not produce dopamine on its own; would you agree?)
3) What causes dopamine deficiency in a person? I'm comfortable reading technical/medical literature if you could refer me to any sources.
One last question: my new doctor and I have discussed a therapeutic trial of compounded T3 to augment my Wellbutrin/Adderall combo. In your practice, do you have any experience with T3 being helpful for euthyroid depressed patients?
Again, I thank you for your time and opinion.
IrisT