Dopamine Deficiency and Its Impact on Anxiety Medications

Dopamine deficiency and medications such as Levodopa and Clonazepam?

In mid-August last year, I started experiencing noticeable symptoms where sometimes while walking, my left foot would suddenly start to twitch involuntarily (possibly due to anxiety or other reasons), or my left foot would suddenly stop while walking.
Occasionally, my left leg would feel numb.
Consequently, I visited the neurology department at the Veterans General Hospital.
Following the doctor's instructions, I underwent X-rays of my lower back and an EEG, both of which showed no abnormalities.
Dr.
Chen from the neurology department suggested that it might be caused by emotional stress and prescribed Lexotan.
He advised me to visit a family medicine clinic near my home in late September if the symptoms persisted to obtain Vanipen.

Starting in October, I began to experience pain in my left thigh, particularly upon waking up or when getting up from a chair.
When I consulted a doctor at the Veterans General Hospital, he indicated that this was due to my cerebral palsy.
Beginning in November, I experienced insomnia, a racing heart, and frequent muscle twitching in my back (although my EEG was normal in August).
When I visited the family medicine clinic near my home to get medication and asked the doctor if this could be due to my irregular sleep schedule over the past decade causing autonomic nervous system dysfunction, he said it was possible.
In simple terms, he mentioned that I might be prone to anxiety, and that my left thigh pain upon waking or getting up from a chair could be indicative of suspected autonomic nervous system dysfunction.
At the end of last year, I suspected I had autonomic nervous system dysfunction, so I went to Cheng Ching Hospital to consult an expert in this area.
Dr.
Yeh Shou-Cheng admitted me early last month for a series of tests, but the autonomic nervous system tests came back normal.
However, nuclear medicine and MRI results indicated "basal ganglia damage" and "dopamine deficiency." I have a history of cerebral palsy, and the doctor prescribed three medications.
I have significant concerns about two of these medications that I take before bed: Clonopam 0.5mg (Clonazepam) and Leeyo 10mg (Lurasidone).
I later found out that both are classified as anxiolytic medications, so I have been taking them inconsistently.
I would like to ask why medications for anxiety were prescribed in light of the findings of "basal ganglia damage" and "dopamine deficiency." I asked the doctor, and he mentioned that they are all for "nerve support." I also want to know if the dopamine deficiency is the reason for my increased emotional tension over the past few months.
Additionally, given my history of cerebral palsy, why would I suddenly have a deficiency in dopamine now? Thank you.

Zhong Xiansheng, 30~39 year old female. Ask Date: 2019/02/07

Dr. Hong Weibin reply Neurology

You are very diligent! You've done a lot of homework.
Occasionally, you experience muscle twitching in your left leg, sometimes accompanied by a tingling sensation, followed by pain in your left thigh.
My thought is that it may be due to lumbosacral radiculopathy.
Lumbosacral radiculopathy is a common peripheral nerve disorder of the lower limbs in adults, with the most common cause being a herniated intervertebral disc that compresses the nerve root, resulting in numbness and pain in the thigh and calf.
Nerve conduction velocity tests and lumbar MRI can assist in diagnosis.
Symptoms such as insomnia, increased heart rate, and frequent muscle twitching in the back suggest checking thyroid hormones through blood tests to see if there is hyperthyroidism.

The principle of the Tc-99m TRODAT single-photon emission computed tomography (SPECT) scan in nuclear medicine is to assess the availability of dopamine receptors, which can help indirectly evaluate dopamine deficiency.
This scan is used to assist in the differential diagnosis of conditions such as movement disorders, including Parkinson's disease, atypical Parkinsonism (which includes multiple system atrophy, vascular Parkinsonism, drug-induced Parkinsonism, heavy metal poisoning, etc.), and congenital enzyme abnormalities in the dopamine system.
What I mean is that if there is suspicion of these conditions, this type of examination would be arranged to assist the physician in diagnosis.

The most prominent symptoms of dopamine deficiency include slowed movements, unsteady and slow gait, muscle rigidity, and feelings of depression.
The results of such tests need to be interpreted in conjunction with symptoms to be meaningful.
If you have cerebral palsy, it may be due to asphyxia or hypoxia, which can lead to damage in oxygen-demanding neurons in the brain.
The basal ganglia are rich in nerve cells and are often susceptible to damage from hypoxia.
Since the basal ganglia contain many dopamine receptors, if they are damaged, the Tc-99m TRODAT SPECT scan may show a reduction in dopamine receptors, which could be interpreted as dopamine deficiency; however, this phenomenon does not necessarily indicate true dopamine deficiency.
Dopamine secretion in the human brain primarily originates from the substantia nigra in the midbrain and is transmitted through complex pathways to the basal ganglia and cortex for utilization.
A reduction in dopamine receptors observed in the Tc-99m TRODAT SPECT scan may also indicate damage to the pathways of dopamine transmission rather than a decrease in dopamine secretion.
Escitalopram is an antidepressant commonly used to adjust mood and help alleviate anxiety.
I hope this information is helpful to you.

Reply Date: 2019/02/07

More Info

Dopamine deficiency can significantly impact various aspects of mental and physical health, particularly in relation to anxiety and mood disorders. In your case, the symptoms you've described, including involuntary movements, pain, insomnia, and heightened anxiety, may indeed be linked to dopamine levels and the functioning of the basal ganglia, which is crucial for motor control and emotional regulation.

Dopamine is a neurotransmitter that plays a vital role in the brain's reward system, mood regulation, and motor control. When dopamine levels are insufficient, it can lead to a range of symptoms, including anxiety, depression, and movement disorders. In your situation, the diagnosis of "basal ganglia damage" and "dopamine deficiency" suggests that there may be an underlying neurological issue affecting your dopamine production or receptor sensitivity.

The medications you have been prescribed, Clonopam (Clonazepam) and Leeyo (likely referring to a medication like Levetiracetam or a similar anxiolytic), are indeed classified as anxiolytics. Clonopam is a benzodiazepine that acts on the central nervous system to produce a calming effect, which can help alleviate anxiety symptoms. Leeyo, depending on its exact formulation, may also have anxiolytic properties. These medications can help manage anxiety and improve sleep quality, which is essential for overall well-being.

Your concern about the prescription of anxiolytics in the context of dopamine deficiency is valid. While these medications do not directly increase dopamine levels, they can help stabilize mood and reduce anxiety, which may indirectly support better dopamine function. Anxiety and stress can exacerbate dopamine deficiency symptoms, creating a cycle that can be difficult to break. By managing anxiety, these medications may help improve your overall mental state, potentially allowing for better dopamine function over time.

It's also important to note that dopamine deficiency can arise from various factors, including genetic predispositions, environmental influences, and neurological conditions. In your case, having a history of cerebral palsy may contribute to the complexity of your symptoms and the way your brain processes neurotransmitters. The brain's neuroplasticity allows for some degree of adaptation, but it can also lead to imbalances in neurotransmitter systems, particularly if there has been damage to specific areas like the basal ganglia.

In summary, while dopamine deficiency can lead to increased anxiety and other symptoms, the use of anxiolytic medications like Clonopam and Leeyo can be a part of a comprehensive treatment plan. These medications can help manage anxiety and improve sleep, which may create a more favorable environment for dopamine function. It's crucial to maintain open communication with your healthcare provider about your symptoms and any concerns regarding your treatment plan. They can provide further insights into how these medications work in the context of your specific neurological condition and help monitor your progress. Additionally, exploring other therapeutic options, such as cognitive-behavioral therapy (CBT), lifestyle changes, and possibly supplements that support dopamine production, could also be beneficial in addressing your symptoms holistically.

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