This article was medically reviewed by Dr. Troy Noonan, MD Psychiatry. Dr. Noonan received his M.D. from Finch University at the Chicago Medical School, Psychiatry Residency and fellowship at the University of South Florida (USF) College of Medicine. He is Certified by the American Board of Psychiatry & Neurology.
Dopamine and Depression
What is the link between dopamine and depression? If you’re confused about this topic, you’re not alone. The internet is rampant with misconceptions, generalizations, and oversimplifications about the role dopamine plays in our mental health. This is especially true when it comes to the link between dopamine and depression, and between dopamine and bi-polar depression.
This article untangles this complicated topic, including what we know and don’t know about the role of dopamine in the brain. We’ll also talk about other chemicals that are believed to play a role in depression, and why some depression medications target dopamine and other chemicals.
Most importantly, we’ll discuss how modern doctors are treating depression without medication, and what you can do if antidepressants have stopped working for you. We’ll start with some facts about what dopamine is, what we know about it, and its influence on our mental health.
What is Dopamine and What Does it Do?
Dopamine is a type of chemical known as a neurotransmitter. You’ve probably also heard it called a hormone, which can be confusing if you don’t know the difference between the two.
Neurotransmitters and hormones are alike in that they both send signals from one place in your body to another place. Both can influence your thoughts, feelings, and cognition (learning, concentration, etc.). The most important difference between the two types of chemicals is that neurotransmitters move through your nervous system, while hormones are released into your bloodstream.
Because of this, the effects of neurotransmitters are short-lived and, in most cases, more local. Hormones, on the other hand, move through your bloodstream affecting multiple systems in your body, from mood, to muscle function, to digestion, and even other hormone releasing glands. Dopamine is often called your “feel-good” hormone, your “reward chemical,” or your “motivation hormone.” It plays a key role in creating that winning feeling you get when you achieve a goal or have a novel experience.
Research into the motivations behind gambling, pornography addictions, and even excessive use of video games and social media show that dopamine can also be released in anticipation of a novel or rewarding experience. Dopamine also plays a key role in various bodily functions, including movement, sleep, mood regulation, learning, memory, and attention.
Pop Culture Myths About Dopamine
In an attempt to explain everything from political views, to the impact of digital media on brains, the internet has been filled with several folk theories about dopamine. Most of them can be boiled down to the assumption that dopamine is “addictive” or that it can explain sweeping theories about people’s political or religious beliefs.
An article in Harvard Health cites one such example featured in a program called the “Dopamine Fast.” The creator of this program, a California psychiatrist Dr. Cameron Sepah, even admits that the program has little to do with dopamine or even with fasting.
"Dopamine is just a mechanism that explains how addictions can become reinforced, and makes for a catchy title. The title’s not to be taken literally.”
As someone with a background in marketing, I understand why catchy titles matter. But I have to say that this is over the line from an ethical standpoint. The statement “not to be taken literally” suggests that the word “dopamine” can be used as a metaphor to describe non-chemical addictions.
Sepah based her method on the idea that reducing interruptions (text messages, notifications, beeps, rings, etc.) would keep our brain from developing a dependency on these potentially addictive stimulants.
The program also encourages “fasting” from negative (and potentially addicting) behaviors like emotional eating, excessive internet usage, gambling, porn, video games, shopping, recreational drugs, thrill and novelty seeking, and even masturbation. In fairness to Sepah, hers is just one of many “digital fasting” theories that you’ll find online, and some of them are stranger and much less scientific.
The fact that people are encouraging less exposure to interruptions is good. But I worry that dopamine could, over time, become a conceptional metaphor for the broader idea of non-chemical addiction. The idea that too much technology is bad for our higher thinking capacities is not new anyway. Neil Postman wrote about it in his book Amused to Death, as did Marshall Mcluhan in his book and lectures on The Medium is the Massage.
Ancient References to Non-Chemical Addiction
The idea of achieving higher mental states through the quieting of sensory stimulants even goes back to the ancient texts. You’ll find it in Book I (verses 1-16) and Book II (verses 1-25) of The Yoga Sutras of Patanjali and Book III (Titled “Thought”) of the Buddhist Dhammapada. Ancient Mystics would retreat into caves to escape the stimulants of the outside world in hopes to explore the contents of their own minds, and beyond.
While the ancients didn’t talk about neurotransmitters the way we do today, their descriptions how to “fast” from the sensory stimulants, and the benefits of doing so, prove that they understood why it was important. Not to mention that they were probably better at it than we are today.
Bottom line, digital age folk theories about dopamine are based on an oversimplification of the role this chemical plays in our brains. Yes, your brain releases dopamine in anticipation and in response what it perceives as a “win” or a novel experience. But this is an extremely broad function which is necessary for our survival. The fact that it can be hijacked by people who create “addictive” products doesn’t change that.
I’ll explain why this is important when we talk about the link between dopamine and depression and other mental health challenges. More importantly, I’ll introduce you to a more scientific treatment (and medication free) method that’s getting impressive results in treating everything from clinical depression, to OCD, to PTSD, and even substance addiction.
What We Know About Dopamine and Depression
Dopamine deficiencies are associated with multiple physical and mental disorders, including symptoms of reactive depression and clinical depression. It can also contribute to more permanent and severe health conditions, including Parkinson’s disease:
"Too little dopamine can lead to Parkinson’s disease, a brain disorder that causes shaking and problems with movement and coordination. Abnormally high concentrations of dopamine are linked to schizophrenia and other psychiatric disorders.”
Parkinson’s is a serious condition characterized by tremors and muscle spasms, and eventually loss of mobility. This happens as the result of dopamine producing neurons being destroyed, which are otherwise essential to the basal ganglia. The basal ganglia is a group of subcortical nuclei responsible primarily for motor control, motor learning, executive functions and behaviors, and emotions.
This also explains some of the other symptoms of dopamine deficiency, which include:
- Decreased Motivation
- Procrastination
- Inability to experience pleasure
- Lack of interest in life
- Mood Swings
- Disrupted sleep patterns
- Fatigue
- Excessive guilt or hopelessness
- Impaired concentration
- Memory problems
- Trouble focusing
- Weight gain
- Impulsive or self-destructive behaviors
- Addictions to stimulants (caffeine, etc.)
If this list of symptoms sounds like a description of clinical depression, that’s probably because depression and dopamine deficiency go together like puberty and pimples. However, scientists also believe that the following neurotransmitters play a role in clinical depression:
- Serotonin: a neurotransmitter that plays an important role in sleep, appetite, pain inhibition, and mood regulation.
- Norepinephrine: a neurotransmitter that raises blood pressure by constricting blood vessels and which (like dopamine) seems to play a role in motivation and reward.
- Acetylcholine: a neurotransmitter important to both the learning and recall aspects of memory.
The most important imbalance to understand when it comes to depression is the combination of dopamine deficiency and serotonin deficiency. In layman’s terms, depression is characterized by a deficiency in your “motivation hormone” (dopamine) and your “happy hormone” (serotonin).
While this is an oversimplification in terms of what these two chemicals do, it captures the everyday essence of what it means to be depressed. This is why the most popular antidepression medications (listed below) act on one or all of the above three neurotransmitters:
- Serotonin Reuptake Inhibitors act to increase serotonin levels.
- Tricyclic Antidepressants increase serotonin and norepinephrine while blocking acetylcholine.
- Bupropion act to inrease norepinephrine and dopamine.
- Monoamine Oxidase Inhibitors inhibit breakdown of serotonin, norepinephrine, and dopamine.
Beyond Dopamine and Depression Symptoms
By itself, dopamine deficiency makes it hard to concentrate, follow instructions, or to stay focused on a task for long. If these symptoms sound familiar, it’s probably because they describe children and adults who have ADHD (attention deficit hyperactivity disorder).
Some experts, believing that people with ADHD have decreased concentrations of dopamine, prescribe Methylphenidate (Ritalin), a drug that raises dopamine levels. As for dopamine and substance addiction, what we know is that many illegal drugs stimulate dopamine release.
This skyrockets the pleasure experienced from taking these drugs, making users more susceptible to addiction. The most common illicit drugs that boost dopamine levels include:
- Heroin Cocaine (Crack and Powder)
- Crystal Meth
- Ecstasy (MDMA derivative)
- Pure MDMA
- Bath Salts
- Marijuana
- LSD
Other legal drugs that act on dopamine include alcohol, prescription painkillers, benzodiazepines, and even caffeine. Prolonged use of dopamine increasing drugs are responsible for the “withdrawal” symptoms that come from quitting these drugs. This happens because the brain becomes accustomed to these high levels of feel-good chemicals. When it suddenly stops getting these chemical rewards, the brain sends pain and sickness (nausea) causing signals to the central nervous system.
These withdrawal symptoms can resemble the flu, create body temperature fluctuations, nausea, vomiting, diarrhea, muscle and joint pain, tremors, paranoia, anxiety, and depression. The need to alleviate these symptoms is often what leads to more using, creating a downward spiral of addiction. On a milder scale, this might help us understand how non-chemical activities become addictive.
“Dopamine release is also responsible for people becoming addicted, in that [people] are always seeking pleasure, so that they can reach higher and higher dopamine levels. Dopamine is the reason why a lot of people are constantly seeking to satisfy their cravings.”
What Mr. Sitte is describing in this quote is called the “dopamine theory of addiction,” and has opened an important conversation about how to treat substance addictions.
However, the proposed link between dopamine and addiction has also created some irrational fears about treating dopamine deficiencies with medications. This is why it’s important to understand that dopamine itself is not the problem and that it should not be treated as a cultural metaphor for addiction.
As for treating depression, the research shows us that about 33% of the people who use antidepressants will continue to experience symptoms. Such depression is called “treatment-resistant depression” (TRD) or “refractory depression.” Treatment-resistant depression can persist for months or even years, and can lead to other serious mental health problems. Thankfully, there are options for treating depression without medication, and other problems associated with dopamine deficiencies, and even addiction.
Dopamine and Depression - Medication Free Treatment
One of the safest and most effective methods for treating depression without medication is Transcranial Magnetic Stimulation (TMS). TMS was approved by the FDA in 2008 for treating clinical depression and again in 2018 for treating OCD (Obsessive Compulsive Disorder).
TMS is often confused with ECT, but the difference between the two is vast in depth and in scope, as explained in our TMS vs ECT article. TMS uses magnetic fields similar to those used in MRI machines to stimulate blood flow in the prefrontal cortex.
Controlled clinical studies show that 83% of Neurostar TMS patients see a positive response. They also show that TMS has a remarkably low relapse rate of only 11% across all patients. This is a lower relapse rate than any other depression treatment. Most importantly, Only 37% of TMS patients in these studies required additional TMS treatments. In those that did, 85% re-achieved clinical benefits. Most importantly, TMS has a minimal list of negative side-effects.
Aside from treating clinical depression, TMS appears to be a “promising candidate for treating addictive behaviors and other brain diseases.”* The pulsatile electromagnetic field generated by the TMS machine is capable of directly exciting/inhibiting neurons in the underlying cortices (Padberg and George, 2009).
TMS is also showing potential therapeutic value for treating brain pathologies such as bipolar syndrome, and negative symptoms of schizophrenia and even the drug addiction field. The therapeutic potential of TMS for treating drug addiction has been tested on nicotine-dependent subjects, cocaine addicts, and alcoholics (Conte et al., 2008; Mishra et al., 2010). As of now, the main disparities in these studies are the result of differences in pattern, sites, and methodology of stimulation.
*SOURCE: The Dopamine Hypothesis of Drug Addiction and Its Potential Therapeutic Value
“Transcranial magnetic stimulation has shown its potential to help patients suffering from depression and headaches. With today’s marketing authorization, patients with OCD who have not responded to traditional treatments now have another option.”
Treatment cycles for TMS typically last six to eight weeks, with five 20-minute treatments per week. TMS treatment sessions are non-invasive outpatient procedures that require no medications or sedatives. Patients can drive themselves to and from a TMS session in the middle of a workday and resume their normal activities afterward.
If you or someone you know would like a medication free way to put clinical depression into remission, Mental Health Management Group is here to help. Mental Health Management Group offers treatment for mental wellness, emotional and behavioral conditions. They do this through psychiatric medical evaluation, treatment plans, FDA-approved medication management, and therapies with successful outcomes for adults, adolescents, children, and families. They have worked with thousands of patients suffering from depression and other mental illnesses.
To see if you or a family member qualify for TMS treatment, please fill out the patient referral form and one of our practitioners will call you. If you’re not ready to talk to someone, fill out one of our free mental health assessments to get started. If medication hasn’t worked for you, maybe there is a better way. Book an appointment with us today and find out.
This concludes our article on dopamine and depression.
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