Episode 380: Dopamine Misconceptions

Hello friends!

In today’s enlightening episode, we delve deep into the intricacies of neurotransmitters, specifically dopamine, and their impact on our behavior and mental health. We also touch on trichotillomania and the role of medications like Wellbutrin in treating such conditions.

Demystifying Dopamine and Serotonin: We kick off by addressing a common oversimplification in the world of mental health. Dopamine and serotonin are often reduced to mere ‘happiness’ and ‘reward’ chemicals in popular culture. We explore how these neurotransmitters are far more complex and play a variety of roles in our body, from movement and mood regulation to learning and memory.

Understanding Neurotransmitters: What exactly are neurotransmitters like dopamine? We explain their crucial role in brain communication and their diverse functions. We also discuss other key neurotransmitters such as serotonin, acetylcholine, epinephrine, norepinephrine, GABA, and glutamate.

Dopamine’s Role Beyond Pleasure: Moving beyond the ‘feel-good molecule’ tag, we delve into dopamine’s involvement in anticipation of rewards, motivation to pursue goals, and its critical role in learning and habit formation.

Impact of Modern Habits: How do activities like scrolling on social media, playing video games, or watching TV series influence our dopamine levels? We discuss how these activities engage our brain’s reward system and the concept of negative reinforcement in avoiding stress or emotional discomfort.

Trichotillomania and Dopamine: Addressing a listener’s specific concern, we explore trichotillomania, a complex mental health condition involving recurrent hair pulling. We examine the potential roles of dopamine, serotonin, glutamate, genetic factors, and environmental influences in this disorder.

Wellbutrin – A Closer Look: What about medications like Wellbutrin? We clarify how Wellbutrin, or bupropion, an NDRI, differs from other antidepressants and its effectiveness in treating depression, aiding smoking cessation, and its potential implications in treating trichotillomania.

Final Thoughts and Recommendations: We wrap up by emphasizing the importance of seeking professional advice for personalized treatment plans, especially for conditions like trichotillomania, and encourage listeners to keep sending their thoughtful questions and topics.

As always, you can send me your questions to duffthepsych@gmail.com and find the full show notes for this episode at http://duffthepsych.com/episode380

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Question:

Forgive me if you have addressed these topics already. I did a search and didn’t find any episodes that specifically addressed this.

Have you ever done an episode or blog post about dopamine? Supposedly, it’s the key to everything, right? It is supposed to be why we scroll our phones…to get a hit of dopamine. Other things like video games, TV, streaming series, etc. All dopamine, right? I have a mild case of trichotillomania…that’s about dopamine too, right? What does that mean? What are the alternatives?

Also, what does that mean if someone is taking a dopamine reuptake inhibitor, like wellbutrin? If I still have trichotillomania behaviors, does that mean that the wellbutrin isn’t working?

Response:

Before diving in, I want to say that I really love this question and I want to encourage you all to send in more questions or topics like this. Even if you don’t have a specific issue that you’d like advice about in your life, you can send me topics that you are curious about or terms that you hear people throwing around that you’d like some clarification on.

I’m super happy to address this question because it taps into a little bit of a frustration of mine. What I have noticed in the past few years is that the understanding of mental health, neurology, and psychiatry has been sort of meme-ified. By that I mean, you see these memes that talk about someone’s last molecule of serotonin or there will be a viral article about someone going on a dopamine fast, and it really creates a lot of confusion about what these molecules actually do in your body. Essentially, I think that people tend to use serotonin as a shorthand for happiness and dopamine as a shorthand for reward/addiction. Truthfully this is a very inadequate way of looking at them.

What if I told you that too little dopamine would prevent you from being able to move your body in a normal way? What if I told you that too much serotonin could cause you to have severe muscle rigidity and fever? Let’s dive into it.

There is no way to get around having to define some terminology here. The first thing that we should explain is what dopamine even is. Dopamine is something called a neurotransmitter. In your brain, the cells that send signals back and forth are called neurons. Your neurons accomplish this by sending chemical messengers from one to the other. The very small space between two neurons is called the synapse.

One neuron releases a neurotransmitter, which floats across the synapse and then if there is a receptor on the other neuron, it will attach to that receptor and cause some action to occur. Dopamine is one example of a neurotransmitter. There are some other well-known ones that you may have heard of such as serotonin, acetylcholine, epinephrine and norepinephrine, gamma-aminobutyric acid (GABA), and glutamate. There are also other molecules that you may have not thought of as neurotransmitters, such as histamine or glycine.

One interesting thing about neurotransmitters is that it’s more a description of function rather than the particular type of molecule and there are some molecules that serve other functions as well. For example, epinephrine (adrenaline) is considered a hormone when it is released into the blood stream by adrenal glands, but it serves as a neurotransmitter when it is involved in communication within the brain.

All of this is to say that the science of molecules in the body, especially neurotransmitters is massively complex and more than we can get into here. We aren’t even going get into the fact that neurotransmitters as we know them aren’t even a single entity. Therefore, when we reduce dopamine to the “feel good molecule,” it can be a bit misleading.

Let’s now address some of the specifics in your question. You said that dopamine is supposedly the key to everything, right? I think what you are getting at here is dopamine’s importance in the brain’s reward system. It is true that dopamine is released during pleasurable activities, which is a way for the brain to reinforce behaviors that are essential for survival like eating and socializing.

In modern times, things like watching TV or playing games does activate dopamine release, but it is much more complex than you would think. Technically, in these cases, dopamine isn’t what makes you feel pleasure, but it’s what makes you feel the anticipation of a reward. So when you feel your phone buzz in your pocket, dopamine increases in anticipation of a potentially rewarding message. It also plays a role in your motivation to pursue rewards.

For example, when someone gambles, endorphins are released when you win, which contributes to the feeling of euphoria that happens. From there, the dopamine is released in anticipation of the potential reward as you play again, whether you win or lose. The uncertainty of reward actually increases dopamine release because you are constantly in anticipation (variable reinforcement schedule).

Dopamine is actually crucial in learning. When an action leads to a rewarding outcome, such as the euphoria caused when winning at the slot machine, dopamine release strengthens the pathways that lead to that behavior, making it more likely to be repeated in the future. This can lead to addiction in some cases.

When it comes to things like social media and video games, there are other factors that come into play. Another form of reinforcement is negative reinforcement. In other words, in addition to feeling good from engaging with an activity, you might also have the opportunity to avoid feeling bad by reducing attention to your stressors or negative aspects of your environment.

It’s also important to recognize that it’s not necessarily a dopamine issue that might cause someone to be “addicted” to their phone, but it’s more related to how the activity itself is structured. Imagine if food had no immediate negative consequences like fullness or feeling sick. If you just kept getting rewarded every time you ate, and there was a source of constant food at your disposal, you might just start eating compulsively. In this case, you wouldn’t want to jump to the conclusion that someone’s dopamine system is unregulated, rather that the activities they are doing are rife for compulsivity, and dopamine of course plays a role in that. These activities are also ubiquitous in our lives now. These structures are driven by money and algorithms are designed to get you even more engaged and reliant on them. They are also lower effort than many other activities. It feels great and euphoric to have sex or eat a nice meal with friends or hit a runner’s high from pushing yourself through several miles, but those take a lot of time and effort. You have other options for engagement that do not take the same kind of willpower.

Beyond just the reward system, dopamine is also central to coordinating smooth and controlled muscle movements. Especially in a portion of your brain called the basal ganglia, deficiency in dopamine would lead to symptoms that are common in parkinsonism, such as tremor, stiffness, and difficulty with coordination. It also plays a role in thinking, especially executive functioning like decision-making, planning, and problem solving. It helps to dilate blood vessels, regulating blood flow and blood pressure. It is essential for learning and memory. It helps to regulate emotional responses and too much dopamine can lead to psychosis, as you see in schizophrenia… and I could go on.

So, let’s talk more about the specific concern regarding trichotillomania, which is also known as hair-pulling disorder. Trichotillomania is a mental health condition in which people have a recurrent urge to pull out hair. This could be in the eyebrows, scalp, or other parts of the body. It’s a nuanced disorder with no one specific cause.

There is some evidence to suggest that dopamine may play a role, since it is involved in habit formation and reward-seeking behavior. However, aside from dopamine, serotonin and glutamate may also be involved, as they are linked to obsessive-compulsive behaviors, which trich is similar to. There are also genetic predispositions and environmental factors involved. For example, someone with a history of trauma may find that pulling hair is a good way for them to achieve the negative reinforcement of reducing emotional pain from the trauma, which leads to a habit being generated. So, dopamine plays a role in the development and maintenance in trichotillomania because of it’s role in learning, habit formation, and anticipation of reinforcement, but there are other pieces of the puzzle as well.

You asked about Wellbutrin, which is also known as the generic medication, bupropion. This is a medication that is used primarily to treat depression and to help with breaking habits, such as smoking. It’s different from other antidepressants that primarily work on serotonin. Wellbutrin is an NDRI or a norepinephrine-dopamine reuptake inhibitor. So, actually, rather than reducing the amount of dopamine in your brain, it increases it. This is why it’s helpful in improving motivation and reducing fatigue in people with depression. Rather than allowing dopamine and norepinephrine to be sucked back up from the synapse, it lingers there and has a chance to bind to another receptor.

The reason it helps with smoking is not because it reduces the dopamine involved in the reward pathway, it’s actually because it essentially replaces the nicotine. When you stop smoking, you would normally have some withdrawal effects and cravings. Since your dopamine reward pathway is already being stimulated by the Wellbutrin instead, these symptoms are not as present, which helps you to break the habit. In other words, your brain isn’t relying on nicotine to provide reward, therefore the desire to smoke is decreased. That combined with the possible increase in motivation can help to break the particular habit of smoking.

When it comes to trichotillomania, the research in treating it with Wellbutrin is limited. It makes intuitive sense, since trich is associated with compulsive habits, similar to smoking or another kind of addiction, but the exact neurobiological factors behind trich is not fully understood. It likely varies on a person to person basis, and it may be considered as a medication particularly for those who don’t find relief on SSRIs. As I mentioned, there are other factors involved with the disorder, such as environment and associated mental health concerns. For example, if your tendency to pick is highly tied to your level of anxiety, an SSRI might help reduce the anxiety significantly, which in turn provides less of a prompt for your picking. In that way, it addresses the issue indirectly.

So, to answer your question directly, your trichotillomania persisting is not necessarily a sign that your Wellbutrin is not working, but it may also be the case that Wellbutrin isn’t supposed to be treating it. There is no current FDA approved medication for the disorder. However, there are other medications with more research support than Wellbutrin. I would suggest that you talk to your doctor about your specific concerns to see if there are adjustments to your medications that may be more helpful. As well, it would be helpful to work with a therapist that has experience in treating trichotillomania, as behavioral changes and better coping strategies are half (or more) of the battle.

And I think that basically covers it. Hopefully, you learned a little bit more about what neurotransmitters are, what dopamine is, and why we shouldn’t let tiktok lead us to oversimplify very complex mechanisms in our bodies. Hope that helps!

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