Morning everyone!

Welcome to another edition of the Doctor’s Note where we talk about what’s on our minds when it comes to your health. 

This week we’re going to talk about a fascinating subject, one of the most important and powerful chemicals in our body, a neurotransmitter called DOPAMINE. 


The Dopamine Pathways 


There are two main pathways that Dopamine goes down. 

The first one is the movement pathway. Think of Parkinson’s Disease where you can’t express yourself and can’t control your movement, where dopamine gets depleted in the brain and causes dementia and a shuffling gait. 

The second pathway is the motivation and mood pathway. This is what I’m most interested in right now and will be the focus of today’s Note. 

The motivation and mood pathway is where vesicles release the chemical called dopamine in your brain which acts in a couple of different ways. 

  1.  Locally at the synapse (nerve connection). In continual small amounts. 
  2.  Volumetrically where a bunch of it gets released at once. 

We call this Baseline and Peak Levels of Dopamine. There are different reasons and purposes for both. 

This is all very complex, but I am going to try and make it as simple and practical as possible. I believe that understanding Dopamine can help you gain control of many areas in your life. 


The Peaks And Valleys Of Dopamine 


Think of Dopamine as a currency. A way of tracking your success at baseline levels and then you get dopamine hits, or what we would call a peak, when you get pleasurable experiences. 

A dopamine hit is like when you eat chocolate. You feel good for a few seconds or minutes and then it goes back down. It turns on the release of dopamine. 

You can use chocolate for a small hit of dopamine, and (unfortunately) some people use cocaine or amphetamines for huge hits of dopamine. When you get these big hits of dopamine it destroys your baseline and makes you crave more. 

This is called drug addiction. 

Baseline levels of dopamine are different for different people. Genetics and epigenetics are involved. An example of a baseline might be Winnie The Pooh and Eeyore. One is really upbeat and the other is naturally sluggish and kind of in a bad mood all the time.

Think of someone who is hyper excitable, or seems to be on all the time. This person probably has a higher baseline level of dopamine than most. 

Dopamine also interacts with adrenaline (another word for epinephrine). This is the neurotransmitter that is called the fight or flight chemical.

Here are a few examples of things we consume and do that increase our levels of dopamine: 

  • Chocolate: 1.5X
  • Sex: 2X
  • Nicotine: 2.5X
  • Exercise: 2.5X
  • Caffeine: only a slight increase 
  • Amphetamine: 10X

As you can see you have to watch out if you layer too much of these together because it can lead to depression. If you overdo it, it depletes it. 

There are peaks and valleys. Think of Christmas day. 

The days leading up to Christmas create heightened anticipation of what’s ahead. Then finally Christmas morning comes and you get this huge high. But what happens on Christmas night when it’s all over?  You go below baseline and feel kind of depressed. 

It seems the higher the highs, the lower the lows. 

Another good example is Postpartum Depression (associated with childbirth), which is very serious. There’s a high and then a low. 


Why Do We Have Dopamine In The First Place? 


It has its function, reproduction being the main one. 

Another function is seeking. Seeking food and water. You seek and then you get rewarded.

It’s interesting thinking about your baseline and your peak. If you peak too much and have continual hits of dopamine it can lead to addiction. This is why we have so many addicted people. 

For example, gambling. Everyone knows you can’t beat “the house”. But you get addicted to trying because “the house” makes sure you win some. That little dopamine hit when you win keeps you going. 

Same thing with playing video games, texting, and social media. This is why it’s important to take some time away from these types of activities. Especially if you find yourself in a continual pattern (i.e. you can’t stop scrolling).

Addiction Note: constant hits of dopamine will cause a decrease in your baseline levels. This leads to you needing higher highs. 

You need to be careful about these things, especially in kids. 


Manage Your Dopamine Levels


The key here is intermittent release. Don’t chase the highs and don’t layer things that will raise your levels. By layering I mean don’t add things together to give you bigger hits of dopamine.  

For example: don’t drink energy drinks before you exercise.  

I have spent a lot of time being the team physician for our local high school football team. I noticed that a lot of them would drink energy drinks before the games. They would be extremely hyped up (FYI: they were already extremely hyped up even before the energy drink!) and then completely worn out by the third quarter. 

Bottom line, they were too high on the way in. 

So be careful when layering things like energy drinks with activities that are already a hit of dopamine (like a high school football game would be for these athletes).

Side note: Coffee is interesting because it only increases dopamine by moderate amounts. Coffee upregulates your dopamine so it doesn’t wear it out. 


Different Ways To Increase Dopamine Levels 


There are some medicines that can safely help you increase dopamine levels when administered correctly. 

Adderall and Provigil: These drugs can be very useful in certain cases. I’ve even seen it change people’s lives. These medicines increase dopamine. Provigil is normally used to treat narcolepsy or shift worker’s syndrome. As a physician you really need to know how to use Provigil in a safe way. You need to take breaks from it. You don’t need to keep working your dose up. Only use it for activities that it’s intended for. Things like studying, focus, or keeping awake while driving on a long trip. 

Don’t take it along with pleasure activities. It’s not meant for that. 

Wellbutrin is an antidepressant. It increases dopamine and adrenaline. It’s a good drug for addictions. It also works well with depression. We often use it to help people stop smoking or drinking. You have to know who to prescribe it to. You don’t want to prescribe this to an angry man or someone who has bipolar disorder for example. 

Note: Wellbutrin works differently for depression than Prozac or Lexapro. Prozac and Lexapro are serotonin drugs that can work well for depression, but also can cause sexual side effects and make you apathetic. 


Natural Ways To Increase Your Dopamine Levels


You can raise your dopamine levels naturally.

Exercise is a great way to do this. But remember, you can also become addicted to exercise. Some people need to watch out for this because it can hurt them down the line. Too much exercise keeps your body inflamed. It’s been proven that moderate exercise is actually more healthy for the heart than long and extremely intense exercise. 

Note: I am a fan of HIIT (high intensity interval training). This is exercise where you go extremely hard for short intense bursts. 

Social connections can raise your dopamine levels. 

Oxytocin can also help you raise your dopamine levels. We prescribe a lot of Oxytocin (the hugging hormone).It’s the feel good hormone that’s responsible for a lot of things. It’s very safe. 

Cold exposure is another thing that helps raise your dopamine levels. It also helps your immune system. Cold exposure has been shown to promote dopamine for about 3-4 hours by 10X. 

Practicing gratitude can help you increase your baseline dopamine levels. 

Intermittent fasting also increases dopamine levels. With intermittent fasting your brain clears up and you just feel better. It’s almost like you’re rewarding yourself for depriving yourself of food for that long. Plus you’re going to lose weight doing this. 

Supplements that increase dopamine levels: 

  • Purine Velvet Beans: I haven’t tried this. They are very intense. You definitely don’t want to take too much of this. Be careful with this one. 
  • L-Tyrosine: A lot safer. This is a precursor to L-Dopa. It’s used for people with ADHD who don’t want to take a stimulant like Adderall. You can also use L-Tyrosine along with Adderall and it can help the Adderall work even better. Again don’t use this for bipolar patients. 
  • Huperzine A: An OTC that increases dopamine and also acetylcholine. Also used for Alzheimer’s Disease. 
  • Phenylalanine (PEA)
  • Life Extension Dopa Mind: It’s from wild green oats and mildly increases dopamine. I use it when I think I may need it.

Dopamine is a fascinating neurotransmitter that you need to be smart in managing. 

Understand your baseline and your peaks. That you can get too high and too low. 

Incorporate naturally healthy activities in your day (i.e. exercise, social connections, gratitude, etc. 

Know how Dopamine works for you and how not to abuse it. 

Don’t focus on the prize. Focus on the effort associated with the pleasure. 

That is the reward!