How do the medications work?
Psychiatrists use several different types of medications to help people suffering from stress-related disorders. The basic idea is to reverse chemical imbalance back as close to balance as possible. Medications merely control symptoms. They do not shrink the balloon. It is no different than a diabetic medication controlling blood sugar. Whereas medication push brain chemicals to their original state, stress pushes them in the opposite direction (see picture below). If stress wins, medications lose their efficacy. Patients can help medications work better by coping with stress better. Education and counseling are essential for recovery. Because many patients do not learn better coping ways and do not wish to address their buried issues, every two or three years they become immune to their medications. The poor doctor has to come up with new drugs, or add more drugs, or send the patient for electro-convulsive therapy (ECT) also known as shock treatment.
Prolactin is normally inhibited (suppressed) by the hypothalamic (brain) hormone, dopamine. Drugs known as dopamine agonists act like dopamine to inhibit prolactin production. Dopamine agonists available in the U.S. include bromocriptine (Parlodel) and pergolide (Permax). A very effective drug, Norprolac, is only available in Europe and Canada. An newer dopamine agonist, cabergoline (Dostinex), is now FDA approved and available in the U.S. Bromocriptine and pergolide are usually given 1 to 3 times a day, cabergoline is given once or twice a week. All of these drugs act on the tumor in the same way – by inhibiting or reducing the amount of prolactin made by the tumor and thus causing the tumor to shrink. Over 90% of patients treated with these medications have a decrease in prolactin and in tumor size. Some patients are not able to take these medications because of side effects (nausea, vomiting, nasal stuffiness, constipation).
Stimulants seem to work by increasing activity within certain brain regions. By increasing or stimulating these brain regions, they result in greater powers of inhibition. The individual is able to stop and is able to engage their processes before they act. . . . Now, as far as what they’re doing at the level of chemistry and proteins, we’re not quite sure yet. We do have some indications that the stimulants are achieving an increase in the amount of dopamine that is within the synapses between brain cells–those critical gaps between the brain cells where the neurotransmitters are supposed to do their job. Evidence indicates that drugs like Ritalin slow up how much of that chemical is being reabsorbed into the nerve cell, so that more is left in the synapse. Other medications, like Dexedrine, may just increase the production of dopamine within these nerve cells.
