Tag: drugs

  • Caffeine - Our Favorite Legal Stimulant

    Caffeine - Our Favorite Legal Stimulant

    (Note: This article is from the archive and was written c. 2022.)

    Caffeine is the most used drug in the world. It is a stimulant that works primarily by blocking adenosine receptors.

    Some of you may remember cellular respiration from biology. This is where our cells take glucose (food) and use it plus water and oxygen to create energy in the form of ATP — adenosine triphosphate. This and other adenosine compounds are used to cause actions in cells. Need to walk a protein to another part of the cell? Bam! ATP to the rescue. Reading RNA and need to build a protein? Bam! ATP makes it happen. Need to trigger a Rube Goldberg style intercellular cascade? Bam! ATP can do that.

    And as the cells in your body work, as you burn through your glucose stores to create ATP to make actions happen, you’ll have a build up of adenosine. All this adenosine then will connect with adenosine receptors, telling your body you’ve been busy and should get some sleep.

    …and this is where caffeine comes in.

    Caffeine puts the brakes on that process. It antagonizes the adenosine receptor, meaning it blocks or dampens them from functioning correctly. So you have all this adenosine building up, ready to tell your body you need some rest, and caffeine interferes with the message from getting through. This tricks your body into an alert state, and staves off sleep.

    But that’s not all caffeine does. It has downstream effects on serotonin, dopamine, and norepinephrine. These are powerful mood hormones, and also the primary hormones found in the original antidepressants. Sure enough, studies show that caffeine intake can help with mild depression.

    One of the ways this happens is that these adenosine receptors are linked to dopamine receptors. When the adenosine binds to its receptor, telling the body you’ve been working and need to rest, it kicks the dopamine off the adjacent dopamine receptor, so the body gets less of the dopamine response. But when we intake caffeine, the adenosine receptor is blocked, so the dopamine continues to activate its dopamine receptor, and we keep getting the infamous “dopamine hit.”

    Of course, there’s a catch. Too much dopamine can increase irritability. Caffeine can also exacerbate anxiety. It does this partially through hindering sleep; partially through keeping body cortisol — stress hormones — high; and partially through inhibiting our body’s GABA system, which is our body’s natural way of relaxing.

    In other words, a little caffeine can help fight against subclinical depression, too much caffeine can increase your anxiety and irritability.

    Caffeine also seems to potentiate acetylcholine, which is tied to increased memory and learning. Oh, and increased urination, too. Doesn’t help that it’s generally consumed as a liquid, either.

    Other benefits to drinking coffee seem to be lowered risk of dementia, lowered risk of Parkinson’s disease, and possibly even lowering incidences of type 2 diabetes.

    On the other hand, it is a mild contributor to hypertension, can increase episodes of acid reflux largely due to its acidity when imbibed as coffee, and can be harmful in pregnancy if not kept at low doses.

    So what to do? The answer for most people seems to be just keep your consumption low. 1–2 cups of coffee in the morning will equate to about 100–200 mg caffeine total, assuming about 100 mg of caffeine per 8 oz cup. Caffeine has an average half life of 4–6 hours. So it takes the average person between 20 to 30 hours to get caffeine out of their system. That’s a full day including the night. For this reason, it’s better not to have coffee as the day progresses, but to keep it to early parts of your day. Additionally, a coffee-free day here and there to make sure your body gets it out of the system, that it’s not accumulating, is a good idea if you find your anxiety levels getting too high.

    Consider also switching to tea. Green tea especially has been found to have incredible health benefits, from being more calming due to included l-theanine compounds to helping reduce blood sugar levels. It also has less than half the amount of caffeine compared to an average cup of coffee.

    If you stop coffee altogether, be aware of rebound headaches if you were a chronic coffee consumer. We mentioned that caffeine has downstream effects on norepinephrine, and norepinephrine is a vasoconstrictor. This causes your blood vessels to get smaller. If you drink a lot of coffee, your body will use mechanics to compensate and get your vessels a little larger again. Then, when you suddenly stop drinking coffee, there is no longer the extra norepinephrine causing the vasoconstriction, but the balancing mechanics countering the norepinephrine will still be in place, meaning your vessels will get even larger…

    …and you’ll get a headache from the extra pressure in your brain.

    So take it easy.

    At the end of the day, you know your body. But watch out for negative effects from excess caffeine consumption, usually found in the form of poor sleep, increasing anxiety, and/or increasing irritability. If that is happening to you, consider cutting down and replacing much of your coffee habit with teas. And consider having the occasional caffeine-free day.

    PS~ If you want to nerd out a bit, caffeine is metabolized by the CYP1A2 system, and some researchers are looking at genetic links with consumption and health benefits.

  • The Monoamine Theory of Antidepressants

    The Monoamine Theory of Antidepressants

    (Note: This article is from the archive, written when exploring the history of psychopharmaceuticals.)

    This hypothesis has its origins with some of the old SSRIs, and tries to explain:

    • Why it takes time for antidepressants to work
    • How side effects come before the antidepressant works
    • How the side effects go away over time

    Here is a sketch of a serotonergic neuron:

    From Stahl’s Guide to Essential Pharmacology

    On the left side are dendrites. Think of these as arms that receive input. On the right is the axon. This is the output arm. The end of the axon is called the presynapse, and the half circle to the right of that is the postsynapse. The little yellow bars are serotonin hormones. The blue blocks on the dendrites and the postsynapse are serotonin receptors.

    What we don’t see is the neuron getting the message to release serotonin. You might be thinking the receptors on the dendrites are for that since they’re input, but they’re actually autoreceptors. Their job is to apply brakes to the serotonin release.

    When the neuron gets a message from another neuron or neurons to release serotonin, it becomes an electrical message that shoots down the neuron and releases serotonin at the presynaptic site. The serotonin then diffuses over to the postsynaptic receptors and BAM! That serotonin makes something happen. Maybe you get happier. But then maybe you get anxious. Weird, right?

    Those serotonin receptors are called 5-HT receptors (5-hydroxytryptamine, the “other” name of serotonin*). There are many 5-HT receptors, involved in mood, blood pressure, sexual activity, headaches, anxiety, memory, nausea, sleep… the list goes on and on.

    So this monoamine hypothesis states that depression is in part cause by that serotonergic neuron not releasing very much serotonin from its axon anymore. When that happens, the postsynaptic neuron wonders what’s going on, why it’s not getting much serotonin anymore, and it up-regulates, it creates more serotonin receptors. These new receptors will be many kinds of receptors, not just the ones that help you feel better. So now it’s not just that there is less serotonin, but there are a greater spread of receptor types to be triggered by what little serotonin there is.

    Enter an SSRI. This person starts taking an SSRI, a selective serotonin reuptake inhibitor. Look again at the picture above and you’ll see five “Do Not Enter” type circles. These are all on reuptake pumps. While the neuron releases serotonin, it also has reuptake pumps to try to get the serotonin back after it does its job of triggering a receptor. Well, the SSRI interferes with these pumps working. So where we had very little serotonin, now we have more serotonin hanging around these neurons.

    Remember the arms on the left, the dendrites, get input. When the uptake pumps shut down over there, the autoreceptors start getting really busy. They become too active, too sensitive. When this happens, the dendrites begin to downregulate the receptors there.

    Now, here’s one of the odd things. Those autoreceptors are supposed to help the neuron understand how much serotonin to release. Of course, we have a dysfunctional neuron here, and we’re trying to get it to change, literally trying to change you on a cellular level. When these autoreceptors downregulate due to being over stimulated, there are now fewer receptors receiving serotonergic messages. The result is that the neuron will begin to create more serotonin, and release more from the axon.

    Those postsynaptic receptors also have been being flooded with serotonin, and so they too are going to downregulate. Ultimately, this should be the natural state of the neurons: the presynaptic neuron releasing a healthy flow of serotonin when needed (not stunted, not too little), and the postsynaptic neuron having the right amount of proper receptors to receive the serotonin stimuli.

    Let’s go back to our original questions:

    • Why it takes time for antidepressants to work
    • How side effects come before the antidepressant works
    • How the side effects go away over time

    Why does it take time for the antidepressant to work?
    Because that up and downregulation of the receptors takes time, and that’s a big part of the neuronal change we’re looking for the medication to make.

    How come there are side effects before the antidepressant even helps?
    Because the synaptic zone gets flooded with serotonin while all those extra receptors are there. Many of the receptors do things we don’t want them to do like cause anxiety, give stomachaches, cause sexual issues. For this reason, it is recommended that SSRIs be started at a low dose and increased gradually, as the neurons begin to change.

    How do the side effects go away over time?
    I think you can answer this one by now. As the postsynaptic zone downregulates, removes, 5-HT receptors over time, less side effects will be felt.

    So that is a nutshell summary of the monoamine hypothesis of antidepressants. Obviously, things are more complicated than this. Serotonin, as mentioned before, has many receptors all over the place and a very wide range of capabilities. There are many questions not answered, such as the function of antidepressants in OCD and eating disorders. Personally, I think the hypothesis is a little rough, but it helps us start forming an idea of functions.

    This hypothesis grew over time and was dominant, but largely has become superseded by other things such as research on brain-derived neurotropic factors. Regardless, it’s good information to be aware of.