Could you have a dopamine defecit?

For a long time we’ve been focusing on dopamine detoxes, but do we need more, not less, of the d-word? And could a dopamine defecit be the real culprit behind treatment-resistant depression, asks Emma Green

Dopamine has come into the spotlight in recent years, and it’s not always been for good reasons. Our over reliance on our phones in general, and social media specifically, are causing imbalances, we’re reliably informed: we get an easy buzz on our phone, and we struggle to do anything else useful, leading to the rise in popularity of dopamine detoxes, and the general vilification of dopamine.

But what is the bigger picture behind this much-maligned hormone, and is it possible that the problem with our low moods is we’re actually not getting enough of the stuff? We need to take a little trip back in time to find out more. Dopamine is one of the four main mood-influencing hormones, along with serotonin, oxytocin and cortisol.

Each fulfils a different role in the body and brain, and, understandably, have an impact on how we feel. The focus on hormones and mood has been around since the 1960s, when it was proposed that low levels of serotonin could cause depression-like symptoms (known as the ‘serotonin hypothesis of depression’).

Our understanding of the mood disorder has been increasingly shaped around the idea that if we increase the availability of serotonin in the brain, we can then relieve depression. As a result, since the late 1980s, selective serotonin reuptake inhibitors (SSRIs) have been the go-to drug of choice for treating depression.

But while studies have shown that SSRIs show some improvement in depressive symptoms amongst 40-60% of those who take them, there remains a significant proportion of people who report gaining little relief. It’s something I can attest to myself. I have been on and off SSRIs since I was diagnosed with depression during my first year of university.

Although the origins of my depressive tendencies took root long before then, it was the culture shock of moving to London from rural Shropshire, and then having to deal with numerous personal problems going on back home, that saw me fall into a crippling depressive episode and subsequently led me to pay a visit to the GP’s office about my mental health for the first time.

Since then, I have cycled through various types and doses of SSRIs, including citalopram, sertraline and fluoxetine, all to relatively little effect. Despite taking them for nearly 15 years, I have still dealt with frequent, debilitating episodes of depression.

I have had days, sometimes weeks, in bed, with dirty cutlery and rubbish piling up all around me. I rarely showered or changed my clothes and relied on takeaways to feed myself.

There are many, many more out there like me. Numerous studies have demonstrated a lack of substantial evidence to prove that depression is caused by a serotonin deficiency, and a major review led by British professor and psychiatrist Joanna Moncrieff in 2022 concluded that the ‘serotonin theory of depression’ was completely groundless.

Yet over the last 25 years, research highlighting the significance of another feel-good chemical in depression has remained largely ignored. You guessed it: dopamine. Countless studies have shown the impact of a lack of dopamine, such as triggering depressive-like behaviours in mice, to the extent that their motivation to eat becomes so low, that they eventually die of starvation.

So could a possible dopamine deficit be the reason why the focus on serotonin regulation has seemed to have had so little impact on my own depressive symptoms?

What’s your flavour?

Dopamine is both a hormone and neurotransmitter — a chemical messenger in the brain that allows neurons to communicate with each other and regulate our mood.

It plays a vital role in motivation and reward, and drives our behaviour towards things that we find gratifying, such as eating a good meal. ‘Dopamine is about identifying goal-based behaviours, achievement and looking forward to things,’ says Dr Amber Johnston, clinical psychologist and director of Healthy Mind Psychology.

‘Serotonin is more about connection, contentment and emotional regulation.’ It is believed that low levels of these chemicals result in imbalances in the brain and can lead to the onset of mental health conditions, including depression. When we think of ‘typical’ depression, we might associate it with persistent sadness or suicidal ideation.

This kind of depression is often described as ‘emotional’ and is usually characterised by low mood, excessive worry, guilt and feelings of worthlessness. However, in some cases of depression, there may be more prominent issues regarding drive and motivation rather than melancholy.

‘Dopamine-based depression is a little bit different to the emotional overwhelm or high levels of anxiety or self-criticism that we often find with more clinical depression — but that doesn’t mean it is any less debilitating,’ says Dr Amber. ‘The difference is this lack of ability to pursue interest, pleasure and purpose the way we once used to, or the way we see others doing.’

Although dopamine-based depression is not an official diagnosis or sub-type of depression, its fundamental feature — anhedonia, or the loss of pleasure — is a core part of the diagnostic criteria for the disorder. Common symptoms that we might see are lethargy, a general lack of zest or enjoyment for life, apathy, emotional blunting, poor attention, slowed-down cognitive function and reduced reward sensitivity. (If you want to reclaim your attention span, read our 6 tips!)

My own experiences with depression have certainly reflected this. Although I have had bouts of ‘melancholic’ depression after sad or traumatic events, many of my depressive episodes have seemingly come out of nowhere. It would often feel like all the colour had been drained from my life.

Food tasted like cardboard, anything that usually brought me joy, like watching my favourite comfort shows, left me feeling even more empty and my only escape was to sleep excessively. So is dopamine (or a lack of it) to blame?

As science cannot yet accurately measure certain neurochemical levels in the brain, we can only rely on observable indicators that might pinpoint a possible neurochemical deficiency. People with a dopamine deficiency often crave sugar and stimulants, as these can temporarily boost dopamine levels.

They also tend to seek out unhealthy dopamine hits through addictive activities such as gambling, chronic social media use and impulsive spending.

A quick fix?

This certainly resonates with me.

Even when I wasn’t depressed, I seemed to unconsciously seek these out. In hindsight, my attraction to stimulants like caffeine and nicotine, junk food, avoidant men and buying myself shiny new things were my way of self-medicating. This was probably most evident when I was procuring off-prescription ‘study drug’ Modafinil as a desperate means to artificially motivate myself.

Again, it’s fairly common behaviour. Issues with substance abuse and addiction are often clear indicators of a dopamine deficiency, although it isn’t clear whether low dopamine is the cause or result of addictive behaviour — or a combination of both.

Other disorders associated with dopamine deficiency include Parkinson’s disease, attention deficit hyperactivity disorder (ADHD), schizophrenia, fibromyalgia and chronic pain. I have recently come to realise that I might be neurodivergent — and it could be that low dopamine levels have played a role in my symptoms of both ADHD and depression.

What are other causes? A dopamine imbalance can be triggered by an array of biological and environmental factors, including inflammation, chronic stress, hormonal shifts, poor diet, not enough Vitamin D and even certain medications that block dopamine activity. Dr Amber adds that an imbalance is not always necessarily caused by a depletion in dopamine, but rather a desensitisation to it.

‘Our brains are always trying to create homeostasis and balance so if we’re in an environment that’s creating a lot of dopamine within our system, the brain will start to expect it and therefore need more of it for normal dopamine regulation function.’

She says that some behaviours mean we can risk overexerting our dopamine networks: ‘We start to become desensitised and receive less pleasure from things that used to excite us.’

So perhaps there was method in all that dopamine detox talk after all. However, it is also possible to increase our dopamine levels. One way is through supplements and diet. L-tyrosine, L-phenylalanine, magnesium, omega-3 fatty acids and ginkgo biloba can all promote dopamine, either by supporting its production, enhancing its activity, or preventing its breakdown.

Foods such as animal products, bananas and avocados can also provide the necessary building blocks for creating dopamine. Other lifestyle changes that can boost dopamine include exercise, good sleep hygiene, listening to music, working towards goals, massage, getting out in nature and even cold-water plunges.

‘Sometimes we need to do something even if we don’t feel like doing it,’ says Dr Amber. ‘It’s about eventually getting to a state where we can find activities meaningful and purposeful again.’

What is the bigger picture? She warns though, that treating depression isn’t as simple as pinpointing a single neurochemical. ‘Our systems just don’t work that neatly.

Medication can be a useful tool, but we need a more holistic understanding of what other factors might maintain or drive depression.’  Although I am still currently taking SSRIs, I feel like something has shifted in me. Since I started taking magnesium supplements just over two years ago, I have noticed a substantial improvement in my mood and productivity, and depressive episodes have been far less frequent.

This also coincides with other dopamine-inducing lifestyle interventions that I have implemented, such as deliberately carving out time every day to work on personal projects that I find gratifying. But most importantly, gaining insight into how dopamine plays a significant role in motivation and mood, especially when you’re neurodivergent, has been utterly transformative for me.

I now feel pity for the young woman who believed that she was inherently lazy and pathetic, and who struggled on in silence. I finally feel as if something inside of me has begun to heal.

Dr Amber Johnston is a practising clinical psychologist, specialising in clinical, health, pain management, and neuropsychology. As the founder and director of Healthy Mind Psychology, she leads a team of more than 25 doctoral-level psychologists, serving patients in London and across the UK.

Read more: Dr Alex George discusses his ADHD diagnosis and empowering young people to feel more positive.