Dopamine and Serotonin Agonists Given in tandem remit Multiple Medical Conditions: Are These Neurotransmitters the Primal Regulators? A paradigm-shifting hypothesis

[Pietr Hitzig]

Are the Monoamines dopamine and Serotonin Neurotransmitters the Primary 
Regulators? A paradigm-shifting hypothesis

The serotonin (5HT) agonist, fenfluramine (FEN), and the dopamine (DA)
agonist, phentermine (PHEN) when given in tandem have an extremely wide 
therapeutic effect.  Combined FEN/PHEN administration has far superior 
anorectic effects when compared to either of these substituted 
amphetamines taken alone.  Furthermore, not only is there a superior 
weight loss result, but also tachyphylaxis does not develop(1).

FEN/PHEN abolishes not only alcohol and alcohol craving(2,3) but also
resolves all psychoneuroses in nineteen severely depressed alcoholics, 
seven of them cocaine co-addicted(4).  Over the last 39 months, 
582 patients with affective and/or obsessive/compulsive disorders (OCD) 
with (166) or without (416) alcohol or substance addiction have enjoyed 
relief of depression, obsession and craving.  More than 300 alcoholics 
and 100 cocaine-addicted individuals had experienced craving relief, very 
nearly always in less than 2 hours if craving at the time of the first 
visit.

These monoamines, acting reciprocally, act clinically as TH1 and TH2
modulators(5).  Dopamine is almost certainly a TH1-type agonist and an 
inhibitor of TH2 while 5HT is a TH2-like agonist and a TH1 
antagonist(6,7).

Patients suffering from immediate and delayed hypersensitivity disorders 
(IHD, DHD) enjoyed a similar relief and also had a resolution of their 
immune disorders.  At least thirty-nine asthmatics, more than twelve of 
them refractory to traditional treatment, savored resolution of symptoms. 
Their previously prescribed sympathomimetics, antihistamine and 
corticosteroids became redundant. Persistence of allergic rhinitis, 
urticaria, or asthma is an indication to increase DA in the FEN/PHEN 
protocol.  The response is universal.

A forty-three year old registered nurse with not only refractory asthma 
but also idiopathic and shellfish anaphylaxis had a resolution of her 
asthma despite the cessation of multiple medications,had no reaction when 
she ate shellfish and reduced her markedly elevated histamine levels to 
normal. 

Response to TH2-driven conditions also respond. More than 20 efractory 
psoriasis patients,Two out of three with Crohn's disease(2/3), 
individuals with cutaneous lupus and Sjogren's enjoyed a total or near 
total resolution.  Both IHD and autoimmune patients were able to 
discontinue all other medications.

A patient suffering from amyotrophic lateral sclerosis lost his extensive 
fasciculations and severe fibromyalgia-like pain within 60 minutes of 
initiation of therapy and continues without them two months later. The 
only patient with multiple sclerosis, previously experiencing 
exacerbations every three to four months, commented that not only had she 
had no attacks in the eighteen months she has been taking FEN/PHEN but 
the amount of physical exertion she was capable of doing during the 
recent blizzard couldn't have been done by her 18 months before therapy. 
The response rate in all these conditions has been greater than 75%.

Three HIV+ patients have had clinically significant improvement.  All 
three showed impressive psychological and physical improvement when 
treated with FEN/PHEN.  In two of these cases, CD4+ counts increased with 
FEN/PHEN (170 to 480, 480 to 900).  They had relief of severe depression 
and cocaine craving.  The third patient, suffering from advanced AIDS, 
had a CD+ count of five.  He suffered from oral and esophageal thrush, 
wasting, depression, anxiety, abdominal pain with diarrhea, anorexia and 
wasting. 

Treatment with FEN/PHEN  was initially directed toward relief of his 
affective disorders.  This goal was realized after three days of 
treatment.  By the fifth day, his thrush and all the other symptoms had 
resolved.  Appetite returned with a 2.5 kg. Weight gain for the six weeks 
he continued the protocol.  Abdominal pain and his chronic diarrhea 
resolved. Unfortunately, he expired two weeks after his AIDS physician 
stopped FEN/PHEN therapy.
 
Many patients report a marked decrease in viral illnesses and that an 
increase in the DA agonist dose results in a marked decrease of symptoms. 
Patients with frequent or chronic candidiasis have found relief.  

There is increasing belief that a balance of TH1 and TH2 promotes health 
and homeostasis eerily similar to Hippocrates balance of the humors or 
Yin/Yang(8-11).  Serotonin, in relative excess, presumably triggers 
immediate hypersensitivity disorders. Immediate hypersensitivity 
patients, not fully responding to the initial FEN/PHEN, will go into 
remission with a DA increase. Excessive TH1, caused by dopamine relative 
excess causes organ-specific autoimmunity(12). Conversely, those with 
psoriasis or Crohn's respond to when the TH1 antagonist FEN dose is 
increased.

Dopamine and 5-HT deficiencies are not only found in HIV but also in 
chronic stress(13) and during alcohol withdrawal(14,15).  These monoamine
deficiencies have been considered the etiology of stress-induced 
behavioral and immunological pathology(13,16).  The HIV and murine stress 
immobilization induce excessive TNF-alpha and interferon-gamma  
production and start a cascade resulting in DA and 5-HT deficiency(17). 

TH1 cytokines increase indoleamine 2,3 dioxygenase (IDO)(18).  This 
enzyme shunts tryptophan towards the kynurenic pathway thereby decreasing 
5HT production. Marked increases in kynurenate and quinolinate(19) and 
deficiencies of tryptophan, 5-hydroxytryptophan and 5-HT result(17).  
Excessive quinolinic acid being a dopaminergic cell neurotoxin, DA 
production and DA levels decrease.  

A similar tyrosine depletion secondary to an increase in tyrosine 
aminotransferase activity occurs with chronic stress(20). A similar 
mechanism may be occurring in HIV.

Clinicians have been utilizing this monoamine immunomodulating effect 
unknowingly.  Pentoxifylline, a methylxanthine, is a DA and 5HT 
agonist(21) and is effective against both endotoxic shock(22) and HIV in 
vitro replication(23).  Methylxanthines and cannabis, both effective 
against asthma(24), are DA and 5-HT agonists(25,26).  Bromocriptine, a DA 
agonist, combined with cyclosporine, a 5-HT agonist(27), increases murine 
and human cardiac transplant survival(28,29). Finally, fluoxetine and
other SSRI's, the "panaceamycins" of the 90's, promote 5-HT and DA(30).  
It is likely that thalidomide, with its wide therapuetic range, is also a 
combined monoamine agonist.

FEN/PHEN's ability to reverse psychiatric, craving, and immediate and 
delayed hypersensitivity disorders suggests that DA and 5HT, both only 
one precursor away from amino acids may be not only Selye's "first 
mediators of stress," but also the primary regulatory neurotransmitters 
formed coincident or shortly after life began. The hypothesis is that all 
other controlling mechanisms are derived from the DA-HT interaction with 
multiple intricate mediators developing along the way.  

Further studies, especially if done expeditiously, are eagerly awaited by 
the author who, as a internist in general medicine, is neither 
practically nor ethically able to proceed with these mandatory studies.  
However,unpublished murine studies by Bart Hoebel at Princeton and Hans 
Fisher at Rutgers confirm the addiction hypothesis. In the works are 
alcohol and cocaine studies at the Kansas City VA, a Persian Gulf illness 
and fibromyalgia study at the U. of Wisc. and an asthma study at Mass 
General.

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NOTE OF EXPLANATION
  In this advanced era clinicians are unable to pass through all the 
hurdles imposed by IRB's, cannot do double-blind studies. Journals, 
oriented towards the laboratory, demand placebo controlled work. Despite 
a wealth of clinical data, the author has been unable to have his 
material printed.  In the late nineteenth century, Baron von Humboldt 
once commented, and I paraphrase that revolutionary ideas go through 
three stages.  In the beginning these ideas are ignored, next they are 
ridiculed, and, finally, the experts say they knew it all along. 

Fortunately, I have been fortunate to have strong allies.  Dr. Richard 
Rothman, a research psychiatrist at NIDA, for three years carried the 
FEN/PHEN crusade forward.  Despite murine confirmatory work, the 
byzantine politics of NIDA was stronger.  

I suppose it should be a signal honor that Dr. Alan Leschner, the chief 
at NIDA, executed the alcohol and cocaine studies.  Despite wide-spread 
use of the self-same drugs for obesity, he was able to say with a 
straight face that the toxicity of these medications out in the 
marketplace for thirty years was in question.  Whether he is involved in 
the alternative work being done at NIDA, Hopkins, and Guilford 
Pharmaceuticals is not known. Fortunately, Jan Campbell, Rothman, and I 
are collaborating in the VA Kansas City.

Dr. Dan Malone, his interest whetted by my claim that FEN/PHEN treated 
fibromyalgia, and his scepticism vanishing when he reproduced the 
findings, has been pushing for a fibromyalgia study.  That multi-center 
study should start in the very near future.

Dr. Bernard Hitzig, a second cousin once removed and a Harvard research 
pulmonologist, has had an informal approval from Mass. General's 
pulmonary division.  Now, when we get the money........

I would appreciate any potential researcher or clinician acknowledge the 
fact that the basic concepts have been covered by patents and FEN/PHEN is 
trademarked.

Sorry for the length.  I would have preferred NEJM, Nature, SCIENCE, 
JAMA, or Lancet but they are not interested in clinical findings anymore.

copyright 1996, all rights reserved, Pietr Hitzig 

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