"I was a third-year medical student at Northwestern on my ICU rotation the first time I saw a dopamine drip. The patient was pale and motionless, his blood pressure dropping by the minute despite large volumes of IV fluids. My senior resident said to the bedside nurse, "Let's start a dopamine drip at five micrograms per kilogram per minute." I stood at the foot of the bed, watching the monitor as the patient's heart rate and pressure began to climb."
"In the ICU, dopamine doesn't come in a burst. It flows slowly and steadily. That's what keeps a patient alive. Outside the hospital, though, our brains rarely experience dopamine that way. When we scroll, swipe, shop, or chase likes, dopamine arrives as a surge then crashes. Over time, we need more to feel the same reward. In medicine, that loss of response is called tachyphylaxis. In life, that phenomenon creates the experience of never having enough, an emptiness that seeks to be filled with neurotransmitters."
Dopamine functions primarily as a signal of anticipation rather than direct pleasure. Slow, steady dopamine exposure increases cardiac contractility, heart rate, and blood pressure in controlled medical settings, while rapid spikes can be harmful. Repeated, high-amplitude dopamine surges from behaviors like scrolling, shopping, or chasing social rewards produce tolerance (tachyphylaxis), requiring larger stimuli to elicit the same anticipatory response. That pattern fosters chronic craving and an ongoing sense of insufficiency. Practices that promote a balanced, low-variance dopamine tone support sustained equanimity and reduce compulsive reward-seeking. Dose and delivery determine whether dopamine preserves function or promotes dysregulation.
Read at Psychology Today
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