Posted by AndrewB on May 2, 2000, at 2:36:57
In reply to Re: Shorter Trials, Cam W, posted by Cam W. on May 1, 2000, at 16:23:14
Scott,
I'll be kind of brief since my bedtime is creeping up.
Your comments supporting the use of 3 week trials make perfect sense to me. Thanks for explaining it to me.
The information I have on studies done with pramipexole is sketchy. One unpublished study concluded that pramipexole was as effective as fluoxetine for major depression. A new study came out this month that examines the use of pramipexole as an adjunct with an SSRI. The abstract is not available yet though. In another study pramipexole was used as an augmentor to various ADs with 6 patients after they failed to respond to an 8 week course with those antidepressants. Five of six of the patients had a greater than forty percent reduction in their depressive symptoms after 4 weeks. Most of their improvement had occurred during week 1.
In a separate case study they gave pramipexole to a bipolar man who was in a vegetative state. He was severely depressed and on a variety of mood stabilizers. He was taking no antidepressants though had tried a great variety of them, all without success. After six weeks on pramipexole a marked antidepressant response occurred. His functional improvement, with only low grade depression and no cycling, continued through his six month follow up. It was speculated by the author of this case study that pramipexole’s D3 activity may be responsible for pramipexole’s efficacy with psychomotor retarded conditions. It was also speculated that pramipexole may have a preferential response in atypical depression versus melancholic.
As far as differences between presynaptic D2 antagonists versus D2 postsynaptic antagonists I’m still not convinced there has be to much of a difference between the two. I don’t see why you would use the examples you do to make your point (reboxetine versus provigil?). Anyway, in my mind the major difference between the amisulpride and pramipexole may be the receptor sites they are selective for. Both are D2/D3 selective. But pramipexole has a preference for D3 over D2 receptors and has a preference for the D2/D3 receptors in the striatum over those in the limbic system. Contrast this with amisulpride which has limbic system selectivity and probably a preference for D2 over D3 receptors. By the way, pramipexole is a full agonist and bromocriptine and peroglide are partial agonists.
Yes keeping track of people’s responses to meds is a good idea. I have been soliciting and tracking peoples’ responses to amisulpride, pramipexole, amineptine and sulpiride. I also have tracked reboxetine responses, though less completely.
I’m the only one who has mentioned poop out on amisulpride on this board. I am sure of this. I had a partial poop out, where it lost its fatigue prevention properties. After about a month of this partial poop out I quit it for 4 days, and when I restarted, it was working fully again. I started reboxetine after this. I stopped amisulpride again for 4 days recently and I got quite depressed in the interim. I’ve been on it now for nearly 10 months. It takes 1 to 4 days to kick in whether I am on reboxetine or not.
You talk about targeting a secondary site to kick start a response at the primary site. I’m doing something like that, at least I think I am. The D2/D3 is the primary site for me but the D1 is a secondary site since D1 stimulation potentiates (or creates a supersensitivty) at the D2 (and D3?) receptors. I use amineptine to stimulate the D1 receptors.
The D3 receptor seems to be very much involved with mood. I don’t think its function has been clearly defined yet, as D3 specific agonists and antagonists have only recently been developed. To describe all that the D2/D3 are involved in and where would take a bit of space but relating to depression these receptors are involved with mood, anxiety and one’s sense of energy or fatigue.
Well, this post is a lot longer than I intended and I have stayed up longer than I should. So I shall say goodnight and again I thank you for this wonderful dialogue.
AndrewB
poster:AndrewB
thread:31785
URL: http://www.dr-bob.org/babble/20000429/msgs/31903.html