Posted by Ame Sans Vie on June 15, 2003, at 5:46:17
In reply to Re: ok need input going to p-doc tommorrow » Ame Sans Vie, posted by babak on June 14, 2003, at 21:52:24
There has been no problem demonstrated taking both an SSRI (paroxetine, sertraline, fluoxetine, etc.) along with Mirapex. In fact, the Mirapex has been shown to relieve many SSRI-related side effects. Apathy and sexual dysfunction seem to be the ones we all know so well--Mirapex can be wonderful for both of those. For a while, I was taking Lexapro along with Mirapex, and the mild sexual dysfunction caused by the Lexapro not only disappeared with the addition of the Mirapex, but my libido actually increased. A very welcome change, lol.
The literature suggests that you start off at a very low dose (125µg three times a day) and titrate upwards very slowly (add another 375µg per day each week). My doctor explained to me that this was just to keep the nausea in check, as it can be a pretty bad side effect of the drug at first, but gradually dissipates. So he told me to start with a 500µg dose, see how nauseus it made me and if I could handle it, and just raise or lower the dose as I saw fit until I reached the US FDA approved maximum daily dose, 4.5mg. The nausea wasn't much of a problem at all, it turned out. I just kept some ginger ale on hand (only the type with real ginger root) which is a great natural remedy for upset stomach. By doing this, I was able to go very quickly from 500µg three times daily on the first day, to 1.5mg three times daily by the sixth day. It was around the third or fourth day that I noticed a very pronounced effect immediately upon awakening.
I know this is more a matter for semantics, not medicine, but I really wouldn't think of Mirapex as a "stimulant". Not any more than one might think of adrafanil/modafinil as stimulants. Mirapex's "stimulating" effect seems to be along the same lines as these two drugs; I've heard the word "eugoroic" (good-arousal) used to describe drugs that create this effect. Just keep in mind that there's so much more to it than a stimulating effect (and some people actually find it somewhat sedating; there is a warning in the prescribing information about sudden daytime attacks of sleepiness). It also increases motivation and reward, lifts depression, rids anhedonia, induces a good mood, enhances sexuality, and increases confidence--all presumably through its uniquely high-affinity for the D-3 dopamine receptors.
Here is that study I mentioned in my last posting:
And here are some other links you may want to print out to bring to your doctor:
http://www.biopsychiatry.com/pramropbi.htm
http://www.biopsychiatry.com/pramipexoleantidep.htm
http://www.biopsychiatry.com/mirapex.htm
http://www.biopsychiatry.com/dopamine-sex.html
http://www.biopsychiatry.com/d3.htm
http://www.biopsychiatry.com/nicotine-dopamined3.htm
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12479663&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10984002&dopt=Abstract
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10698826&dopt=AbstractFinally, here's the official US prescribing information--be sure to read it thoroughly:
http://www.mirapex.com/includes/Mirapex.pdfhttp://www.mirapex.com/includes/Mirapex.pdf
Always feel free to ask if you have any more questions. :-)~Michael
poster:Ame Sans Vie
thread:233583
URL: http://www.dr-bob.org/babble/20030614/msgs/234097.html