![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 22 of 22. This is the beginning of the thread.
Posted by SalArmy4me on February 13, 2001, at 4:05:11
First, the background: I have treatment-resistant depression with painful flashbacks and Obsessive-Compulsive Disorder.
Mirapex started working for me in a little less than a week (possibly because I got up to 6 mg per day in two days' time)! I found out that it needs to be taken about every 5 hours, otherwise I relapse. I have no side-effects from it (thank God).
Mirapex is a dopamine agonist that is most often used for Parkinson's Disease. But, it has been shown in two studies to have antidepressant properties in non-Parkinson's patients.
Studies on Medline:
2. Pramipexole augmentation in the treatment of unipolar and bipolar depression: a retrospective chart review Ann Clin Psychiatry. 2000 Sep;12(3):137-40. [Record as supplied by publisher] PMID: 10984002
3:
Maj J, Rogoz Z.
Related Articles
Synergistic effect of pramipexole and sertraline in the forced swimming test. Pol J Pharmacol. 1999 Nov-Dec;51(6):471-5.
PMID: 10817524
4: Corrigan MH, Denahan AQ, Wright CE, Ragual RJ, Evans DL. Related Articles Comparison of pramipexole, fluoxetine, and placebo in patients with major depression. Depress Anxiety. 2000;11(2):58-65. PMID: 10812530
5: DeBattista C, Solvason HB, Breen JA, Schatzberg AF. Related Articles Pramipexole augmentation of a selective serotonin reuptake inhibitor in the treatment of depression. J Clin Psychopharmacol. 2000 Apr;20(2):274-5. No abstract available. PMID: 10770475
6:
Goldberg JF, Frye MA, Dunn RT.
Related Articles
Pramipexole in refractory bipolar depression.
Am J Psychiatry. 1999 May;156(5):798. No abstract available.
PMID: 10327923
7:
Bennett JP, Piercey MF.
Related Articles
Pramipexole--a new dopamine agonist for the treatment of Parkinson's disease. J Neurol Sci. 1999 Feb 1;163(1):25-31. Review.
PMID: 10223406
8: Piercey MF. Related Articles Pharmacology of pramipexole, a dopamine D3-preferring agonist useful in treating Parkinson's disease. Clin Neuropharmacol. 1998 May-Jun;21(3):141-51. Review. PMID: 9617505
9:
Willner P.
Related Articles
The mesolimbic dopamine system as a target for rapid antidepressant action. Int Clin Psychopharmacol. 1997 Jul;12 Suppl 3:S7-14. Review.
PMID: 9347387
Posted by PhoenixGirl on February 13, 2001, at 18:09:02
In reply to Mirapex will be the next Remeron of ADs, posted by SalArmy4me on February 13, 2001, at 4:05:11
I'm treatment resistant too. I want to try mirapex, but have heard that it causes terrible nausea. How slowly should it be increased, and does the nausea go away? When I first tried selegiline (deprenyl), another dopamine agonist, my stomach hurt a lot. But lately I've tried it again, and have had no stomach problems. When I tried it the first time, I was on celexa and a high dose of wellbutrin, but now I'm on desipramine and moderate dose of wellbutrin. Thanx.
> First, the background: I have treatment-resistant depression with painful flashbacks and Obsessive-Compulsive Disorder.
>
> Mirapex started working for me in a little less than a week (possibly because I got up to 6 mg per day in two days' time)! I found out that it needs to be taken about every 5 hours, otherwise I relapse. I have no side-effects from it (thank God).
>
> Mirapex is a dopamine agonist that is most often used for Parkinson's Disease. But, it has been shown in two studies to have antidepressant properties in non-Parkinson's patients.
>
> Studies on Medline:
> 2. Pramipexole augmentation in the treatment of unipolar and bipolar depression: a retrospective chart review Ann Clin Psychiatry. 2000 Sep;12(3):137-40. [Record as supplied by publisher] PMID: 10984002
> 3:
> Maj J, Rogoz Z.
> Related Articles
> Synergistic effect of pramipexole and sertraline in the forced swimming test. Pol J Pharmacol. 1999 Nov-Dec;51(6):471-5.
> PMID: 10817524
> 4: Corrigan MH, Denahan AQ, Wright CE, Ragual RJ, Evans DL. Related Articles Comparison of pramipexole, fluoxetine, and placebo in patients with major depression. Depress Anxiety. 2000;11(2):58-65. PMID: 10812530
> 5: DeBattista C, Solvason HB, Breen JA, Schatzberg AF. Related Articles Pramipexole augmentation of a selective serotonin reuptake inhibitor in the treatment of depression. J Clin Psychopharmacol. 2000 Apr;20(2):274-5. No abstract available. PMID: 10770475
> 6:
> Goldberg JF, Frye MA, Dunn RT.
> Related Articles
> Pramipexole in refractory bipolar depression.
> Am J Psychiatry. 1999 May;156(5):798. No abstract available.
> PMID: 10327923
> 7:
> Bennett JP, Piercey MF.
> Related Articles
> Pramipexole--a new dopamine agonist for the treatment of Parkinson's disease. J Neurol Sci. 1999 Feb 1;163(1):25-31. Review.
> PMID: 10223406
> 8: Piercey MF. Related Articles Pharmacology of pramipexole, a dopamine D3-preferring agonist useful in treating Parkinson's disease. Clin Neuropharmacol. 1998 May-Jun;21(3):141-51. Review. PMID: 9617505
> 9:
> Willner P.
> Related Articles
> The mesolimbic dopamine system as a target for rapid antidepressant action. Int Clin Psychopharmacol. 1997 Jul;12 Suppl 3:S7-14. Review.
> PMID: 9347387
Posted by ChrisK on February 14, 2001, at 5:21:45
In reply to What about nausea?, posted by PhoenixGirl on February 13, 2001, at 18:09:02
I've been taking Mirapex since the first of the year and am very happy with the results. I ramped up to 3 mg/day in less than a week and have never had a problem with nausea. I realize that I am resistant to a lot of side effects that others feel but the mental improvements would outweigh an upset stomach in my case. The improvement in my depression has been dramatic. I would reccomend to anyone that it is worth a try.
Posted by SalArmy4me on February 14, 2001, at 10:43:09
In reply to Re: What about nausea? » PhoenixGirl, posted by ChrisK on February 14, 2001, at 5:21:45
Maybe you will have nausea, and maybe you won't. But its definitely worth a try because otherwise, the side-effect profile is benign. There are no sexual side-effects, anticholinergic effects, or big drowsiness.
There are many solutions for the nausea, as Dr. Bob points out. The ginger root idea is interesting.
http://www.dr-bob.org/tips/split/Medication-induced-nausea.html
Posted by JahL on February 14, 2001, at 11:09:14
In reply to Mirapex will be the next Remeron of ADs, posted by SalArmy4me on February 13, 2001, at 4:05:11
> > Mirapex started working for me in a little less than a week (possibly because I got up to 6 mg per day in two days' time)! I found out that it needs to be taken about every 5 hours, otherwise I relapse.Does this mean you wake up each morning depressed? If so how long before the first dose 'fixes' you?
I tried Mirapex only briefly & @ low (1mg/d) doses but I have to say it worked quickly (ie 3days) to take the edge off my depression. It would appear to be a drug with some promise.
Thanks,
Jah.
Posted by SLS on February 14, 2001, at 15:33:24
In reply to Re: Mirapex will be the next Remeron of ADs » SalArmy4me, posted by JahL on February 14, 2001, at 11:09:14
Hi Jah.
I think it is premature to compare Mirapex (pramipexole) to Remeron (mirtazepine), or any of the other recognized antidepressants. At this point, I would guess that Mirapex will show itself to be one of the better adjuncts to antidepressant treatment. That it works so quickly is demonstrative of its direct effect fo stimulate dopamine receptors. It is similar in this way to Parlodel (bromocriptine) and Permax (pergolide) two DA agonists occasionally used successfully as augmenting agents. The same can be said of the psychostimulants: Ritalin (methylphenidate), dexedrine (l-amphetamine), Adderall (dl-amphetamine), Cylert (pemoline) and others. These drugs do not do very much by themselves as they often poop-out rather quickly.
Perhaps Mirapex will end up being our next Remeron, but that is a tough act to follow. I doubt that it will. That you "relapse" so frequently during the day is characteristic of the psychostimulants. However, this is not true of the true antidepressants.
There are some people on the board who have experienced a particularly robust response to adding Mirapex to their ongoing treatment of Risperdal. There may be a special synergy going on here. I would be curious to see if the same is true of the other atypical neuroleptics (Zyprexa, Clozaril, Seroquel, and ziprazidone), and perhaps Serzone (nefazodone) or Remeron. 5-HT2 blockade is the common property shared by these other drugs.
Sincerely,
Scott>
> > > Mirapex started working for me in a little less than a week (possibly because I got up to 6 mg per day in two days' time)! I found out that it needs to be taken about every 5 hours, otherwise I relapse.
>
> Does this mean you wake up each morning depressed? If so how long before the first dose 'fixes' you?
>
> I tried Mirapex only briefly & @ low (1mg/d) doses but I have to say it worked quickly (ie 3days) to take the edge off my depression. It would appear to be a drug with some promise.
>
> Thanks,
> Jah.
Posted by natg on February 15, 2001, at 7:09:51
In reply to What about nausea?, posted by PhoenixGirl on February 13, 2001, at 18:09:02
Mirapex has been a life- saver to me and I would definitly recommend it.
I take 3.5 mgs a day and I must admit the nausea was horrible. It felt like morning sickness to me!
Anyway, 10 days later I woke up with no nausea and so far it has not returned.
At lower doses I did not experience any nausea.To me this drug has really saved me. For the first time in 10 years, I can say I am happy most of the time. I do not have this dreaded feeling of impending doom.
I, too, suffer from treatment resistant depression and OCD. /after years of hell and trying too many meds. with very little results, this is definitly very promising.Best of Health to all,
natNat
Posted by SLS on February 15, 2001, at 9:43:28
In reply to About Mirapex, posted by natg on February 15, 2001, at 7:09:51
Hi Nat.
Are you taking any other drugs?
For how long has Mirapex been helping you?
How would you describe your depression?
Are you bipolar or do you have a family history of bipolar disorder?
Thanks for your input, Nat.
I pray for your continued success with Mirapex (or whatever it takes).
- Scott
> Mirapex has been a life- saver to me and I would definitly recommend it.
> I take 3.5 mgs a day and I must admit the nausea was horrible. It felt like morning sickness to me!
> Anyway, 10 days later I woke up with no nausea and so far it has not returned.
> At lower doses I did not experience any nausea.
>
> To me this drug has really saved me. For the first time in 10 years, I can say I am happy most of the time. I do not have this dreaded feeling of impending doom.
> I, too, suffer from treatment resistant depression and OCD. /after years of hell and trying too many meds. with very little results, this is definitly very promising.
>
> Best of Health to all,
> nat
>
> Nat
Posted by judy1 on February 16, 2001, at 0:00:44
In reply to Re: About Mirapex » natg, posted by SLS on February 15, 2001, at 9:43:28
Hi Scott,
I'm not familiar with this AD- when you asked natg about history of bipolar is that because it's contraindicated in bp? Thanks- Judy
Posted by SLS on February 16, 2001, at 9:39:05
In reply to Re: About Mirapex » SLS, posted by judy1 on February 16, 2001, at 0:00:44
> Hi Scott,
> I'm not familiar with this AD- when you asked natg about history of bipolar is that because it's contraindicated in bp? Thanks- Judy
Hi Nat.No. It is not contraindicated for bipolar disorder.
I am bipolar. I believe bipolar depression and perhaps very anergic atypical depressions can be somewhat responsive to stimulants and dopaminergic drugs like Mirapex.
I am most interested to know if Mirapex can act as an antidepressant by itself or whether its success depends on the presence of another psychotropic drug. At least two people here have reported feeling greatly improved after adding Mirapex to the Risperdal they were taking.
- Scott
Posted by natg on February 16, 2001, at 11:13:15
In reply to Re: About Mirapex, posted by SLS on February 16, 2001, at 9:39:05
Scott:
No, I'm not bi- polar but there is somr history of it in my family.
I've suffered from depression for 10 + years.
When depressed I isolate, find no pleasure in life. I am completely unable to achieve the easiest tasks ( ie, get out of bed, take a shower, eat etc.,)
Life is an absolute HELL. I sleep 14- 16 hours a day when I'm depressed. I cry a lot too.
I have social pobia and it is really traumatic for me to be in social situations without having terrible anxiety.A lot of AD's I've taken in the last 5 years have helped as far as obssessive, negative recurrent thoughts. The panic attacks subsided as well. Therapy heped too.
It wasn't until last August that I first started Zyprexa then Risperdal that I began noticing a big change. I added the Mirapex about 9- 10 weeks ago ( I've lost track of time, sorry) and started feeling drastically better. For the first time ever, I feel OK with me. I function really well, I get out of my house a lot. Nonetheless, I still spend a lot of time alone-- but that's me.I'm OK with myself.
I tried to stop taking Mirapex for 7 days and I could definitly feel a difference. Recently, I did the same with Risperdal ( 5- 6 days) and I could not do it. So, as far as I am concerned I have to take them together.
Note: I've had to give up caffeine because I was really wired, I wasn't getting to sleep before 2- 3 AM (this is the only med that affects me in such a way, usually I have to drink loads of caffeine because all the meds made me so sleepy and lethargic)
I don't know if this has helped you but I hope it has.
All the best,
Nat
Posted by michael on February 16, 2001, at 12:30:47
In reply to Re: About Mirapex/ To Scott, posted by natg on February 16, 2001, at 11:13:15
Hi,
I know you've probably mentioned this already, but I haven't found it yet... I'm curious what dosages you're taking?
And also, did you previously suffer from fatigue/feeling run down all of the time, or was it more that you slept so much? It sounds like motivation to do things - even small things - was an issue too? I ask because those are some of the problems that I have too. Thanks - michael
> Scott:
> No, I'm not bi- polar but there is somr history of it in my family.
> I've suffered from depression for 10 + years.
> When depressed I isolate, find no pleasure in life. I am completely unable to achieve the easiest tasks ( ie, get out of bed, take a shower, eat etc.,)
> Life is an absolute HELL. I sleep 14- 16 hours a day when I'm depressed. I cry a lot too.
> I have social pobia and it is really traumatic for me to be in social situations without having terrible anxiety.
>
> A lot of AD's I've taken in the last 5 years have helped as far as obssessive, negative recurrent thoughts. The panic attacks subsided as well. Therapy heped too.
> It wasn't until last August that I first started Zyprexa then Risperdal that I began noticing a big change. I added the Mirapex about 9- 10 weeks ago ( I've lost track of time, sorry) and started feeling drastically better. For the first time ever, I feel OK with me. I function really well, I get out of my house a lot. Nonetheless, I still spend a lot of time alone-- but that's me.
>
> I'm OK with myself.
>
> I tried to stop taking Mirapex for 7 days and I could definitly feel a difference. Recently, I did the same with Risperdal ( 5- 6 days) and I could not do it. So, as far as I am concerned I have to take them together.
>
> Note: I've had to give up caffeine because I was really wired, I wasn't getting to sleep before 2- 3 AM (this is the only med that affects me in such a way, usually I have to drink loads of caffeine because all the meds made me so sleepy and lethargic)
>
> I don't know if this has helped you but I hope it has.
>
> All the best,
> Nat
Posted by SLS on February 16, 2001, at 19:25:03
In reply to Re: About Mirapex/ To Scott, posted by natg on February 16, 2001, at 11:13:15
Dear Nat,
Thanks for answering my questions. You have given me hope that adding Mirapex might help me.
> It wasn't until last August that I first started Zyprexa then Risperdal that I began noticing a big change. I added the Mirapex about 9- 10 weeks ago ( I've lost track of time, sorry) and started feeling drastically better. For the first time ever, I feel OK with me. I function really well, I get out of my house a lot. Nonetheless, I still spend a lot of time alone-- but that's me.
I am curious though, why did you switch from Zyprexa to Risperdal? I can't make up my mind as to which of the two I should commit to.
Our cases sound very similar.
> I tried to stop taking Mirapex for 7 days and I could definitly feel a difference. Recently, I did the same with Risperdal ( 5- 6 days) and I could not do it. So, as far as I am concerned I have to take them together.
I hope your new medications "stick". You have every reason to be optimistic. From what I have seen here, Risperdal tends to have a stable and persistent effect, and you are not the first to have successfully added Mirapex to it. All I can say to you is YAY!
> I'm OK with myself.
You're OK with me too. :-)
Thanks again.
- Scott
Posted by natg on February 17, 2001, at 12:44:52
In reply to Re: About Mirapex/ To Scott » natg, posted by SLS on February 16, 2001, at 19:25:03
>
>
> I am curious though, why did you switch from Zyprexa to Risperdal? I can't make up my mind as to which of the two I should commit to.
>
>Scott,
The only reason I switched was b/c of the weight gain factor with Zyprexa.I will eventually have to give up Risperdal because of side- effects which are no longer acceptable to me ( loss of menstrual period)
So, we'll see.One day at a time!
All the best,
Nat
Posted by AndrewB on February 17, 2001, at 13:19:14
In reply to Re: About Mirapex/ To Scott, posted by natg on February 17, 2001, at 12:44:52
I've been following the studies on Mirapex for over a year now. I've always felt that it has the potential to help a lot of treatment resistant depressives, including bipolars. Scott and I disagreed on its potential, he tended to think it was another bromocriptine. From what I have read though, compared to bromocriptine, it has a much higher response rate and is not prone to poop out. This can be explained by a mode of action significantly different from bromocriptine.By itself, Mirapex should not be expected to give complete relief of depressive symptoms. Rather it will find its place as an adjunct. It is not known all the meds that it may combine well with. It does however tend to improve the response to SSRIs while also lessening the side effects (i.e. sexual). It also seemingly can be combined synergistically with low dose neuroleptics. Since, it lowers prolactin, it also is likely to lessen or take away hyperprolactinemia (i.e. breast swelling in women) that can occur with certain neuroleptics. For example, given sufficient time and dosage, Mirapex may allow NatG to resume her menses while continuing Risperdal.
Nausea, not lack of response, may the main reason for discontinuation of Mirapex. Nausea, most often transient, will be experienced in the majority of people who use it, especially at the higher doses required for full AD effect. Probably domperidone (available only from overseas), a peripheal dopamine antagonist, will lessen or eliminate the nausea without interfering with the AD effect. I haven’t read of anyone trying this combo though.
For some Mirapex also has an arousal effect and can mediate anergia. It is will be interesting to see how it combines with other arousal agents.
Beyond this, it also may be anxiolytic for some. I’ve heard this purposed but have not read any reports on its anxiolytic efficacy.
AndrewB
Posted by natg on February 17, 2001, at 14:48:19
In reply to Re: About Mirapex » natg, posted by michael on February 16, 2001, at 12:30:47
> Hi,
>
> I know you've probably mentioned this already, but I haven't found it yet... I'm curious what dosages you're taking?
> #################Michael:
I'm taking 3.5 mgs of Mirapex at the moment.
I also take 1- 2 mgs of Risperdal.> And also, did you previously suffer from fatigue/feeling run down all of the time, or was it more that you slept so much? It sounds like motivation to do things - even small things - was an issue too? I ask because those are some of the problems that I have too. Thanks - michael
>
>
> Yes, I did suffer from fatigue all the time. The other AD's made it even worse, I was a complete zombie ( not too bad on Prozac though)
I used to take naps every day; I don't anymore.
In fact, I have to discipline myself to go to bed at a reasonable time.
> Hope this helps you.Take Care,
Nat#####################
> > Scott:
> > No, I'm not bi- polar but there is somr history of it in my family.
> > I've suffered from depression for 10 + years.
> > When depressed I isolate, find no pleasure in life. I am completely unable to achieve the easiest tasks ( ie, get out of bed, take a shower, eat etc.,)
> > Life is an absolute HELL. I sleep 14- 16 hours a day when I'm depressed. I cry a lot too.
> > I have social pobia and it is really traumatic for me to be in social situations without having terrible anxiety.
> >
> > A lot of AD's I've taken in the last 5 years have helped as far as obssessive, negative recurrent thoughts. The panic attacks subsided as well. Therapy heped too.
> > It wasn't until last August that I first started Zyprexa then Risperdal that I began noticing a big change. I added the Mirapex about 9- 10 weeks ago ( I've lost track of time, sorry) and started feeling drastically better. For the first time ever, I feel OK with me. I function really well, I get out of my house a lot. Nonetheless, I still spend a lot of time alone-- but that's me.
> >
> > I'm OK with myself.
> >
> > I tried to stop taking Mirapex for 7 days and I could definitly feel a difference. Recently, I did the same with Risperdal ( 5- 6 days) and I could not do it. So, as far as I am concerned I have to take them together.
> >
> > Note: I've had to give up caffeine because I was really wired, I wasn't getting to sleep before 2- 3 AM (this is the only med that affects me in such a way, usually I have to drink loads of caffeine because all the meds made me so sleepy and lethargic)
> >
> > I don't know if this has helped you but I hope it has.
> >
> > All the best,
> > Nat
Posted by SLS on February 17, 2001, at 15:24:19
In reply to Re: About Mirapex/ To Scott, posted by natg on February 17, 2001, at 12:44:52
Thanks, Nat.
Try ziprasidone as soon as it comes out. It is basically a Zyprexa without the weight-gain. I am looking forward to trying it myself.
Good luck.
Sincerely,
Scott>
> >
> >
> > I am curious though, why did you switch from Zyprexa to Risperdal? I can't make up my mind as to which of the two I should commit to.
> >
> >Scott,
> The only reason I switched was b/c of the weight gain factor with Zyprexa.
>
> I will eventually have to give up Risperdal because of side- effects which are no longer acceptable to me ( loss of menstrual period)
> So, we'll see.
>
> One day at a time!
>
> All the best,
> Nat
Posted by SLS on February 17, 2001, at 16:04:30
In reply to Re: About Mirapex, posted by AndrewB on February 17, 2001, at 13:19:14
Hi Andrew.
> Scott and I disagreed on its potential,
No.
You must surely be thinking about another Scott.
I was always well focused on the potency of Mirapex to stimulate D3 (D2 subtype) receptors in limbic structures. It more potently agonizes D3 receptors than it does D2 by a large margin. This makes this drug quite a bit different from bromocriptine in that bromocriptine is a selective D2 agonist with greater potency for that receptor than Mirapex. It seemed to me that this difference would give Mirapex greater antidepressant potential than bromocriptine. The thing that I find exciting is that you indicate that Mirapex is not as likely to poop-out. I bet the D2/D3 binding ratio is important in allowing Mirapex to provide a more persistant antidepressant response.
My thoughts regarding bromocriptine is that it is probably more effective to treat hyperprolactinemia due to its more potent D2 stimulatory effects in the pituitary gland. I have not seen Mirapex used this way. Perhaps Mirapex is of comparable efficacy. After all, how much is enough?
D3.
- Scott
----------------------------------------------------------------------
*** Check this out ***
Please note the timeline of the onset of effect.Pretty cool, huh?
Maybe even pertinent. :-)
----------------------------------------------------------------------
1: Mol Psychiatry 2000 Jul;5(4):378-88 Related Articles, Books, LinkOut
Selective increase of dopamine D3 receptor gene expression as a common effect of chronic antidepressant treatments.Lammers CH, Diaz J, Schwartz JC, Sokoloff P
Laboratoire de Physiologie, Universite Rene Descartes, 4 Avenue de l'Observatoire, 75006 Paris, France.
The mesolimbic dopaminergic system is a neuroanatomical key structure for reward and motivation upon which previous studies indicated that antidepressant drugs exert a stimulatory influence, via still unknown neurobiological mechanisms. Here we examined the effects of chronic administration of antidepressants of several classes (amitriptyline, desipramine, imipramine, fluoxetine and tranylcypromine) and repeated electroconvulsive shock treatments (ECT) on dopamine D3 receptor expression in the shell of the nucleus accumbens, a major projection area of the mesolimbic dopaminergic system. Short-term drug treatments had variable effects on D3 receptor mRNA expression. In contrast, treatments for 21 days (with all drugs except fluoxetine) significantly increased D3 receptor mRNA expression in the shell of nucleus accumbens; D3 receptor binding was also significantly increased by amitriptyline or fluoxetine after a 42-day treatment. ECT for 10 days increased D3 receptor mRNA and binding in the shell of nucleus accumbens. D1 receptor and D2 receptor mRNAs were increased by imipramine and amitriptyline, but not by the other treatments. The time-course of altered D3 receptor expression, in line with the delayed clinical efficiency of antidepressant treatment, and the fact that various antidepressant drugs and ECT treatments eventually produced the same effects, suggest that increased expression of the D3 receptor in the shell of nucleus accumbens is a common neurobiological mechanism of antidepressant treatments, resulting in enhanced responsiveness to the mesolimbic dopaminergic system.
PMID: 10889548
--------------------------------------------------------------------
Posted by Sunnely on February 17, 2001, at 20:03:52
In reply to Mirapex will be the next Remeron of ADs, posted by SalArmy4me on February 13, 2001, at 4:05:11
Pramipexole (Mirapex) is a dopamine agonist approved for the treatment of Parkinson's disease. There is preliminary evidence that Mirapex has antidepressant properties and that it also lacks significant interactions with the cytochrome P450 enzymes (CYP450). As a result, Mirapex may be a useful adjunctive drug in combination with standard antidepressants. Its dopamine-agonist properties might also be expected to help with some selective serotonin reuptake inhibitor (SSRI)-associated side effects, including sexual dysfunction, because other dopaminergic drugs, such as amphetamine, amantadine, and bupropion, have proven helpful in some patients. In addition, dopamine agonists have sometimes proven useful as augmentors of standard antidepressants.
Mirapex has a unique pharmacologic profile among the available drugs, with specific dopamine agonist properties favoring D3 to D2 by a ratio of 8:1. Restless leg syndrome (RLS) may emerge during treatment with SSRIs and has responded to treatment with dopamine agonists, including L-dopa. Thus, it is intuitive that Mirapex should also be helpful for SSRI-induced restless legs.
More clinical studies are needed as to the role of Mirapex as an adjunctive agent to standard antidepressants particularly the SSRIs, as well as its role in alleviating potential side effects such as RLS.
Posted by AndrewB on February 17, 2001, at 22:53:35
In reply to Re: About Mirapex, posted by SLS on February 17, 2001, at 16:04:30
Scott,
Sorry to misinterpret your previous opinions on Mirapex.
Interesting abstract......could the D-3 receptors in the shell of the nucleus accumbens be a (the) terminal loci of depressed mood????
Posted by michael on February 20, 2001, at 17:02:13
In reply to Re: About Mirapex, posted by AndrewB on February 17, 2001, at 13:19:14
another thought regarding nausea - another soulution might be ondansetron - I believe it is supposed to help w/that? (used for chemo patients, I THINK...?)
it's expensive, but can be purchased pretty cheaply at indian-drugstore.com (at least it could in the past). the only drawback is the shipping fee - something like $40... Not as bad if you're getting a number of meds at the same time (one ship fee) - the meds are so inexpensive that the ship fee isn't that bad in the end...
One mirapex question - any info on mirapex in conjunction w/wellbutrin?>
> I've been following the studies on Mirapex for over a year now. I've always felt that it has the potential to help a lot of treatment resistant depressives, including bipolars. Scott and I disagreed on its potential, he tended to think it was another bromocriptine. From what I have read though, compared to bromocriptine, it has a much higher response rate and is not prone to poop out. This can be explained by a mode of action significantly different from bromocriptine.
>
> By itself, Mirapex should not be expected to give complete relief of depressive symptoms. Rather it will find its place as an adjunct. It is not known all the meds that it may combine well with. It does however tend to improve the response to SSRIs while also lessening the side effects (i.e. sexual). It also seemingly can be combined synergistically with low dose neuroleptics. Since, it lowers prolactin, it also is likely to lessen or take away hyperprolactinemia (i.e. breast swelling in women) that can occur with certain neuroleptics. For example, given sufficient time and dosage, Mirapex may allow NatG to resume her menses while continuing Risperdal.
>
> Nausea, not lack of response, may the main reason for discontinuation of Mirapex. Nausea, most often transient, will be experienced in the majority of people who use it, especially at the higher doses required for full AD effect. Probably domperidone (available only from overseas), a peripheal dopamine antagonist, will lessen or eliminate the nausea without interfering with the AD effect. I haven’t read of anyone trying this combo though.
>
> For some Mirapex also has an arousal effect and can mediate anergia. It is will be interesting to see how it combines with other arousal agents.
>
> Beyond this, it also may be anxiolytic for some. I’ve heard this purposed but have not read any reports on its anxiolytic efficacy.
>
> AndrewB
Posted by jrw on February 26, 2001, at 10:30:42
In reply to Re: About Mirapex, posted by michael on February 20, 2001, at 17:02:13
indian-drugstore.com has been permanently shut down....
anybody know any other sources of mirapex, without
a prescription, hopefully fairly affordable?thanks and good luck,
j
> another thought regarding nausea - another soulution might be ondansetron - I believe it is supposed to help w/that? (used for chemo patients, I THINK...?)
>
> it's expensive, but can be purchased pretty cheaply at indian-drugstore.com (at least it could in the past). the only drawback is the shipping fee - something like $40... Not as bad if you're getting a number of meds at the same time (one ship fee) - the meds are so inexpensive that the ship fee isn't that bad in the end...
>
>
> One mirapex question - any info on mirapex in conjunction w/wellbutrin?
>
>
>
> >
> > I've been following the studies on Mirapex for over a year now. I've always felt that it has the potential to help a lot of treatment resistant depressives, including bipolars. Scott and I disagreed on its potential, he tended to think it was another bromocriptine. From what I have read though, compared to bromocriptine, it has a much higher response rate and is not prone to poop out. This can be explained by a mode of action significantly different from bromocriptine.
> >
> > By itself, Mirapex should not be expected to give complete relief of depressive symptoms. Rather it will find its place as an adjunct. It is not known all the meds that it may combine well with. It does however tend to improve the response to SSRIs while also lessening the side effects (i.e. sexual). It also seemingly can be combined synergistically with low dose neuroleptics. Since, it lowers prolactin, it also is likely to lessen or take away hyperprolactinemia (i.e. breast swelling in women) that can occur with certain neuroleptics. For example, given sufficient time and dosage, Mirapex may allow NatG to resume her menses while continuing Risperdal.
> >
> > Nausea, not lack of response, may the main reason for discontinuation of Mirapex. Nausea, most often transient, will be experienced in the majority of people who use it, especially at the higher doses required for full AD effect. Probably domperidone (available only from overseas), a peripheal dopamine antagonist, will lessen or eliminate the nausea without interfering with the AD effect. I haven’t read of anyone trying this combo though.
> >
> > For some Mirapex also has an arousal effect and can mediate anergia. It is will be interesting to see how it combines with other arousal agents.
> >
> > Beyond this, it also may be anxiolytic for some. I’ve heard this purposed but have not read any reports on its anxiolytic efficacy.
> >
> > AndrewB
This is the end of the thread.
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