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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 30. This is the beginning of the thread.
Posted by Rainee on June 12, 2003, at 22:41:46
I take 30 mgs of lexapro. Even though I'm not so overwhelmed with thoughts and I have no get up and go. It seems I could use a little more OCD help. also I want a little stimulant I have lethargic depression and need a mood stabilizer. I'm 100 pounds over weight and was thinking of asking to try topomax. What y'all think. Any suggestions welcome! I need to get bak into life all I do is lay in bed and watch tv.
Thanks, RAINEE..PS i ALSO HEARD OF A MILD STIM THAT STARTS WITH A p? WELLBUTRIN MAKES ME A LITTLE UPTIGHT. thank!
Posted by Caleb462 on June 13, 2003, at 0:12:58
In reply to ok need input going to p-doc tommorrow, posted by Rainee on June 12, 2003, at 22:41:46
> Thanks, RAINEE..PS i ALSO HEARD OF A MILD STIM THAT STARTS WITH A p? WELLBUTRIN MAKES ME A LITTLE UPTIGHT. thank!You're probably thinking of Provigil. I tried it for a few weeks, first at 100 mg, then at 200 mg, and a few days I tried 300 or 400 mg. I also have what you might call "lethargic depression"... and I can't say Provigil helped really. It was not a motivating drug, for ME. I felt that if I was to get motivated and do something, then the Provigil would give me the extra endurance I needed - but it wasn't a jumpstart kinda drug. Again, this is just my experience.
Posted by Ame Sans Vie on June 13, 2003, at 8:09:11
In reply to ok need input going to p-doc tommorrow, posted by Rainee on June 12, 2003, at 22:41:46
As far as a mild stimulant is concerned, of course I'm going to recommend Mirapex. :-) It'll definitely get you out of your bed, out and about doing things with people--it may even help with the weight loss, if your problem is overeating (and not simply eating the wrong foods).
The stimulant you're talking about is pemoline (Cylert)... it's rough on your liver, though, and doesn't always work.
Posted by fallsfall on June 13, 2003, at 9:14:23
In reply to ok need input going to p-doc tommorrow, posted by Rainee on June 12, 2003, at 22:41:46
I take Provigil and Strattera (have to take them both, one or the other doesn't do it). They give me energy, motivation, initiative. I looked for over a year before I found them. I take them with Lithium and Prozac.
Good luck.
Posted by babak on June 14, 2003, at 6:13:14
In reply to Re: ok need input going to p-doc tommorrow » Rainee, posted by Ame Sans Vie on June 13, 2003, at 8:09:11
> As far as a mild stimulant is concerned, of course I'm going to recommend Mirapex. :-) It'll definitely get you out of your bed, out and about doing things with people--it may even help with the weight loss, if your problem is overeating (and not simply eating the wrong foods).
This question is for Ame Sans Vie. Can you tell me what dose of Mirapex you recommend. Since I believe this drug is for those with Parkinson and I assume a lower dosage is more appropriate in the case of depression.
Thanks
Babak
Posted by Ame Sans Vie on June 14, 2003, at 11:33:30
In reply to Re: ok need input going to p-doc tommorrow » Ame Sans Vie, posted by babak on June 14, 2003, at 6:13:14
> This question is for Ame Sans Vie. Can you tell me what dose of Mirapex you recommend. Since I believe this drug is for those with Parkinson and I assume a lower dosage is more appropriate in the case of depression.
Hi Babak,Actually, there was one study I read in which Prozac, Mirapex, and placebo were tested for depression. While there was more nausea approaching the upper dosage limits (5mg), it also mentioned a more pronounced antidepressant effect than those at the 1mg dose. And for the record, I take 4.5mg (1.5 three times daily) and the nausea went away within a week.
I'll post that study when I come across it again.
Posted by babak on June 14, 2003, at 21:52:24
In reply to Re: ok need input going to p-doc tommorrow » babak, posted by Ame Sans Vie on June 14, 2003, at 11:33:30
Thank you for your reply.
Can it be taken with Paroxetine (Paxil 30mg) as well?
Also how did you titrate to 4.5 and how long and at what dose did you start to get some effect.
I live in UK and it is very difficult to get the p-docs to try anything new especially when it is not directly related to depression.
I was on 225 Effexor & 45mg of Mirtazapine. I had this constant tension in my left side and I could never relax for about seven years. Since I have change to Paroxetine the body tension and headaches are a lot better but I am still very very lethargic and still have social phobia. I am looking for an stimulant which wont cause tension like bupropion does.
Thanks again
Babak
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
Posted by babak on June 17, 2003, at 10:15:16
In reply to Mirapex ('Mirapexin' in the UK) » babak, posted by Ame Sans Vie on June 15, 2003, at 5:46:17
I started on Mirapex yesterday and I have spent most of my time asleep. I have never seen anything to knock me out like this. Is this OK?
Will this go away?Thanks
Babak
Posted by Ame Sans Vie on June 17, 2003, at 10:45:34
In reply to Re: Mirapex ('Mirapexin' in the UK) » Ame Sans Vie, posted by babak on June 17, 2003, at 10:15:16
That's a perfectly normal reaction, and it should disappear with time--though it will return each time you raise the dose.
Which dose are you starting out on, by the way? Maybe it's too high.
Posted by babak on June 17, 2003, at 13:29:21
In reply to Re: Mirapex ('Mirapexin' in the UK) » babak, posted by Ame Sans Vie on June 17, 2003, at 10:45:34
I started on 3X0.25 but after 4 doses I couldn't handle it so I have reduced it to 3X 0.125.
Posted by McPac on June 19, 2003, at 2:42:10
In reply to Mirapex ('Mirapexin' in the UK) » babak, posted by Ame Sans Vie on June 15, 2003, at 5:46:17
Does Mirapex do anything for OCD?
Any studies saying so?
Thanks!
Posted by Ame Sans Vie on June 19, 2003, at 9:16:50
In reply to Ames, Re: Mirapex ('Mirapexin' in the UK), posted by McPac on June 19, 2003, at 2:42:10
> Does Mirapex do anything for OCD?
> Any studies saying so?
> Thanks!
Hi McPac,Sorry, but all the studies I've read regarding dopamine, dopamine agonists, and OCD suggest that dopamine-agonism is something you definitely want to avoid, unless your OCD is accompanied by tics. If I understand correctly, the main reason for this is that, in most OCD patients, norepinephrine levels are too high. SSRIs not only regulate serotonin, but also balance out the NE. However, dopamine turns into norepinephrine in the brain, so using a dopamine agonist would probably be a bad idea, unless it was at a low dose (maybe up to 0.25mg Mirapex three times a day).
All the research I came across suggested using dopamine *antagonists* (anti-psychotics) when necessary as adjuncts to primary OCD meds.
Posted by McPac on June 19, 2003, at 10:06:27
In reply to Re: Ames, Re: Mirapex ('Mirapexin' in the UK) » McPac, posted by Ame Sans Vie on June 19, 2003, at 9:16:50
Ames, Thanks for that great info! Much appreciared.
Posted by babak on June 19, 2003, at 10:20:23
In reply to Re: Mirapex ('Mirapexin' in the UK) » babak, posted by Ame Sans Vie on June 17, 2003, at 10:45:34
The sleepiness passed on so I increased my dose up to 3*0.5 a day, and I am already feeling the effects. I have a lot more emotions and I respond to stimuli like music again and more intensely that I have for years. I feel aroused as well not exactly sexually but as if my body is finally ready to do something. It reminds of when I took E some fifteen years ago. Is this stuff safe?
If it lasts, this could really help me get back to work and who knows may be even living once again. Should I increase the dose again in three days?
Posted by Ame Sans Vie on June 19, 2003, at 14:12:53
In reply to Ames, Re: Mirapex ('Mirapexin' in the UK), posted by McPac on June 19, 2003, at 10:06:27
Posted by Ame Sans Vie on June 19, 2003, at 14:18:38
In reply to Re: Mirapex ('Mirapexin' in the UK) » Ame Sans Vie, posted by babak on June 19, 2003, at 10:20:23
> The sleepiness passed on so I increased my dose up to 3*0.5 a day, and I am already feeling the effects. I have a lot more emotions and I respond to stimuli like music again and more intensely that I have for years. I feel aroused as well not exactly sexually but as if my body is finally ready to do something. It reminds of when I took E some fifteen years ago.
Great! Now you're starting to see how I feel now that I found this stuff!
>Is this stuff safe?
Well, because it's only been around since the mid-90s, it's impossible to say whether there could be any long-term effects from taking the drug. On the other hand, other dopamine agonists (Permax, Parlodel, et al) have been used safely for a good long time. And it's recently been shown that atypical antipsychotics like Zyprexa can lead to diabetes, yet many, many people still take them. So I wouldn't be concerned unless a new study is released saying it causes hepatitis or something. lol
> If it lasts, this could really help me get back to work and who knows may be even living once again. Should I increase the dose again in three days?Well, the general rule is to increase yor dose every week, but I of course didn't follow that schedule. Naturally, it's best to discuss this with your doctor, but in my experience, it seems logical to raise the dose once the nausea/sleepiness goes away from the former dose. That is, after all, the only reason for the slow titration--avoidance of side effects.
Keep me updated!
Posted by colin wallace on June 19, 2003, at 15:48:51
In reply to Re: Mirapex ('Mirapexin' in the UK) » babak, posted by Ame Sans Vie on June 19, 2003, at 14:18:38
Mirapex sounds promising.Has anyone been prescribed it for depression in the UK?
This being an 'off-label' use(I assume?), something tells me the chances of receiving it here for depression are slight at best.
Anyone had an experience to the contrary?
Posted by garylee on July 1, 2003, at 15:10:07
In reply to Re: Mirapex ('Mirapexin' in the UK), posted by colin wallace on June 19, 2003, at 15:48:51
Hi
Please read the thread below, hopefully you'll find it useful.
http://www.dr-bob.org/babble/20030624/msgs/237937.html
I've been taking Pramipexole (Mirapex) in the UK for 3 months now. My Pdoc is very open minded as far as experimenting with off label medication goes, as he sees I do my research well.
My bother is also taking a DA Agonist, Ropinerole, as an add on med. He's only been on it two weeks now, but seems to be responding fairly well.
Hope this helps.
Gary
P.S. The slow titration of Pramipexole (as far as I know) is not due to the nausea, but from the risk of psychosis... My doctor has known of Parkinsons patients who have become delusional, so take your time - don't let that put you off though, Mirapex has helped me significantly, so much so that I'm now back at work.
Posted by babak on July 1, 2003, at 21:22:39
In reply to Re: Mirapex ('Mirapexin' in the UK) » babak, posted by Ame Sans Vie on June 19, 2003, at 14:18:38
I have been on 4.5mg for two days and yes I do feel a substantial lift in my spirit and my libido is gradually returning but I have developed some pains which I hope will go away?
The other thing I have noticed is the return of tension I had when I was on Effexor.
I haven't told my doctor yet as they don't prescribe this drug in UK for depression.
I want to give it a full three months & see how it works out and then decide.
One other strange feeling I have noticed is the return of cravings I get for cigarettes after having given up smoking more than three months ago
Posted by garylee on July 5, 2003, at 19:15:46
In reply to Re: Mirapex ('Mirapexin' in the UK) » Ame Sans Vie, posted by babak on July 1, 2003, at 21:22:39
> I have been on 4.5mg for two days and yes I do feel a substantial lift in my spirit and my libido is gradually returning but I have developed some pains which I hope will go away?
I have no pains as such, though I have had a dull ache just below my shoulder and the bottom of my neck
> The other thing I have noticed is the return of tension I had when I was on Effexor.
Possibly reduce the dose, the tension could be (in lay mans terms) too much dopamine?
> I haven't told my doctor yet as they don't prescribe this drug in UK for depression.My doctor has prescribed it to me *off label* in the UK for 3 months now. If a medication works then who are they to say you can't have it?
> I want to give it a full three months & see how it works out and then decide.
I'd say the same.
> One other strange feeling I have noticed is the return of cravings I get for cigarettes after having given up smoking more than three months ago
This is usual with meds that affect dopamine, the majority of antipsycotic users are heavy smokers. Have have gone from not smoking to 10 - 15 a day! Though I have 'quit' today...Gary
Posted by babak on July 14, 2003, at 12:13:47
In reply to Re: Mirapex ('Mirapexin' in the UK), posted by garylee on July 1, 2003, at 15:10:07
Hi
I have been taking Mirapex with Paroxetine. Mirapex has really been helpful but now I am getting these sudden asleep feelings. It is not just that I feel sleepy but I actually fall asleep for a fraction of a second which is scary when I am driving. Is this effect dose related and why has it taken so long to appear.
Babak
Posted by babak on July 14, 2003, at 13:25:33
In reply to Re: Mirapex ('Mirapexin' in the UK), posted by garylee on July 1, 2003, at 15:10:07
I forgot to ask can anyone suggest an alternative to Mirapexin.
Babak
Posted by garylee on July 14, 2003, at 15:09:03
In reply to Re: Mirapex ('Mirapexin' in the UK), posted by babak on July 14, 2003, at 13:25:33
Hi
Try Requip (ropinerole). Same D2/D3 action as Mirapexin, without the noradrenergic receptor activity.
Gary
Posted by babak on July 17, 2003, at 6:57:48
In reply to Re: Mirapex ('Mirapexin' in the UK), posted by garylee on July 14, 2003, at 15:09:03
> Hi
>
> Try Requip (ropinerole). Same D2/D3 action as Mirapexin, without the noradrenergic receptor activity.
>
> GaryBut has it ever been used for treating depression or is it only used for PK?
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