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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 15 of 15. This is the beginning of the thread.
Posted by Flame on July 1, 2007, at 13:30:49
Okay .. yes, it's Flame posting, once again, in regards to her husband.
If you want (need?) LOL! to read previous posts by me .. with all of my laments, I believe you can do a search of my poster name "flame" and I'll bet they all come up.
After meeting with husband's doc early last week, I realized that his doc was not going to budge on changing anything in his prescription regimen .. UNTIL/UNLESS husband could go off alcohol for at least 4 weeks. He said that he couldn't (in good conscience) change anything unless he took the alcohol out of the picture. His psychiatrist SO thinks that the medications husband is on SHOULD be helping him, that he can't fathom husband's current issues being cause by anything other than the alcohol.
Husband is on Effexor 450mgs (for anxiety/depression) Provigil 200mgs(for daytime sleepiness and I guess this is ALSO supposed to help somewhat augment the Effexor)Mirapex 1 mg (for RLS) and Ambien 12.5 (for sleep).
I went to his doc advocating that he change husband's meds. My logic on this was that husband's VERY dramatic change in his drinking habits did not begin until six months after he began the above new(er) prescription regimen. Of course the psychiatrist did not agree with me. He told me that throughout these past three years he has advocated (even tried to help with supplying him with Campral) that he go off the alcohol .. if even for just a month. Well, he didn't and his doc is STILL advocating that he can't change anything until he does.
So .. after three years of enduring this and realizing that nothing is going to change, I stepped in. I showed up at husband's appt. .. much to his dismay. He was very angry at me. I think he was afraid that I was going to tell this doc his "secrets" in regards to some recent bizarre behaviours and things he has said in relationship to him finishing himself off. (This is one of his many forms of manipulation that he uses in on me.) Anyway, I must have done good, cause when we left his appointment, my husband actually thanked me for not causing trouble!
While there husband admitted that he could not stop drinking. Husband DID say that he would try to cut way back .. meaning that he would only drink in weekends. His doc did not think he could do this, but he said that if he COULD that certainly at least be an improvement.
So the doc gave my husband Campral to take throughout this. But, from what I have read about Campral .. you are really supposed to be trying very hard to get off alcohol totally while using this. Can anyone help me with this? I'm thinking that if my husband continues to drink (regularly) several times a week, this Campral will not help. (From what I have read anyway ..?)
My next question is in regards to Mirapex. Again .. I really need to be straightened out on this. The Mirapex works by mimicking the effects of dopamine in the brain. From what I understand it is supposed to up that dopamine in the brain .. thus giving more of a "feel good" response.
The Campral .. from what I understand is supposed to take away the "feel good" feeling that a person would get from the alcohol.
I know that this is very simplistic in the way I am describing these two. But from what I can gather, this is kind of the "jist" of these two .. isn't it? If this is correct, aren't these two (more or less) doing the opposite of each other?
Can someone help me get this straightened out in my mind?
Posted by Phillipa on July 1, 2007, at 15:52:48
In reply to Confused about Mirapex and Campral, posted by Flame on July 1, 2007, at 13:30:49
Hi Flame campral is helpful in the desire to drink and help with associated anxiety of not drinking. Has a good rep. The miramax is primarily for restless leg sydrome. How do they cancel each other out? Oh and with the campral groups like AA or counseling are advised. Best wishes Phillipa
Posted by Flame on July 1, 2007, at 16:49:26
In reply to Re: Confused about Mirapex and Campral » Flame, posted by Phillipa on July 1, 2007, at 15:52:48
"The Mirapex works by mimicking the effects of dopamine in the brain." From what I understand it is supposed to "up" that dopamine in the brain .. thus giving more of a "feel good" response.
"Acamprosate (Campral) has a structure similar to chemical transmitters (neurotransmitters) in the brain e.g. gamma aminobutyric acid (GABA). These neurotransmitters act by sending inhibitory messages to the brain, and acamprostate is thought to act by enhancing their inhibitory effects. It is also thought to oppose the action of certain amino-acids that send excitatory messages to the brain. As a result, there is a reduction in the desire or craving to consume alcohol, and hence its use in alcohol dependence."
The two paragraphs above (more or less) explain "how" the two medications work.
To me .. what it is saying is that Mirapex gives an individual more of the "feel good" feeling by mimicking the effects of dopamine.
The Campral actually "inhibits" the "excitatory" effects that a person will experience while drinking the alcohol. Thereby taking away the "feel good" feeling that the alcohol previously gave them.
I understand that Mirapex is a medication for Parkinson's and RLS .. but side effects caused by Mirapex have very definitely been proven to lead to compulsive tendencies. (Alcoholism as one of those?) The compulsive tendencies come on because of the increased dopamine that the Mirapex produces.
Anyway, I'm not sure that I've explained any better what I am getting at. In my frustration, what I am thinking/feeling is that my husband has become an alcoholic because of the drugs his psychiatrist put him on. (Is it because of the Effexor OR Mirapex? .. I'm not sure. Doc doesn't agree with me.) But, now husband's doc has given him the Campral that appears to work by taking away some of what the Mirapex is doing for him.
Maybe I am WAY off base with this. Please .. Anyone .. just pipe in and explain this to me. I really am wanting/needing to know.
Thanks,
Flame
Posted by Larry Hoover on July 2, 2007, at 10:22:22
In reply to Re: Confused about Mirapex and Campral, posted by Flame on July 1, 2007, at 16:49:26
> Maybe I am WAY off base with this. Please .. Anyone .. just pipe in and explain this to me. I really am wanting/needing to know.
>I shall try.
> "The Mirapex works by mimicking the effects of dopamine in the brain." From what I understand it is supposed to "up" that dopamine in the brain .. thus giving more of a "feel good" response.
It mimics dopamine. It does not stimulate natural dopamine in any way. Think of it as a forgery. Close enough to natural dopamine in structure that it tricks the dopamine receptors into acting as if they had actually come into contact with dopamine. More below.
> "Acamprosate (Campral) has a structure similar to chemical transmitters (neurotransmitters) in the brain e.g. gamma aminobutyric acid (GABA). These neurotransmitters act by sending inhibitory messages to the brain, and acamprostate is thought to act by enhancing their inhibitory effects. It is also thought to oppose the action of certain amino-acids that send excitatory messages to the brain. As a result, there is a reduction in the desire or craving to consume alcohol, and hence its use in alcohol dependence."
>
> The two paragraphs above (more or less) explain "how" the two medications work.
>
> To me .. what it is saying is that Mirapex gives an individual more of the "feel good" feeling by mimicking the effects of dopamine.
>
> The Campral actually "inhibits" the "excitatory" effects that a person will experience while drinking the alcohol. Thereby taking away the "feel good" feeling that the alcohol previously gave them.Campral mimics the calming effect of alcohol. Alcohol has complex actions. It would not be too much of an exaggeration to say that it distorts the effects of every neurotransmitter in the brain.
Overall, though, alcohol has a numbing effect. In some individuals, at some times, the numbing of inhibitory centres in the brain comes to the forefront, and you see exaggerated behaviour, a loss of control. But generally, it's an anaesthetic, a depressant. The brain can habituate to the numbing effect, and during times of abstinence, agitation grows. It grows so much that it exceeds the baseline level, called a rebound effect. Campral can provide some of the calming effect that an alcoholic's brain can no longer produce, giving it a chance to recover that capacity over time.
An example of the rebound effect is seen in people using nasal sprays (e.g. Dristan) to control a runny nose. If used for more than a couple of days, the tissues become dependent on the spray. If the person stops using it, their nose runs like a tap (the rebound phenomenon). If a person drinks to find calm, the rebound effect can leave them worse off than before they drank.....promoting further drinking. Campral mimics the calming effect of the drinking, without the intoxication.
Just as with Mirapex, though, the drug Campral acts as a forgery of existing neurotransmitters. Close enough in structure to trick the brain into thinking it's getting the real deal.
Now, the real neurotransmitter that Campral mimics is not GABA. It's taurine, a totally underappreciated neurotransmitter, IMHO. But it really doesn't matter.....if it works.
> I understand that Mirapex is a medication for Parkinson's and RLS .. but side effects caused by Mirapex have very definitely been proven to lead to compulsive tendencies. (Alcoholism as one of those?) The compulsive tendencies come on because of the increased dopamine that the Mirapex produces.Most certainly alcohol use can be induced by Mirapex. Gambling is also a known risk. Dopamine receptors come in different forms, and the specific dopamine receptors that are hit by Mirapex tend to be related to muscle control. But that's not really all that's affected. It's the cross-over to other dopamine receptors that likely underlies the adverse effects, which can include hallucinations, paranoia, and distorted thinking. It really could be thought of as drug-induced schizophrenia, sort of.
> Anyway, I'm not sure that I've explained any better what I am getting at. In my frustration, what I am thinking/feeling is that my husband has become an alcoholic because of the drugs his psychiatrist put him on. (Is it because of the Effexor OR Mirapex? .. I'm not sure. Doc doesn't agree with me.) But, now husband's doc has given him the Campral that appears to work by taking away some of what the Mirapex is doing for him.
>> Thanks,
> Flame
>
>In your other post you wondered if your husband had to quit drinking to obtain benefit from the Campral? Not literally. If it works, it works by lessening the craving that an alcoholic feels when he goes "dry". Hopefully, that gives the alcoholic longer periods of time of sobriety, and gives his brain a chance to recover. It's not enough to take drugs, though. There are some real psychological issues to be addressed, such as understanding the motivations for drinking in the first place, and how to find ways to manage those thoughts without resorting to a drink.
Lar
Posted by flame on July 2, 2007, at 11:40:22
In reply to Re: Confused about Mirapex and Campral » Flame, posted by Larry Hoover on July 2, 2007, at 10:22:22
Thanks Larry, for a very informative post. It is just what I needed.
Yes, I do know that my husband should be getting some kind of therapy to address "the" issues, but he refuses .. right now. (He has never been one for therapy, even in the past. Thus his "issues" are getting worse 'cause they were never addressed.)
After reading all of the internet info I really thought he would not get any help from the Campral unless he was truly trying to get off the alcohol. I could not understand why his psychiatrist would have him take the samples, if this was in fact the case. So .. your post helped in supporting the theory that he can possibly be helped, even if he is drinking three nights a week.
I can only hope that the Campral might help and he will curb his drinking enough to be able to see a bit more light in his situation.
Thanks for your support and for taking the time to reply in such detail.
Posted by hgi698 on July 2, 2007, at 19:22:50
In reply to Re: Confused about Mirapex and Campral » Larry Hoover, posted by flame on July 2, 2007, at 11:40:22
I would think the campral would be a partial substitute for the alcohol. It seems to block the nmda receptors but in a manner different from alcohol. Blocking nmda receptors usually leads to an antidepressant effects. I think it would be best for your husband to get of the mirapex because that definitely could worsen alcoholism. Has he tried the antidepressant wellbutrin? It is a dopamine/norepinephrine reuptake inhibitor. It is also used as an anti-addiction therapy like for smokers. It has also showed efficacy in decreasing restless legs (anything that increases dopamine ameliorates restless legs). I think wellbutrin would be a much better choice than mirapex.
Here's a website with stuff on mirapex:
http://www.yourlawyer.com/topics/overview/mirapexAnother website said this:
"People given dopamine agonists like pramipexole and ropinirole to battle Parkinson's disease were more likely to gamble compulsively, drink more, increase their spending,and become "hypersexual," researchers said. "
Here's the link:
http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/07/12/npark12.xml
Posted by Phillipa on July 2, 2007, at 21:28:54
In reply to Re: Confused about Mirapex and Campral, posted by hgi698 on July 2, 2007, at 19:22:50
Let me ask this then. Could someone like me who drank beer from there teens and 6l now and was drinking on benzos pdoc said okay. Now tolerant to benzos and dry ll years. Could campral take the place of a benzo for calming me down as the benzos are only keeping me out of withdrawal according to the board? Thanks Phillipa ps nothing at all to relieve anxiety.
Posted by cactus on July 3, 2007, at 20:28:08
In reply to Confused about Mirapex and Campral, posted by Flame on July 1, 2007, at 13:30:49
Wow interesting topic, I'm an alcoholic who is on ropinirole, similar to mirapex, for restless leg too. The thing that stands out to me the most is Efexor. While I was on efexor xr I craved alcohol more than anytime in my life and by the time I stopped taking it I keep drinking. Efexor DID NOT create my alcoholism, it just made it worse. There is also evidence that efexor should not be prescribed to patients with drug or alcohol problems/history and I don't know why this is.
I started ropinirole about 5 months ago and at first i drank more but people kept commenting on how good I was looking then something within in me gave me the courage to face my drinking problem. I might be wrong but I think that the ropinirole helped me achieve this. I have been sober for over 10 weeks now and yes it is very hard but it's not the craving for grog, it's the crazy thoughts that have been coming back which is why i drank in the first place. AA is good for some people, I have a love hate relationship with it at the moment but it is helping. I never took campral. If there is more I can help you with please feel free to babblemail me and I can explain my journey and what I went through. Don't forget that everyone is different with medication. I hope this helped you.
Posted by Flame on July 4, 2007, at 10:00:52
In reply to Re: Confused about Mirapex and Campral, posted by hgi698 on July 2, 2007, at 19:22:50
Hi HGI,
Well, my husband is now on the Campral. There has only been one day that he has taken the full "three times a day" prescription. It seems like he is only getting the suggested dosage twice daily.. when it is supposed to be the three times daily. He is getting the two dosages (that he does get) because I put it with his morning pills (than am gone at work for the day)and then I am (more or less) pushing it on him around supper time. I'm not sure if it will "work" .. after a period of time, with the just two times daily or not.
I so whole heartedly agree with you about trying to get him off the Mirapex. My husband (and I) are at all time highs of frustration levels (with each other!) I have told my husband we are out of money and I don't have any more that I can give him for his spending on alcohol. He truly about lost it, when I told him this. (I have been advocating that we were getting to that point for some time now, so it should NOT have been such a shock for him.) He more or less through an adult tantrum, telling me that he was not going to live this way. He went on and on .. even making some actual suicide threats. (He has verbalized these types of things before, but never done anything.)This time he took a bunch of pills. A number of Ambien pills and then others were just antibiotics. (I don't think he knew what he grabbed when he put them all in his mouth.) I am convinced that he did this as a way to get to me .. it didn't work. This happened a couple of nights ago and nothing happened as far as side effects from what he took. (I did pretty much figure out what he took and realized that all that would result from it is extreme sleepiness or a very upset stomach .. from the antibiotic capsules.)
Going into great detail about this 'cause I wanted to "vent" about how extreme he has gotten in regards to having/getting the money he needs to continue drinking in the manner that he needs/wants/is accustomed to.
The next day, husband profusely apologized to me and told me that he knew he just had to get a grip. Then comes the next day (last night). My husband calls me on my cell and tells me that he is supposed to meet his friend up at the bar and then go to a special biker function at another bar. I asked him if he had money to finance that. Husband lost it AGAIN! I told him that our checking account was bombarded with checks that he wrote three weeks ago at the local bar (it takes that long for them to put it through . I guess??) The total amount of all checks for one week was $300 .. which is a lot for us!
He didn't bat an eyelash when I told him about the checks (that I wasn't counting on) that came through. He just continued to tell me that he wasn't going to live like this. Because he doens't have the money he wants/ needs to drink, he says we are living in squalor.
As I said .. I am really ready to call it quits. There is NO talking to my husband,the way things stand right now.
Husband, of course, is very "addicted" to all the meds that he is currently on. There is NO WAY that he would consider going off these meds unless he psychiatrist would strongly recommend it. Husband's psychiatrist does not agree with me .. in that I think my husband's problems definitely stems from the meds he is on. (Mirapex or Effexor? .. I can't be sure) But it all began going very bad approximately six months after he began on his new medication regimen three years ago.
I don't believe that my husband has ever been prescribed Wellbutrin. Maybe in the future?
Currently, we (I?) have to wait a month to see if my husband can cut back on his alcohol. (Thus the Campral samples that was given to husband by psychiatrist.) Husband's psychiatrist is very adamant that he will not change anything in husband's medication regimen until he gets off (or cuts way back) on his drinking.
I am very seriously frustrated here . (Sigh ...)
Thanks for your response to my posts.
Flame
Posted by hgi698 on July 4, 2007, at 20:38:14
In reply to Re: Confused about Mirapex and Campral » hgi698, posted by Flame on July 4, 2007, at 10:00:52
I think effexor/ssri can definitely make alcoholism worse too. It seems very likely that it is either the effexor or the mirapex or the combination that is aggravating you husbands alcoholism. Wellbutrin is a decent antidepressant and is also good for attention problems, restless legs and addiction. I would definitely ask about it.
"Husband's psychiatrist is very adamant that he will not change anything in husband's medication regimen until he gets off (or cuts way back) on his drinking."
Sounds like he's a bad psychiatrist. If he was a good psychiatrist he would realize that it is likely that the previous meds probably lead to the drinking. I would get a new psychiatrist to be honest. He sounds like he is just giving too many meds to your husband. Sometimes adding more meds can just make things worse. At this point he is taking so many things it is hard to know what is doing what. I think it would be better to have your husband take a break from some of the drugs, just to get a feel for what they are doing. Mirapex doesn't have much withdrawal. He could try taking a break from that for a couple weeks (with doctors permission). What dose of effexor is your husband on? Maybe he could lower it a little. I know when I was on an ssri it really made me feel like drinking more. Your doctor is just ludicrous to say he will not change your husband's meds until he stops drinking. If the drugs are probably causing your husband to drink, how does that make any sense? It seems like this psychiatrist is just throwing meds at every problem your husband has. I am not anti drug at all, but I realize not everything needs a heavy duty medication.
You might want to read this article about polypharmacy. I put an excerpt of it below. It is about a girl who went to a psychiatrist and after 8 months was on a regimen of 8 medications. The gist of the story is that it was questionable whether she needed ANY medications at all. But as more medications were added more problems came up. Well, just read the story because I think it applies to your husband's case.Here's the link: http://www.preskorn.com/columns/9703.html
"A 17-year-old female became distressed after breaking up with her first boyfriend. She was taken by her mother to a senior psychiatrist in another community after she made superficial cuts on her arm. Her past psychiatric history was unremarkable. She had been an A and B student in school, but her grades had recently declined following the breakup. She had no truancy or disciplinary problems at school but had been more irritable and sullen at home. After 8 months of care she was on the following regimen:
Lithium 1200 mg/day
Carbamazepine 500 mg/day
Valproate 1750 mg/day
Fluoxetine 40 mg/day
Risperidone 3 mg/day
Benztropine 1 mg/day
Ranitidine 300 mg/dayShe came to our community for the summer to stay with her father, who requested a second opinion. The interview was difficult because the patient would fall asleep unless she was actively engaged and prompted by the interviewer. While the father was receptive to the recommendation to attempt to simplify the current regimen, her mother was convinced that her daughter would significantly deteriorate if any of the medications were stopped or even reduced."
Another article (Polypharmacy when is it rational)
http://www.preskorn.com/columns/9507.htmlMore articles:
http://www.preskorn.com/column1.htmlI think your husband's psychiatrist needs to read this guy's stuff.
Posted by hgi698 on July 4, 2007, at 21:30:48
In reply to Re: Confused about Mirapex and Campral, posted by hgi698 on July 4, 2007, at 20:38:14
I don't know your husbands full case, but here's how it could have happened.
Your husband goes in to see a psychiatrist because he's depressed. The psychiatrist gives him a prescription for effexor. Okay so your husband feels better. But suddenly he begins to have insomnia (side effect of ssri's) So the psychiatrist gives him a prescription for ambien. Then afterwards your husband begins to feel tired during the day (side effect of ambien or ssri) so the psychiatrist gives him a prescription for provigil to stay awake. Then your husband says he thinks he has "restless legs" (side effect of ssri or maybe ambien). So your doctor gives him a prescription for mirapex. Then after a med change your husband starts to drink (side effect of mirapex, ambien, effexor or who the hell knows?). Your psychiatrist then gives him campral to combat the drinking. Okay I don't know if this is your husbands exact story, but I hope I have made my point. See how ludicrous this can be.
Maybe your husband didn't even need the effexor in the first place (or whatever his first drug was). Maybe he could have gotten more exercise, eaten omega 3 fatty acids, taken a B vitamin etc. (these things have been proven to help) Psychiatrists can sometimes get carried away. Drugs can be helpful, but there are also lifestyle changes which can also have a beneficial effect.
Alcholism will just make any mental condition much worse. You MUST get your husband off the alcohol as it will definitely worsen any mental issues he has.
Throwing more drugs at a problem does not always work. It can make things worse. If your psychiatrist doesn't understand this then FIND A NEW ONE THAT DOES. Your husband is just trapped in a vicious cycle. Psychiatric drugs that make him drink alcohol, then alcohol exacerbates his problems which make him need more psychiatric drugs.
Remember, doctors are not gods. They don't know everything and they make mistakes.
I think your husband should lower the effexor dose, drop the mirapex and try as hard as he can to quit drinking alcohol. Then get some exercise (preferably jogging). Eat more fish (or omega 3 fatty acids). Take a B-vitamin, drop the effexor altogether if possible. Get cognitive behavioral therapy if he has psychological issues (a regular talk therapist is useless). If he has negative thinking patterns he needs them to be changed. He doesn't need to talk about his problems incessantly. If he still needs an antidepressant then I would ask about wellbutrin. Wellbutrin could replace the provigil. It might also help your husband to stop smoking. Ideally your husband would need no drugs. But try aiming for only one or two.
Increasing serotonin can be good for decreasing depressive feelings like (crying, sadness, hopelessness) but it can also increase addictive behaviors (by decreasing dopamine).
Wellbutrin would take care of the dopamine/norepinephrine. Not many supplements are very effective at raising dopamine naturally.
If your husband was still sad he could take 5-htp (precursor for serotonin sold over the counter), a B vitamin, or omega 3. Omega 3 can effect both dopamine and serotonin, but I found it more serotonergic. Serotonin is much easier to raise by natural methods than dopamine. Just be careful because too much serotonin can lead to addictive behaviors while too little will lead to depression.
Exercise in general can be very good at improving depressive symptoms. Just a warning though, I happen to be a case where exercise makes my mental condition worse, so ANYTHING can happen.
I would have your husband write a journal to document any behavioral changes that occur when he undergoes a med change. Like a detailed one (how many drinks he had, how many times he ate, thoughts, feelings etc.) This could help him determine what is doing what.
Posted by Flame on July 7, 2007, at 10:04:57
In reply to Re: Confused about Mirapex and Campral » Flame, posted by cactus on July 3, 2007, at 20:28:08
Hi Cactus,
I received your babble mail and tried to respond. It keeps saying there is some type of error. Is it (possibly) in your settings for babble mail?
Thanks for the info and your support.
Best,
Flame
Posted by Flame on July 7, 2007, at 10:07:33
In reply to Re: Confused about Mirapex and Campral, posted by hgi698 on July 4, 2007, at 21:30:48
Hi hg,
Wow! In my opinion you have hit the nail on the head in your description of my husband's "history"!
I am short on time right now, but wanted to acknowledge your great responses to me. I will be back to post more in response to YOUR thoughtful posts.
Best,
Flame
Posted by cactus on July 8, 2007, at 0:32:39
In reply to Re: Confused about Mirapex and Campral » cactus, posted by Flame on July 7, 2007, at 10:04:57
> Hi Cactus,
>
> I received your babble mail and tried to respond. It keeps saying there is some type of error. Is it (possibly) in your settings for babble mail?
>
> Thanks for the info and your support.
>
> Best,
> Flame
Hi flame I just had the same problem but it's fixed now, I had to get a new confirmatiom code and my babble mail is on
Posted by cactus on July 8, 2007, at 0:59:02
In reply to Re: Confused about Mirapex and Campral » cactus, posted by Flame on July 7, 2007, at 10:04:57
Also if you haven't already tried this give it a go. Just under the topic heading on this page, my name will appear in blue. Click on this and I should get your babble mail.
This is the end of the thread.
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