![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by dopaminerequiem on August 22, 2007, at 21:53:14
When I first found Parnate, it was a miracle drug. I was taking 120 mg/day for treatment-resistant depression [and I was more than just "asymptomatic" - I was HAPPY!], body dysmorphic disorder [which disappeared completely for the first time in my life, freeing me from the biggest trigger for my anorexia nervosa and enabling me to stay out of the hospital and eat relatively normally for almost a year], and borderline personality disorder [and I found that I had much less mood reactivity, urges to self-injure, abandonment issues, etc.]
It was also a miracle because all SSRIs and SNRIs cause me to wet the bed which is NOT a side effect I am willing to deal with and most mood stabilizers and antipsychotics and benzos have caused this to happen, too - so not only did Parnate "cure" my depression/BDD/much of my BPD, it also "cured" my bladder issues and enabled me to take sleeping meds I NEVER could have taken without it. I have NO idea why this is. It also happened on high-dose Adderall [not an option; behavioral sensitization is apparently irreversible, as even low dose Dexedrine has me paranoid].
It was like the perfect drug. And then the insomnia hit like a tornado, even worse than the last time I'd been on Parnate. And, because each sleeping medication would work and then become totally ineffective, I found myself on this merry-go-round of sleeping meds. And then suddenly, I developed hypersomnia. To this day, I don't know if it was indicative of a depressive episode, being on too many sleeping medications, or a paradoxical response to either benzodiazepine withdrawal OR high-dose Parnate.
Side Note: It has taken me three months to go from 0.5 mg Halcion to 0.125 mg, by the way. A drug I once exalted as the cure to my insomnia turned viciously on me and the prescription is now a chain hanging around my leg.
Anyway, my borderline symptoms certainly came back, prompting my (now-ex-)girlfriend to break up with me, which then induced an unmistakable depressive episode (if the hypersomnia was due to another factor, which is still debatable). Because I was in danger of losing my job - I literally would wake up at 5:00 p.m. and go back to sleep at 9:00 p.m. - I tapered the Parnate to 60 mg, which didn't stop it from happening. And then I sought out Dexedrine from a source other than my doctor. However, when she saw how it improved my mood AND enabled me to wake up in the morning, she wrote a prescription.
She left for her vacation and will be back after Labor Day. When she left, I was taking 60 mg Parnate, 2.5 immediate-release Dexedrine, 5 mg extended-release Dexedrine, 30 mg Librium (down from 60 mg), 0.125 mg Halcion (down from 0.5 mg), 10 mg Ambien, and 25 mg Seroquel.
Parnate seemed to be no longer doing what it had magically done before, despite adding the Dexedrine. I still felt dysthymic, though not in a severe depressive episode anymore. My body dysmorphic disorder returned violently. Mood swings like crazy. Abandonment issues overtaking my life.
I decided to taper off of Parnate so by the time she returned I would have had the two-week washout and could try a SSRI with Dexedrine, since amphetamines have, in the past (albeit at high doses), "cured" my bladder as well. Of course, there was that little problem of stimulant addiction, too, though I am happy to say I am not abusing Dexedrine at all and am having it doled out to me weekly by a family member to prevent abuse.
This was one of the stupidest things I have ever done. Now I am back to being in a severe depressive episode, the Dexedrine is actually worsening my mood swings without anything to "stabilize" it, I am feeling extremely suicidal and totally hopeless and I can't imagine that anyone has ever experienced such depths of self-hatred.
Can I ever be on a medication that will actually last? If I do return to high dose Parnate, can I take Dexedrine with it or would that be too dangerous? If not, then how can I make Parnate "work" again? What about the insomnia/hypersomnia mess?
Or should I forget Parnate and try Nardil (though I am terrified of the weight gain associated with it and will cold-turkey it immediately if the scale climbs too high), perhaps with Dexedrine to prevent oversedation and (maybe) weight gain?
But I am convinced that I need a dopaminergic drug; I know that this is the source of my depression. The only other medication that EVER worked for me was Zoloft, which is profoundly dopaminergic, moreso than Wellbutrin. And I've tried all of the bladder drugs with Zoloft; it just doesn't stop the bedwetting.
EMSAM didn't work. Wellbutrin caused bedwetting. No doctor in the world could make me take Remeron. Tricyclics make me extremely irritable, plus there's the weight gain issue. I was stable on Desipramine, Trileptal, and Seroquel at one point (and was anorexic during this time; it's the one TCA that didn't make me gain weight) but how can one compare STABILITY with HAPPINESS? How can I give up what I know can be possible, the person I know I was meant to be my entire life, the person I was on Parnate, for mere stability?
Does anyone remain on MAOIs for long periods of time? Will I always have to be tip-toeing around sleeping medication and waking-up medication and augmenting medication if I continue to take Parnate?
Please help. My doctor has seen me through so many medication trials. I'm in my mid-twenties and there are no medications left to try. I can't live like this. I just want to be happy again. I just want to look in the mirror and not collapse into tears and be able to go outside without hearing people talk about how ugly I am again. I want my smile to be genuine again.
I can't go back to being just "asymptomatic." Not when I have known true happiness. I thought, for so long, that I was not meant to live a full life, a life like other people, a life of happiness. And then Parnate came along and changed my entire world. I can't go back to flatness, to defining my life by what it is "not" instead of what it IS.
Please tell me how I can try and find a long-term solution. I am not asking for euphoria. If I wanted euphoria, I'd abuse illicit drugs like I used to. I want the kind of happiness that exists without ups and downs, without you really even noticing that it's happening until one day you find that you are an actual human being again and you have no idea how it happened but it feels magical.
Sorry this was so long. I searched and searched for words to convey my desperation but I don't know if I even came close.
Posted by polarbear206 on August 22, 2007, at 23:54:12
In reply to Parnate/Dexedrine/500 sleeping meds, please help, posted by dopaminerequiem on August 22, 2007, at 21:53:14
Hi,
All of your symptoms indicate that you "could" have an underlying bipolar spectrum disorder. I would ditch the stimulants, they just exacerbate your moods. Switch to Nardil because it is less likely to induce cycling. Lamictal is a great mood stablizer, with no bothersome side effects. You could also try to increase the Seroqel and remain on the Parnate and see what happens. I wouldn't rely on sleeping meds. You can use a benzo, like klonopin when needed for sleep. You are taking too many meds and thus probably causing interactions and mood cycling.
http://www.psycom.net/depression.central.lieber.html
Polarbear
Posted by Quintal on August 23, 2007, at 1:45:02
In reply to Parnate/Dexedrine/500 sleeping meds, please help, posted by dopaminerequiem on August 22, 2007, at 21:53:14
I had my best response ever to a cocktail of Parnate, Klonopin and Lamictal. I know you've taken Lamictal already though - what happened with that? How about lithium as an augmenter/mood stablilizer?
How do you respond to opiates? It sounds as though you're getting to the point where bupe might be a reasonable option, at least for a while, until you regain your tolerance(?) to Parnate. I have similar 'issues' with BPD and substance misuse, and opiates have been very helpful. The small amounts of codeine in OTC products has kept me well and functioning for about a year now, but tolerance is fast gaining ground of course. They seem to have mood-stabilizing, antidepressant and anxiolytic effects. I've also found opiates helpful with rage - they have a pacifying at-pace-with-the-world effect, whereas benzos, although they got rid of my anxiety, were often like throwing petrol on glowing embers. They're also highly dopaminergic, obviously.
Have you ever tried a dopamine agonist? Mirapex has shown robust effects as a mood stabilizer and antidepressant in bipolar disorder, and it's safe to take it with Parnate. Might be helpful as an augmentation strategy?
Q
Posted by jhj on August 23, 2007, at 8:22:22
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he » dopaminerequiem, posted by Quintal on August 23, 2007, at 1:45:02
Hi Quintal,
What do you mean by trying opiates? They are illegal drugs.I thought they are illegal in India Only but i have seen articles in famous journals like "science" too describing them as illegal drugs. Not only that i have seen articles on financing of terror strikes.I have read that money comes through traffiking and smuggling of illegal drugs and opiates were there in the list.
Posted by dopaminerequiem on August 23, 2007, at 9:46:40
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he » dopaminerequiem, posted by Quintal on August 23, 2007, at 1:45:02
> I had my best response ever to a cocktail of Parnate, Klonopin and Lamictal. I know you've taken Lamictal already though - what happened with that? How about lithium as an augmenter/mood stablilizer?
>
> How do you respond to opiates? It sounds as though you're getting to the point where bupe might be a reasonable option, at least for a while, until you regain your tolerance(?) to Parnate. I have similar 'issues' with BPD and substance misuse, and opiates have been very helpful. The small amounts of codeine in OTC products has kept me well and functioning for about a year now, but tolerance is fast gaining ground of course. They seem to have mood-stabilizing, antidepressant and anxiolytic effects. I've also found opiates helpful with rage - they have a pacifying at-pace-with-the-world effect, whereas benzos, although they got rid of my anxiety, were often like throwing petrol on glowing embers. They're also highly dopaminergic, obviously.
>
> Have you ever tried a dopamine agonist? Mirapex has shown robust effects as a mood stabilizer and antidepressant in bipolar disorder, and it's safe to take it with Parnate. Might be helpful as an augmentation strategy?
>
> QLamictal caused bedwetting. But if I were taking Parnate, I could probably take it. However, I have an underlying chronic insomnia that started at age five [I was actually diagnosed with this at the age of five, primary insomnia, but not medicated until 16 - so many nights spent staring at the ceiling waiting for my mother or father to "wake me up" for school] so I do need some kind of sleeping medication.
I agree with benzos - once I am off Halcion, the Librium taper will be a breeze in comparison. I certainly do NOT want to take benzos any more. Ambien + Ambien CR (one to help with falling asleep, one to help with staying asleep) + Seroquel worked at one point with Parnate.
I can't take opiates because I am a former heroin addict. Pretty severely so.
My doctor has sent me to all kinds of specialists and one recommended Requip for sleep with the Parnate. Has anyone heard of this? Would it augment the Parnate?
What about Abilify?
Posted by dopaminerequiem on August 23, 2007, at 9:50:44
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please help, posted by polarbear206 on August 22, 2007, at 23:54:12
> Hi,
>
> All of your symptoms indicate that you "could" have an underlying bipolar spectrum disorder. I would ditch the stimulants, they just exacerbate your moods. Switch to Nardil because it is less likely to induce cycling. Lamictal is a great mood stablizer, with no bothersome side effects. You could also try to increase the Seroqel and remain on the Parnate and see what happens. I wouldn't rely on sleeping meds. You can use a benzo, like klonopin when needed for sleep. You are taking too many meds and thus probably causing interactions and mood cycling.
>
> http://www.psycom.net/depression.central.lieber.html
>
> PolarbearI've been evaluated for bipolar disorder several times; the consensus is always that it's borderline personality disorder. The reason we even tried Parnate to begin with is because of that one paper in the literature remarking on the profound response borderline patients had with Parnate.
My problem with Nardil is the weight gain issue; I will relapse into anorexia if my weight starts climbing, which is why Zyprexa (though it was a great medication to calm me down, for about a week, until I realized I had gained 5 lbs that week alone and stopped it) is on my "black list."
Also, I have no issues with anxiety. I have never responded positively to GABAergic drugs. They have made me sleepy and amotivated. It's only the dopaminergic ones that induce ANY response at all, even if it isn't lasting.
Posted by dopaminerequiem on August 23, 2007, at 9:57:32
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he, posted by jhj on August 23, 2007, at 8:22:22
>
> Hi Quintal,
> What do you mean by trying opiates? They are illegal drugs.I thought they are illegal in India Only but i have seen articles in famous journals like "science" too describing them as illegal drugs. Not only that i have seen articles on financing of terror strikes.I have read that money comes through traffiking and smuggling of illegal drugs and opiates were there in the list.I believe Quintal is referring to drugs like Bupenorphine, Oxycodone, Hydrocodone, morphine - in other words, prescription opiates (Schedule II drugs, for the most part). These are different from heroin and opium, which are Schedule I (completely illegal in all circumstances) drugs.
I couldn't take an opiate without running right back to heroin, unfortunately. I've found that sometimes 10 mg Librium (which is a baby dose) does help to smooth out my mood during the day. But I also wasn't mood-cycling when I was on Parnate & it was working.
Posted by dopaminerequiem on August 23, 2007, at 10:06:16
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please help, posted by polarbear206 on August 22, 2007, at 23:54:12
Parnate was like an antidepressant and a mood stabilizer. I didn't have true mood cycling on it for at least six months, just sleeping issues.
I am wondering if maybe when I taper the benzodiazepines, I will be able to feel the full effect of Parnate again. I have always responded badly to benzodiazepines. Xanax and Ativan (taken illegally) prompted several hospitalizations and a million horrifyingly embarrassing acts that I only remember bits and pieces of.
I do know that my (at-times) EXTREMELY high dose Xanax usage was the culprit for severe depression. It's possible that being on the maximum dose of Halcion, plus Ativan somewhere there in the middle (discontinued shortly after I kept taking more and more pills and ended up sleeping with one of my friends and then spending a week in bed, hysterically sobbing), plus Librium, has not been good for my overall mood stability at all.
Actually, now that I think about it, the mood issues began when I started taking benzodiazepines. That's when Parnate became less effective. I still have no answer for the insomnia PLUS hypersomnia debacle.
Posted by Quintal on August 23, 2007, at 10:48:46
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he, posted by dopaminerequiem on August 23, 2007, at 9:46:40
>I can't take opiates because I am a former heroin addict. Pretty severely so.
Ahh, I think understand why :o) Well, the interesting thing is that when I ran out of codeine a few months ago I discovered quite by accident that Mirapex suppressed my withdrawal symptoms. It reminded me of the 'nodding phase' of opiate intoxication. This inspired me to do a bit of research, and this is what I found:
http://www.dr-bob.org/babble/20070730/msgs/773860.htmlI don't think Requip or Mirapex would be an effective monotherapy for insomnia. Although sleep attacks are a common side effect at high doses, dopamine agonists are not sedatives as such and they won't reliably put you to sleep on demand as conventional hypnotics (can) do. I think Requip and Mirapex are the only dopamine agonists considered suitable for everyday use in non-Parkinson's patients, because the ergot-derived ones have been associated with fibrotic reactions and cardiac valve defects.
There seems to be more research on efficacy of pramipexole (Mirapex) in mood and anxiety disorders at present, but ropinirole too has shown robust effects in clinical trials in those conditions, and antidepressant-induced sexual dysfunction.
__________________________________________________1: CNS Spectr. 2006 Mar;11(3):172-5.Links
Pramipexole: augmentation in the treatment of depressive symptoms.
Gupta S, Vincent JL, Frank B.Department of Psychiatry, University of Buffalo School of Medicine, USA. sgupta1@adelphia.net
We describe a retrospective case series of three patients, two with bipolar depression and one with unipolar depression. Pramipexole is a Food and Drug Administration-approved antiparkinsonian agent, which, when used to augment antidepressants, would be considered an off-label use and should be discussed with the patient. These patients had robust responses to pramipexole augmentation of their treatment regimen. All three patients had been taking an atypical antipsychotic. The depressive symptoms were evaluated using the Hamilton Rating Scale for Depression.
PMID: 16575373 [PubMed - indexed for MEDLINE]
--------------------------------------------------2: Biol Psychiatry. 2004 Jul 1;56(1):54-60.Click here to read Links
Pramipexole for bipolar II depression: a placebo-controlled proof of concept study.
Zarate CA Jr, Payne JL, Singh J, Quiroz JA, Luckenbaugh DA, Denicoff KD, Charney DS, Manji HK.Laboratory of Molecular Pathophysiology, Mood and Anxiety Disorders Program, National Institute of Mental Health, National Institute of Health, Department of Human and Health Services, Bethesda, Maryland, USA.
BACKGROUND: The original serotonergic and noradrenergic hypotheses do not fully account for the neurobiology of depression or mechanism of action of effective antidepressants. Research implicates a potential role of the dopaminergic system in the pathophysiology of bipolar disorder. The current study was undertaken as a proof of the concept that dopamine agonists will be effective in patients with bipolar II depression. METHODS: In a double-blind, placebo-controlled study, 21 patients with DSM-IV bipolar II disorder, depressive phase on therapeutic levels of lithium or valproate were randomly assigned to treatment with pramipexole (n = 10) or placebo (n = 11) for 6 weeks. Primary efficacy was assessed by the Montgomery-Asberg Depression Rating Scale. RESULTS: All subjects except for one in each group completed the study. The analysis of variance for total Montgomery-Asberg Depression Rating Scale scores showed a significant treatment effect. A therapeutic response (>50% decrease in Montgomery-Asberg Depression Rating Scale from baseline) occurred in 60% of patients taking pramipexole and 9% taking placebo (p =.02). One subject on pramipexole and two on placebo developed hypomanic symptoms. CONCLUSIONS: The dopamine agonist pramipexole was found to have significant antidepressant effects in patients with bipolar II depression.
PMID: 15219473 [PubMed - indexed for MEDLINE
--------------------------------------------------3: Bipolar Disord. 2002 Oct;4(5):307-14.Click here to read Links
Pramipexole in treatment-resistant depression: a 16-week naturalistic study.
Lattanzi L, Dell'Osso L, Cassano P, Pini S, Rucci P, Houck PR, Gemignani A, Battistini G, Bassi A, Abelli M, Cassano GB.Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, University of Pisa, Italy. paolo.cassano@psico.med.unipi.it
OBJECTIVE: To assess the antidepressant efficacy and tolerability of adjunctive pramipexole, a D2-D3 dopamine agonist, in patients with drug-resistant depression. METHODS: The study sample consisted of in-patients with major depressive episode, according to the DSM-IV, and drug resistance. Pramipexole was added to antidepressant treatment with TCA or SSRI, at increasing doses from 0.375 to 1.0 mg/day. Two independent response criteria were adopted: a > 50% reduction of the Montgomery-Asberg Depressive Rating Scale (MADRS) total score and a score of I or 2 on the Clinical Global Impression scale (CGI-1) at endpoint. Side-effects were assessed by the Dosage Record Treatment Emergent Symptom Scale (DOTES). RESULTS: Thirty-seven patients were enrolled. Of these. 16 had unipolar depression and 21 had bipolar depression. Six patients dropped out in the first week. Of the 31 patients included in the analyses. 19 completed the 16-week follow-up. Mean maximal dose of pramipexole was 0.95 mg/day. Mean scores on MADRS decreased from 33.3 +/- 8.4 at baseline to 13.9 +/- 11.5 at endpoint (p < 0.001) and the CGI-S decreased from 4.6 +/- 0.8 at baseline to 2.8 +/- 1.3 at endpoint (p < 0.001). At endpoint, 67.7% (21/31) of patients were responders on MADRS and 74.2% on CGI-I. Of the 37 patients enrolled, 10 discontinued pramipexole because of adverse events. CONCLUSIONS: These preliminary data suggest that pramipexole adjunction to antidepressant treatment may be effective and well tolerated in patients with resistant major depression.
PMID: 12479663 [PubMed - indexed for MEDLINE]
--------------------------------------------------4: Am J Psychiatry. 2004 Mar;161(3):564-6.Click here to read Links
Preliminary randomized, double-blind, placebo-controlled trial of pramipexole added to mood stabilizers for treatment-resistant bipolar depression.
Goldberg JF, Burdick KE, Endick CJ.Department of Psychiatry, Weill Medical College of Cornell University, New York, NY, USA. jgoldber1@lij.edu
OBJECTIVE: Previous studies suggest that the dopamine agonist pramipexole may possess antidepressant properties. The authors conducted a preliminary randomized, placebo-controlled trial to determine the safety and antidepressant efficacy of pramipexole in treatment-resistant bipolar depression. METHOD: Twenty-two depressed outpatients with DSM-IV nonpsychotic bipolar disorder were randomly assigned to receive placebo or flexibly dosed pramipexole (mean maximum dose=1.7 mg/day, SD=1.3) added to existing mood stabilizers for 6 weeks. The primary outcome measure was response, defined as improvement in Hamilton Depression Rating Scale score of 50% or more over the baseline score; secondary analyses involved changes in Clinical Global Impression (CGI) severity scores. RESULTS: More patients given pramipexole (10 [83%] of 12) than patients given placebo (six [60%] of 10) completed the study. Eight (67%) of 12 patients taking pramipexole and two (20%) of 10 taking placebo had an improvement of at least 50% in their Hamilton depression scale scores. The mean percentage of improvement from baseline Hamilton depression scale scores was greater for patients taking pramipexole (48%) than for those taking placebo (21%). Mean improvements in CGI severity were also greater with pramipexole than placebo. No patients discontinued the study because of adverse events except for one patient who became hypomanic while taking pramipexole. CONCLUSIONS: Pramipexole was a safe and effective antidepressant among patients with bipolar depression. Larger randomized, controlled trials are needed to affirm these initial observations.
PMID: 14992985 [PubMed - indexed for MEDLINE]
--------------------------------------------------5: Depress Anxiety. 2004;20(3):131-8.Click here to read Links
Pramipexole in treatment-resistant depression: an extended follow-up.
Cassano P, Lattanzi L, Soldani F, Navari S, Battistini G, Gemignani A, Cassano GB.Department of Psychiatry, Neurobiology, Pharmacology and Biotechnology, University of Pisa, Pisa, Italy. pcassano@partners.org
We evaluated the long-term antidepressant safety and response of adjunctive pramipexole, a D2-D3 dopamine agonist, in the course of drug-resistant depression. Twenty-three patients with treatment-resistant major depressive episode (MDE) were followed up after a 16-week pramipexole add-on trial. Pramipexole was added to current treatment with TCA or SSRI, at increasing doses from 0.375-1.500 mg/day. The LIFE scale was administered at baseline of the acute trial, at Weeks 16, 32, and 48. Patients were analyzed for sustained remission (score= <2 at LIFE for at least 8 weeks) and recurrence (after remission score > =3 at LIFE for at least 2 weeks) of depression. Of 23 patients, 12 had major depression and 11 had bipolar depression (16 women; mean age=52.8 years). Mean age of onset and median duration of current MDE were 35.1 years and 6 months, respectively; all subjects had at least two prior MDEs. Mean pramipexole dose was 0.990 mg/day. Median duration of follow-up was 28 weeks. Mean baseline MADRS and CGI-S scores were 33.7+/-8.4 (sd) and 4.6+/-0.8, respectively. Median time to sustained remission from baseline was 10 weeks and overall 60.9% (14/23) of subjects recovered within Week 22. Recurrence of depression occurred in 35.7% (5/14) of remitters after Week 24 and within Week 28 from remission. Although there were no sleep attacks, two cases of hypomania and one case of psychotic mania occurred at Weeks 22, 24, and 30, respectively. Pramipexole augmentation of antidepressant treatment was relatively safe and presumably effective in the long-term course of treatment resistant depression. (c) 2004 Wiley-Liss, Inc.
PMID: 15549689 [PubMed - indexed for MEDLINE]
--------------------------------------------------6: Depress Anxiety. 2000;11(2):58-65.Click here to read Links
Comparison of pramipexole, fluoxetine, and placebo in patients with major depression.
Corrigan MH, Denahan AQ, Wright CE, Ragual RJ, Evans DL.Pharmacia & Upjohn, Inc., Global Clinical Research, Bridgewater, NJ 08807-0995, USA.
Pramipexole, a dopamine D2 receptor agonist, was tested in 174 patients with major depression, with or without melancholia and without psychotic features. Three daily dose levels (0.375 mg, 1.0 mg, and 5.0 mg) were compared to fluoxetine (Prozac) at 20 mg and placebo in a randomized, double-blind, parallel-group study. After a 1 week placebo run-in period, patients were treated for 8 weeks, had a post-study follow-up (week 9), and were evaluated primarily with the Hamilton Psychiatric Rating Scale for Depression (HAM-D), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinician's Global Impressions-Severity of Illness scale (CGI-SI). All patients who received one dose of study medication were included in the observed-case analysis (no missing data were replaced). Results indicated that by endpoint (week 8), patients receiving pramipexole at the 1.0 mg per day dose had significant improvement over baseline compared to the placebo group by measure of the HAM-D, MADRS, and CGI-SI. Significant improvement in this dose group was seen at other timepoints as well. The most obvious improvement was seen in the pramipexole 5.0 mg group, although a substantial dropout rate for this group precluded statistical tests vs. placebo late in the study. Patients taking fluoxetine also showed significant improvements at endpoint on the MADRS and earlier in the study on the HAM-D. No new or unusual safety concerns were generated during this study. Pramipexole helped safely alleviate the symptoms of depression at 1.0 mg per day and especially in those patients who could tolerate the escalation to 5 mg per day.
PMID: 10812530 [PubMed - indexed for MEDLINE]
--------------------------------------------------7: Pharmacopsychiatry. 2001 Jul;34(4):137-41.Links
Adjunctive dopamine agonists in treatment-resistant bipolar II depression: an open case series.
Perugi G, Toni C, Ruffolo G, Frare F, Akiskal H.Department of Psychiatry, University of Pisa, Italy. gperugi@psico.med.unipi.it
OBJECTIVE: Previous studies and case observations have suggested that dopamine agonists (DAAs) such as pramipexole (PPX) and ropinirole (RPN) might be effective for major depression, but their adjunctive use in treatment-resistant bipolar II depression has not yet been specifically addressed. METHOD: A chart review was conducted on 18 patients with a DSM-III-R bipolar NOS (Bipolar II) major depressive episode who were admitted to the day-hospital of the Department of Psychiatry at the University of Pisa. DAAs were added to ongoing treatments with conventional antidepressants and mood stabilizers to which patients had no responded after a period of at least 8 weeks. Clinical state and adverse effects were assessed at each visit. Final improvement in CGI scores of 1 or 2 were considered as responders. RESULTS: Mean DAA trial duration was 17.6 (sd = 7.8, range 4-34) weeks, with a mean final dose of 1.23+/-0.32 mg/day (range, 0.75-1.50mg/day) for PPX, and 2.97+/-0.99mg/day (range, 1.50-5.00mg/day) for RPN. DAAs were well tolerated and did not show any negative interaction with concomitant psychotropic medications. Only one patient became worse (final CGI = 5), and had to interrupt PPX due to nausea, increased agitation and irritability. Eight patients (44.4%) were considered responders (4 with PPX and 4 with RPN): 5 showed marked improvement (CGI = 1), and 3 showed moderate improvement (CGI = 2); another 5 (27.8%) manifested a transient response not sustained up to the end. The initial and final scores of CGI severity scale for all patients (responders and non-responders combined) were, respectively, 5.33+/-0.7 and 3.94+/-1.3 (mean +/- S.D). The mean change according to the CCI severity scale was statistically significant (t=4.74. p < 0.0002). CONCLUSION: From the results, PPX and RPN appear to be well tolerated and potentially useful in the adjunctive treatment of drug-resistant bipolar II depression.
PMID: 11518474 [PubMed - indexed for MEDLINE]
--------------------------------------------------8: Nervenarzt. 2007 Jan;78(1):31-8.Click here to read Links
[Antidepressant effects of dopamine agonists : Experimental and clinical findings.]
[Article in German]Lemke MR.
Rheinische Kliniken Bonn, Kaiser-Karl-Ring 20, 53111, Bonn, Deutschland, mr.lemke@lvr.de.
Results of preclinical and clinical studies implicate that, in addition to serotonin and norepinephrin, dopaminergic mechanisms play a role in the pathogenesis and treatment of depression. Newer antidepressants such as bupropion, sertraline, and venlafaxine act as partial inhibitors of presynaptic dopamine reuptake. Experimental studies show that dopaminergic effects contribute to the development of anxiety, depression, and anhedonia. These studies revealed, among the new nonergot dopamine agonists, anxiolytic properties for ropinirole and anxiolytic, antidepressive, and antianhedonic effects of pramipexole which seem to relate to its specific action on D(2) and D(3) receptors in the mesolimbic system and prefrontal cortex. In addition, affective disorders may be associated with impairments of neuronal plasticity, and pramipexole seems to exert neurotrophic properties. Controlled and open studies in depressed patients with Parkinson's disease show therapeutic effects of dopamine agonists on motor deficits, anhedonia, and depression. Various dopamine agonists have been tested in open studies in patients with depression and may add to the spectrum of treatment options in mood disorders. Recently published placebo-controlled trials in small patient groups implicate that pramipexole is effective as additional treatment to mood stabilizers in I and II bipolar depression.
PMID: 17187269 [PubMed - in process]
--------------------------------------------------9: Psychopharmacology (Berl). 2000 Jul;151(1):91-7.Click here to read Links
Anxiolytic profile of ropinirole in the rat, mouse and common marmoset.
Rogers DC, Costall B, Domeney AM, Gerrard PA, Greener M, Kelly ME, Hagan JJ, Hunter AJ.Neuroscience Research, SmithKline Beecham Pharmaceuticals, Harlow, Essex, UK. Derek_C_Rogers@sbphrd.com
RATIONALE: Some features of Parkinson's disease are exacerbated by stress and anxiety and it is important to understand the effects of dopamine receptor agonists on measures of anxiety. The aim of this study was to assess the effects of the dopamine D2/D3 receptor agonist ropinirole in models of anxiety and depression in the rat, mouse and marmoset. RESULTS: In the rat elevated plus-maze test, ropinirole (0.01-1 mg/kg, i.p.) produced an inverted-U dose-response curve in the percentage time spent in the open arms. Compared with vehicle, ropinirole (0.1 mg/kg) had a significant anxiolytic-like effect, which was similar to that observed with 1.5 mg/kg diazepam. This effect was found at doses that did not affect motor behaviour or induce stereotypy. In the mouse black and white box test of anxiety, ropinirole (0.1-10 mg/kg, i.p.) increased both the rearing time and number of line crosses in the white section. This effect reached statistical significance for both measures at a dose of 0.1 mg/kg and suggests an anxiolytic-like action of the compound. By contrast, the dopamine agonist bromocriptine (0.1-10 mg/kg, i.p.) did not produce significant changes in these behaviours. In the marmoset human threat test, ropinirole (0.01-10 microg/kg, s.c.) reduced the number of postures at all doses tested and this reached statistical significance at 10 microg/kg. Ropinirole did not compromise the effect of amitriptyline in the Porsolt test of depression and in itself produced antidepressant-like effects. CONCLUSIONS: These data demonstrate that systemic administration of ropinirole produces anxiolytic-like effects in three separate models in the mouse, rat and marmoset. This may predict an action of ropinirole in man that would provide a superior profile of action over other presently available anti-parkinsonian agents.
PMID: 10958122 [PubMed - indexed for MEDLINE]
--------------------------------------------------10: Can J Psychiatry. 2005 May;50(6):357-60.Links
Ropinirole in treatment-resistant depression: a 16-week pilot study.
Cassano P, Lattanzi L, Fava M, Navari S, Battistini G, Abelli M, Cassano GB.Depression Clinical and Research Program, Massachusetts General Hospital, Boston 02114, USA. pcassano@partners.org
OBJECTIVE: The study aimed to assess the antidepressant efficacy and tolerability of adjunctive ropinirole in outpatients with treatment-resistant depression (TRD). METHOD: The study sample consisted of patients with a major depressive episode (diagnosed according to DSM-IV criteria) and TRD. Ropinirole 0.25 to 1.5 mg daily was added to tricyclic antidepressants or selective serotonin reuptake inhibitors. We conducted assessments at baseline and at weeks 2, 4, 8, 12, and 16. We defined response as a 50% or greater reduction of the Montgomery-Asberg Depression Rating Scale (MADRS) total score plus a score of 1 ("very much improved") or 2 ("much improved") on the Clinical Global Impression of Improvement scale at endpoint. Tolerability was monitored with the Dosage Record Treatment Emergent Symptom Scale. RESULTS: Seven patients had major depressive disorder, and 3 had bipolar II disorder. The mean maximum dose of ropinirole was 1.33 mg daily. Mean (SD) scores on the MADRS decreased from 29.6 (7.6) at baseline to 16.9 (12.1) at endpoint (P < 0.02). At endpoint, 4 of 10 (40%) patients were responders. Two patients discontinued ropinirole because of dizziness. CONCLUSIONS: These pilot data suggest that, in selected cases of TRD, ropinirole augmentation of antidepressants is effective and relatively well tolerated.
PMID: 15999953 [PubMed - indexed for MEDLINE]
--------------------------------------------------11: Int Clin Psychopharmacol. 2002 Nov;17(6):307-10.Click here to read Links
Ropinirole for antidepressant-induced sexual dysfunction.
Worthington JJ 3rd, Simon NM, Korbly NB, Perlis RH, Pollack MH; Anxiety Disorders Research Program.Massachusetts General Hospital and Harvard Medical School, Boston 02114, USA. jworthington@partners.org
Sexual dysfunction is a relatively common side-effect of antidepressants, occurring in approximately one-half of patients, and is associated with significant distress and treatment non-compliance. Dopaminergic agents have been reported to be helpful for the treatment of antidepressant-induced sexual dysfunction and, in this report, we examined the efficacy of the dopamine agonist ropinirole for this indication. Thirteen patients (three women, 10 men), aged 42.6 +/- 7.7 years, who reported sexual dysfunction on a stable dose of antidepressant, were treated openly with ropinirole initiated at 0.25 mg/day and titrated up to 2-4 mg/day over 4 weeks, as tolerated. Ten of the 13 took ropinirole for at least 4 weeks, one discontinued due to an adverse event and two because of lack of response. Sexual dysfunction, as assessed by the Arizona Sexual Experience Scale scores, was reduced from 18.8 +/- 3.6 to 13.8 +/- 4.3 after 4 weeks on ropinirole at a mean dose of 2.1 mg/day. Overall, seven of 13 patients (54%) were rated as responders on the Clinical Global Impression of Improvement Scale. The addition of ropinirole may represent a potentially useful treatment strategy for antidepressant-induced sexual dysfunction.
PMID: 12409684 [PubMed - indexed for MEDLINE]
__________________________________________________
I found one study examining sleep quality in patients taking dopamine agonists, although the population sample were Parkinson's Disease patients, so that may not be relevant to psychiatric illness, but from my own experiences with dopamine agonists I'm inclined to think it is.
__________________________________________________1: CNS Drugs. 2001;15(4):267-75.Links
Sleep disorders in patients with Parkinson's disease: epidemiology and management.
Larsen JP, Tandberg E.Department of Neurology, Central Hospital of Rogaland, Stavanger, Norway.
Patients with Parkinson's disease can experience a number of sleep disorders, including insomnia, parasomnias and daytime somnolence [specifically, excessive daytime sleepiness (EDS) and sleep attacks]. Insomnia is a frequent and important complaint of patients with the disease. Both the pathology of Parkinson's disease and dopaminergic drugs may contribute to the much higher than expected frequency of sleep fragmentation and disrupted sleep among these patients. In addition, coexisting depression seems to be a major and frequent risk factor for insomnia in Parkinson's disease. After recognising a sleep problem, the first step in management is to examine and diagnose the type of insomnia and possible medical or psychological factors that may disturb nocturnal sleep. The next step is to give the patient appropriate advice on sleep hygiene. Increasing the dosage of dopaminergic drug treatment will often increase sleep disruption and should be avoided unless the patient's sleep is primarily disturbed by the motor manifestations of parkinsonism during the night. Depression should be looked for and if appropriate be treated in any patients with insomnia. If it becomes necessary to treat the patient with an hypnosedative agent, it is important to use a drug with a short half-life and that manifests as few adverse effects as possible the next morning. Up-to-date guidelines for the use of hypnosedatives should be followed. Patients with Parkinson's disease experience a wide range of parasomnias. The majority of behaviours may be related to rapid eye movement (REM) sleep behaviour disorder (RBD) or to a spectrum of symptoms ranging from vivid dreaming to psychosis. RBD is effectively treated with clonazepam. In addition, the atypical antipsychotics have given physicians new and better treatment options for psychotic symptoms in individuals with Parkinson's disease. EDS is common in Parkinson's disease, while sleep attacks seem to be rare manifestations of the disease or its treatment. Significant EDS is found in 15% of patients with Parkinson's disease compared with in 1% of healthy elderly people. Sleep attacks are observed in patients treated with all dopaminergic medications but have recently been brought to prominence because of their association with the newer dopamine agonists ropinirole and pramipexole. Patients with Parkinson's disease should be informed about the possibility of developing sleep problems during the day when prescribed new drugs. Appropriate actions with regard to driving must be taken if significant and persistent daytime somnolence or sleep attacks appear.
PMID: 11463132 [PubMed - indexed for MEDLINE]
__________________________________________________Q
Posted by Phillipa on August 23, 2007, at 11:43:54
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he » dopaminerequiem, posted by Quintal on August 23, 2007, at 10:48:46
Is this like requip? Antiparkison's too I believe or used to treat it but off label for depression, anxiety I believe. Don't get all the technical terms. Phillipa ps I know someone on requip that was unresponsive to all the MAOI's and even ECT. This is working well for him
Posted by cumulative on August 23, 2007, at 15:14:55
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he, posted by dopaminerequiem on August 23, 2007, at 9:50:44
>I <b>will</b> relapse into anorexia if my weight starts climbing
Tried CBT?
Posted by dopaminerequiem on August 23, 2007, at 17:59:41
In reply to Re: dopaminerequiem, posted by cumulative on August 23, 2007, at 15:14:55
> >I <b>will</b> relapse into anorexia if my weight starts climbing
>
> Tried CBT?I'm in Dialectical Behavior Therapy.
I've been drug-free for eight months, at a stable weight for ten months, free of self-injury for ninteen months, and my last hospitalization was nearly two years ago.
This is the first time in twelve years that I have not had some kind of self-destructive behavior. And it makes it even harder now that I'm severely depressed. I used to be able to numb it all away with some maladaptive coping technique. I haven't felt like this in over a decade, because I was either severely drug addicted or severely anorexic. My depression actually prompted me to start those behaviors. Drugs worked and anorexia worked and meds and therapy didn't work [at least traditional CBT didn't work]; so what if I was slowly killing myself? Better than the quick way, I reasoned.
My psychiatrist is also my therapist. She has saved my life more times than I can count. I'm not even sure if I'm not relapsing right now because I want to be in recovery from all of those behaviors or because of her, despite her vacation (which, to a borderline, is always a traumatic event).
Posted by Phillipa on August 23, 2007, at 20:16:39
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he, posted by dopaminerequiem on August 23, 2007, at 9:46:40
Yes I have heard of requip officially for Parkinson's but right now it has literally cured what ECT, nardil and every med know couldn't do for a friend of mine with small dose of lithium,and zyprexa and in the process of weaning off the others. Off label Use. But it's working he has his life back. No diagnois of borderline or bipolar just major depression. Phillipa
Posted by Phillipa on August 23, 2007, at 20:21:17
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he » dopaminerequiem, posted by Phillipa on August 23, 2007, at 20:16:39
Oh very true vacations are not good for borderline . Sorry about suggesting meds. Phillipa
Posted by Quintal on August 23, 2007, at 22:28:28
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he, posted by jhj on August 23, 2007, at 8:22:22
Hi jhj,
Small amounts of codeine are sold over-the-counter at pharmacies here in the UK, so they are legal in some contexts. Psychiatrists have successfully used buprenorphine to treat severe depression refractory to mainstream treatments.
____________________________________________________1: J Clin Psychopharmacol. 1995 Feb;15(1):49-57.Click here to read Links
Buprenorphine treatment of refractory depression.
Bodkin JA, Zornberg GL, Lukas SE, Cole JO.McLean Hospital, Consolidated Department of Psychiatry, Harvard Medical School, Belmont, MA 02178, USA.
Opiates were used to treat major depression until the mid-1950s. The advent of opioids with mixed agonist-antagonist or partial agonist activity, with reduced dependence and abuse liabilities, has made possible the reevaluation of opioids for this indication. This is of potential importance for the population of depressed patients who are unresponsive to or intolerant of conventional antidepressant agents. Ten subjects with treatment-refractory, unipolar, nonpsychotic, major depression were treated with the opioid partial agonist buprenorphine in an open-label study. Three subjects were unable to tolerate more than two doses because of side effects including malaise, nausea, and dysphoria. The remaining seven completed 4 to 6 weeks of treatment and as a group showed clinically striking improvement in both subjective and objective measures of depression. Much of this improvement was observed by the end of 1 week of treatment and persisted throughout the trial. Four subjects achieved complete remission of symptoms by the end of the trial (Hamilton Rating Scale for Depression scores < or = 6), two were moderately improved, and one deteriorated. These findings suggest a possible role for buprenorphine in treating refractory depression.
PMID: 7714228 [PubMed - indexed for MEDLINE]
__________________________________________________Amphetamines are drugs of abuse, yet have legitimate medical indications. The same goes for benzodiazepines; the clobazam you're taking, for example, is a Class C drug here in the UK, the same category as cannabis, ketamine, and GHB. All of these drugs can alleviate suffering and have legitimate medical indications in some contexts, and so long as they are obtained via prescription at a pharmacy, and treatment is properly supervised by a doctor, most people will have few problems with them, whatever their legal status.
Q
Posted by jhj on August 24, 2007, at 0:32:16
In reply to Re: Parnate/Dexedrine/500 sleeping meds, please he » jhj, posted by Quintal on August 23, 2007, at 22:28:28
Hi Quintal,
I am sorry for deviating from the main subject.But,yesterday itself i talked to a senior official in "narcotics control beuro" of India.He told me that it is true that it is available in western countries and used for some medical purposes also.But,he also made it clear that opium trading is financing terrorism worldwide.He further said that he is confident that in next five years opium will be off the shelf in all the western countries too because India is lobbying really hard with all these governments and also through United Nations with some success to make use of opium illegal even for treatment purposes.
Posted by Quintal on August 24, 2007, at 0:55:59
In reply to Re: Parnate/Dexedrine/500 sleeping meds-quintal, posted by jhj on August 24, 2007, at 0:32:16
Opium is no longer used in western medicine. Opiates are listed as essential medicines by the WHO for management of moderate-to-severe pain, and until something equally effective arrives to replace them, no amount of lobbying will change that. Synthetic opiates, such as methadone and the fentanyls could, and would, be used by medical staff, terrorists, and recreational users to fill any vacuum created by a shortage of natural sources.
If you wish to pursue this debate further I suggest starting a new thread.
Q
Posted by jhj on August 24, 2007, at 1:32:09
In reply to Re: Parnate/Dexedrine/500 sleeping meds-quintal » jhj, posted by Quintal on August 24, 2007, at 0:55:59
Hi Quintal,
No i have no interest in pursuing the debate.I was just saying what my country's position is and which i have come to know from my friend's father who is working with narcotics control beuro of India.
Posted by Quintal on August 24, 2007, at 6:42:49
In reply to Re: Parnate/Dexedrine/500 sleeping meds-quintal, posted by jhj on August 24, 2007, at 1:32:09
Posted by dopaminerequiem on August 24, 2007, at 8:54:50
In reply to Re: Parnate/Dexedrine/500 sleeping meds-quintal, posted by jhj on August 24, 2007, at 0:32:16
> Hi Quintal,
> I am sorry for deviating from the main subject.But,yesterday itself i talked to a senior official in "narcotics control beuro" of India.He told me that it is true that it is available in western countries and used for some medical purposes also.But,he also made it clear that opium trading is financing terrorism worldwide.He further said that he is confident that in next five years opium will be off the shelf in all the western countries too because India is lobbying really hard with all these governments and also through United Nations with some success to make use of opium illegal even for treatment purposes.
****Totally OT but one issue that gets under my skin is the so-called "war on drugs." A war that can never be won. A war that has CREATED more victims than saved or rescued them. Yes, I am a former (very severe) drug addict and I believe in drug legalization.
So: opium is not legal in the United States for ANY purposes. Neither is heroin. This is NOT because either of those drugs are necessarily more dangerous than the current available opiates. It is solely a political decision, which has mostly to do with anti-Communist propaganda [the Chinese and their "opium dens"].
Funny, because when you could buy heroin in a pharmacy [for pain relief] and it was even over the counter and when opium WAS legal, the drug problem was not even a fraction of what it is today. By making these drugs illegal, we have forced the drug trade underground, increasing all criminal aspects associated with it and increasing the number of addicts and overdoses as well.
What ARE legal are so-called "synthetic" opiates like Fentanyl (hundreds of times stronger than heroin, thousands of times stronger than opium), OxyContin (which hits your veins just like heroin does and gives you the same heroin nod), morphine (which is the precursor to heroin), etc.
Basically, a scientist took a poppy plant and made opium and codeine. Another scientist took this a step further, did a minor chemical alteration, and made codeine. Same thing happened, and morphine was made. Then, out of morphine, heroin was made. ALL of this [and opium] from a plant!
And yet morphine and codeine stayed legal. Heroin and opium were made illegal. Of course, fentanyl and OxyContin soared through the FDA like nobody's business. If you think that this does not have political undertones, you are out of your mind.
As far as opiates funding terrorism, this is insane. The Taliban actually PROHIBITED drug use and trafficking of any kind and were responsible for some serious heroin droughts on the East Coast, since the poppy plant thrives in Afghanistan. Of course, since no one seems to be able to differentiate between different political groups in the Middle East, everyone says that drugs fund terrorism. Actually, the terrorist groups that the US has targeted - especially the group that we have PRIMARILY targeted - are fundamentalist Muslims, who believe that drug use of any kind (including alcohol and cigarettes) are immoral and did far more to stop the drug trade than anyone else.
Anyway, in today's world, even if all of the poppy plants in the WORLD were destroyed, we could still make opiates using various chemical compounds in laboratories. Fentanyl is diluted and sold as "China White" [an especially strong type of heroin] on the streets. Even the recent drug "epidemic" in the US is because of crystal methamphetamine, which can be cooked up in a bathtub using completely legal ingredients.
I know I went way off topic here but ignorance on this topic is something that really disturbs me. Propaganda is still alive and thriving in both our so-called "war on terror" and "war on drugs."
And to think, before the Bush administration, I would never have been afraid to post something so "inflammatory" on an Internet message board. Why aren't we talking about the "war on free speech and free thought and free public opinion without propaganda"? I can't imagine what it must be like to be psychotic in this day and age, when a posting like this is grounds for CIA investigation merely because I criticized the current administration and suggested that the war on terror and the war on drugs are a facade that has been sold to us via Fox News.
Okay, enough ranting. I'm sorry!
Posted by chubland on August 30, 2007, at 21:58:16
In reply to Parnate/Dexedrine/500 sleeping meds, please help, posted by dopaminerequiem on August 22, 2007, at 21:53:14
First off, any medication changes should be monitored and ultimately made by your doctor. Secondly, if 120 mg parnate has worked well for you, stay with it! There are many people including me who know if you find something that works well stay with it, especially after numerous medicine trials. You just have to find a remedy for your insomnia. This might be finding the right adjunct for sleep, or playing with the times you take the parnate( last dose shouldn't be taken after 1pm generally, effects sleep).
I am taking parnate 30 mg (I've been as high as 90 mg) and it helps me moderatley, also take provigil 200-400 mg. I've taken dexedrine, and ritalin in combo with parnate in the past. This is not an uncommon combo, parnate + stimulant. though technically it is contraindicated but many expert psychs sometimes find the combo helpful. I find they augment antidepressant effect a little, but more so act like a motivator during the day. I like provigil the best cause it makes my head clearer and makes you more sharp, and usually doesn't make you nervous, anxious, jittery. I too experience that slight paranoid, anxoius feeling on too high a dose of stimulants, which can sometimes be counter productive as I get socially anxious and avoidant. Many people have been on MAOIS for life because thats all that works for them. There aren't any longterm risks as far as I know. As for sleeping meds, I think sleeping pills, ambien, and benzos all tend to make depression worse, so I would talk to your doc about something like higher dose neurontin, another potential mood stabilizer/ or anticonvulsant, or maybe seroquel, etc.. These would be less likely to worsen your depression, might help sleep, and actually stabilize your mood for the longterm.I am not a doctor, just a patient who knows alot about meds from my own experience and a lot of internet research. So anything I've said is not based on real medical experience. Always rely on good doctors and yourself for the best decisions to make, not internet junkies.
This is the end of the thread.
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