Psycho-Babble Medication Thread 849566

Shown: posts 1 to 19 of 19. This is the beginning of the thread.

 

Mirapex dosage as add-on antidepressant?

Posted by oceancat on August 31, 2008, at 21:32:02

Hi everyone,

I am wondering what dosage I should use for Mirapex (pramipexole) for depression, specifically apathy and anhedonia, if already taking Zoloft, Lamictal, and Abilify. From reading studies I think 1 mg/day sounds about right, but I'm not sure. Also, would the Abilify stop the Mirapex from working, since the Abilify is a dopamine regulator and the Mirapex a dopamine enhancer?

Thanks for any advice!

Oceancat

 

Re: Mirapex dosage as add-on antidepressant? » oceancat

Posted by SLS on September 1, 2008, at 6:49:22

In reply to Mirapex dosage as add-on antidepressant?, posted by oceancat on August 31, 2008, at 21:32:02

Hi Oceancat.

Theoretically, Abilify and Mirapex should not antagonize each other.

Basically, the two drugs hit different DA receptors: Abilify with D2 and Mirapex with D3.

If this treatment does not help, you might consider adding Geodon at 40mg to see if it helps. You could then withdraw the Abilify if your response to Geodon is robust. With Geodon, it is important to try to start at 40mg. 20mg drives people crazy with agitation and anxiety. Abilify and Geodon both hit a myriad of receptors at therapeutic dosages. Both are usually weight neutral and energizing. I know someone for whom adding Geodon to her ongoing treatment with Wellbutrin and Lexapro served as the trigger for obtaining a robust antidepressant response. She is currently at
80mg (40mg b.i.d.).

Good luck. Please follow up with posts of your progress.


- Scott

 

Re: Mirapex dosage as add-on antidepressant? » oceancat

Posted by Jay_Bravest_Face on September 1, 2008, at 9:52:00

In reply to Mirapex dosage as add-on antidepressant?, posted by oceancat on August 31, 2008, at 21:32:02

Hi...

I am on 0.5 mg of Mirapex at bedtime for SSRI apathy and such. That is all I can handle. Anymore or more frequent, I am anxious, sweaty, feel really bad. Best wishes..

Jay

 

Re: Mirapex dosage as add-on antidepressant?

Posted by desolationrower on September 1, 2008, at 12:01:05

In reply to Re: Mirapex dosage as add-on antidepressant? » oceancat, posted by SLS on September 1, 2008, at 6:49:22

Isn't aripirazole's binding affinity for d3 almost as great as for d2? I'm not sure you can really thread that needle.

 

Re: Mirapex dosage as add-on antidepressant? SLS!

Posted by oceancat on September 1, 2008, at 12:29:01

In reply to Re: Mirapex dosage as add-on antidepressant? » oceancat, posted by SLS on September 1, 2008, at 6:49:22

SLS,
Did you receive my e-mail? Check your spam folder if not...sorry everyone...
Oceancat

 

Re: Mirapex dosage as add-on antidepressant? » desolationrower

Posted by SLS on September 1, 2008, at 13:33:59

In reply to Re: Mirapex dosage as add-on antidepressant?, posted by desolationrower on September 1, 2008, at 12:01:05

Hi.

I looked into it and discovered that you are right regarding the relative binding affinities of Mirapex and Abilify being about equal. As far as "threading the needle" is concerned, that is pure conjecture and does not take into consideration any regional differences in the kinetic deposition of drug. It is not only what, but where. I guess that is another thing to investigate to help put this story together.

Your theory makes sense. However, I personally don't rely too much on our theories to make clinical decisions. There is too much at stake. Combining Abilify with Mirapex might yield a positive net result for reasons we don't understand or have access to. The combination is probably safe. We don't even know if Abilify would help prevent the sleep attacks that come with Mirapex. It might, given that the binding affinity of Abilify to presynaptic autoreceptors is greater than that of Mirapex, and that a stabilization of the dopamine synapse may still be stabilized by the partial agonist property of Abilify at D2 postsynaptic receptors.

That's a hastily thought-out theoretical scenario that could also make sense now that a few more facts have been added.

Given that the Abilify + Mirapex combination seems safe, it becomes nothing more than a clinical experiment to be performed on someone who has thus far not found an adequate treatment.


- Scott

 

Re: Mirapex dosage as add-on antidepressant? » SLS

Posted by desolationrower on September 1, 2008, at 15:55:45

In reply to Re: Mirapex dosage as add-on antidepressant? » desolationrower, posted by SLS on September 1, 2008, at 13:33:59

I was specifically responding to your claim that Pramipexole would work on D3 unimpeded by aripiprazole. I did not say 'This combination could not possibly work'. Mechanisms are not relevant only when you think it shows a combination has potential.

 

Re: Mirapex dosage as add-on antidepressant?

Posted by oceancat on September 1, 2008, at 19:12:21

In reply to Re: Mirapex dosage as add-on antidepressant? » SLS, posted by desolationrower on September 1, 2008, at 15:55:45

Hi,

Thank you for your responses. Jay, has the Mirapex been helping you with apathy? How has it been affecting you?

The Geodon sounds like a good idea, but I tried Geodon in the past and got terrible muscle pain and weakness for some reason. I don't remember if I was at 20mg or went up to 40mg. Is it known to work for apathy and depression?

Are sleep attacks a serious concern with pramipexole? I've read about this side effect but thought it was relatively rare.

Any further thoughts about meds for apathy/anhedonia other than stimulants and bupropion (they poop out on me)?

Thanks all,
oceancat

 

Re: Mirapex dosage as add-on antidepressant?

Posted by SLS on September 1, 2008, at 19:13:18

In reply to Re: Mirapex dosage as add-on antidepressant? » SLS, posted by desolationrower on September 1, 2008, at 15:55:45

> Mechanisms are not relevant only when you think it shows a combination has potential.

I agree. I guess you gotta start somewhere when someone isn't responding to treatment as usual.


- Scott

 

Re: Mirapex dosage as add-on antidepressant? » SLS

Posted by Phillipa on September 1, 2008, at 23:41:09

In reply to Re: Mirapex dosage as add-on antidepressant?, posted by SLS on September 1, 2008, at 19:13:18

Scott sorry hyjacking for a quick question why is geodon at 40mg better with anxiety than 20mg I don't get that. Phillipa

 

Re: Mirapex dosage as add-on antidepressant? » Phillipa

Posted by desolationrower on September 1, 2008, at 23:58:35

In reply to Re: Mirapex dosage as add-on antidepressant? » SLS, posted by Phillipa on September 1, 2008, at 23:41:09

Probably like prozac, 5ht-2c antagonism. it can be activating. higher doses it starts to hit some other receptors too. (note: it has high affinity for 2a at very low dose but thats probably irrelevant)
-D/R

 

Re: Mirapex dosage as add-on antidepressant?

Posted by oceancat on September 2, 2008, at 0:44:49

In reply to Re: Mirapex dosage as add-on antidepressant? » Phillipa, posted by desolationrower on September 1, 2008, at 23:58:35

D/R,
Prozac 20 mg was the first AD I ever tried and it was extremely activating for me, even making me social, and I have social phobia. Unfortunately it wore me out and made me a little nutty (I think hypomanic) and I had to stop it, but I always wish I could get a little of that back. I always assumed it had some dopaminergic effect and that's why it was activating, but it's 5HT2c antagonism? Do you have any studies you can refer me to? What other meds have this property other than Geodon and Prozac?

Thanks,
oceancat

> Probably like prozac, 5ht-2c antagonism. it can be activating. higher doses it starts to hit some other receptors too. (note: it has high affinity for 2a at very low dose but thats probably irrelevant)
> -D/R

 

Re: Mirapex dosage as add-on antidepressant? » Phillipa

Posted by SLS on September 2, 2008, at 5:52:58

In reply to Re: Mirapex dosage as add-on antidepressant? » SLS, posted by Phillipa on September 1, 2008, at 23:41:09

> Scott sorry hyjacking for a quick question why is geodon at 40mg better with anxiety than 20mg I don't get that. Phillipa

Geodon (ziprasidone) potently antagonizes (blocks) 5-HT2c receptors at low dosages that do not promote the binding to dopamine (DA) receptors. Without DA antagonism, someone can experience activation, agitation and anxiety. This is what occurs at 20mg. At 40mg, Geodon now blocks enough DA receptors to conteract 5-HTc receptors and promote calmness.


- Scott

 

Re: Mirapex dosage as add-on antidepressant? » SLS

Posted by Phillipa on September 2, 2008, at 20:00:02

In reply to Re: Mirapex dosage as add-on antidepressant? » Phillipa, posted by SLS on September 2, 2008, at 5:52:58

Thanks Scott!!!! Love Phillipa

 

Re: Mirapex dosage as add-on antidepressant? » SLS

Posted by theo on September 4, 2008, at 20:11:23

In reply to Re: Mirapex dosage as add-on antidepressant? » Phillipa, posted by SLS on September 2, 2008, at 5:52:58

Have you ever had any trouble with Abilify and tardive dyskensia? Does it have a pretty low track record compared to other newer ones?

 

Re: Mirapex dosage as add-on antidepressant? » theo

Posted by SLS on September 4, 2008, at 21:42:02

In reply to Re: Mirapex dosage as add-on antidepressant? » SLS, posted by theo on September 4, 2008, at 20:11:23

> Have you ever had any trouble with Abilify and tardive dyskensia? Does it have a pretty low track record compared to other newer ones?

It seems that Abilify has the lowest incidence of TD. Of course, we don't yet have people who have been taking it for decades. However, Abilify spares the striatum (movement) and works instead on limbic structures (activation). Whereas Abilify might not cause dystonias, it might very well produce tardive akathisia. Again, we won't know for a few years.

I take Abilify 20mg. I am not currently worried about tardive akathisia. I hope this drug stands the test of time as being virtually free of EPS.


- Scott

 

Re: Mirapex dosage as add-on antidepressant? » SLS

Posted by theo on September 4, 2008, at 22:18:38

In reply to Re: Mirapex dosage as add-on antidepressant? » theo, posted by SLS on September 4, 2008, at 21:42:02

I do remeber when I took Abilify before at just 2.5-5mg, I had akathisia episodes but it stopped when I discontinued it. I would get out of bed in the middle of the night and feel like peeling my skin off or running on a treadmill till I was exhausted. That would be horrible if it were permanent, that indeed would be maddening.

> I take Abilify 20mg. I am not currently worried about tardive akathisia. I hope this drug stands the test of time as being virtually free of EPS.
>
>
> - Scott

 

Re: Mirapex dosage as add-on antidepressant? » theo

Posted by SLS on September 5, 2008, at 5:25:05

In reply to Re: Mirapex dosage as add-on antidepressant? » SLS, posted by theo on September 4, 2008, at 22:18:38

> I do remeber when I took Abilify before at just 2.5-5mg, I had akathisia episodes but it stopped when I discontinued it. I would get out of bed in the middle of the night and feel like peeling my skin off or running on a treadmill till I was exhausted.

Yup. That's the real thing you had. It was true akathisia. However, it is what is called a startup side effect rather than a latent - or tardive - akathisia. Tardive means "late". This is when the EPS emerge after years of taking an AP. I don't know to what degree tardive akathisia is reversible. The startup akathisia is, and should not cause you to worry. If Abilify were your last resort, you could take a benzodiazepine during this startup period to counteract the akathisia until it dissipates on its own. Some doctors might choose to use an anticholinergic instead. I really don't know how well that works.


- Scott

 

Re: Mirapex dosage as add-on antidepressant? » SLS

Posted by theo on September 7, 2008, at 14:56:19

In reply to Re: Mirapex dosage as add-on antidepressant? » theo, posted by SLS on September 5, 2008, at 5:25:05

In your opinion, is Valium more of an anticonvulsant than Xanax and smoother benzo to discontinue?

If Abilify were your last resort, you could take a benzodiazepine during this startup period to counteract the akathisia until it dissipates on its own. Some doctors might choose to use an anticholinergic instead. I really don't know how well that works.
>
>
> - Scott
>


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