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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 14 of 14. This is the beginning of the thread.
Posted by Shes_Initforthemoney on March 24, 2012, at 22:09:23
I was wondering what you guys thought of adding a dose of a dopamine agonist like pramipexole to my 225 mg dose of Effexor XR? I am looking at trying to slightly stimulate the few dopamine receptors pramipexole can do.(As high dose Effexor tingles the dopamine a little bit.) Mostly, to enhance sex drive, but take away a bit of the apathy ad's can cause.
Thanks,
Jay
Posted by Elanor Roosevelt on March 24, 2012, at 22:47:59
In reply to Scott et al...dopamine agonist + Effexor?, posted by Shes_Initforthemoney on March 24, 2012, at 22:09:23
I have been experiencing some good results from the Pramipexole. Make sure to eat with your doses.
Good luck
Posted by sigismund on March 24, 2012, at 23:22:37
In reply to Re: Scott et al...dopamine agonist + Effexor?, posted by Elanor Roosevelt on March 24, 2012, at 22:47:59
>I have been experiencing some good results from the Pramipexole.
You want to say a bit more?
Or compare it with Trivastal?
Posted by SLS on March 25, 2012, at 5:14:54
In reply to Scott et al...dopamine agonist + Effexor?, posted by Shes_Initforthemoney on March 24, 2012, at 22:09:23
> I was wondering what you guys thought of adding a dose of a dopamine agonist like pramipexole to my 225 mg dose of Effexor XR? I am looking at trying to slightly stimulate the few dopamine receptors pramipexole can do.(As high dose Effexor tingles the dopamine a little bit.) Mostly, to enhance sex drive, but take away a bit of the apathy ad's can cause.
Would you consider trying a low dose of Abilify first? As a partial DA agonist, it acts to gently increase dopamine flow when levels in the synapse are low. By contrast, pramipexole, as a full agonist, should be more likely to cause a downregulation of postsynaptic DA receptors, leaving them less sensitive than when you started. This is speculation on my part. However, what is not speculation is that pramipexole can cause sleep attacks, especially at low dosages.I have seen only one report on Psycho-Babble of a robust response being associated with pramixole treatment. By contrast, there are multiple reports of Abilify being effective at dosages ranging between 2 - 5 mg, usually when used as an adjunct to other drugs in unipolar depression. For bipolar depression, the dosage might have to be higher. I need a minimum of 10 mg for Abilify to have good effect.
I like Effexor. Two drugs that I know work to augment Effexor are Wellbutrin and nortriptyline. Of course, Abilify is a valid option.
Of course, I hope you do well with pramipexole should you opt to try it first.
- Scott
Posted by Phillipa on March 25, 2012, at 10:14:32
In reply to Re: Scott et al...dopamine agonist + Effexor? » Shes_Initforthemoney, posted by SLS on March 25, 2012, at 5:14:54
What is it? Never heard of it before? Phillipa
Posted by Shes_Initforthemoney on March 25, 2012, at 10:55:18
In reply to Re: Scott et al...dopamine agonist + Effexor? » Shes_Initforthemoney, posted by SLS on March 25, 2012, at 5:14:54
> > I was wondering what you guys thought of adding a dose of a dopamine agonist like pramipexole to my 225 mg dose of Effexor XR? I am looking at trying to slightly stimulate the few dopamine receptors pramipexole can do.(As high dose Effexor tingles the dopamine a little bit.) Mostly, to enhance sex drive, but take away a bit of the apathy ad's can cause.
>
>
> Would you consider trying a low dose of Abilify first? As a partial DA agonist, it acts to gently increase dopamine flow when levels in the synapse are low. By contrast, pramipexole, as a full agonist, should be more likely to cause a downregulation of postsynaptic DA receptors, leaving them less sensitive than when you started. This is speculation on my part. However, what is not speculation is that pramipexole can cause sleep attacks, especially at low dosages.
>
> I have seen only one report on Psycho-Babble of a robust response being associated with pramixole treatment. By contrast, there are multiple reports of Abilify being effective at dosages ranging between 2 - 5 mg, usually when used as an adjunct to other drugs in unipolar depression. For bipolar depression, the dosage might have to be higher. I need a minimum of 10 mg for Abilify to have good effect.
>
> I like Effexor. Two drugs that I know work to augment Effexor are Wellbutrin and nortriptyline. Of course, Abilify is a valid option.
>
> Of course, I hope you do well with pramipexole should you opt to try it first.
>
>
> - ScottScott:
You know, you may be my long lost brother..lol. We seem to have similar responses to meds, hence maybe similar genetics. I have tried Abilify numerous times, and I'd get an 'okay' response. I've also tried it at the 2, 5, and 10 mg doses. All no avail. I would often get the really bad akathisia, and have stuck it out for up to 8 month trials. But in particular I am looking for the slight boost in sex drive, which I didn't find with Abilify.
BUT...that being the key word..I have never tried Abilify with Effexor. My thinking is along the lines of hitting possible, even if only weakly, dopamine pathways. Maybe I will give Abilify a shot with my new combo. Plus, I am going to cut down my Prozac augmentation a fair bit.(Which of course dampens sex drive as well.)
I agree Effexor and Nortriptyline are really good drugs, and even in anxiety, they hit the norepinephrine pathways that, likely through regulation, help with the anxiety. Prozac has been my outstanding award winner for years (about 11) and the Effexor seems to have a positive additive effect. I also take Dexedrine Spansules, 10mg 2 x a day. Dexedrine has been excellent for me, as it is so much smoother to me than the other stimulants.
I see you are doing well with Notriptyline augmentation. Nortriptyline has also partially helped me in the past.
Thanks and best,
Jay
Posted by Shes_Initforthemoney on March 25, 2012, at 10:58:37
In reply to Re: Scott et al...dopamine agonist + Effexor?, posted by Elanor Roosevelt on March 24, 2012, at 22:47:59
> I have been experiencing some good results from the Pramipexole. Make sure to eat with your doses.
>
> Good luckThanks kindly...I am just worried a bit about dopamine receptor down-regulation. How long have you been on the Mirapex?
Jay
Posted by novelagent on March 30, 2012, at 19:49:29
In reply to Scott et al...dopamine agonist + Effexor?, posted by Shes_Initforthemoney on March 24, 2012, at 22:09:23
I'd be careful-- first, Mirapex can really screw up your life. It's a very serious drug. I want to take it, but I've also never had an orgasm during intercourse before. So if you're doing this for lifestyle reasons, I'd say no, it doesn't justify the risk of lifetime apathy + anhedonia that is not reversible.
As for apathy, there's other drugs besides SSRI's and SNRI's if this entire class as a whole is giving you serious apathy (I don't know what extent, if it really is apathy, your apathy is-- you haven't described it-- but apathy is a very serious condition, so I'd be surprised if you had it just from taking an SNRI-- especially if you're bothering to tolerate the SNRI, and not switching to Emsam, for instance, or trying a go with ECT).
Actual apathy is something that I don't even have, and I have schizophreniform-- which is more likely to cause it.
Also, keep in mind Effexor at doses higher than 225mg is known to cause psychosis. I up'd to 225mg, and within a couple of weeks, even just at 225mg, I got first episode psychosis-- schizphreniform, a schiziphrenia-like condition. That's probably due to the combination of Dexedrine and Effexor. And let me tell you, if you're even thinking of taking an amphetamine along with pramipexole along with Effexor at 225, you will cause serious and life long damage to your brain that will make you wish you just had whatever you have now.
So, in a word, no, it's not worth it-- if you do actually orgasm, and you're not using it as a transgendered person, then no, I cannot see how a dose that high of Effexor is remotely safe.
The apathy will likely go away if you move away from the Effexor, or even the whole class of SSRI/SNRIs. They're not the only treatment for depression or anxiety by a long shot, and if you actually have apathy-- you're socially withdrawn, and not engaging in meaningful activities, and basically dead inside, then you would be best to switch off the thing that's causing it and not throw on a band aide.
And if you're using the word apathy to express a more vague, subtle sense of perception about your life, it's not apathy. Again, I'm very skeptical anyone would tolerate genuine apathy by remaining on the drug, much less remain on the drug and toss a band aide on rather than address the actual med causing it.
I hope this helps. Trying to be stern because I'm concerned, and hope you feel better. But I've had apathy for a week once, likely due to increased prolactin levels, and trust me-- you know it when you have it. It's not subtle.
> I was wondering what you guys thought of adding a dose of a dopamine agonist like pramipexole to my 225 mg dose of Effexor XR? I am looking at trying to slightly stimulate the few dopamine receptors pramipexole can do.(As high dose Effexor tingles the dopamine a little bit.) Mostly, to enhance sex drive, but take away a bit of the apathy ad's can cause.
>
> Thanks,
> Jay
Posted by phidippus on April 3, 2012, at 19:04:43
In reply to Scott et al...dopamine agonist + Effexor?, posted by Shes_Initforthemoney on March 24, 2012, at 22:09:23
I did Pristiq + Ropinirole. I had some fun.
Eric
Posted by Novelagent on April 5, 2012, at 15:29:33
In reply to Re: Scott et al...dopamine agonist + Effexor? » Shes_Initforthemoney, posted by phidippus on April 3, 2012, at 19:04:43
> I did Pristiq + Ropinirole. I had some fun.
>
> EricI've heard from a number of people dopamine agonists like mirapex cause awful withdrawal that causes depression, social isolation, anhedonia... For a year and maybe forever.
You seem to like drugs with a bad rap : )
Having taken straterra and then accidentally took 1000mg of Effexor, I can tell you, it causes anhedonia and flat affect for a few weeks anyhow... Also, I use to get hyper sexuality from Dexedrine while on Effexor (although not due to Effexor). Now Effexor makes me not have any sexual interest since the mishap in July.I wonder if mirapex would help...
Posted by Elanor Roosevelt on April 7, 2012, at 21:30:46
In reply to Re: Scott et al...dopamine agonist + Effexor?, posted by novelagent on March 30, 2012, at 19:49:29
As far as the question about Trivestal, I don't think the Pramipexole has gotten me there yet. Don't know if it will but I do hope so. I am not up to full dosage yet. I am feeling okay--maybe 3 months now. It has increased my sex drive.
Posted by SLS on April 8, 2012, at 6:16:49
In reply to Re: Scott et al...dopamine agonist + Effexor?, posted by Elanor Roosevelt on April 7, 2012, at 21:30:46
> As far as the question about Trivestal, I don't think the Pramipexole has gotten me there yet. Don't know if it will but I do hope so. I am not up to full dosage yet. I am feeling okay--maybe 3 months now. It has increased my sex drive.
I am glad that you are getting some relief.
- Scott
Posted by Alexei on April 24, 2012, at 12:52:52
In reply to Re: Scott et al...dopamine agonist + Effexor? » Shes_Initforthemoney, posted by SLS on March 25, 2012, at 5:14:54
> Would you consider trying a low dose of Abilify first? As a partial DA agonist, it acts to gently increase dopamine flow when levels in the synapse are low. By contrast, pramipexole, as a full agonist, should be more likely to cause a downregulation of postsynaptic DA receptors, leaving them less sensitive than when you started. This is speculation on my part. However, what is not speculation is that pramipexole can cause sleep attacks, especially at low dosages.
> I have seen only one report on Psycho-Babble of a robust response being associated with pramixole treatment. By contrast, there are multiple reports of Abilify being effective at dosages ranging between 2 - 5 mg, usually when used as an adjunct to other drugs in unipolar depression. For bipolar depression, the dosage might have to be higher. I need a minimum of 10 mg for Abilify to have good effect.
> I like Effexor. Two drugs that I know work to augment Effexor are Wellbutrin and nortriptyline. Of course, Abilify is a valid option.
> - Scott
To Scott or anyone ...May I ask your experience of effexor ... and why you stopped it? I'm having decent results at 225mg but not good enough.
My doc actually offered me both nortriptyline and abilify for augmentation. Can you use both... or by what criteria do you choose? What dose of nortriptyline are you thinking of here?
I am taking vyvanse as prescribed. Is this med capable of causing this downregulation of DA receptors? ... I do not abuse it in the least..
Thanks
Posted by SLS on April 24, 2012, at 13:46:05
In reply to Re: Scott et al...dopamine agonist + Effexor? » SLS, posted by Alexei on April 24, 2012, at 12:52:52
> I'm having decent results at 225mg but not good enough.
The first thing to do is to consider increasing the dosage of Effexor to a minimum of 300 mg if you can tolerate it.
> My doc actually offered me both nortriptyline and abilify for augmentation.
These are two excellent choices. If necessary, they can both be combined with the Effexor. It makes sense to try the nortriptyline first and avoid the risk of akathisia with Abilify. I am currently taking both at the same time.
Good luck. Let us know what your next move is.
- Scott
This is the end of the thread.
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