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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 37. This is the beginning of the thread.
Posted by blueberry on December 10, 2006, at 18:31:27
I was wondering why we don't see more mention of dopamine agonists such as requip-ropinirole or mirapex-pramipexole here at pbabble. Realizing mileage varies, these drugs do look pretty decent in literature anyway, for depression, augmentation of antidepressants or mood stabilizers, sexual dysfunction from antidepressants, and bipolarII depression. I wonder why they aren't more popular. It looks like their biggest side effects are somnolence and dizziness. Maybe that's it? Or do they just not work as good in the real world as they do in trials? Or are doctors mainly focused on the serotonin meds? It seems like the dopamine approach would be more popular than it is. ???
Posted by linkadge on December 10, 2006, at 18:56:43
In reply to Why Are Dopamine Agonists Not More Popular?, posted by blueberry on December 10, 2006, at 18:31:27
Good question, I'd like to know myself. I don't think I'd care about sleep attacks that much, I could be wrong.
The herb vitex, is a d2 agonist, and I am finding it has a very nice antidepressant, and antianhedonic effect.
Linkadge
Posted by djmmm on December 10, 2006, at 19:05:49
In reply to Why Are Dopamine Agonists Not More Popular?, posted by blueberry on December 10, 2006, at 18:31:27
> I was wondering why we don't see more mention of dopamine agonists such as requip-ropinirole or mirapex-pramipexole here at pbabble. Realizing mileage varies, these drugs do look pretty decent in literature anyway, for depression, augmentation of antidepressants or mood stabilizers, sexual dysfunction from antidepressants, and bipolarII depression. I wonder why they aren't more popular. It looks like their biggest side effects are somnolence and dizziness. Maybe that's it? Or do they just not work as good in the real world as they do in trials? Or are doctors mainly focused on the serotonin meds? It seems like the dopamine approach would be more popular than it is. ???
I think that there is a preconceived notion that dopamine agonists are potentially abusable. It does seem that, however, drugs that act upon dopamine are becoming more popular, as the SSRIs continue to fail us.
Posted by djmmm on December 10, 2006, at 19:11:12
In reply to Re: Why Are Dopamine Agonists Not More Popular?, posted by linkadge on December 10, 2006, at 18:56:43
> Good question, I'd like to know myself. I don't think I'd care about sleep attacks that much, I could be wrong.
>
> The herb vitex, is a d2 agonist, and I am finding it has a very nice antidepressant, and antianhedonic effect.
>
> Linkadge
>
>what brand of vitex do you use?
Posted by yxibow on December 10, 2006, at 19:11:23
In reply to Why Are Dopamine Agonists Not More Popular?, posted by blueberry on December 10, 2006, at 18:31:27
> I was wondering why we don't see more mention of dopamine agonists such as requip-ropinirole or mirapex-pramipexole here at pbabble. Realizing mileage varies, these drugs do look pretty decent in literature anyway, for depression, augmentation of antidepressants or mood stabilizers, sexual dysfunction from antidepressants, and bipolarII depression. I wonder why they aren't more popular. It looks like their biggest side effects are somnolence and dizziness. Maybe that's it? Or do they just not work as good in the real world as they do in trials? Or are doctors mainly focused on the serotonin meds? It seems like the dopamine approach would be more popular than it is. ???
For one reason, D2/D3 agonists while they may adjust an imbalance / improve a condition in Bipolar in trials for some, they unfortunately also can cause hallucinations, activating that region of the brain in the same way that schizophrenia can.
Parkinsons patients who take carbidopa-levodopa may have to take Zyprexa (possibly), Seroquel, or Clozaril to counteract some of these symptoms and it is a delicate balance of course there because they can't take much of a stronger neuroleptic.
Posted by linkadge on December 10, 2006, at 19:41:42
In reply to Re: Why Are Dopamine Agonists Not More Popular? » linkadge, posted by blueberry on December 10, 2006, at 19:13:00
I don't think dopamine agonists have any abuse potential, thought I could be wrong. I've never heard of agonist abuse. They don't directly activate reward circutry.
Linkadge
Posted by Phillipa on December 10, 2006, at 19:55:34
In reply to Re: Why Are Dopamine Agonists Not More Popular?, posted by linkadge on December 10, 2006, at 19:41:42
Well another question from ding bat what are they and what are they supposed to do.? Love Phillipa
Posted by leo33 on December 10, 2006, at 20:24:29
In reply to Re: Why Are Dopamine Agonists Not More Popular? » linkadge, posted by Phillipa on December 10, 2006, at 19:55:34
Because most of the drugs of abuse target dopamine and since a lot of people turn to these drugs to battle depression they run the risk of abuse. Remember the DEA credo, if it makes you feel good then is should be outlawed. The psychiatrist credo, if it makes you feel like sh*t then we must prescribe it. I apologize for the sarcasm but could not resist because it seems so true.
Posted by psychobot5000 on December 10, 2006, at 21:08:12
In reply to Re: Why Are Dopamine Agonists Not More Popular?, posted by leo33 on December 10, 2006, at 20:24:29
The brain is not really very well understood, but the direct connection between dopamine and pleasure is considered by many modern researchers an exaggeration, a mistake, or an oversimplification. Dopamine agonists have some potentiating action at particular types of dopamine receptors, and the experience and their uses are both quite different from abusable drugs that involve dopamine.
I think the reason dopamine agonists aren't used much is the side-effects, combined with a lack of response from the highly-treatment-resistant patients who turn to them. They were developed for Parkinson's, which is a nasty disease--nasty enough that patients are willing to put up with a relatively large side-effect load for something that works. The posters on this board typically have not gotten much mileage out of them, though, and many complain of the damned somnolence, me included.
Perhaps studies ought to be done on dopamine agonists for -treatment resistant- depression.
Posted by Dr. Bob on December 11, 2006, at 1:21:28
In reply to Re: Why Are Dopamine Agonists Not More Popular?, posted by djmmm on December 10, 2006, at 19:11:12
> what brand of vitex do you use?
Sorry to interrupt, but I'd like to redirect follow-ups regarding vitex to Psycho-Babble Alternative. Here's a link:
http://www.dr-bob.org/babble/alter/20061203/msgs/712474.html
Thanks,
Bob
Posted by djmmm on December 11, 2006, at 7:34:52
In reply to Dopamine does not always mean abusability, posted by psychobot5000 on December 10, 2006, at 21:08:12
> The brain is not really very well understood, but the direct connection between dopamine and pleasure is considered by many modern researchers an exaggeration, a mistake, or an oversimplification. Dopamine agonists have some potentiating action at particular types of dopamine receptors, and the experience and their uses are both quite different from abusable drugs that involve dopamine.
>
> I think the reason dopamine agonists aren't used much is the side-effects, combined with a lack of response from the highly-treatment-resistant patients who turn to them. They were developed for Parkinson's, which is a nasty disease--nasty enough that patients are willing to put up with a relatively large side-effect load for something that works. The posters on this board typically have not gotten much mileage out of them, though, and many complain of the damned somnolence, me included.
>
> Perhaps studies ought to be done on dopamine agonists for -treatment resistant- depression.Very true... however, I still think that dopamine acting drugs are still perceived as potentially abusable. We have all be programed to make the connection between dopamine->stimulation/euphoria-->abuse/addiction. Although this "connection" has been proven untrue with a variety of dopamine acting medications, this idea still carries over to research and development. There also seems to be this stigma against very effective medications, that just happen to make us feel good-- instead of anesthetized/apathetic. There is some good info on anhedonia and dopamine at [xxx]
Posted by linkadge on December 11, 2006, at 9:17:11
In reply to Re: Dopamine does not always mean abusability, posted by djmmm on December 11, 2006, at 7:34:52
I think a good doctor would know that dopamine agonists have little/no abuse potential.
Yes, a number of drugs of abuse may target dopamien, but a greater common denominator is that they target the neucleus accumbens.
Posted by liliths on December 11, 2006, at 12:58:55
In reply to Why Are Dopamine Agonists Not More Popular?, posted by blueberry on December 10, 2006, at 18:31:27
just wondering if anyone has asked their pdocs about these meds and their potential or if anyone here has tried either of them
thanks
namaste,
lilith> I was wondering why we don't see more mention of dopamine agonists such as requip-ropinirole or mirapex-pramipexole here at pbabble. Realizing mileage varies, these drugs do look pretty decent in literature anyway, for depression, augmentation of antidepressants or mood stabilizers, sexual dysfunction from antidepressants, and bipolarII depression. I wonder why they aren't more popular. It looks like their biggest side effects are somnolence and dizziness. Maybe that's it? Or do they just not work as good in the real world as they do in trials? Or are doctors mainly focused on the serotonin meds? It seems like the dopamine approach would be more popular than it is. ???
Posted by linkadge on December 11, 2006, at 13:20:07
In reply to Re: Why Are Dopamine Agonists Not More Popular? » blueberry, posted by liliths on December 11, 2006, at 12:58:55
I think there is more evidence for mirapex than others.
Linkadge
Posted by Maxime on December 11, 2006, at 16:01:18
In reply to Why Are Dopamine Agonists Not More Popular?, posted by blueberry on December 10, 2006, at 18:31:27
I've been on one it causes EXTREME nausea and didn't help my depression. It was Mirapex.
Maxime
> I was wondering why we don't see more mention of dopamine agonists such as requip-ropinirole or mirapex-pramipexole here at pbabble. Realizing mileage varies, these drugs do look pretty decent in literature anyway, for depression, augmentation of antidepressants or mood stabilizers, sexual dysfunction from antidepressants, and bipolarII depression. I wonder why they aren't more popular. It looks like their biggest side effects are somnolence and dizziness. Maybe that's it? Or do they just not work as good in the real world as they do in trials? Or are doctors mainly focused on the serotonin meds? It seems like the dopamine approach would be more popular than it is. ???
Posted by psychobot5000 on December 12, 2006, at 20:51:17
In reply to Re: Why Are Dopamine Agonists Not More Popular? » blueberry, posted by liliths on December 11, 2006, at 12:58:55
> just wondering if anyone has asked their pdocs about these meds and their potential or if anyone here has tried either of them
>
> thanks
>
> namaste,
> lilithA doc recommended mirapex as a potentially useful adjunct or monotherapy for treatment-resistant depression--the evidence really does seem to be better for that agent. I found the somnolence and fatigue to be quite severe.
Posted by Maria3667 on December 13, 2006, at 7:53:48
In reply to Why Are Dopamine Agonists Not More Popular?, posted by blueberry on December 10, 2006, at 18:31:27
> I was wondering why we don't see more mention of dopamine agonists such as requip-ropinirole or mirapex-pramipexole here at pbabble. It looks like their biggest side effects are somnolence and dizziness.???
Yes looks like.
Have you tried them yourself? I think not, otherwise you wouldn't be wondering about them.
I was the stupid *ss to try and guess what happened? They made me go crazy with fear. It was the worst experience in my life.
Dopamine-agonist are often very energizing and can have the tendency to increase anxiety. This happens in many people. Other side effects: insomnia. And yes, maybe a slight increase in libido, but you'll be so scared you won't be thinking about it...
If you don't believe me, just go and find out. But don't come crying...
Posted by linkadge on December 13, 2006, at 15:14:56
In reply to Re: Why Are Dopamine Agonists Not More Popular?, posted by Maria3667 on December 13, 2006, at 7:53:48
Well, lets not project our experiences on to others. Wellbutrin for instance, can make some people very anxious. But, for others it is a very effective antidepressant, and does not cause these effects. If a dopamine agonist is making anxiety worse, then I would suspect that your brain is providing sufficiant agonism to these receptor sites.
Linkadge
Posted by Phillipa on December 13, 2006, at 19:18:03
In reply to Re: Why Are Dopamine Agonists Not More Popular? » Maria3667, posted by linkadge on December 13, 2006, at 15:14:56
Link so since Wellbutrin in a weeks time at 150mg aggitated me so I was hospitalized I can assume I have enough dopamine? What med would you recommend? Love Phillipa please answer
Posted by Paulbwell on December 14, 2006, at 3:56:24
In reply to Re: Why Are Dopamine Agonists Not More Popular? » linkadge, posted by Phillipa on December 13, 2006, at 19:18:03
Hold on people!, are we talking only selective Dopamine agonists-like Mirapex?
Why Are Dopamine Agonists Not More Popular?----Are
-Dextroamphetamine
-Methylphenidate
-Mixed Amphetamine salts
-Methamphetamine
Not Dopamine agonists? yes Norepinephrine too, and in Meth's case Serotonin, these drugs are very much in demand, Ritalin is in the top 5 CD's reported stolen and extensively abused.Am i missing something here?
They are probably the most used meds by kids in the USA, but thanks to their Sch II status, and the tight rules placed on Amps, Ritalin, by the CD Act of 1970, this may explaine their lower scripted rates-very much more so outside the US.Wrong Dopamine Agonists? if so disreguard the above.
Cheers
Posted by Maria3667 on December 14, 2006, at 4:52:07
In reply to Re: Why Are Dopamine Agonists Not More Popular? » Maria3667, posted by linkadge on December 13, 2006, at 15:14:56
>If a dopamine agonist is making anxiety worse, then I would suspect that your brain is providing sufficiant agonism to these receptor sites.
>
> LinkadgeTotally agreed. But how do you know if ones dopamine's levels are out of whack? By trial and error, or, just give the text below a thought:
Depression is often coupled to anxiety symptoms(especially if it is a long standing depression). So a rule of thumb could be that if a person is already anxious, adding a dopamine agonist is going to make things worse.
On the other hand, the paradox being that higher dopamine levels often relieve depression symptoms.So the solution? Maybe administrating a dopamine agonist to lift the depression & combining it with some sort of anxiolitic to dampen the fear.
That is the best my warped mind can cook up right now!
I'd like to know your thought on this.
Cheers,
MariaP.S. I've tried Wellbutrin and Mirapex on separate occassions and it was a nightmare.
Posted by Dr. Bob on December 14, 2006, at 7:35:57
In reply to Re: Dopamine does not always mean abusability, posted by djmmm on December 11, 2006, at 7:34:52
> There is some good info on anhedonia and dopamine at [xxx]
There may be, but FYI there's also information on that page that could be used to import into the US prescription medication without a prescription, and I'd rather this site weren't used to exchange the latter sort of info.
If you or others have questions about this or about posting policies in general, please first see the FAQ:
http://www.dr-bob.org/babble/faq.html#illegal
http://www.dr-bob.org/babble/faq.html#enforceFollow-ups regarding these issues should be redirected to Psycho-Babble Administration.
Thanks,
Bob
Posted by psychobot5000 on December 14, 2006, at 11:24:02
In reply to Re: Why Are Dopamine Agonists Not More Popular?, posted by Paulbwell on December 14, 2006, at 3:56:24
As far as I can tell, the term "dopamine agonists" refers to a class of drugs that have direct exhibiting action on dopamine receptors, rather than by increasing dopamine action in another way like dextroamphetamine and methylphenidate, which seem mostly to act by inhibiting reuptake of dopamine and/or increasing its release (as well as working with other transmitters).
I believe people are (as you suggested) wondering about Mirapex, ropinirole, bromocriptine, cabergoline, etc, which all seem to share some characteristics, and are termed 'agonists' because of the particular nature of their effect on dopaminergic stuff.
Best,
P-bot> Hold on people!, are we talking only selective Dopamine agonists-like Mirapex?
>
> Why Are Dopamine Agonists Not More Popular?----Are
> -Dextroamphetamine
> -Methylphenidate
> -Mixed Amphetamine salts
> -Methamphetamine
> Not Dopamine agonists? yes Norepinephrine too, and in Meth's case Serotonin, these drugs are very much in demand, Ritalin is in the top 5 CD's reported stolen and extensively abused.
>
> Am i missing something here?
> They are probably the most used meds by kids in the USA, but thanks to their Sch II status, and the tight rules placed on Amps, Ritalin, by the CD Act of 1970, this may explaine their lower scripted rates-very much more so outside the US.
>
> Wrong Dopamine Agonists? if so disreguard the above.
>
> Cheers
Posted by Paulbwell on December 14, 2006, at 11:54:01
In reply to Re: Why Are Dopamine Agonists Not More Popular? » Paulbwell, posted by psychobot5000 on December 14, 2006, at 11:24:02
> As far as I can tell, the term "dopamine agonists" refers to a class of drugs that have direct exhibiting action on dopamine receptors, rather than by increasing dopamine action in another way like dextroamphetamine and methylphenidate, which seem mostly to act by inhibiting reuptake of dopamine and/or increasing its release (as well as working with other transmitters).
>
> I believe people are (as you suggested) wondering about Mirapex, ropinirole, bromocriptine, cabergoline, etc, which all seem to share some characteristics, and are termed 'agonists' because of the particular nature of their effect on dopaminergic stuff.
>
> Best,
> P-bot
>
Thanks for that
-so i wonder in the PDR when, under ARs to Risperdal it states: "may antagonise effects of Dopamine agonists" they mean the above mentioned agents, AND stimulants?-likely.Cheers
Posted by psychobot5000 on December 14, 2006, at 16:50:04
In reply to Re: Why Are Dopamine Agonists Not More Popular? » psychobot5000, posted by Paulbwell on December 14, 2006, at 11:54:01
> -so i wonder in the PDR when, under ARs to Risperdal it states: "may antagonise effects of Dopamine agonists" they mean the above mentioned agents, AND stimulants?-likely.
>
> CheersI've wondered about those interactions too. ...Don't know enough about it to say what exactly they mean...but in my experience, antipsychotics didn't really seem to block the effect of low-dose stimulants. Of course it was different, taking them together. But Risperdal and most of its brothers (except Amisulpride and abilify?) I believe are all D2 antagonists, which seems as though it ought to put them in direct opposition to agonists like Pramipexole and bromocriptine. Perhaps that specific is all they mean.
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