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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 13 of 13. This is the beginning of the thread.
Posted by Willow on August 1, 2001, at 21:06:30
I may have the wrong spelling of the medication, it is commonly used for Parkinsons. I started two days ago for restless sleep, sever limb movements. Today I wasn't tired and significant less muscle pain. I'll have to wait some time longer to see if it is really helping.
Why were you considering this medication?
Willow
Posted by medlib on August 2, 2001, at 2:31:34
In reply to Medlib Re: Mirapex , posted by Willow on August 1, 2001, at 21:06:30
Hi Willow--
I'm interested in Mirapex because it's a dopamine agonist, and some reports on Babble and in med lit suggest it may be useful in treating anhedonia and lack of motivation--both big problems for me that my other meds haven't helped. I e-mailed my pdoc some URLs, but I don't see him until the 8th--hope he'll okay a trial then.
You're taking Mirapex now? Were the symptoms you mentioned start-up effects from Mirapex or the reason you're trying it? I'd be interested in your experience with it.
TIA---medlib
Posted by ChrisK on August 2, 2001, at 5:08:30
In reply to Re: Medlib Re: Mirapex , posted by medlib on August 2, 2001, at 2:31:34
medlib,Willow,
Look back in the archives for some of my posts on my Mirapex experience. It has been great for me and my anhedonia. It was the last breakthrough that got me almost back to a normal life. It has been shown to have some good AD effects. I would reccommend trying Mirapex to anyone who has problems with apathy/anhedonia. The one drawback is that it does cause nausea in a lot of people. That is why it is reccommended to titrate up slowly until you hit a theraputic dose.
Chris
Posted by Willow on August 2, 2001, at 5:38:05
In reply to Re: Medlib Re: Mirapex , posted by medlib on August 2, 2001, at 2:31:24
> You're taking Mirapex now? Were the symptoms you mentioned start-up effects from Mirapex or the reason you're trying it? I'd be interested in your experience with it.
I've only taken three dosages, three nights, so far. The dosage is low. The doctor who prescribed it mentioned that if you take too high a dose at first that your stomach will expel it. I'll post the dosage when I wakeup; little one came down to check if I was sleeping.
I'm taking it for the movements during my sleep and twitches during the day. I think it is helping with the muscle tightness.
Dopamine agonist, what does this mean? That it stops a person from using dopamine? Do you know how dopamine is assumed to play a role in schizophrenia? My father has schizophrenia and we believe it was brought on by "street" drugs in his mid-30's. This illness is common in our family, so I was concerned if mirapex would have any relation to the chemistry of schizophrenia.
Interesting that you mentioned it's potential to help anhedonia. I've suffered with severe fatigue and lack of stamina. Psychologist on occassion has said that I have had anhedonia, but it isn't chronic, though the fatigue is. Yesterday I did not have the strong urge to sleep, though it probably is too early to tell how it will affect me. The muscle tightness I usually have is pleasantly gone two mornings in a row now.
The doctor who prescribed it did tell me to contact him if I have any problems. It is used at higher dosages for Parkinsons. I'm not sure but I do think this illness affects the brain too.
Willow
Posted by medlib on August 3, 2001, at 1:07:00
In reply to Mirapex , posted by Willow on August 2, 2001, at 5:38:05
Hi Willow--
In pharmacology, an agonist is an enhancer, and an antagonist is a blocker. In Parkinsons, dopamine neurons in one part of the brain begin to die; Mirapex acts by enhancing dopamine production and function in those which remain.
I know little about schizophrenia. The med lit for Geodon, an antipsychotic I recently discontinued, said that G.'s effect treating schizophrenia was thought to be due to its *antagonism* of dopamine D2 and serotonin (5HT2) receptors. Mirapex, a dopamine agonist, enhances dopamine D3 receptors much more than it does D2s, but it would seem to have the potential to make schizophrenia worse.
That's probably clear as mud, which may reflect the current level of my understanding and/or the lateness of the hour. But, as JohnL is fond of saying, it probably matters less *how* meds work, than *whether* they work, and how well.
Hope Mirapex works well for you--I'm looking forward to hearing!---medlib
Posted by Willow on August 3, 2001, at 5:06:02
In reply to Re: Mirapex » Willow, posted by medlib on August 3, 2001, at 1:07:00
Medlib
Well you were able to answer my question, thank you. I'm taking 1/2tablet of .25mg. I think it is starting to give me insomnia. Not sure if that is what you call it. Woke up all by myself after four hours of sleep, tossed for an hour, then decided to get up. And it's suppose to make my sleep get better. Time will tell, I do feel better during the day, no drowsy periods!! : )
I'll keep you posted!
Willow
Posted by ChrisK on August 4, 2001, at 5:47:13
In reply to Re: Mirapex » Willow, posted by medlib on August 3, 2001, at 1:07:00
It seems a little odd to both me and my pdoc but I have benefited from the combination of Geodon (at first Zyprexa) and Mirapex. It would appear that there would be a dopamine battle going on but the combination has worked great for me. Maybe it's the particular receptors but I'm not going to argue with the final result.
Posted by Willow on August 4, 2001, at 9:44:54
In reply to Re: Mirapex » medlib, posted by ChrisK on August 4, 2001, at 5:47:13
Chris
I have been having success with effexor. I've just started the mirapex and it seems to have put me back "emotionally" to my "normal" self. It is just a slight difference. So far I'm quite impressed.
I do get a tummy ache, though I have previous stomach problems which may make me sensitive. I'm still twitching in my sleep, but am waiting for my stomache to settle before I increase the dose.
I also have a minor headache, can this be the mirapex?
Willow
Posted by Peter S on August 4, 2001, at 12:24:34
In reply to Re: Mirapex » medlib, posted by ChrisK on August 4, 2001, at 5:47:13
Hi Chris,
I've been taking Mirapex (.25 mg) and Prozac (20mg). The Mirapex seems to have eliminated the SSRI fatigue that I used to always get, but the depression has not completely lifted. Can you tell me your regimen and dosages? I'm especially curious as to how much Geodon your taking and how long it took to notice an effect from it. Why did you switch from Zyprexa?
Thanks!
Peter
> It seems a little odd to both me and my pdoc but I have benefited from the combination of Geodon (at first Zyprexa) and Mirapex. It would appear that there would be a dopamine battle going on but the combination has worked great for me. Maybe it's the particular receptors but I'm not going to argue with the final result.
Posted by SalArmy4me on August 4, 2001, at 14:37:58
In reply to Re: Mirapex Chris, posted by Peter S on August 4, 2001, at 12:24:34
Here are some advantages of Mirapex:
--It has a benign side-effect profile, with most patients reporting nausea as the main side-effect. But that side-effect may have been from the levodopa that the Parkinsons' patients were also taking during the clinical trials.
--Mirapex is definitely less expensive than Prozac or Wellbutrin. 100 of the 1.5 mg Mirapex tablets costs $80 on insurance at the largest HMO in the US. Prozac and Paxil are definitely more costly.
--It has few anticholinergic effects.
--It is not known to cause sexual dysfunction.
--Though it probably has to be taken three times a day, so does Neurontin, Wellbutrin IR, Effexor IR, and Visken.
--Mirapex has two studies done on it in non-Parkinsons' patients--one for unipolar depression and the other for bipolar disorder.
--It has minimal drug interactions as compared to Tricylcics Antidepressants or MAOI's (& RIMA's).Thus, if it works for you, its a good deal.
-Studies on Medline:
2. Pramipexole augmentation in the treatment of unipolar and bipolar depression: a retrospective chart review Ann Clin Psychiatry. 2000 Sep;12(3):137-40. [Record as supplied by publisher] PMID: 10984002
3:
Maj J, Rogoz Z.
Related Articles
Synergistic effect of pramipexole and sertraline in the forced swimming test. Pol J Pharmacol. 1999 Nov-Dec;51(6):471-5.
PMID: 10817524
4: Corrigan MH, Denahan AQ, Wright CE, Ragual RJ, Evans DL. Related Articles Comparison of pramipexole, fluoxetine, and placebo in patients with major depression. Depress Anxiety. 2000;11(2):58-65. PMID: 10812530
5: DeBattista C, Solvason HB, Breen JA, Schatzberg AF. Related Articles Pramipexole augmentation of a selective serotonin reuptake inhibitor in the treatment of depression. J Clin Psychopharmacol. 2000 Apr;20(2):274-5. No abstract available. PMID: 10770475
6:
Goldberg JF, Frye MA, Dunn RT.
Related Articles
Pramipexole in refractory bipolar depression.
Am J Psychiatry. 1999 May;156(5):798. No abstract available.
PMID: 10327923
7:
Bennett JP, Piercey MF.
Related Articles
Pramipexole--a new dopamine agonist for the treatment of Parkinson's disease. J Neurol Sci. 1999 Feb 1;163(1):25-31. Review.
PMID: 10223406
8: Piercey MF. Related Articles Pharmacology of pramipexole, a dopamine D3-preferring agonist useful in treating Parkinson's disease. Clin Neuropharmacol. 1998 May-Jun;21(3):141-51. Review. PMID: 9617505
9:
Willner P.
Related Articles
The mesolimbic dopamine system as a target for rapid antidepressant action. Int Clin Psychopharmacol. 1997 Jul;12 Suppl 3:S7-14. Review.
PMID: 9347387
Posted by ChrisK on August 5, 2001, at 3:49:11
In reply to Re: Mirapex Chris, posted by Peter S on August 4, 2001, at 12:24:34
Peter,
I take 3-4mg of Mirapex/day, 80 mg/day of Geodon and 100 mg/day of Nortriptyline. I am a big person (approx 250 lbs) so my doses tend to run on the high side plus I seem to be fairly med resistant. I rarely get side effects from the meds I have tried and only had withdrawl problems from Xanax.
My depression was helped by the Nortriptyline so I have remained on that as my main AD. IT still didn't help with the suicidal thoughts so I started on Zyprexa (after a few failed trials with things like Remeron and Risperdal). The Z helped clear up my thinking but I still had the anhedonia/apathy problem. After quite a few trials I stumbled on Mirapex which has been great. I'm almost back to what I would call normal. I still have lost interest in some things but they are coming back into my life.
As far as the switch from Zyprexa to Geodon I'm not 100% sure why but both my pdoc andI thought that it would be a good match for my type of depression. I had no problem with the switch and haven't noticed a big difference betweeen the two. I think some of the change had to do with the weight gain and the possibility of TD with long term Zyprexa use. Either way it has worked out.
If you don't feel that you are getting the full effects of your Prozac I would suggest upping your dose a little. It seems to be helping somewhat and dose changes are easier to manage than changing your meds all together.
Hope this helps a little,
Chris
Posted by Peter S on August 5, 2001, at 12:19:21
In reply to Re: Mirapex Chris » Peter S, posted by ChrisK on August 5, 2001, at 3:49:11
Chris,
Thanks for all the info! I may take your suggestion and up the Prozac.
Peter
> Peter,
>
> I take 3-4mg of Mirapex/day, 80 mg/day of Geodon and 100 mg/day of Nortriptyline. I am a big person (approx 250 lbs) so my doses tend to run on the high side plus I seem to be fairly med resistant. I rarely get side effects from the meds I have tried and only had withdrawl problems from Xanax.
>
> My depression was helped by the Nortriptyline so I have remained on that as my main AD. IT still didn't help with the suicidal thoughts so I started on Zyprexa (after a few failed trials with things like Remeron and Risperdal). The Z helped clear up my thinking but I still had the anhedonia/apathy problem. After quite a few trials I stumbled on Mirapex which has been great. I'm almost back to what I would call normal. I still have lost interest in some things but they are coming back into my life.
>
> As far as the switch from Zyprexa to Geodon I'm not 100% sure why but both my pdoc andI thought that it would be a good match for my type of depression. I had no problem with the switch and haven't noticed a big difference betweeen the two. I think some of the change had to do with the weight gain and the possibility of TD with long term Zyprexa use. Either way it has worked out.
>
> If you don't feel that you are getting the full effects of your Prozac I would suggest upping your dose a little. It seems to be helping somewhat and dose changes are easier to manage than changing your meds all together.
>
> Hope this helps a little,
> Chris
Posted by Peter S on August 5, 2001, at 21:18:38
In reply to Re: Mirapex Chris » Peter S, posted by ChrisK on August 5, 2001, at 3:49:11
Chris,
Thanks for all the info! I may take your suggestion and up the Prozac.
Peter
> Peter,
>
> I take 3-4mg of Mirapex/day, 80 mg/day of Geodon and 100 mg/day of Nortriptyline. I am a big person (approx 250 lbs) so my doses tend to run on the high side plus I seem to be fairly med resistant. I rarely get side effects from the meds I have tried and only had withdrawl problems from Xanax.
>
> My depression was helped by the Nortriptyline so I have remained on that as my main AD. IT still didn't help with the suicidal thoughts so I started on Zyprexa (after a few failed trials with things like Remeron and Risperdal). The Z helped clear up my thinking but I still had the anhedonia/apathy problem. After quite a few trials I stumbled on Mirapex which has been great. I'm almost back to what I would call normal. I still have lost interest in some things but they are coming back into my life.
>
> As far as the switch from Zyprexa to Geodon I'm not 100% sure why but both my pdoc andI thought that it would be a good match for my type of depression. I had no problem with the switch and haven't noticed a big difference betweeen the two. I think some of the change had to do with the weight gain and the possibility of TD with long term Zyprexa use. Either way it has worked out.
>
> If you don't feel that you are getting the full effects of your Prozac I would suggest upping your dose a little. It seems to be helping somewhat and dose changes are easier to manage than changing your meds all together.
>
> Hope this helps a little,
> Chris
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