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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Maverick on September 3, 2002, at 23:18:08
Hi there,
I am currently on Effexor 225mg (75mg tid), 1mg Xanax (before bed) and 100mg Trazodone (before bed). I currently use Viagra for the sexual dysfunction caused by the Effexor. I have been wondering whether anyone has added a dopamine agonist like Mirapex to augment the Effexor and to correct the sexual dysfunction and cognitive side-effects.
I look forward to hearing from anyone who has.
Posted by linkadge on September 4, 2002, at 17:38:07
In reply to Effexor with Mirapex?, posted by Maverick on September 3, 2002, at 23:18:08
In this scenario, the effexor is not
causeing the sexual disfunction by means
of dopamin down-regulation. It is more
likely caused by an overstimulted seretonin
receptor. Unlike SSRI's Effexor actually
raises brain Dopamine to a certain extent.
I personally found Effexor to be the best
for cognition, (certainly better than some of the
SSRI meds). I don't know of any interactions,
but be careful of Seritonin Syndrome. Dopamine
reputake inhibitors can tend to raise seritonin
as well. It may also raise the insommnia.Let me know if you do - I am interested.
Posted by Maverick on September 4, 2002, at 20:16:11
In reply to Re: Effexor with Mirapex?, posted by linkadge on September 4, 2002, at 17:38:07
I haven't started any form of dopamine agonist yet, but I will let you know when I decide on one.I have tried Wellbutrin SR in the past and don't find it to be of any benefit. It just increased my anxiety andthe Effexor side effects.
What would your suggestions be to reclaim my sex life? I am unable to decrease my Effexor without the depression returning.
In this scenario, the effexor is not
> causeing the sexual disfunction by means
> of dopamin down-regulation. It is more
> likely caused by an overstimulted seretonin
> receptor. Unlike SSRI's Effexor actually
> raises brain Dopamine to a certain extent.
> I personally found Effexor to be the best
> for cognition, (certainly better than some of the
> SSRI meds). I don't know of any interactions,
> but be careful of Seritonin Syndrome. Dopamine
> reputake inhibitors can tend to raise seritonin
> as well. It may also raise the insommnia.
>
> Let me know if you do - I am interested.
>
>
>
>
Posted by Rick on September 4, 2002, at 22:28:10
In reply to Re: Effexor with Mirapex?, posted by Maverick on September 4, 2002, at 20:16:11
Not positive, but my understanding was that Mirapex can cause some cognitive dulling, even if it *is* a dopamine agonist. While it might have more side effects (especially nausea and hypotension), bromocriptine/Parlodel might be a better choice. Bromocriptine is sometimes considered a "smart drug." Both Mirapex and bromocriptine have been shown to potentiate antidepressants, too, so you might be able to cut down your Effexor dose a bit, which could further help the sexual dysfunction.
A few other "antidotes" to consider include a small dose of selegiline/deprenyl (although this dopaminergic agent is an MAOI, so strictly speaking it's contraindicated and there's a small possibility of serotonin syndrome...be careful); Buspar; Ginkgo Biloba; and Serzone (again, might allow you to cut the Effexor dose). There are lots of other antidotes to try -- though no guarantees, of course, and some can take awhile to kick in even if they do work.
If none of the add-ons work, maybe you could "ease" into a trial of Serzone or Remeron monotherapy (or moclobemide if you're NOT in the U.S., although this would require a washout period, I believe). I know that's easier said than tried, especially if you've been on Effexor awhile and it works well for your depression.
Good Luck,
Rick>
> I haven't started any form of dopamine agonist yet, but I will let you know when I decide on one.
>
> I have tried Wellbutrin SR in the past and don't find it to be of any benefit. It just increased my anxiety andthe Effexor side effects.
>
> What would your suggestions be to reclaim my sex life? I am unable to decrease my Effexor without the depression returning.
>
>
>
> In this scenario, the effexor is not
> > causeing the sexual disfunction by means
> > of dopamin down-regulation. It is more
> > likely caused by an overstimulted seretonin
> > receptor. Unlike SSRI's Effexor actually
> > raises brain Dopamine to a certain extent.
> > I personally found Effexor to be the best
> > for cognition, (certainly better than some of the
> > SSRI meds). I don't know of any interactions,
> > but be careful of Seritonin Syndrome. Dopamine
> > reputake inhibitors can tend to raise seritonin
> > as well. It may also raise the insommnia.
> >
> > Let me know if you do - I am interested.
> >
> >
> >
> >
>
>
Posted by Maverick on September 6, 2002, at 0:30:16
In reply to Re: Effexor with Mirapex? » Maverick, posted by Rick on September 4, 2002, at 22:28:10
Thanks Rick, your feedback is much appreciated.I chose Mirapex because there have been some studies on its effectiveness in depression. My other choice would be Dostinex (cabergoline) as it is a D2 receptor agonist which can assist in libido and sexual function. It only needs to be taken twice per week as is cheaper.
I do think that my problems stem from high prolactin levels, which dopamine agonists can correct. The reason I say this is that I have noticed a female type fat distribution around my waist, chest area and buttocks, water retention, sore nipples, zero sex drive and erectile dysfunction. I feel that this has dampened by natural production of growth hormone and testosterone production as I fail to see the benefits of excercise like I used to, and no longer retain muscle gains.
I have tried added Wellbutrin to my Effexor regime in the past with no effect. The Effexor is a tried and trusted AD for me, as I have been on at least 10 others with minimal and diminishing effects. I have been on and off AD's for 6 years now.
What is your opinion?
Thanks
Merrick> Not positive, but my understanding was that Mirapex can cause some cognitive dulling, even if it *is* a dopamine agonist. While it might have more side effects (especially nausea and hypotension), bromocriptine/Parlodel might be a better choice. Bromocriptine is sometimes considered a "smart drug." Both Mirapex and bromocriptine have been shown to potentiate antidepressants, too, so you might be able to cut down your Effexor dose a bit, which could further help the sexual dysfunction.
>
> A few other "antidotes" to consider include a small dose of selegiline/deprenyl (although this dopaminergic agent is an MAOI, so strictly speaking it's contraindicated and there's a small possibility of serotonin syndrome...be careful); Buspar; Ginkgo Biloba; and Serzone (again, might allow you to cut the Effexor dose). There are lots of other antidotes to try -- though no guarantees, of course, and some can take awhile to kick in even if they do work.
>
> If none of the add-ons work, maybe you could "ease" into a trial of Serzone or Remeron monotherapy (or moclobemide if you're NOT in the U.S., although this would require a washout period, I believe). I know that's easier said than tried, especially if you've been on Effexor awhile and it works well for your depression.
>
> Good Luck,
> Rick
>
> >
> > I haven't started any form of dopamine agonist yet, but I will let you know when I decide on one.
> >
> > I have tried Wellbutrin SR in the past and don't find it to be of any benefit. It just increased my anxiety andthe Effexor side effects.
> >
> > What would your suggestions be to reclaim my sex life? I am unable to decrease my Effexor without the depression returning.
> >
> >
> >
> > In this scenario, the effexor is not
> > > causeing the sexual disfunction by means
> > > of dopamin down-regulation. It is more
> > > likely caused by an overstimulted seretonin
> > > receptor. Unlike SSRI's Effexor actually
> > > raises brain Dopamine to a certain extent.
> > > I personally found Effexor to be the best
> > > for cognition, (certainly better than some of the
> > > SSRI meds). I don't know of any interactions,
> > > but be careful of Seritonin Syndrome. Dopamine
> > > reputake inhibitors can tend to raise seritonin
> > > as well. It may also raise the insommnia.
> > >
> > > Let me know if you do - I am interested.
> > >
> > >
> > >
> > >
> >
> >
>
>
Posted by Rick on September 6, 2002, at 15:44:33
In reply to Re: Effexor with Mirapex?, posted by Maverick on September 6, 2002, at 0:30:16
Sounds like you've thought this through pretty well and understand the posibilities better than I would. I had never heard of Dostinex, but it sounds as if it might indeed be worth trying first.
Let us know how it goes! (Although if it's not posted to this same thread -- so that I get an update notification email from P-B -- I likely won't see it. Gonna be too busy to do much P-B browsing over the next month.)
Rick
>
> Thanks Rick, your feedback is much appreciated.
>
> I chose Mirapex because there have been some studies on its effectiveness in depression. My other choice would be Dostinex (cabergoline) as it is a D2 receptor agonist which can assist in libido and sexual function. It only needs to be taken twice per week as is cheaper.
>
> I do think that my problems stem from high prolactin levels, which dopamine agonists can correct. The reason I say this is that I have noticed a female type fat distribution around my waist, chest area and buttocks, water retention, sore nipples, zero sex drive and erectile dysfunction. I feel that this has dampened by natural production of growth hormone and testosterone production as I fail to see the benefits of excercise like I used to, and no longer retain muscle gains.
>
> I have tried added Wellbutrin to my Effexor regime in the past with no effect. The Effexor is a tried and trusted AD for me, as I have been on at least 10 others with minimal and diminishing effects. I have been on and off AD's for 6 years now.
>
> What is your opinion?
>
> Thanks
> Merrick
>
> > Not positive, but my understanding was that Mirapex can cause some cognitive dulling, even if it *is* a dopamine agonist. While it might have more side effects (especially nausea and hypotension), bromocriptine/Parlodel might be a better choice. Bromocriptine is sometimes considered a "smart drug." Both Mirapex and bromocriptine have been shown to potentiate antidepressants, too, so you might be able to cut down your Effexor dose a bit, which could further help the sexual dysfunction.
> >
> > A few other "antidotes" to consider include a small dose of selegiline/deprenyl (although this dopaminergic agent is an MAOI, so strictly speaking it's contraindicated and there's a small possibility of serotonin syndrome...be careful); Buspar; Ginkgo Biloba; and Serzone (again, might allow you to cut the Effexor dose). There are lots of other antidotes to try -- though no guarantees, of course, and some can take awhile to kick in even if they do work.
> >
> > If none of the add-ons work, maybe you could "ease" into a trial of Serzone or Remeron monotherapy (or moclobemide if you're NOT in the U.S., although this would require a washout period, I believe). I know that's easier said than tried, especially if you've been on Effexor awhile and it works well for your depression.
> >
> > Good Luck,
> > Rick
> >
> > >
> > > I haven't started any form of dopamine agonist yet, but I will let you know when I decide on one.
> > >
> > > I have tried Wellbutrin SR in the past and don't find it to be of any benefit. It just increased my anxiety andthe Effexor side effects.
> > >
> > > What would your suggestions be to reclaim my sex life? I am unable to decrease my Effexor without the depression returning.
> > >
> > >
> > >
> > > In this scenario, the effexor is not
> > > > causeing the sexual disfunction by means
> > > > of dopamin down-regulation. It is more
> > > > likely caused by an overstimulted seretonin
> > > > receptor. Unlike SSRI's Effexor actually
> > > > raises brain Dopamine to a certain extent.
> > > > I personally found Effexor to be the best
> > > > for cognition, (certainly better than some of the
> > > > SSRI meds). I don't know of any interactions,
> > > > but be careful of Seritonin Syndrome. Dopamine
> > > > reputake inhibitors can tend to raise seritonin
> > > > as well. It may also raise the insommnia.
> > > >
> > > > Let me know if you do - I am interested.
> > > >
> > > >
> > > >
> > > >
> > >
> > >
> >
> >
>
>
Posted by Dinah on September 6, 2002, at 16:25:58
In reply to Re: Effexor with Mirapex? » Maverick, posted by Rick on September 6, 2002, at 15:44:33
>
> Let us know how it goes! (Although if it's not posted to this same thread -- so that I get an update notification email from P-B -- I likely won't see it. Gonna be too busy to do much P-B browsing over the next month.)
>
> Rick
> >Doing something rewarding and enjoyable I hope. :)
Best wishes,
Dinah
Posted by Jerrympls on September 6, 2002, at 23:33:14
In reply to Re: Effexor with Mirapex? » Maverick, posted by Rick on September 6, 2002, at 15:44:33
hi all -
I've been starting to research the use of dopaminergic meds like mirapex, etc to help augment ADs - etc. Can anyone point me towards some good studies that have been published?
Thanks
Jerry
Posted by Maverick on September 7, 2002, at 21:42:13
In reply to Re: Effexor with Mirapex? » Rick, posted by Jerrympls on September 6, 2002, at 23:33:14
Jerry,Click on this hyperlink and type the Mirapex generic name (pramipexole) in the search and it will display all the available studies:
www.ncbi.nlm.nih.gov/entrez/query.fcgi
Merrick
> hi all -
>
> I've been starting to research the use of dopaminergic meds like mirapex, etc to help augment ADs - etc. Can anyone point me towards some good studies that have been published?
>
> Thanks
> Jerry
>
Posted by Rick on September 8, 2002, at 1:30:42
In reply to Re: Effexor with Mirapex? » Rick, posted by Dinah on September 6, 2002, at 16:25:58
>
> >
> > Let us know how it goes! (Although if it's not posted to this same thread -- so that I get an update notification email from P-B -- I likely won't see it. Gonna be too busy to do much P-B browsing over the next month.)
> >
> > Rick
> > >
>
> Doing something rewarding and enjoyable I hope. :)
>
> Best wishes,
> DinahYikes! Why didn't I see this nice note *before* I commented on one of your posts to someone else about civility, in another thread. Now I feel guilty!
Regardless, thanks for the nice sentiments. As you can see, I've "cheated" by taking "one last look" at the complete message listing. So make that a "double guilty!"
Rick
Posted by Dinah on September 8, 2002, at 2:02:26
In reply to Re: Effexor with Mirapex? » Dinah, posted by Rick on September 8, 2002, at 1:30:42
It can get a bit confusing if you don't read every thread. And perhaps I should have done a bit of follow-up on each thread.
Hope you're well.
Dinah
This is the end of the thread.
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