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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 6 of 6. This is the beginning of the thread.
Posted by Stellaz on February 19, 2003, at 21:08:58
Hi - I just read the linked article about the discovery that numerous addictive substances all appear to stimulate dopamine release in the brain:
http://www.msnbc.com/news/874631.asp?0cv=CB10
I just started a prescription for ReQuip which my doc prescribed to improve the sexual side effects I've had with Lexapro. He explained that it is a dopamine aganist - which sounds to my uneducated ear as though it serves the same purpose as the addictive drugs referenced in the article. I'd been taking 150 mg of Wellbutrin but made me too anxious. Anyway, I find that I've been smoking ALOT recently - is it possible that the ReQuip will help me cut down on smoking by providing the same dopamine release?
Also, I'd love to hear any experiences with Lexapro, ReQuip, sexual dysfunction etc. Although I was hospitalized in 2000 for major depression I haven't been really good about continuing med treatment and thus find myself rather uninformed. I am going to start taking fish oil though! Thanks!
Posted by Stan on February 22, 2003, at 13:33:22
In reply to Article re: drug addiction and dopamine?, posted by Stellaz on February 19, 2003, at 21:08:58
> Hi - I just read the linked article about the discovery that numerous addictive substances all appear to stimulate dopamine release in the brain:
>
> http://www.msnbc.com/news/874631.asp?0cv=CB10
>
> I just started a prescription for ReQuip which my doc prescribed to improve the sexual side effects I've had with Lexapro. He explained that it is a dopamine aganist - which sounds to my uneducated ear as though it serves the same purpose as the addictive drugs referenced in the article. I'd been taking 150 mg of Wellbutrin but made me too anxious. Anyway, I find that I've been smoking ALOT recently - is it possible that the ReQuip will help me cut down on smoking by providing the same dopamine release?
>
> Also, I'd love to hear any experiences with Lexapro, ReQuip, sexual dysfunction etc. Although I was hospitalized in 2000 for major depression I haven't been really good about continuing med treatment and thus find myself rather uninformed. I am going to start taking fish oil though! Thanks!>>>>>>>>>>>>>>>>>>>>>>>>
hi stellaz -- i took a glance at that article -- dopamine's role in brain function is so complex that i don't even try to understand all of its facets -- if i start reading about the more technical aspects of the way that psych-meds work, my eyes quickly glaze over, so i don't even bother to research that kind of thing. anyway, how's it going with the requip at this point? have the side effects you described in another post subsided at all (nausea, fatigue, drowsiness)? is it helping you reduce smoking or providing any improvement in the sexual dysfunction arena? have you noticed any improvement in your GAD or a subtle anti-depressant effect? i know you aren't taking it for those last two issues, but as i've mentioned previously, i've experienced some degree of improvement in anxiety and depression while taking requip. a very similar drug, mirapex, was compared to prozac in a study of their AD effects and was they were found to be equally effective for depression -- i don't think it was a large-scale trial though. many of the mirapex subjects complained of the side effects you described earlier, and some dropped out, but i guess it worked well enough to match prozac.
anti-parkinson's dopamine agonists such as requip and mirapex are also being studied for the treatment of drug cravings involving some of the recreational drugs mentioned in the article you posted. since they don't produce euphoria, they are unlikely to be abused themselves. they aren't "addictive," but i've noticed a wicked "discontinuation syndrome" associated with sudden cessation of use. it's quite unpleasant, with an extremely heightened sensation of anxiety present. if you decide to throw in the towel and stop taking it, it's best to taper down gradually.
anyway, i've gone on a bit long here -- let me know how you're doing if you have time.
Stan
Posted by Tony P on February 23, 2003, at 1:36:18
In reply to Article re: drug addiction and dopamine?, posted by Stellaz on February 19, 2003, at 21:08:58
I am currently on Wellbutrin (low dose, 100 mg/day), and have a history of addiction disorder (Rx and OTC drugs). Wb is defintely a dopamine agonist, but it's the only AD I've found so far that really energizes me and lifts my mood.
I was warned by one psychiatrist that Wb was not a good AD for addicts, not because it's likely to be abused itself, but because the side effects (anxiety, shakiness etc.) may encourage self-medicating to relieve the anxiety, or bring on craving for other drugs. I am aware of that effect in myself, but with a low dose and plenty of support from people I'm doing OK today.
Tony P
----------------------------------
> Hi - I just read the linked article about the discovery that numerous addictive substances all appear to stimulate dopamine release in the brain:
>
> http://www.msnbc.com/news/874631.asp?0cv=CB10
>
> I just started a prescription for ReQuip which my doc prescribed to improve the sexual side effects I've had with Lexapro. He explained that it is a dopamine aganist - which sounds to my uneducated ear as though it serves the same purpose as the addictive drugs referenced in the article. I'd been taking 150 mg of Wellbutrin but made me too anxious. Anyway, I find that I've been smoking ALOT recently - is it possible that the ReQuip will help me cut down on smoking by providing the same dopamine release?
>
> Also, I'd love to hear any experiences with Lexapro, ReQuip, sexual dysfunction etc. Although I was hospitalized in 2000 for major depression I haven't been really good about continuing med treatment and thus find myself rather uninformed. I am going to start taking fish oil though! Thanks!
Posted by Stellaz on February 23, 2003, at 19:33:44
In reply to Re: Article re: drug addiction and dopamine? » Stellaz, posted by Stan on February 22, 2003, at 13:33:22
Stan,
Thanks so much for taking the time to respond to both of my posts. I really appreciate your insight and your kindness in posting.
I have stopped taking both requip and lex cold turkey for the last two days. I found that one or the other was making me feel so dulled that I could barely function, let alone see how the sexual response was going! Because I was new to the requip and still taking the lowest dose, I have not experienced the discontinuation effects you've noticed. I'm going to start back on the lex tomorrow and note any side effects of that all by itself, then go back on the requip. Like you, I think I experienced a lessening of the GAD symptoms from the requip, although Lex is supposed to help with that as well. HAve you taken the mirapex as well as the requip? I certainly don't mean to pry, but I'm curious about what other meds you've found to be effective for both your GAD and depression. I've tried effexor, which I found to be fairly effective for the GAD and passable for the depression. I think the smoking is more a psych craving than a physical one - I smoke about 5-10 a day when I really need to decompress. Anyway, I am rambling. Again, many thanks. I hope you are well -
Stellaz
Posted by Stellaz on February 23, 2003, at 19:37:16
In reply to Re: Article re: drug addiction and dopamine? » Stellaz, posted by Tony P on February 23, 2003, at 1:36:18
Hi Tony,
Thanks for your response. That's a really intersting observation about Wellbutrin leading to further self-medication. WB certainly did lift my mood too - did you feel like you were on a megadose of caffeine?I'm glad you have a good support system - must be hard to have your meds turn out to be such a double-edged cure. Take care, and congrats on beating your addictions!
Stellaz
Posted by Stan on February 24, 2003, at 4:28:21
In reply to Re: drug addiction and dopamine? Stan, posted by Stellaz on February 23, 2003, at 19:33:44
> Stan,
>
> Thanks so much for taking the time to respond to both of my posts. I really appreciate your insight and your kindness in posting.
>
> I have stopped taking both requip and lex cold turkey for the last two days. I found that one or the other was making me feel so dulled that I could barely function, let alone see how the sexual response was going! Because I was new to the requip and still taking the lowest dose, I have not experienced the discontinuation effects you've noticed. I'm going to start back on the lex tomorrow and note any side effects of that all by itself, then go back on the requip. Like you, I think I experienced a lessening of the GAD symptoms from the requip, although Lex is supposed to help with that as well. HAve you taken the mirapex as well as the requip? I certainly don't mean to pry, but I'm curious about what other meds you've found to be effective for both your GAD and depression. I've tried effexor, which I found to be fairly effective for the GAD and passable for the depression. I think the smoking is more a psych craving than a physical one - I smoke about 5-10 a day when I really need to decompress. Anyway, I am rambling. Again, many thanks. I hope you are well -
>
> Stellaz>>>>>>>>>>>>>>>>>>>>>>>>
Hi StellaZ,
i've been kind of 'blah' lately (this is normal;) but otherwise not too bad -- thanks for wishing me well -- btw you definitely don't need to worry about "prying" when asking about my meds and whatnot.....you can ask me about whatever topic you'd like, in fact. i was surprised to hear you dropped both meds like a hot potato there all of a sudden -- let me know how it goes when you jump back into the lex and (hopefully) ease your way towards requip again. it's a shame that those requip tabs have such an odd shape with that bump in the middle -- makes 'em hard to split -- starting with 1/2 tab of the .25 would probably hold much of the sleepiness at bay.
you asked if i've taken both mirapex and requip -- the answer is yes -- i actually have both on hand at present. i always stick with the lowest strength tab taken three times a day -- for mirapex that's .125, for requip it's .25. i take mirapex for a few weeks or months, until it seems to lose some of its effectiveness and i feel i'm at a point where i need to increase the dosage to retain the benefits for my RLS.......*but* instead of taking more mirapex, i drop it for awhile and switch to requip, which works better than mirapex at that point because i've been away from it for awhile. my doctor suggested this "drug holiday" technique in order to maintain the effectiveness of both meds. although both are dopamine agonists at the D2 & D3 dopamine receptors, there's something different about the various sectors of the brain in which some of their 'operations' take place. it's a bit technical and i'm not so hot at comprehending or describing that fancy stuff -- i recall the term basal ganglia (sp?) and something about pre and post synaptic.....or something like that ;)
you were curious about meds that had been effective for me to treat GAD and depression. i haven't tried a whole laundry list of options primarily because my pdoc copays are sky-high and my drug copays for the more modern medicines are on the moon as well. i try to just see my pdoc once a year and generally get stuck in a rut with the same meds i've taken previously. i can give you a brief (you're hoping ;) history though:
tried SSRIs in '95 -- zoloft and paxil for a month -- i felt 'different' and intially mistook that for better, but soon wised up. i found that they didn't improve my anxiety symptoms and in fact exacerbated them somewhat -- i felt more 'wired' and couldn't relax -- too much nervous energy without accompanying physical energy to 'burn it off.' i did a bit of reading and found that many of the adverse side effects of the SSRIs are linked to the fact that they stimulate the 5HT2 serotonin receptor. this is probably the primary root cause for SSRI-induced anxiety, agitation, insomnia, restlessness, and sexual dysfunction. so after researching serzone a bit (it "blocks" or "antagonizes" this "bad" 5HT2 serotonin receptor), i tried that and stuck with it. it improved rather than added to anxiety, and didn't have the other side effects mentioned above which are common with SSRIs. i often ask myself why SSRIs (and even SNRIs like Effexor) are so popular when the side effects are so problematic for so many. it seems like an enormous number of threads on this board are devoted to lexapro and other SSRIs -- i don't read them but from the looks of the subject headers i detect a lot of people complaining of adverse effects -- it could just be the law of large numbers -- lots of folks take them, so the number of complaints should be proportionate.
anyway, off the anti-SSRI soapbox for a moment but with one additional comment directed your way, StellaZ -- you might ask your doctor about non-SSRI, non SSRI remedies to help alleviate the side effects you've mentioned in the past. Effexor can be a double whammy because it blocks the reuptake of serotonin (without antagonizing 5HT2) *and* it blocks the reuptake of norepinephrine, which can cause increased anxiety in some people who are sensitive to the effects of increased NE and have an exaggerated "fight or flight" response. then again, it does work for GAD in some people; it just depends on how your brain's wired.
this is getting long so i need to wrap and get to the point (what was it, again?;)......you wanted to know if i'd come across some effective meds for GAD/depression -- i'd say serzone is partially effective for both with no side effects -- i view it as a less harsh choice that the SSRIs & SNRIs, which make things worse overall for me, and i'll never take them again. i combine it with a small dose of buspar (tiny because there's an interraction between the two that causes blood levels of buspar to rise dramatically and a small dose is amplified). the buspar helps reduce anxiety when combo'd.....or at least if i try to phase it out, i'm climbing the walls, so it must be doing something. add to that the aforementioned mirapex or requip for RLS, and sprinkle in 2mg of ativan, taken primarily in the evening, and the four part plan is complete. i'm dependent on the ativan and will probably have to take it forever. if it was withdrawn for some reason i'm quite certain that i would wig out entirely and have a succession of full-blown panic attacks (though i've never had one before).
i consider this combo ok for now -- i'm still anxious and depressed, but i'd be a basket case if i dropped any of these pills. other things tried: trazodone (similar to serzone but with a sedating effect....very effective for anxiety and helps sleep but it burns you out so bad you get depressed due to fatigue. tried a sample of remeron (1/2 of lowest strength tab) and it knocked me out for 12 hours -- the party line is "you'll get used to it" but i don't want to try. any drug that has an antihistamine effect as its most potent mechanism of action doesn't make much sense to me. haven't tried TCAs (due to anticholingeric (sp?) side effects -- dry mouth/eyes, blurred vision, more. also haven't tried the anti-epilepsy drugs cos i hear they can make you clumsy. and the APS are a non-starter cos all of them to some degree or another block dopamine D2 receptors, a no-no if you have RLS. i took a half tablet of the lowest strength wellbutrin one time as an experiment and felt like i was on speed -- never again. MAOI's are out due to the dietary restrictions.
StellaZ, if you read this far (hehe), have you tried a benzo for the GAD? and have you considered serzone as an AD -- some people develop liver complications while taking it, but the incidence of these problems is quite rare. the side effect that you most object to from the lex/effex would probably disappear and then you may not even need the potentially energy-draining requip.
well, that was almost a book -- sorry i got carried away -- keep in touch with your progress and take care.
Stan
This is the end of the thread.
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