Psycho-Babble Medication Thread 1099490

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mirapex in psychotic problems?

Posted by Christ_empowered on July 9, 2018, at 7:50:00

is it a real option? intuitively, it makes sense. is it safe? anyone have experiences? Do you think it'd be a good idea w/ Abilify, given the whole D2 partial agonist thing w/ Abilify?

im wondering if 'negative symptoms' might be a better word for my 'depression.' my diagnosis is 'bipolar i,' but my counselor still speaks of 'negative symptoms.' whaaa?

my other thought was a dosage reduction down to 10-15/abilify. i did ok going from 30 to 20, just needed gabapentin for a little while.

stimulants are a no-go, not even the 'vigils. this shrink seems against the antidepressants, too.

thanks for your help, everyone.

 

Re: mirapex in psychotic problems?

Posted by linkadge on July 9, 2018, at 7:59:35

In reply to mirapex in psychotic problems?, posted by Christ_empowered on July 9, 2018, at 7:50:00

Difficult to say.

In theory, Mirapex could worsen schizophrenia owing to the potent d2/d3 agonism. However, for bipolar, Mirapex has been shown to help the depressive phase.

It has other targets too (to a lesser extent) like 5-ht1a, and purportedly has neuroprotective / neruotrohpic effects.

I suppose it could be worth a try (depending on whether your doctor is willing to prescribe).

Low dose selegeline might also be helpful for some cognitive / energy symtpoms.

Linkadge


 

Re: mirapex in psychotic problems?

Posted by Tfeld on July 17, 2018, at 9:43:32

In reply to mirapex in psychotic problems?, posted by Christ_empowered on July 9, 2018, at 7:50:00

Hi all,

Re: negative symptoms, a past pdoc once mentioned to me that they can occur in bipolar as well. They are basically more severe depressive Sx typically seen in bipolars, the chronically ill and treatment-resistant: a longer-term loss (hence "negative") of previous functioning or further deterioration in cognitive/ behavioral/ social functioning than seen in MDD. Given that bipolars are known to develop worsening cognitive impairment over the course of illness, it makes sense to me that this would apply to bipolars. They are basically under of blanket of apathy (*loss*/ lack of feeling/ emotion/ interest/ concern), like anhedonia, amotivation, asociality/ alogia (lack of speech), blunted affect or loss/lack of responsiveness to cognitive/social input of typical. Negative sx are more severe than classic MDD sx and contribute to heavier socioocupational impairment. I see them more as a progressive "shutting off" of the mind to external stimuli rather than sx that develop in reaction to events.

Pramipexole can help with cognitive decline in bipolar and has relatively little but strong evidence for bipolar and Tx-resistant depression. I've even seen a study as an adjunct in schizoaffectives, and it seemed to help both neg and positive symptoms more than it induced psychosis (I can find it if you'd like).

I've taken PPX for (formerly) severe bipolar TRD with Abilify for the past 4.5 years. It does not cancel out the mood-stabilizing effects for me and has a low manic switch rate in the studies. As well, **negative symptoms can also be a consequence of neuroleptic use, esp. high dosages and long-term use**, and the PPX does seem to help quite a bit with the affective, cognitive, and social deficits that many of the atypicals have afflicted me with.

I took it alone for depression (with my stabilizers) during my most-recent hospitalization (~1mo ago) after being stripped of my MAOI + TCA + pstim, and I strongly attribute it to keeping me together during my stay esp. given the horrific AD and crystal meth withdrawal I was undergoing. Nonetheless I'm back on MAOIs (Nardil now since Marplan's MIA) and Desoxyn along with the PPX, Abilify, lithium, lamotrigine and clonazepam)... but my depression is better than ever and I've remained off the TCA (desipramine).

Interestingly enough it wasn't until desipramine was added to the MAOI + pstim + PPX combo that I began to respond in 2015; I was on low-dose PPX (0.375mg) at the time thought and was taking the extended-release formulation (see below). I believe once the PPX was titrated to 1.25mg last year with my current doc is when I began to experience remission for the first time, and I deteriorate when even 0.25mg is removed.

I take the PPX all at night as it seems to work better as the immediate-release formulation, all qHS, compared to a BID split or the ER form. At lower concentrations PPX can *inhibit* of dopamine release due to a higher affinity for presynaptic autoreceptors, although some do respond at lower dosages. With higher concentrations, there is a greater psychostimulant effect, hence giving it all qHS works better for depression, and can help deal with the sedation. If you're concern about it wearing off during the day, don't be; PPX tends to work better as the IR formulation due to a "pulse" effect as my pdoc calls it: you get benefits of stimulating the postsynaptic receptors while the drug is active, and once it wears off the presynaptic receptors free up and burst firing (incr release) of dopamine occurs and sedation (it's also an a2-adrenergic agonist) lessens.

Safety:
-there is still a relatively small risk of manic or hypomanic switch or worsening of psychosis, but that's why very slow titration (~0.25mg/ wk) is recommended
-sedation can occur, hence slow titration and suggested to take all qHS
-perhaps most importantly, compulsive behavior and dependence liability. I am tolerating the sedation fine at my dosage, do not gamble, and sexual compulsivity was a pre-existing condition, lol, and I'm working on it as part addiction recovery -- so in my case I wouldn't consider it addictive, because it's not causing issues in my life. But I am highly dependent on it; complete cessation or even attempted dosage decr is very difficult for me and many others, although I have no reason to decr as it's proven to be a utility in my life. If it's causing you issues though, it can either be a bitch and a half to d/c, can cause long-term withdrawal, OR you may feel much better to have it out of your system.

Don't let this frighten you though, because many are able to decrease or come off like any other med, and who cares about being dependent on a psych med if you need it? As long as you're not taking it irresponsibly and it's not ruining your life (addiction = continuing a behavior despite major consequences; dependence just means it might cause an issue if you d/c, but IMO unimportant if it's necessary for you to stay on for your health).

So yes, it is potentially a very real option if administered correctly (timing-wise) and titrated slowly for tolerability and to watch for any tx-related emergent symptoms. I believe it's saved my life.

And don't worry about the psychopharmacology aspect of being on an partial agonist AP with a full agonist b*llsh*t. I know I explained some psychopharm of PPX above, but just to explain recommendations of *how* the drug is best administered for depression and tolerability. On the flip side using this type of thinking to consider initiating pharmacotherapy can create doubt, fear, and remove hope (belief in your Tx/ placebo can be a huge contributor to eventual response from the drug itself). The only important thing is your response, which is highly individual, and can't be predicted by theory.

Sorry if this is long, but this is a complicated yet potentially life-saving drug that many shy away from on this board full of TRDs because the topic of DA agonists pops up again and again from time to time including much theorizing, postulation, fear, and little accuracy or clinical experience. This I can provide citations for a comprehensive, large review that explains the psychopharm- AND -clinically backed recommendations I elucidated above, because after all this is a psychobabble forum!

 

Re: mirapex in psychotic problems?

Posted by Christ_empowered on July 17, 2018, at 15:31:33

In reply to Re: mirapex in psychotic problems?, posted by Tfeld on July 17, 2018, at 9:43:32

hi. wow, thanks for the reply. I mean that.

I do think neuroleptics can cause and/or contribute to "negative symptoms," but...I pretty much need Abilify, for paranoia. Also, I don't do well on depakote, never tried lithium, so...there ya go.

does it help any with obsessive stuff? some of my 'psychosis' is looking more and more like ruminations and general looping thoughts. I think the core problems are well controlled on lamictal and abilify.

thanks again for your reply. I'm going to re-read it and then try to summon up the courage to talk to the shrink about mirapex.


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