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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by anita on April 18, 2000, at 15:07:56
Has anyone tried Mirapex for atypical depression? I've had a decent response to other dopaminergic meds (Ritalin, amisulpride, etc.) except that after a few weeks I get very irritable.
I'd like to know if it helped anyone with depression or energy, how long it took, and what the major side effects were.
Thanks very much,
anita
Posted by AndrewB on April 19, 2000, at 12:23:18
In reply to Mirapex users?, posted by anita on April 18, 2000, at 15:07:56
Hello again Anita,
Can you tell me more about your experience with amisulpride. I am very interested. What symptoms did it help you with and where did it fail you.?
I use Mirapex now. I really don't know what it does for me since I've never used it by itself. My impression is that it pretty much duplicates what amisulpride does except that it may have more anxiolytic action. One poster said that Mirapex worked well for her, relieving her depression, improving her energy, until it pooped out on her, as all her other ADs had. In one small study Mirapex was used with vegetative bipolars. It seems the Mirapex relieved their depression and improved their energy. No poop out occurred.
Adrafinil or reboxetine also may help with atypical.
AndrewB
Posted by anita on April 19, 2000, at 16:23:10
In reply to Re: Mirapex users?, posted by AndrewB on April 19, 2000, at 12:23:18
Hi Andrew,
Good to hear from you again, and much thanks for the info. Further questions: Why did you switch from amisulpride to Mirapex? What else are you taking? What is your Mirapex dosage, and what is the dose recommended for depression? I am very seriously considering adding Mirapex to Zoloft (which only helps for anxiety), but the cost is daunting.
I discontinued amisulpride after about 2 months because I was getting quite irritable, as is usual for me w/ dopamine enhancing meds. I was also gaining weight, but not that much. It did help me with energy and improving my mood.
I'm also considering reboxetine (although other noradrenergic drugs haven't helped) and modafinil (which I haven't heard great things about). No other meds left for me to try, other than amineptine, which I understand is unavailable now, and Celexa, which seems pointless at this point. Next step: vagus nerve stimulator?
anita
> Hello again Anita,
>
> Can you tell me more about your experience with amisulpride. I am very interested. What symptoms did it help you with and where did it fail you.?
>
> I use Mirapex now. I really don't know what it does for me since I've never used it by itself. My impression is that it pretty much duplicates what amisulpride does except that it may have more anxiolytic action. One poster said that Mirapex worked well for her, relieving her depression, improving her energy, until it pooped out on her, as all her other ADs had. In one small study Mirapex was used with vegetative bipolars. It seems the Mirapex relieved their depression and improved their energy. No poop out occurred.
>
> Adrafinil or reboxetine also may help with atypical.
>
> AndrewB
Posted by AndrewB on April 20, 2000, at 8:16:03
In reply to Re: Mirapex users?, posted by anita on April 19, 2000, at 16:23:10
Anita,
Thank you for filling me in on your experience with amisulpride. The irritability you experienced may be a sign that your diagnosis is incorrect. Read these passages from Dr. Bob's Tips Page:
----------------------
Date: Thu, 8 Jun 1995 23:06:07 -0700 (PDT)
From: Ivan Goldberg
Subject: Irritability from bupropionOn Wed, 7 Jun 1995, Thomas Lewis wrote:
Given the proconvulsive aspect of bupropion,
would the development of irritability sway one
towards the use of valproate or carbamazepine?Given the proconvulsant activity of antidepressants, and
antipsychotics and lithium, the development of irritability with any
of them often leads me to suggest a trial of anticonvulsants.Date: Sun, 05 Jan 1997 04:32:55 -0500
From: Ivan Goldberg
Subject: Irritability from antidepressantsIn a message dated 97-01-04 20:55:30 EST, Ms. Picard writes:
I have a female patient in her 20s who was quite
depressed and has gotten some relief from
sertraline 100 mg and desipramine 25 mg.
However, she tells me she is irritable with friends
and at work. She says she has no patience and is
snappy and very sarcastic toward others. She
recently got written up at work for having a "bad
attitude". She is not manic. She does not feel that
this is a response to the meds, she feels it's an
untreated symptom.At 10:24 PM 1/4/97 -0500, HRudMD@aol.com wrote:
I have several patients that fit into this very same
profile. You do not have to be classically "manic"
to have bipolar disorder. Sometimes extreme
irritability, sarcasm, having a "bad attitude,"
pugnaciousness, paranoia, etc., can be the
presenting symptoms with hypomania more
subclinical.Many patients who show this response to antidepressants do well
when one of the mood-stabilizing anticonvulsants is added to their
antidepressant.Date: Thu, 9 Jan 1997 18:45:52 +0900
From: fukuda@med.teikyo-u.ac.jp (Rimmei Fukuda)
Subject: Possible indications of bipolarityAt 21:13 97.01.06, Ivan Goldberg wrote:
Among the possible indicators of some degree of
bipolarity are:hypersomnia when depressed
winter intensification of depression
family hx of bipolar spectrum disorders
profound lethargy when depressed
irritability as a response to
antidepressants
"mini-hypomanias" -- seldom reported by
the pt, but often by significant others, if
asked.I agree with Ivan's very beautiful illustration. It is my humble
impression that bipolar depression (especially type II) tends to
show up with these features rather than melancholia (except for
acute double-depression). Patients with the initial dx of atypical
depression or dysthymia often reveal bipolarity later.Clinically I often see many, many of these typically young, mildly
dysthymic, not necessarily suicidal, apparently functioning patients
with histories of possible hypomania. They are sometimes with
conflicts of identity and of human relationship and need
psychotherapy or cognitive changes. The worst thing is to
medicate them with too much long-term, short-acting
benzodiazepine
---------------------
What do you think of this Anita?To answer your questions.....I still take amisulpride along with Mirapex, reboxetine and aminpetine. I take 0.75mg of Mirapex twice a day (1.5mg. total). Dosage for depression varies between .75mg/day to 2mg/day. And yes, Mirapex is expensive. I'm considering switching to ropinirole (Requip), which has very similar characteristics, buying it from overseas to save money. I worry though that if you indeed do have bipolar, whether you take ropinirole or Mirapex, they will just make you irritable again.
AndrewB
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