![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 8 of 8. This is the beginning of the thread.
Posted by marjorie on August 19, 1999, at 17:13:19
Hi,
I have received advice from a psychiatrist that I should
perhaps try Mirapex for my depression. I have been on
many, many different medications and combinations but
nothing has work (although Nardil did help some). The
advice was a dopamine agonist. But my HMO will not
authorize the medication unless I can find case reports
supporting this use of Mirapex. Does anyone know of such
reports or where I might find them. The Psychiatrist
I'm working with asked me to find the studies on the internet
if I could - but I'm not having any luck. Please help
if you know anything.
Posted by Kat on August 19, 1999, at 18:41:55
In reply to mirapex as treatment for depression, posted by marjorie on August 19, 1999, at 17:13:19
> Hi,
> I have received advice from a psychiatrist that I should
> perhaps try Mirapex for my depression. I have been on
> many, many different medications and combinations but
> nothing has work (although Nardil did help some). The
> advice was a dopamine agonist. But my HMO will not
> authorize the medication unless I can find case reports
> supporting this use of Mirapex. Does anyone know of such
> reports or where I might find them. The Psychiatrist
> I'm working with asked me to find the studies on the internet
> if I could - but I'm not having any luck. Please help
> if you know anything.Hi, I don't know of anything yet, but I am seeing my pdoc for the same idea, too. What did you understand about it? I hear it may treat anhedonia or dysthymia. What's your take?
Posted by andrewb on August 19, 1999, at 19:30:12
In reply to mirapex as treatment for depression, posted by marjorie on August 19, 1999, at 17:13:19
> Hi,
> I have received advice from a psychiatrist that I should
> perhaps try Mirapex for my depression. I have been on
> many, many different medications and combinations but
> nothing has work (although Nardil did help some). The
> advice was a dopamine agonist. But my HMO will not
> authorize the medication unless I can find case reports
> supporting this use of Mirapex. Does anyone know of such
> reports or where I might find them. The Psychiatrist
> I'm working with asked me to find the studies on the internet
> if I could - but I'm not having any luck. Please help
> if you know anything.
Marjorie,
Here is some information on pramipexole, tradename Mirapex, copied from the American Jornal of Psychiatry website (http://ajp.psychiatryonline.org/)
If you do start using Mirapex, please let us know how it goes. I'm sure others at this site would be very interested in hearing of your experiences with it.
-------------------------------------------------
Am J Psychiatry 156:798, May 1999
© 1999 American Psychiatric AssociationLetter to the Editor
Pramipexole in Refractory Bipolar Depression
JOSEPH F. GOLDBERG, M.D.
New York, N.Y., MARK A. FRYE, M.D. and
ROBERT T. DUNN, M.D., PH.D.To the Editor: Pramipexole, a direct dopamine agonist with D3 receptor selectivity, recently approved by the FDA for the treatment of Parkinson's
disease (1), has been reported to be as effective as fluoxetine in the treatment of major depression (unpublished 1997 study by Corrigan and Evans)
and an effective neuroleptic adjunct for the negative symptoms of schizophrenia (2). We report two cases of treatment-resistant bipolar depression
where improvement followed augmentation with pramipexole.Mr. A, a 50-year-old man with a 23-year history of bipolar I disorder and over 15 hospitalizations, had recurrent dysphoric
manias and major depressions with reversed vegetative signs. There was a remote period of cocaine abuse and a dense family
history of bipolar illness. Past manias had responded poorly to lithium, carbamazepine, and valproate monotherapies or
combinations. Incidents of depression persisted despite regimens of bupropion; however, low doses of sertraline triggered
mania. Depressions previously responded to ECT but resisted a course of 40 bilateral treatments. Mr. A's condition was stable
for over 1 year on a high-dose regimen of lamotrigine and clonazepam, until he was rehospitalized for anergic depression that
was unresponsive to lithium augmentation. Pramipexole was begun at a dose of 0.25 mg/day and increased over 10 days to
0.75 mg/day. Within 1 week, marked improvement was noted in mood and activity. Euthymia was achieved, and Mr. A
remained without side effects at his 8-week follow-up.Mr. B, a 33-year-old artist with a 15-year history of bipolar I illness and alcohol abuse (in remission), had 14 hospitalizations
for both psychotic depressions and manias. His episodes improved minimally with lithium, carbamazepine, valproate,
verapamil, and gabapentin alone and in combination with adjunctive typical neuroleptics and benzodiazepines. Sertraline,
tricyclics, and one course of ECT were ineffective for his depressions. Nortriptyline and venlafaxine each induced dysphoric
mania and cycling. Bupropion plus lithium and lamotrigine provided substantial improvement until he developed a tolerance
after 2 months.Olanzapine, topiramate, and lamotrigine controlled mania and cycling until severe depression recurred, with reversed vegetative
signs, prompting a trial of pramipexole. Mr. B was given a 1-mg/day dose of pramipexole; after 6 weeks, a marked
antidepressant response occurred, and the drug was well tolerated except for transient, dose-related nausea. Subsequently, a brief
depressive exacerbation resolved itself without medication changes. Mr. B's functional improvement, with only low-grade
depression and no cycling, continued through his 6-month follow-up.The greater density of D3 receptors in the mesolimbic areas (3) involved in mood regulation may relate to pramipexole's efficacy in
psychomotor-retarded conditions (i.e., negative symptoms, Parkinson's disease, depression). Controlled studies of pramipexole, in doses of
0.25–10.25 mg/day over 4–8 weeks (2, unpublished 1997 study by Corrigan and Evans), are encouraged to clarify dose-related acute and long-term
efficacy in bipolar depression, possible side effects (e.g., insomnia, fatigue, dyskinesias, orthostatic hypotension, hallucinations), potential
induction of mania/psychosis, and preferential response in atypical versus melancholic depression.REFERENCES
1.Parkinson Study Group: Safety and efficacy of pramipexole in early Parkinson disease: a randomized dose-ranging study. JAMA 1997;
278:125–130
2.Kasper S, Barnas C, Heiden A, Volz HP, Laakmann G, Zeit H, Pfolz H: Pramipexole as adjunct to haloperidol in schizophrenia: safety
and efficacy. Eur Neuropsychopharmacol 1997; 7:65–70
3.Levesque D, Diaz J, Pilon C, Martres MP, Giros B, Souil E, Schott D, Morgat JL, Schwartz JC, Sokoloff P: Identification,
characterization, and localization of the dopamine D3 receptor in rat brain using 7-[3H]hydroxy-N,N-di-n-propyl-2-aminotetralin. Proc
Natl Acad Sci USA 1992; 89:8155–8159
Posted by RG on August 19, 1999, at 21:56:20
In reply to Re: mirapex as treatment for depression, posted by andrewb on August 19, 1999, at 19:30:12
Andrew, That is so awesome that you took the time to do that. I have an appt. with my doc Sat. and I'll get a script cuz that's what I want to try first. RG
Posted by jd on August 20, 1999, at 0:26:17
In reply to mirapex as treatment for depression, posted by marjorie on August 19, 1999, at 17:13:19
Hi,
You might also be interested in the following articles on mirapex (pramipexole), which I pulled from the PubMed internet database.
Best,
JD
-------------
Int Clin Psychopharmacol 1997 Jul;12 Suppl 3:S7-14The mesolimbic dopamine system as a target for rapid antidepressant action.
Willner P
Department of Psychology, University of Wales, Swansea, UK.Chronic treatment with antidepressant drugs produces a variety of changes in dopaminergic neurotransmission, most notably a sensitization of behavioural responses to agonists acting at dopamine D2/D3 receptors within the nucleus accumbens. Evidence from animal models of depression (the forced swim test and the chronic mild stress procedure) indicates that these effects are crucial for the therapeutic effect of antidepressants in these models. Antidepressant-like effects in animal models are also seen with drugs that act directly on the dopaminergic system. Because of its prolonged time-course, the chronic mild stress procedure can be used to examine onset latencies. Some dopamine-active drugs (e.g. the catechol-O-methyltransferase inhibitor tolcapone; D2/D3 agonists administered intermittently) are active in this procedure but have a time-course comparable to that of conventional antidepressants. Other dopamine-active drugs may have a more rapid onset; the evidence to date suggests this possibility for the D2/D3 agonist pramipexole and the preferential presynaptic antagonist amisulpride. In clinical studies, rapid-onset latencies have been claimed for the D2/D3 agonist roxindole, the preferential presynaptic antagonist sulpiride and the relatively selective dopamine-uptake inhibitor amineptine. The mechanisms that might give rise to a rapid onset of dopamine-mediated antidepressant effects are discussed.
-------------
J Neurol Sci 1999 Feb 1;163(1):25-31
Pramipexole--a new dopamine agonist for the treatment of Parkinson's disease.
Bennett JP Jr, Piercey MF
Neurology and Psychiatric Research, University of Virginia Health Sciences Center, Charlottesville 22908, USA. jpb8u@virginia.eduAlthough L-DOPA is the current 'gold standard' for treatment of Parkinson's disease, its effectiveness fades rapidly and its use results in serious motor fluctuations (on-off, wearing off, freezing, involuntary movements) for most patients with Parkinson's disease. Pramipexole is an aminothiazole dopamine agonist with selective actions at dopamine receptors belonging to the D2 subfamily, where it possesses full activity similar to dopamine itself. Pramipexole's preferential affinity for the D3 receptor subtype could contribute to efficacy in the treatment of both the motor and psychiatric symptoms of Parkinson's disease. Both in vitro and in vivo studies in animals suggest that pramipexole possesses numerous neuroprotective properties, including dopamine autoreceptor agonist properties, antioxidant properties, ability to block the mitochondrial permeability transition pore and the ability to stimulate the release of trophic factors. Clinical studies have demonstrated that pramipexole has excellent pharmacokinetic properties and that it is an effective monotherapy in treating early Parkinson's disease and an effective adjunctive therapy with L-DOPA in treating late Parkinson's disease. In addition, pramipexole has demonstrated efficacy in a clinical trial for the treatment of major depression. In the early disease studies, pramipexole was able to retard the need for L-DOPA treatment for several years. Thus, a new 'L-DOPA-sparing' paradigm for treating Parkinson's disease may now be possible, whereby patients are initially treated with pramipexole and L-DOPA is added only as necessary.
> Hi,
> I have received advice from a psychiatrist that I should
> perhaps try Mirapex for my depression. I have been on
> many, many different medications and combinations but
> nothing has work (although Nardil did help some). The
> advice was a dopamine agonist. But my HMO will not
> authorize the medication unless I can find case reports
> supporting this use of Mirapex. Does anyone know of such
> reports or where I might find them. The Psychiatrist
> I'm working with asked me to find the studies on the internet
> if I could - but I'm not having any luck. Please help
> if you know anything.
Posted by Bruce on August 20, 1999, at 8:59:56
In reply to Re: mirapex as treatment for depression, posted by andrewb on August 19, 1999, at 19:30:12
> > Hi,
> > I have received advice from a psychiatrist that I should
> > perhaps try Mirapex for my depression. I have been on
> > many, many different medications and combinations but
> > nothing has work (although Nardil did help some). The
> > advice was a dopamine agonist. But my HMO will not
> > authorize the medication unless I can find case reports
> > supporting this use of Mirapex. Does anyone know of such
> > reports or where I might find them. The Psychiatrist
> > I'm working with asked me to find the studies on the internet
> > if I could - but I'm not having any luck. Please help
> > if you know anything.
>
> Marjorie,
> Here is some information on pramipexole, tradename Mirapex, copied from the American Jornal of Psychiatry website (http://ajp.psychiatryonline.org/)
> If you do start using Mirapex, please let us know how it goes. I'm sure others at this site would be very interested in hearing of your experiences with it.
> -------------------------------------------------
> Am J Psychiatry 156:798, May 1999
> © 1999 American Psychiatric Association
>
> Letter to the Editor
>
> Pramipexole in Refractory Bipolar Depression
>
> JOSEPH F. GOLDBERG, M.D.
> New York, N.Y., MARK A. FRYE, M.D. and
> ROBERT T. DUNN, M.D., PH.D.
>
> To the Editor: Pramipexole, a direct dopamine agonist with D3 receptor selectivity, recently approved by the FDA for the treatment of Parkinson's
> disease (1), has been reported to be as effective as fluoxetine in the treatment of major depression (unpublished 1997 study by Corrigan and Evans)
> and an effective neuroleptic adjunct for the negative symptoms of schizophrenia (2). We report two cases of treatment-resistant bipolar depression
> where improvement followed augmentation with pramipexole.
>
> Mr. A, a 50-year-old man with a 23-year history of bipolar I disorder and over 15 hospitalizations, had recurrent dysphoric
> manias and major depressions with reversed vegetative signs. There was a remote period of cocaine abuse and a dense family
> history of bipolar illness. Past manias had responded poorly to lithium, carbamazepine, and valproate monotherapies or
> combinations. Incidents of depression persisted despite regimens of bupropion; however, low doses of sertraline triggered
> mania. Depressions previously responded to ECT but resisted a course of 40 bilateral treatments. Mr. A's condition was stable
> for over 1 year on a high-dose regimen of lamotrigine and clonazepam, until he was rehospitalized for anergic depression that
> was unresponsive to lithium augmentation. Pramipexole was begun at a dose of 0.25 mg/day and increased over 10 days to
> 0.75 mg/day. Within 1 week, marked improvement was noted in mood and activity. Euthymia was achieved, and Mr. A
> remained without side effects at his 8-week follow-up.
>
> Mr. B, a 33-year-old artist with a 15-year history of bipolar I illness and alcohol abuse (in remission), had 14 hospitalizations
> for both psychotic depressions and manias. His episodes improved minimally with lithium, carbamazepine, valproate,
> verapamil, and gabapentin alone and in combination with adjunctive typical neuroleptics and benzodiazepines. Sertraline,
> tricyclics, and one course of ECT were ineffective for his depressions. Nortriptyline and venlafaxine each induced dysphoric
> mania and cycling. Bupropion plus lithium and lamotrigine provided substantial improvement until he developed a tolerance
> after 2 months.
>
> Olanzapine, topiramate, and lamotrigine controlled mania and cycling until severe depression recurred, with reversed vegetative
> signs, prompting a trial of pramipexole. Mr. B was given a 1-mg/day dose of pramipexole; after 6 weeks, a marked
> antidepressant response occurred, and the drug was well tolerated except for transient, dose-related nausea. Subsequently, a brief
> depressive exacerbation resolved itself without medication changes. Mr. B's functional improvement, with only low-grade
> depression and no cycling, continued through his 6-month follow-up.
>
> The greater density of D3 receptors in the mesolimbic areas (3) involved in mood regulation may relate to pramipexole's efficacy in
> psychomotor-retarded conditions (i.e., negative symptoms, Parkinson's disease, depression). Controlled studies of pramipexole, in doses of
> 0.25–10.25 mg/day over 4–8 weeks (2, unpublished 1997 study by Corrigan and Evans), are encouraged to clarify dose-related acute and long-term
> efficacy in bipolar depression, possible side effects (e.g., insomnia, fatigue, dyskinesias, orthostatic hypotension, hallucinations), potential
> induction of mania/psychosis, and preferential response in atypical versus melancholic depression.
>
> REFERENCES
>
> 1.Parkinson Study Group: Safety and efficacy of pramipexole in early Parkinson disease: a randomized dose-ranging study. JAMA 1997;
> 278:125–130
> 2.Kasper S, Barnas C, Heiden A, Volz HP, Laakmann G, Zeit H, Pfolz H: Pramipexole as adjunct to haloperidol in schizophrenia: safety
> and efficacy. Eur Neuropsychopharmacol 1997; 7:65–70
> 3.Levesque D, Diaz J, Pilon C, Martres MP, Giros B, Souil E, Schott D, Morgat JL, Schwartz JC, Sokoloff P: Identification,
> characterization, and localization of the dopamine D3 receptor in rat brain using 7-[3H]hydroxy-N,N-di-n-propyl-2-aminotetralin. Proc
> Natl Acad Sci USA 1992; 89:8155–8159Well, I am all for Mirapex. Trouble is, none of those overseas mail-order pharmacies seem to stock it, and docs here in the US (generally) won't prescribe it because it is off the beaten path. If anyone knows of an overseas mailorder pharmacy that stocks this, please post here!
Amisulpride sounds interesting. The only thing that scares me is that it is an antipsychotic (i.e. dopamine antagonist) at 'higher doses' and an agonist at 'lower doses' from whatI have read.....I definitely want to be on the agonist (enhancing transmission) side of things.
Please keep posting your experiences on amisulpride, Andrew!
Thanks,
Bruce
Posted by andrewb on August 20, 1999, at 10:32:53
In reply to Re: mirapex as treatment for depression, posted by Bruce on August 20, 1999, at 8:59:56
>
> Well, I am all for Mirapex. Trouble is, none of those overseas mail-order pharmacies seem to stock it, and docs here in the US (generally) won't prescribe it because it is off the beaten path. If anyone knows of an overseas mailorder pharmacy that stocks this, please post here!
>
> Amisulpride sounds interesting. The only thing that scares me is that it is an antipsychotic (i.e. dopamine antagonist) at 'higher doses' and an agonist at 'lower doses' from whatI have read.....I definitely want to be on the agonist (enhancing transmission) side of things.
>
> Please keep posting your experiences on amisulpride, Andrew!
>
> Thanks,
>
> BruceThe dosage for amisulpride for depression is 50 mg. (or possibly 100mg.). The dosage for schizophrenia is 400mgs. and above. It is not a razor's edge as far as which of the drugs properties you are going to experience.
Posted by PL on August 20, 1999, at 12:54:35
In reply to Re: Bruce, posted by andrewb on August 20, 1999, at 10:32:53
I've been socially anxious all my life. I learned to compensate to some degree by rehearsal and acting. Of course when I was in an unexpected situation I would just freeze. I couldn't think of my name let alone pay any attention to what was being said. And forget trying to respond. Even with rehearsal, my timing is always off so I just stay quite most of time.
I also have major depression and have taken antidepressants just this past year, trying to find one that works. Since I also have social anxiety, I asked my psyc if I could try klonopin. I started with .5 mg twice day and after a month went to 1 mg twice a day. Well after 2 weeks I had super depression. I was crying uncontrollably at work and call my psyc from my car. He told me to taper off the klonopin, which I did in 2 weeks. Klonopin can cause a worsening of depression so just be careful of that to anyone who is also depressed. Now I'm on BuSpar 10 mg 2 times a day, along with Wellburtrin 200 mg twice a day and Effexor 75 mg a day. I wanted to add (will be 2 weeks) the BuSpar to see if that might help the social anxiety.
Good luck to all.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.