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Dr. Bob is Robert Hsiung, MD,
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Posted by not exactly on April 8, 2003, at 3:04:29
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by PuraVida on April 7, 2003, at 22:47:10
> Question - apparently Mirapex is a dopamine reuptake inhibitor mainly used for Parkinson's, but I have seen on this site some people have used it for depression. Has anyone here tried it? Any info on doses/results is appreciated.
Mirapex (pramipexole) is a dopamine (primarily D3) agonist (NOT a reuptake inhibitor). Its only FDA-approved use is for treating Parkinson's Disease. It was tested for effectiveness as an antidepressant (I was a volunteer in one of the early trials) but it failed to win FDA approval for that use.
In the trial, participants were randomly (double-blind) assigned to one of four groups: 7mg/day, 3mg/day, 1mg/day, or placebo. The drug was administered orally b.i.d. I was in the 1mg/day (0.5mg/dose) group (I didn't know my dose during the trial; they were able to tell me years later).
It was a miracle drug for me. Completely cured my depression and ADD almost immediately! But after the trial, my depression & ADD returned just as quickly. Unfortunately, since pramipexole was not yet approved, they couldn't prescribe it to me. So I went for years trying many other antidepressants, but none worked anywhere near as well (most made me feel worse).
When Mirapex was finally approved (for Parkinson's only, but at least it could be prescribed), I tried it again. Alas, it didn't work as well as it had years before, and finally "pooped out" completely after several months. Bummer.
My theory is that, because it's an agonist, the brain down-regulates the dopamine receptors to compensate, so eventually the benefit wears off.
- Bob
Posted by blondegirl47 on April 8, 2003, at 7:59:32
In reply to Atomoxetine (Straterra) as a stimulant , posted by paulk on April 7, 2003, at 16:48:06
paulk...Thanks so much for the info, very interesting reading. I start 60 mg tonight, it seems when I go up is when I have the most side effects. Like dizzy and wanting to eat everything.
Posted by teacherkris on April 8, 2003, at 10:15:13
In reply to Re: Mirapex » Magpie, posted by PuraVida on April 8, 2003, at 2:32:49
Hi there, I'm not sure if this is appropriate to post or not but I'm in San Diego and have a great psychiatrist that I've worked with for years. He's located in Hillcrest and his name is Randy Hicks. He's very cautious with meds and as you'll see in my earlier posts that frustrated me at first, however, it's paid off. Just to clarify cautious in a good way. I've always brought new meds to his attention and he's more than willing to have me try them he just likes to change one thing at a time and makes sure he has all the info. For example, he wouldn't start me on Strattera until he sat down with a rep from Lily to get all the information. Anyway, hope that helps.
Posted by paulk on April 8, 2003, at 10:44:51
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Lexxey on April 7, 2003, at 22:14:12
> About this stimulant description....I think I understand how it might be described as one but I think the benefit of strattera is this drug is not an "abuseable" stimulant...one there would be a market for in the illegal drug trade.
>
> What junkie is gonna score something that takes a month to have an effect???IMHO non of the stimulants are abusable if prescribed in the amounts needed to treat ADD.
Posted by Lexxey on April 8, 2003, at 10:57:59
In reply to Atomoxetine (Straterra) as a stimulant , posted by paulk on April 8, 2003, at 10:44:51
By "abusable" I meant that it was something that could be sold to another for whom it was not prescribed and taken in higher amounts that would cause a over stimulated experience. As when students sell ritalin or dex to others who want to stay up and study. I don't think there would be a market for Strattera as there is for the others.
Posted by paulk on April 8, 2003, at 11:20:44
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Lexxey on April 8, 2003, at 10:57:59
Such abuse is overrated. More politics than fact. They are even giving our pilots in Iraq Dexadrine.
The result of the politics is that people that suffer from ADD have a hard time getting what they need.
Posted by Magpie on April 8, 2003, at 15:03:38
In reply to Re: Mirapex, posted by teacherkris on April 8, 2003, at 10:15:13
> Hi there, I'm not sure if this is appropriate to post or not but I'm in San Diego and have a great psychiatrist that I've worked with for years. He's located in Hillcrest and his name is Randy Hicks. He's very cautious with meds and as you'll see in my earlier posts that frustrated me at first, however, it's paid off. Just to clarify cautious in a good way. I've always brought new meds to his attention and he's more than willing to have me try them he just likes to change one thing at a time and makes sure he has all the info. For example, he wouldn't start me on Strattera until he sat down with a rep from Lily to get all the information. Anyway, hope that helps.
Hi PV,
Sure, this is appropriate, and I truly appreciate it. But I am East Coast, LOL, in New Yawk, so it is a bit far. :-) But thanks anyway,
Magpie
Posted by BrettMan on April 8, 2003, at 17:36:37
In reply to Straterra approval., posted by scoper on December 28, 2002, at 2:19:34
Incase any one is interested in detailed information that your doctor has access to about Straterra, you can download(*.pdf format) the information here- http://pi.lilly.com/us/strattera-pi.pdf
I'm on my first week and so far so good. Its kinda nice to be off the stimulant because I no longer feel that there arent enough hours in each day to get everything done! The only problem I noticed was that it tends to wear off in the evening. Currently I'm working nights and its not a good thing. I'm considering splitting the morning dosage in two.
Posted by noa on April 8, 2003, at 19:05:21
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by Caleb462 on April 7, 2003, at 17:04:29
This is my understanding of this, but I am not as well versed in the biology/chemistry of these things as many here are:
When I see the word "stimulant" I understand it to mean a "central nervous system stimulant", which implies a "dirty" (non-selective)medication, not a selective one. I did not think stimulants, like Ritalin, are reuptake inhibitors but I might very well be wrong on that.
My *understanding* is that atomoxatine is not a central nervous system stimulant, that it is a selective norepinephrine reuptake inhibitor (SNRI), and that in fact it is supposed to be a highly selective one--targetting specific receptors in a way that CNS stimulants do not.
Posted by PuraVida on April 8, 2003, at 19:05:29
In reply to Re: Mirapex, posted by teacherkris on April 8, 2003, at 10:15:13
Thanks Kris - I've been on the phone all afternoon trying to get an appt somewhere. Left a mssg for my current Dr again (she's an RN) reminding her she promised to get me in for an evaluation...but as I said, she doesn't seem to beleive in Adult ADD.
BTW, there is a program at UCSD that does intensive nueropsychiatric testing and follow up for ADD and all potential comorbid or other disorders. Apparently it costs $1250, which insurance doesn't pay for. Still, if I have the funds I'd be tempted - what price a healthy brain, you know? I am sick of this treadmill!
Thanks again,
PV
BTW, do you know of any groups for ADD in SD? There is a website for an organization, but it looks pretty defunct.
> Hi there, I'm not sure if this is appropriate to post or not but I'm in San Diego and have a great psychiatrist that I've worked with for years. He's located in Hillcrest and his name is Randy Hicks. He's very cautious with meds and as you'll see in my earlier posts that frustrated me at first, however, it's paid off. Just to clarify cautious in a good way. I've always brought new meds to his attention and he's more than willing to have me try them he just likes to change one thing at a time and makes sure he has all the info. For example, he wouldn't start me on Strattera until he sat down with a rep from Lily to get all the information. Anyway, hope that helps.
Posted by paulk on April 8, 2003, at 19:10:08
In reply to Re: Atomoxetine (Straterra) as a stimulant , posted by noa on April 8, 2003, at 19:05:21
If you look at the effects of a CNS you will find them listed as side effects in the monograph. The issue is pointless - except that it is much more difficult get perscriptions of the other, politicaly/government determined classification.
I see it as a lobbying win by Libby on the FDA.
Posted by PuraVida on April 8, 2003, at 19:19:25
In reply to Re: Mirapex » PuraVida, posted by not exactly on April 8, 2003, at 3:04:29
Thanks Bob - I guess I'd better figure out the difference. I did read your posts about your trial, and that whole thread, before I tried it...
>
> Mirapex (pramipexole) is a dopamine (primarily D3) agonist (NOT a reuptake inhibitor).I have heard this, too - but what do you do then?
> My theory is that, because it's an agonist, the brain down-regulates the dopamine receptors to compensate, so eventually the benefit wears off.
>
> - Bob
>
Posted by not exactly on April 9, 2003, at 3:40:22
In reply to Re: Mirapex » not exactly, posted by PuraVida on April 8, 2003, at 19:19:25
> > My theory is that, because it's an agonist, the brain down-regulates the dopamine receptors to compensate, so eventually the benefit wears off.
> I have heard this, too - but what do you do then?
Unfortunately, you give up on the pooped-out med (discontinue, wash out, endure the depression-intensifying rebound) and then look for something else to try. I tried lots of other meds & combinations before I finally found something that provided a significant and sustained benefit.
I've already posted (to another thread) my current successful med combo [http://www.dr-bob.org/babble/20030310/msgs/208344.html] and why I think it's working for me [http://www.dr-bob.org/babble/20030310/msgs/208906.html]. BTW, this combo is also helping with my ADD - I'm feeling less distractable and more focused. It's now easy for me to make decisions, get motivated, and follow projects to completion. It's been working fine for a couple of months now, and I sure hope it doesn't poop out.
I'm not necessarily recommending this combo to anyone else - my brain chemistry seems to be quite different from most people's. But if your ADD is accompanied by atypical depression, anxiety, and social phobia, you might want to give it a try. The meds are cheap (both are available as generics) and have relatively benign s/e profiles.
- Bob
Posted by fallsfall on April 9, 2003, at 8:04:34
In reply to stuffed head feeling?, posted by Lexxey on April 7, 2003, at 12:04:35
I have something similar to your "stuffy head" feeling. For me it feels like I have clogged sinuses in the top third of my head - with that tingly feeling. I've been on Strattera for 2 months and this came up about 2 weeks ago. It seems to be going away in the last couple of days - I hope. It is almost like a lightheadedness, it makes me feel unstable. But the good points of Strattera make that a minor inconvenience.
Good luck!
Posted by blondegirl47 on April 9, 2003, at 8:07:53
In reply to Re: stuffed head feeling?, posted by fallsfall on April 9, 2003, at 8:04:34
Hi Fallsfall
Can you tell what good stuff your getting from strattera and what milligram your on?
Thanks
Posted by Lexxey on April 9, 2003, at 8:11:02
In reply to Re: stuffed head feeling?, posted by fallsfall on April 9, 2003, at 8:04:34
thanks for posting I was just wondering...I had the feeling it was the drug since it just happened a while after each dose and I like to make a record of symptoms in case someone else was wondering too.
when a drug is this new we have to work together to kepp info available.
Posted by Stan on April 9, 2003, at 13:52:35
In reply to Re: life after Mirapex » PuraVida, posted by not exactly on April 9, 2003, at 3:40:22
hi bob -- i've read a few of your posts from time to time and am glad to hear that the buspar/klonopin combo is still performing for you -- i'm curious about one thing though -- i recall that when you were taking neurontin, you thought it was making you forgetful and spacey and mentally "slow" in certain situations -- is the klonopin doing any of these things? judging from the tone of your messages, it seems that it's not, and in fact may be having the opposite effect. would you say that there's no cognitive impairment occuring with the K, in your view? i'm curious because benzos make me tired and depressed and i'm considering an anticonvulsant as an alternative.
thanksStan
Posted by fallsfall on April 9, 2003, at 15:07:53
In reply to Re: stuffed head feeling? » fallsfall, posted by blondegirl47 on April 9, 2003, at 8:07:53
I take 80mg in the morning of Strattera. I take it for Depression.
The benefits are for both Strattera and Provigil. Each one alone doesn't help me, but together they are really good.
They give me energy - so much more than I had before. I also am motivated to actually do something with the energy. I think clearer. I can finish things I start. Basically I have been allowed back into the world. It also is doing a really amazing job in controlling suicidal feelings - Situations exist right now where I would expect to be really suicidal, but I'm doing OK.
I looked for over a year to find something that would work for me. I love my Strattera!
P.S. I also take Prozac and Lithium and some other things for side effects.
Posted by PuraVida on April 9, 2003, at 16:05:49
In reply to Re: life after Mirapex - not exactly » not exactly, posted by Stan on April 9, 2003, at 13:52:35
Thanks Bob -
I have an appt w/ a local Dr who works closely with the Amen clinic - so I am looking forward to that - if I can make it till the appt! :)
Just as an aside - I was on Nuerontin for about a year and had persistent headaches over my right eye. When I stopped the Nuerontin, they went away. I'm not really sure if it ever did anything else for me. Then I was on Topamax - only 50 mg, and got fed up with the tingly feeling in my face and lips.
PV
Posted by not exactly on April 9, 2003, at 19:11:36
In reply to Re: life after Mirapex - not exactly » not exactly, posted by Stan on April 9, 2003, at 13:52:35
Stan,
Within days of stopping the Neurontin, I felt my intellect come back. I hadn't realized just how much mental impairment I was suffering until it went away. Thank God it was reversable! Now I can once again do mental arithmetic, picture intricate objects in my mind, remember details, do complex reasoning, think creatively, and instantly come up with witty replies during conversation. My brain works as well as I remember it had back when I was a straight-A grad student, and when I was a software project leader.
Unfortunately, stopping the Neurontin also caused the return of anxiety. Not that I had been totally anxiety-free while on the Neurontin, but it became much worse without it. I was tempted to resume the Neurontin just to help with the anxiety, but I REALLY didn't want to return to that state of impaired intellect. So, since I already had a Rx for Klonopin (p.r.n. for occasional periods of debilitating anxiety), I tried taking small doses (1 mg/day or less) of that instead.
First of all, the Klonopin helped with the anxiety in a much more effective way than the Neurontin ever had. No more introverting social anxiety, no more terrifying acrophobia (an unexpected and wonderful benefit, since mountaineering is one of my favorite hobbies!), no more paralyzing non-specific background anxiety. It did cause some sedation/drowsiness/hypersomnia for the first few days, but once I got used to it, these side effects completely disappeared. Now it almost feels like a stimulant, because I feel I'm no longer inhibited by my nameless fears. But I'm not taking so much that it's supressing reasonable caution and respect for real danger - I'm still a safe driver and don't act rashly. In short, I'm now confident and functional.
Secondly, the Klonopin did NOT have the inellect-dulling effects that the Neurontin did. I did not do enough careful testing with & without to be able to claim that there is ZERO impairment, but if there's any dulling at all, it's not really noticable. And the ability to think and act without the constant nagging anxiety more than makes up for any minimal dulling. I would say that I'm noticing absolutely NO side effects at this point.
I'm not worried about becoming a benzo addict. This is a very low dosage, I have no desire to escalate the dosage, and I certainly don't intend to discontinue it abruptly. The half-life is long enough so I don't have to worry about falling apart if I accidentallty miss a dose. Since it appears to be effectively solving a significant chronic problem, I wouldn't really mind if I had to take it for the rest of my life. Does a diabetic worry that he's "addicted" to insulin? Klonopin is cheap and benign insurance.
As always, the YMMV disclaimer applies. I'm sure there are folks who think that Klonopin causes cognitive impairment, and Neurontin doesn't.
- Bob
Posted by Stan on April 9, 2003, at 22:08:11
In reply to Re: Klonopin vs. Neurontin » Stan, posted by not exactly on April 9, 2003, at 19:11:36
Posted by Viridis on April 10, 2003, at 0:43:21
In reply to Re: Klonopin vs. Neurontin » Stan, posted by not exactly on April 9, 2003, at 19:11:36
I also find that Klonopin (1 mg/day) helps me think more clearly. Before using it, anxiety interfered tremendously with my cognitive processes and sleep, and induced severe depression on a regular basis. When I started it, I had a week or two of mild sedation etc., then the side effects totally of K disappeared and only the benefits have remained.
I take Neurontin as well (1200 mg/day) and really don't think it does much at all (for me -- YMMV etc.). The first couple of times I took it I experienced a pleasant, "floaty" high, and since then I've felt nothing. My pdoc suggests I stay on it because it may add "background" stability, but honestly, I don't think it has any effect any more, good or bad. Klonopin is definitely the driving force, and for me is a excellent med, with no negatives after almost 2 yrs of use at the same dose.
Posted by Hattree on April 10, 2003, at 13:51:40
In reply to Re: Klonopin vs. Neurontin » not exactly, posted by Viridis on April 10, 2003, at 0:43:21
Posted by blondegirl47 on April 10, 2003, at 14:09:05
In reply to Please keep the Strattera updates coming! (nm), posted by Hattree on April 10, 2003, at 13:51:40
Posted by Lexxey on April 10, 2003, at 15:26:10
In reply to Re: Please keep the Strattera updates coming! (nm), posted by blondegirl47 on April 10, 2003, at 14:09:05
OK...I have an update, of sorts....
I'm in my 11th day at 80mg [40 at 8am, 40 at 4[pm]and this was after 2 weeks on 40mg and all I notice is that I'm sleeping better and still having fun, vivid dreams.
I don't feel any ADHD relief. I haven't been getting much done and I have been all **too hungry**, and I have been as uncoordinated as ever. I was hoping this would help the physical coordination as Ritalin did for the 19 years I took it. I know what it feels like to have my brain work right and this isn't it yet!!!
I just can't get into gear and do some jobs I need to do, and actually, usually enjoy...I just put them off apathetically...[if that's a word]...I mean with apathy....blah-ness. Don't give ahoot!!!
I want some kind of revelation or motivation or something to let me know this is kicking in and I'm not wasting my time.
I have a question....
The doc gave me some 60mg pills in case I wanted to take one of those in the am instead of 40mg. I weigh 150#. Do yall think I should up my am dose to 60mg? I'm putting it to a vote!!! See how bored I am!
I just sat here for 4 hours and read everything I could on this drug and how dopamine affects ADHD and I'm not sure much has sunk in.
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Dr. Bob is Robert Hsiung, MD,
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