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Re: does bromocriptine work for akathsia? » novelagent

Posted by SLS on February 3, 2012, at 7:08:24

In reply to does bromocriptine work for akathsia?, posted by novelagent on January 30, 2012, at 19:49:17

> In the meantime, might bromocriptine work for akathsia?

That's a very logical question. However, if bromocriptine were effective, I think you would see it (or other DA agonists) used as a primary treatment for EPS. It has been studied for this purpose. Results have been disappointing.

I tend to agree with Ed_Uk2010.

Actually, adding bromocriptine might backfire. It may stimulate presynaptic receptors (agonist) while leaving postsynaptic receptors occupied by the neuroleptic AP. In this scenario, dopamine synthesis and release are inhibited without a compensatory increase in the stimulation of postsynaptic receptors. Low dosages of bromocriptine are well known to produce sedation and reduce locomotor activity. Coadministration of a neuroleptic should approximate this dynamic. Of course, this is only an idea that occurred to me as I was replying to your post. I have little evidence to support it.

http://www.comawakening.com/coma.html

"At low doses of bromocriptine, presynaptic activity exceeds postsynaptic activity, and antidopaminergic activity prevails.( )"

Another silly thought I had is that bromocriptine might help akathisia, even though it does not reduce other EPS. Different tracts are responsible for akathisia EPS compared to movement EPS. Using low dosages of bromocriptine (< 10 mg) might be effective to treat akathisia. So, your idea cannont be ruled-out.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1031710/pdf/jnnpsyc00532-0080.pdf

"There is strong animal evidence that
akathisia may be related to blockade of
dopamine in the prefrontal cortex rather
than the striatum."

http://books.google.com/books?id=Ap4cxp1Hi00C&pg=PA236&lpg=PA236&dq=bromocriptine+presynaptic+preferential&source=bl&ots=_aV0VyGXYu&sig=yYJvBFE0hdpMWCu0aeDTSFaiHzo&hl=en&sa=X&ei=69grT6zLKdPjggf1o7X7Dw&sqi=2&ved=0CFAQ6AEwBg#v=onepage&q=bromocriptine%20presynaptic%20preferential&f=false

"I have treated several cases of tardive akathisia with low dosages of bromocriptine (less than 10 mg/day). This chemotherapeutic intervention was selected because the dopamine agonist, bromocriptine, preferentially stimulates presynaptic autoreceptors with the consequence of decreased dopamine synthesis and release."

So, which of my two competing theories is most attractive to you?

Here we have a phenomenon that we see on Psycho-Babble all of the time. People make up their own theories and suggest to others that they act upon them despite the existence of alternative theories or a lack of clinical evidence. From my perspective, most of us - including me - are relative simpletons compared to the researchers in neuroscience and psychiatry. Because bromocriptine can provoke psychotic reactions, I would err on the side of caution and look for other treatments for akathisia first. If you elect to try bromocriptine, keep the dosage low.


* Research the use of low-dose Remeron (mirtazapine) to treat akathisia.


- Scott



Some see things as they are and ask why.
I dream of things that never were and ask why not.

- George Bernard Shaw

 

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