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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 Bruce on March 26, 2000, at 9:47:12
AndrewB - I have read with interest your Mirapex trial. Any side effects?
Bruce
Posted by AndrewB on March 26, 2000, at 13:21:27
In reply to Question for AndrewB...., posted by Bruce on March 26, 2000, at 9:47:12
> AndrewB - I have read with interest your Mirapex trial. Any side effects?
>
> BruceBruce,
Surprisingly I had only very mild nausea and headache over a three day period as I increased the dosage. I've read that some people experience much stronger nausea over a longer period of time. Possibly the combination of amisulpride with the Mirapex limited the side effects.
AndrewB
Posted by JohnL on March 27, 2000, at 4:30:19
In reply to Question for AndrewB...., posted by Bruce on March 26, 2000, at 9:47:12
Andrew, I'm confused. Amisulpride is a D2/D3 antagonist. But Mirapex is a D2/D3 agonist, right? Aren't these drugs counteracting each other? You know the chemistries involved a whole lot better than I do, so I was just wondering how these two could work synergistically? Your thoughts?
Thanks. JohnL
Posted by AndrewB on March 27, 2000, at 9:33:32
In reply to Re: Question for AndrewB...., posted by JohnL on March 27, 2000, at 4:30:19
> Andrew, I'm confused. Amisulpride is a D2/D3 antagonist. But Mirapex is a D2/D3 agonist, right? Aren't these drugs counteracting each other? You know the chemistries involved a whole lot better than I do, so I was just wondering how these two could work synergistically? Your thoughts?
> Thanks. JohnLAt the low doses I take amisulpride it is a presynaptic receptor antagonist. More specifically, the amisulpride is blocking stimulation of the presynaptic autoreceptors which are part of a feedback loop that tells the presynaptic neuron to manufacture and produce less dopamine in response to the (excess) levels of dopamine in the synaptic cleft. The result is amisulpride, by blocking this feedback mechanism, enables excess dopamine to enter the synaptic cleft, causing more stimulation of the postsynaptic receptors. Meanwhile, Mirapex is mimicing dopamine and providing additional stimulation of the postsynaptic receptors.
AndrewB
Posted by JohnL on March 27, 2000, at 16:54:59
In reply to Re: Question for AndrewB...., posted by AndrewB on March 27, 2000, at 9:33:32
> > Andrew, I'm confused. Amisulpride is a D2/D3 antagonist. But Mirapex is a D2/D3 agonist, right? Aren't these drugs counteracting each other? You know the chemistries involved a whole lot better than I do, so I was just wondering how these two could work synergistically? Your thoughts?
> > Thanks. JohnL
>
> At the low doses I take amisulpride it is a presynaptic receptor antagonist. More specifically, the amisulpride is blocking stimulation of the presynaptic autoreceptors which are part of a feedback loop that tells the presynaptic neuron to manufacture and produce less dopamine in response to the (excess) levels of dopamine in the synaptic cleft. The result is amisulpride, by blocking this feedback mechanism, enables excess dopamine to enter the synaptic cleft, causing more stimulation of the postsynaptic receptors. Meanwhile, Mirapex is mimicing dopamine and providing additional stimulation of the postsynaptic receptors.
>
> AndrewBAndrew,
I wonder if Bromocriptine works the same way as Mirapex?
Posted by AndrewB on March 28, 2000, at 9:43:57
In reply to Re: Question for AndrewB...., posted by JohnL on March 27, 2000, at 16:54:59
> Andrew,
> I wonder if Bromocriptine works the same way as Mirapex?John,
Bromocriptine has been shown in studies to be a useful AD, having a similar efficacy to some other more standard ADs. In actual clinical practice, it is used normally only after numerous other ADs have failed, it certainly isn’t for everybody. Perhaps Mirapex will be found to be like bromocriptine and only have a very limited role in the treament of depression, time will tell. It would be interesting though to compare the antidepressant effects of the two meds. Just as these meds have interesting differences, perhaps their ability to treat depression also differs. One difference between the two is that Mirapex is better at treating Parkinsons. Bromocriptine is a D2 agonist with D1 receptor antagonist properties. Mirapex is a D2-D3 receptor agonist. I believe that Mirapex in general has fewer side effects.
AndrewB
Posted by ash on March 28, 2000, at 10:56:55
In reply to Re: Question for AndrewB...., posted by AndrewB on March 28, 2000, at 9:43:57
Hello AndrewB:
My sleepdoc has prescribed Permax (pergolide) 0.4 mg for me for PLMD (Periodic Leg Movement Disorder) a cousin of RLS (Restless Leg Syndrome). Permax, as I am sure you are aware, is another Parkinson's medication like Mirapex but acts on the D1-D2 dopamine receptors. Permax has helped in reducing my PLMD but has had no beneficial effect on my long-time double depression .
Mirapex is another medication that is helpful in PLMD and your post makes me wonder if switching from Permax to Mirapex might have a dual benefit for my PLMD as well as depression. What dose of Mirapex are you on? Do you think the fact that I have PLMD makes it any more or less likely that my treatment-resistant depression would respond to a high dose of Mirapex as an augmentation agent to SSRI's? Any thoughts would be appreciated.
Thanks, Ash
Posted by AndrewB on March 29, 2000, at 9:50:48
In reply to Re: Question for AndrewB...., posted by ash on March 28, 2000, at 10:56:55
Ash,
From what I've just read, there probably isn't a connection between your depression and RLS, therefore having RLS does not make you more or less likely to find an antidepressant response with Mirapex. However, since Mirapex is one of the preferred treatments for RLS, you may want to try out Mirapex just on the chance that it would help your depression too. The dosage of Mirapex for RLS is usually .125mgs, two or three times a day. The dosage of Mirapex for depression is much higher. Usually between .75mgs to 2mgs per day divided into 2 or 3 doses. You may find some of the info. on the following RLS message board useful:
http://www.healthboards.com/restless-leg-syndrome/
AndrewB
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