Add to previous comment: I have been on vutually or most, Tricyclics , SSRI, SNRI, (welbutrin class) Anti psychotics. I have been on 20-30 at least medications for depression during my lifetime
This medication worked really well for me for about two years. I was in complete remission. It was amazing. The side effects were awful, though. I took it at night but if I didn't get into bed quick enough I'd either fall asleep where I was or I'd be literally crawling to my bed. I developed some obsessive behavior but nothing that interfered with my life too much. It made my hair fall out as well.
There is some risk for hedonic adaptation which includes impulsive behavior and obsessive behavior. These side effects are a risk. It's also correct that the medication can be sedating we usually only dose it at night for that reason. I'm not sure about the hair loss part, not a common side effect but it's still possible. All medication for medical or psychiatric conditions come with both risks and benefits. The point you bring up is important, were the side effects worth the two years of remission? The answer will be different for everyone and depend on your own value judgements. This is the importance of informed consent and knowing all the risks and potential benefits before making a decision. In psychiatry it's a little harder because we are dealing with the "mind" and despite all the advances in neuroscience no one really knowns what the mind is. Appreciate the question and it brings up an important point for anyone considering medications
Just started this for treatment resistant depression. Taking 500mg twice a day for the first two weeks and then 1mg twice a day from that point forward. The nausea and fatigue are killing me! Need to try taking it just at night. I'm a little surprised I'm starting right out of the gate at 1mg per day. Maybe this will work - I'm desperate and running out of treatment options. Also concerned about weight gain. My appetite is through the roof already on Day 3.
In my clinical practice I like to dose all medications at night if possible so that can be a good start. Another simple solution to the nausea might be to talk with your doctor about lowering the dose and spacing out the dose increases. They say start low and go slow for a reason. I have a video on antidepressant induced nausea which may be of help to you as many of the things I discuss are reasonable options to use with this medication as well including ginger root. Hope this helps, if you haven't subscribed to the channel please do and read the word about what we are doing here
@@ShrinksInSneakers Here's an update about 6 weeks into taking Pramipexole. I'm now taking 3mg daily. The nausea completely subsided after 3 days. The only side effect that remains is pretty terrible issues with staying asleep. I sleep only 3-4 hours a night now. But that's no big deal compared to this next part.... Within 1 week, I was in complete remission from my refractory depression. NO JOKE. This is after 35+ failed psych meds, 12 sessions of ECT, 2 years of micro dosing psilocybin, TMS, and many other therapies and remedies. I added L-Methylfolate to the Pramipexole due to my MTHFR gene mutation. Doing SO WELL now. I had a number of close calls with suicide as recently as the month before starting the Pramipexole. This is total remission so far and I couldn't be more relieved. Now comes the hard work with a new therapist (CBT, EMDR, and Attachment Style therapy). It was a dopamine deficiency all along for me - go figure. Wish I would have found this medication 15 years ago. :)
Hi there. Appreciate this video. So I take it you've had patients on this drug who have had long term success? My worry with dopamine agonists is long term receptor desensitization/down-regulation. I'd imagine as you alluded to in another comment response, this is probably more prevalent in larger doses/and parkinson applications..
I would say this medication is a near last line option and while I have had patients on the medication long term I try to use the lowest effective dose to avoid problems.
Where is info about target dosage (0.75 - 2mg) taken from? There are many sources everyone from them differs with dose range for depression. I'm interested first of all in MIN dose for depression. MAx dosage is 4.5-5 mg and even 9 mg I met. But not everyone can allow MAX dosage. Imho min dosage for depression equals to min dose for Parkinson and is around 1.5 mg. Thnx.
Sir can this drug be titrated in 0.5 mg every say 4 days with a target of 3 mg? Im currently on 1.5 mg with a .25 mg increase every 4 days and very desperate. No improvement as of yet unfortunately 😔
In regards to fully converting dopamine agonists for treatment resistant depression I've seen many clinicians promote pramipexole and "theorist's" (ie; researchers, and biohackers), promote cabergoline instead. My limited understanding, (and this could be an erroneous line of thinking), is that for an issue such as prolactinoma, either or can be used. (Assuming I'm correct, if not please correct me), does this hold true with treatment resistant depression as well? If not where do the pro's and con's lie between the two compounds?
Hey! I’ve 2 questions. Is it more effective than methylophenidate or modafnil? They’re also dopamine agonist. I’ve heard a lot about pramipexole in MDD with anhedonia (my case). It is better to take it solo or with another SSRI/SNRI?
There are many people using stimulants as adjunctive therapy for depression. This is not the most well established adjunctive treatment but it does go on in the clinical setting. I do not know any head to heat RCTs that looked at stimulants Vs primapexole but it might be worth looking at in the future. The second question about using it in combination of alone is also hard to answer. Of the studies that are available most compared it to placebo and did not have participants taking other medications. I would use it alone in cases where the person had no response to SSRIs or SNRIs and possibly consider adding it in cases where patients are partial responders. Hope this helps, appreciate the question
Anyone know why none of the dopaminergic drugs are used in UK (for Depression)? I can't access any of these meds 'legitimately', nor MAOI. They seem only concerned with the serotonogenic drugs and (oddly) the anticonvulsant Pregabalin: ie the drugs that don't work well.
@@Suttisan78 good luck with it. not sure about doses. i'd read studies and try to max it out. i'm currently taking an antipsych for anxiety/depression, i think it works a little
I suffer TRD and Anhedonia Lexapro 20mg, Lorazepam 1mg X 4, Gabapintin 900mg, Bupropion 300mg, concerta 52mg, Vitamin D3 3000mcg, Magnesium Gly 50mg Tried TMS did not have any effect at all. all this is not working and im dealing suicidal idealation. is the drug in this video could be helpful? DR never mentioned. Please comment on this comment, or anybody. all thats left is ECT or Deep Brain Message
I have also suffered from TRD with anhedonia and avolition for MANY years and been on a huge list of meds I haven't responded to. I just wanted to let you know that ECT is not what Hollywood and society make it out to be; I did it for 8 months and had no adverse effects other than temporary short term memory loss. It was moderately helpful; I discontinued it only because I'm also on higher dose opioids for chronic pain that I think diminished it's effectiveness. Hope you're doing better.
I have TRD and have done everything including all orals, rTMS, ECT, and Spravato. I was out of options but gave pramipexole a try and my depression is about 25-33% better. I had to take 3 - mg to get results. I am not on 4.5 mg Extended Release and that really smoothes out the side effects.
A lot of it will come down to experience and if insurance. It’s hard to justify the coverage of this medication in many cases because it’s off label and the insurance companies will give some push back. I think when discussing it at your appointment just present the idea. Ask if the doctor would be willing to look at some of the data on this medication for treatment resistant depression and if it may be an option. Most doctors will be willing to at least look into it. Hope this helps
Hi, I am from India. I am taking Fluoxetine 20 mg and imipramine 25 mg along with pacitane 2 mg with both antidepressants. It's been 8 years. I have recovered but I am on the meds for maintenance .Now the tremors have come back despite taking pacitane 2 mg. Oh! Forgot to tell you I am also taking the mouth dissolving version of olanzapine 2.5 mg . Do you think I should speak with my Psychiatrist about Pramipexole . What is your opinion ???
Hi could this work for lasting sexual dysfunction/alteration caused by ssri many years ago? Main problems anhedonia and no normal sexual function ever since coming off paxil years ago (which is called pssd) i have improvement but my sexual function has never rlly been pre ssri level , symptoms as low libido/low sexual sensation/low desire . Now i can "temperoraly" completely reverse these lasting sexual alteration by taking a recreational dose of psychostimulants (dexamphetamine/amphetamine). But its only temperoraly and i am done with stims cause it only works taking a recreational dose and has to many side effects which has led me to thinking of how a selective dopamine agonist could maybe work for me since psychostimulants temperoraly reverses it . Greetings !
i got it for restless legs and depression. I noticed them hit the first few times but i dunno. I have too small of dose thx to my do-gooder doctor. My restless legs arent totally gone even
It’s hard to predict who will respond and who will not. There is not nearly as much data on this medication as other more traditional medications for depression. For restless leg syndrome the data is well established for both pramipexole and ropinirole. I would check with the doctor about the dosing for restless leg syndrome. Appreciate you sharing your experience.
I have not seen much data on this, but I usually augment with buspirone for sexual side effects. I'm now more careful who I prescribe antidepressants to. I try to avoid using them in problems of life which has helped me avoid dealing with some of these troubling side effects
I am taking PRAMIPEXOLE 1 mg in the morning and one at night for the path number of years. I’ve had terrible insomnia. I wake up around 2:30 in the morning, maybe sleeping for about 45 minutes to an hour and that’s it for the night. I’m thinking of taking the one I take in the morning to take it in the middle of the night in other words taking one before I go to bed and taking one like 230 3 o’clock in the morning maybe that will get me a little sleepy enough that I can get a little more sleep, would that be OK? I would appreciate an answer and thank you so much for your information.
It's interesting that your target effective range is 0.75mg to 2mg. My psychiatrist says that the target dose is between 2mg and 5mg which is significantly larger. I'm at 0.5mg now and my doctor wants me to go up to at least 2. I did read a few studies where the average dose required was like 2.5mg. But idk. Do you have any experience with prescribing pramipexole for your patients?
@@gregorymalchuk272 I went up to 10mgs a day and gave up I felt nothing, but I'm pretty certain the product I was taking wasn't legit, as a low dose from a different brand I took made me quite nauseated, I'll give it another try again some time
@@Suttisan78 10mgs? Was that prescribed by a doctor? The maximum advised is 5mg and the dose people describe as effective in depression is between 2mg and 5mg. Also, how long were you on it at these doses?It also works by down regulation, so you may notice no results or worsening symptoms for the first two weeks. What was the nausea like? Did it come in episodes or was it constant? Did they give you anything for it?
@@saharnavah7244 Hi! Nausea is pretty common in the beginning but it does go away. I also have had pretty bad insomnia, but it has been worth it. Best of luck to you on it! Let me know if I can answer any questions.
I have now been on 4 mg of Pramipexole for 21 days and it is helping quite a bit and QUICKLY at high dose. I have more interest in things and more energy and focus. I have severe TRD and anhedonia and have tried all of the meds (including Abilify and Wellbutrin), Spravato, rTMS, etc. Side effects: nausea in the beginning and pretty bad insomnia as I tritrated up. I stuck with it because I had no plan B. But it has been worth it. I am praying that I will continue to improve over more time and this is just the beginning.
Update: OK, I have been on pramipexole for about 6 weeks now. I have severe TRD and I would say I am about 25-33% better since starting prami. I have cut back to 2mg (from 4mg) as I was beginning to experience some very discomforting side effects without feeling like I was getting any additional benefit. Those side effects were extreme fatigue, shakiness and muscle weakness, and dizziness. Those symptoms dissipated quickly once I dropped the dose.
Excellent. I am on many antidepressants trying for increased dopamine. Maybe dopamine receptors not working well? Would dopamine agonist improve this? Thanks
Yes, this is the theory. It’s not so much that dopamine receptors are not working but more of a modulation of the dopamine pathways involved in emotion and reward. There is some risk of hedonistic homeostatic dysfunction which is a fancy way of saying over involvement in pleasurable activities. I’ve personally used this medication clinically and seen good results. Hope this helps, if you haven’t subscribed to the channel please do and spread the word about what we are doing on the channel
Hey, sorry I’ve been asking a lot of questions recently lol, but here’s another one. I am considering talking to my psychiatrist about trying this medication in the future as I have TRD and anhedonia is my main and toughest symptom. I have read about DAWS (dopamine agonist withdrawal syndrome) from stopping a medication like this, do you know the chances of this syndrome? I have only read about it in studies with PD patients so its hard to know if this syndrome is more likely a concern in PD patients or its a concerning syndrome regardless of the illness. Thanks!
I have had a few patient on the medication and have not seen any dopamine agonist withdrawal when used for mental health patients. For Parinkson's disease I think the likelihood would be much greater because of the disease process itself destroying dopamine neurons. I would say if someone planned to come off the medication then tapering it slowly over time and watching for and withdrawal like symptoms
@@ShrinksInSneakers Thanks for the reply! I’ve asked a decent amount of questions and you always answer them! This makes me more comfortable about bringing it up to my pdoc and possibly trying it.
I'm not aware of any data on this medication for anxiety, and this is medication best reserved for someone who failed 2 or more trials of other medications. It's also off label so sometimes difficult to find someone to prescribe it. Hope this helps
My panic attacks stopped not long after I began taking pramipexole for anhedonia. There are one or two case reports I have read on PubMed where it was used as monotherapy for panic attacks with success.
I have no evidence to support the use of this medication in schizophrenia. Negative symptoms are often the most difficult to treat there is really no good medication that specifically addresses them. There is some evidence that medications that modulate dopamine and do not just block D2 receptors do have some evidence. cariprazine does have some evidence for the use in negative symptoms. I hope this helps, if you haven't subscribed please do and spread the word about what we are doing here.
Is there any scope for using this medication as a way of limiting the, I would argue negative neurological effects, of abstaining from a 20yr pornography addiction. I've done this cold turkey and I know it's affected me in various ways which I just know are connected to the disregulation of my sexual anatomy and the accompanying release of dopamine from the sexual act itself, either with or without a partner. ?
I do not know of any research in this area, but I think any form of addiction involves increased dopamine in specific pathways, I do not think this medication would be helpful in that regard
I have not seen any randomized controlled trials looking at carbergoline in TRD. I did see one where it was used in combination with another medication. I would say the evidence is weak at this point for its use in TRD. Appreciate the comment.
I've tried both and I would say they both are very similarly effective, but cabergoline has a bit more side-effects. On the other hand cabergoline has a very long half-life so the antidepressant effect is more the same around the clock, with pramipexole and ropinirole I can feel the effects wane during the day due to their relatively short half-lives. That's a potential argument for some to rather prefer taking it in the morning. To me all dopamine agonists interfere with sleep in the beginning, at the same time they do make you tired lol. Both pramipexole and cabergoline are similarly very strong at both the D2 and D3 receptors so it makes sense that their effects on depression are often going to be very similar.
@@ShrinksInSneakers Hey Doc I just wanted to say that I've tried both medications and both were equally effective for my depression. Both drugs are very strong at both the D2 and D3 receptors so it makes sense they overlap a lot in their effects I think. What I liked about cabergoline was that it's very long half-life means that it pretty much works the same around the clock 24/7 and if you forget a dose it's not at all as big of a deal! Meanwhile pramipexole has a much shorter half-life and I could feel the effects wane a bit throughout the day after dosing, I think that could be an argument for some to prefer taking it in the morning. Both pramipexole and cabergoline were both paradoxically stimulating and making me tired at the same time lol, also at first they seriously made sleeping at night harder due to their stimulant effects despite also feeling very fatigued and tired at the same time.. dopamine agonists are very strange drugs! Both the stimulating and tiring effects did improve a lot over time and it got easier to wind down at night. Still it's hard to wind down completely with these because of the constant firing of the dopamine receptors by these drugs, but hey it beats being depressed! I would also say these were for me very pro-cognitive and powerful nootropics and made me feel very sharp in my brain. Again this effect of making me feeling constantly wired in my brain made it easier to sleep at night if I took it in the morning, but I guess it can be very different for everyone and I was never taking more than a small dose. Both pramipexole and cabergoline are very strong at the D2 and D3 receptors despite prami being described as a D3 agonist and cabergoline as a D2 agonist. So if this is the leading cause of the antidepressant effects it makes sense that both could work. I've also tried ropinirole and it also did a lot but its even shorter half-life was definitely noticable. That said cabergoline definitely had more side-effects than pramipexole for me, like giving me more headaches and making my skin feel warm and harder to sleep. I guess cabergoline is more for those who don't tolerate pramipexole for other reasons and that pramipexole should preferably be tried first? I also tried it because I thought I was having an allergic reaction to pramipexole. Hope you didn't mind me chiming in here with my experiences, I am in no way a MD or expert but on a topic with so little information I thought I'd share my experience and hope it helps someone. Edit: Also it's not just pramipexole and cabergoline but I've heard other dopamine agonists such ad piribedil, rotigotine and ropinirole helping others!! You can find case reports and studies of all of these helping depression people in the literature as well! The super dirty dopamine agonist bromocriptine also has multiple studies with collection of case reports describing it as being very effective for depression! I think one even compares it to the TCA imipramine with favourable results. I think for a serious disease like treatment resistant depression where there are tons of gap in knowledge and poor understanding of it and having to experiment with so many different drugs, case reports and anecdotes from clinicians treating TRD and experiences of patients with TRD it is important to take that into account more than what randomized control studies say. 👍
@@jacobski7216 I'm always continuing to learn and bring you guys the most recent research. I think at this point we need to continue the process of finding new ways of treating a debilitating disease process.
Add to previous comment: I have been on vutually or most, Tricyclics , SSRI, SNRI, (welbutrin class) Anti psychotics. I have been on 20-30 at least medications for depression during my lifetime
Try mushrooms
This medication worked really well for me for about two years. I was in complete remission. It was amazing.
The side effects were awful, though. I took it at night but if I didn't get into bed quick enough I'd either fall asleep where I was or I'd be literally crawling to my bed.
I developed some obsessive behavior but nothing that interfered with my life too much.
It made my hair fall out as well.
There is some risk for hedonic adaptation which includes impulsive behavior and obsessive behavior. These side effects are a risk. It's also correct that the medication can be sedating we usually only dose it at night for that reason. I'm not sure about the hair loss part, not a common side effect but it's still possible. All medication for medical or psychiatric conditions come with both risks and benefits. The point you bring up is important, were the side effects worth the two years of remission? The answer will be different for everyone and depend on your own value judgements. This is the importance of informed consent and knowing all the risks and potential benefits before making a decision. In psychiatry it's a little harder because we are dealing with the "mind" and despite all the advances in neuroscience no one really knowns what the mind is. Appreciate the question and it brings up an important point for anyone considering medications
@@ShrinksInSneakers for me the side effects were worth it.
So if I already deal with OCD I guess I should stay away?
What was your dosage? I'm on 1.5mgs and nothing so far
@@Suttisan78 And now?
Just started this for treatment resistant depression. Taking 500mg twice a day for the first two weeks and then 1mg twice a day from that point forward. The nausea and fatigue are killing me! Need to try taking it just at night. I'm a little surprised I'm starting right out of the gate at 1mg per day. Maybe this will work - I'm desperate and running out of treatment options. Also concerned about weight gain. My appetite is through the roof already on Day 3.
In my clinical practice I like to dose all medications at night if possible so that can be a good start. Another simple solution to the nausea might be to talk with your doctor about lowering the dose and spacing out the dose increases. They say start low and go slow for a reason. I have a video on antidepressant induced nausea which may be of help to you as many of the things I discuss are reasonable options to use with this medication as well including ginger root. Hope this helps, if you haven't subscribed to the channel please do and read the word about what we are doing here
@@ShrinksInSneakers Wow, this is HUGE. Thank you so so so much. Subscribed and grateful. 😁
@@ShrinksInSneakers Here's an update about 6 weeks into taking Pramipexole. I'm now taking 3mg daily.
The nausea completely subsided after 3 days. The only side effect that remains is pretty terrible issues with staying asleep. I sleep only 3-4 hours a night now. But that's no big deal compared to this next part....
Within 1 week, I was in complete remission from my refractory depression. NO JOKE.
This is after 35+ failed psych meds, 12 sessions of ECT, 2 years of micro dosing psilocybin, TMS, and many other therapies and remedies. I added L-Methylfolate to the Pramipexole due to my MTHFR gene mutation. Doing SO WELL now. I had a number of close calls with suicide as recently as the month before starting the Pramipexole. This is total remission so far and I couldn't be more relieved. Now comes the hard work with a new therapist (CBT, EMDR, and Attachment Style therapy). It was a dopamine deficiency all along for me - go figure. Wish I would have found this medication 15 years ago. :)
@@BillyG563what is your experience with pramipexole and if it positive when and at which dose do you achieve it?
There’s no way you started at 500 mg that dosage doesn’t exist
Hi there. Appreciate this video. So I take it you've had patients on this drug who have had long term success? My worry with dopamine agonists is long term receptor desensitization/down-regulation. I'd imagine as you alluded to in another comment response, this is probably more prevalent in larger doses/and parkinson applications..
I would say this medication is a near last line option and while I have had patients on the medication long term I try to use the lowest effective dose to avoid problems.
I have another video request: neuroleptics often a go too medication in bpd treatment
I will cover this topic, maybe we can talk about the "borderline cocktail" that often gets used by many psychiatrists, stay tuned...
Did you make this video (the borderline cocktail).
@@butterboy5621 I don't think so. But I hope it will come in the future
Where is info about target dosage (0.75 - 2mg) taken from? There are many sources everyone from them differs with dose range for depression. I'm interested first of all in MIN dose for depression. MAx dosage is 4.5-5 mg and even 9 mg I met. But not everyone can allow MAX dosage. Imho min dosage for depression equals to min dose for Parkinson and is around 1.5 mg. Thnx.
Sir can this drug be titrated in 0.5 mg every say 4 days with a target of 3 mg?
Im currently on 1.5 mg with a .25 mg increase every 4 days and very desperate.
No improvement as of yet unfortunately 😔
Hi. I'm wondering if you could make a video talking a bit about this medication and Dopamine Agonist Withdrawal Syndrome.
In regards to fully converting dopamine agonists for treatment resistant depression I've seen many clinicians promote pramipexole and "theorist's" (ie; researchers, and biohackers), promote cabergoline instead.
My limited understanding, (and this could be an erroneous line of thinking), is that for an issue such as prolactinoma, either or can be used.
(Assuming I'm correct, if not please correct me), does this hold true with treatment resistant depression as well? If not where do the pro's and con's lie between the two compounds?
Hey! I’ve 2 questions. Is it more effective than methylophenidate or modafnil? They’re also dopamine agonist. I’ve heard a lot about pramipexole in MDD with anhedonia (my case). It is better to take it solo or with another SSRI/SNRI?
There are many people using stimulants as adjunctive therapy for depression. This is not the most well established adjunctive treatment but it does go on in the clinical setting. I do not know any head to heat RCTs that looked at stimulants Vs primapexole but it might be worth looking at in the future. The second question about using it in combination of alone is also hard to answer. Of the studies that are available most compared it to placebo and did not have participants taking other medications. I would use it alone in cases where the person had no response to SSRIs or SNRIs and possibly consider adding it in cases where patients are partial responders. Hope this helps, appreciate the question
I’d like to know If pramipexol is used only for the síntoms of depresión or it is a cure ?
Anyone know why none of the dopaminergic drugs are used in UK (for Depression)? I can't access any of these meds 'legitimately', nor MAOI. They seem only concerned with the serotonogenic drugs and (oddly) the anticonvulsant Pregabalin: ie the drugs that don't work well.
Thats strange, MAOIs I think are some of the most effective medications
Yeah this sucks, I'm in the uk and the nhs are not willing to bugde at all regarding prescribing maois, i got my pramipexole online
@@Suttisan78 how is it working for you? im trying to get an maoi via private psychs and then offset the script to nhs after
@@tpl6963 no change in my anhedonia yet unfortunately, I just went up to 1.5mgs
@@Suttisan78 good luck with it. not sure about doses. i'd read studies and try to max it out. i'm currently taking an antipsych for anxiety/depression, i think it works a little
Great content and delivery
Appreciate the comment
Thanks for video Doc. Does this medication affects weight and glicose levels or triglycerides?
Is it activating.does it give energy
I suffer TRD and Anhedonia Lexapro 20mg, Lorazepam 1mg X 4, Gabapintin 900mg, Bupropion 300mg, concerta 52mg, Vitamin D3 3000mcg, Magnesium Gly 50mg Tried TMS did not have any effect at all. all this is not working and im dealing suicidal idealation. is the drug in this video could be helpful? DR never mentioned. Please comment on this comment, or anybody. all thats left is ECT or Deep Brain Message
Get on an MAOI
@@NickArcadeI seconds that
hello, did you try? hope you're doing better
I have also suffered from TRD with anhedonia and avolition for MANY years and been on a huge list of meds I haven't responded to. I just wanted to let you know that ECT is not what Hollywood and society make it out to be; I did it for 8 months and had no adverse effects other than temporary short term memory loss. It was moderately helpful; I discontinued it only because I'm also on higher dose opioids for chronic pain that I think diminished it's effectiveness. Hope you're doing better.
I have TRD and have done everything including all orals, rTMS, ECT, and Spravato. I was out of options but gave pramipexole a try and my depression is about 25-33% better. I had to take 3 - mg to get results. I am not on 4.5 mg Extended Release and that really smoothes out the side effects.
What is the best way to approach a psychiatrist or a physician about being prescribed this medication?
A lot of it will come down to experience and if insurance. It’s hard to justify the coverage of this medication in many cases because it’s off label and the insurance companies will give some push back. I think when discussing it at your appointment just present the idea. Ask if the doctor would be willing to look at some of the data on this medication for treatment resistant depression and if it may be an option. Most doctors will be willing to at least look into it. Hope this helps
Hi, I am from India. I am taking Fluoxetine 20 mg and imipramine 25 mg along with pacitane 2 mg with both antidepressants. It's been 8 years. I have recovered but I am on the meds for maintenance .Now the tremors have come back despite taking pacitane 2 mg. Oh! Forgot to tell you I am also taking the mouth dissolving version of olanzapine 2.5 mg .
Do you think I should speak with my Psychiatrist about Pramipexole . What is your opinion ???
Hi could this work for lasting sexual dysfunction/alteration caused by ssri many years ago? Main problems anhedonia and no normal sexual function ever since coming off paxil years ago (which is called pssd) i have improvement but my sexual function has never rlly been pre ssri level , symptoms as low libido/low sexual sensation/low desire . Now i can "temperoraly" completely reverse these lasting sexual alteration by taking a recreational dose of psychostimulants (dexamphetamine/amphetamine). But its only temperoraly and i am done with stims cause it only works taking a recreational dose and has to many side effects which has led me to thinking of how a selective dopamine agonist could maybe work for me since psychostimulants temperoraly reverses it . Greetings !
Does it helpful nervousness while talking
Gostaria de saber a dosagem do pramipexol para depressao, a dose de 0,25mg pode ajudar ?
I saw your video about Abilify. Is that another drug that would modulate the dopamine pathways? Thanks
i got it for restless legs and depression. I noticed them hit the first few times but i dunno. I have too small of dose thx to my do-gooder doctor. My restless legs arent totally gone even
It’s hard to predict who will respond and who will not. There is not nearly as much data on this medication as other more traditional medications for depression. For restless leg syndrome the data is well established for both pramipexole and ropinirole. I would check with the doctor about the dosing for restless leg syndrome. Appreciate you sharing your experience.
I tried ssris and effexor and bupropion, nothing really helped my anhedonia unfortunately, i wanna try this but quite scared
Did u try it?
@@brice-9696 no
@@vexowmc580 ?
V interesting. Given that it's a dopamine agonist, any application in using it to offset SSRI related sexual dysfunction ahead of say buproprion?
I have not seen much data on this, but I usually augment with buspirone for sexual side effects. I'm now more careful who I prescribe antidepressants to. I try to avoid using them in problems of life which has helped me avoid dealing with some of these troubling side effects
I am taking PRAMIPEXOLE 1 mg in the morning and one at night for the path number of years. I’ve had terrible insomnia. I wake up around 2:30 in the morning, maybe sleeping for about 45 minutes to an hour and that’s it for the night. I’m thinking of taking the one I take in the morning to take it in the middle of the night in other words taking one before I go to bed and taking one like 230 3 o’clock in the morning maybe that will get me a little sleepy enough that I can get a little more sleep, would that be OK? I would appreciate an answer and thank you so much for your information.
I am on the 4.5 mg Extended Release version and it really smoothes out the side effects of the drug and spreads them out. May help with sleep.
It's interesting that your target effective range is 0.75mg to 2mg. My psychiatrist says that the target dose is between 2mg and 5mg which is significantly larger. I'm at 0.5mg now and my doctor wants me to go up to at least 2.
I did read a few studies where the average dose required was like 2.5mg. But idk.
Do you have any experience with prescribing pramipexole for your patients?
Have you gotten any results from pramipexole?
How's it going so far? I'm on 1.5mgs and nothing happening yet
@@Suttisan78 How are you doing now? Have you gone up on the dose?
@@gregorymalchuk272 I went up to 10mgs a day and gave up I felt nothing, but I'm pretty certain the product I was taking wasn't legit, as a low dose from a different brand I took made me quite nauseated, I'll give it another try again some time
@@Suttisan78 10mgs? Was that prescribed by a doctor? The maximum advised is 5mg and the dose people describe as effective in depression is between 2mg and 5mg. Also, how long were you on it at these doses?It also works by down regulation, so you may notice no results or worsening symptoms for the first two weeks. What was the nausea like? Did it come in episodes or was it constant? Did they give you anything for it?
Do you use the Extended Release version?
You could use either formulation. Appreciate the comment
I am now up to 3mg and ready to see if it is going to work for me.
Wow good for you👍im going to start it soon
@@saharnavah7244 Hi! Nausea is pretty common in the beginning but it does go away. I also have had pretty bad insomnia, but it has been worth it. Best of luck to you on it! Let me know if I can answer any questions.
I have now been on 4 mg of Pramipexole for 21 days and it is helping quite a bit and QUICKLY at high dose. I have more interest in things and more energy and focus. I have severe TRD and anhedonia and have tried all of the meds (including Abilify and Wellbutrin), Spravato, rTMS, etc. Side effects: nausea in the beginning and pretty bad insomnia as I tritrated up. I stuck with it because I had no plan B. But it has been worth it. I am praying that I will continue to improve over more time and this is just the beginning.
Update: OK, I have been on pramipexole for about 6 weeks now. I have severe TRD and I would say I am about 25-33% better since starting prami. I have cut back to 2mg (from 4mg) as I was beginning to experience some very discomforting side effects without feeling like I was getting any additional benefit. Those side effects were extreme fatigue, shakiness and muscle weakness, and dizziness. Those symptoms dissipated quickly once I dropped the dose.
@@scottvk4129 Thanks so much for posting your experience and update! Hope things continue to go well.
Excellent. I am on many antidepressants trying for increased dopamine. Maybe dopamine receptors not working well? Would dopamine agonist improve this? Thanks
Yes, this is the theory. It’s not so much that dopamine receptors are not working but more of a modulation of the dopamine pathways involved in emotion and reward. There is some risk of hedonistic homeostatic dysfunction which is a fancy way of saying over involvement in pleasurable activities. I’ve personally used this medication clinically and seen good results. Hope this helps, if you haven’t subscribed to the channel please do and spread the word about what we are doing on the channel
Thank you very much
I have ocd .is it bad for ocd ??
Hey, sorry I’ve been asking a lot of questions recently lol, but here’s another one. I am considering talking to my psychiatrist about trying this medication in the future as I have TRD and anhedonia is my main and toughest symptom. I have read about DAWS (dopamine agonist withdrawal syndrome) from stopping a medication like this, do you know the chances of this syndrome? I have only read about it in studies with PD patients so its hard to know if this syndrome is more likely a concern in PD patients or its a concerning syndrome regardless of the illness. Thanks!
I have had a few patient on the medication and have not seen any dopamine agonist withdrawal when used for mental health patients. For Parinkson's disease I think the likelihood would be much greater because of the disease process itself destroying dopamine neurons. I would say if someone planned to come off the medication then tapering it slowly over time and watching for and withdrawal like symptoms
@@ShrinksInSneakers Thanks for the reply! I’ve asked a decent amount of questions and you always answer them! This makes me more comfortable about bringing it up to my pdoc and possibly trying it.
Does it help with anxiety ?
I'm not aware of any data on this medication for anxiety, and this is medication best reserved for someone who failed 2 or more trials of other medications. It's also off label so sometimes difficult to find someone to prescribe it. Hope this helps
@@ShrinksInSneakers thank you
My panic attacks stopped not long after I began taking pramipexole for anhedonia. There are one or two case reports I have read on PubMed where it was used as monotherapy for panic attacks with success.
Can pramipexole makes a Person alert,i mean work as a stimulant in depression
Not in the traditional sense like other stimulants
I have schizophrenia and wanna try this as i am disabled from my negative symptoms.
I have no evidence to support the use of this medication in schizophrenia. Negative symptoms are often the most difficult to treat there is really no good medication that specifically addresses them. There is some evidence that medications that modulate dopamine and do not just block D2 receptors do have some evidence. cariprazine does have some evidence for the use in negative symptoms. I hope this helps, if you haven't subscribed please do and spread the word about what we are doing here.
Is there any scope for using this medication as a way of limiting the, I would argue negative neurological effects, of abstaining from a 20yr pornography addiction. I've done this cold turkey and I know it's affected me in various ways which I just know are connected to the disregulation of my sexual anatomy and the accompanying release of dopamine from the sexual act itself, either with or without a partner. ?
I do not know of any research in this area, but I think any form of addiction involves increased dopamine in specific pathways, I do not think this medication would be helpful in that regard
@@ShrinksInSneakers thank you for your reply.
@@ShrinksInSneakers thank you for your reply.
prayed for you
@@johnanthonylupton thank you, it's a nice offer. This is where I usually say but. Thanks again
Super like 👍
id like to have. An appointment. with you
What about Cabergoline (Dostinex)??
I have not seen any randomized controlled trials looking at carbergoline in TRD. I did see one where it was used in combination with another medication. I would say the evidence is weak at this point for its use in TRD. Appreciate the comment.
I've tried both and I would say they both are very similarly effective, but cabergoline has a bit more side-effects. On the other hand cabergoline has a very long half-life so the antidepressant effect is more the same around the clock, with pramipexole and ropinirole I can feel the effects wane during the day due to their relatively short half-lives. That's a potential argument for some to rather prefer taking it in the morning. To me all dopamine agonists interfere with sleep in the beginning, at the same time they do make you tired lol.
Both pramipexole and cabergoline are similarly very strong at both the D2 and D3 receptors so it makes sense that their effects on depression are often going to be very similar.
@@ShrinksInSneakers Hey Doc I just wanted to say that I've tried both medications and both were equally effective for my depression. Both drugs are very strong at both the D2 and D3 receptors so it makes sense they overlap a lot in their effects I think. What I liked about cabergoline was that it's very long half-life means that it pretty much works the same around the clock 24/7 and if you forget a dose it's not at all as big of a deal! Meanwhile pramipexole has a much shorter half-life and I could feel the effects wane a bit throughout the day after dosing, I think that could be an argument for some to prefer taking it in the morning. Both pramipexole and cabergoline were both paradoxically stimulating and making me tired at the same time lol, also at first they seriously made sleeping at night harder due to their stimulant effects despite also feeling very fatigued and tired at the same time.. dopamine agonists are very strange drugs!
Both the stimulating and tiring effects did improve a lot over time and it got easier to wind down at night. Still it's hard to wind down completely with these because of the constant firing of the dopamine receptors by these drugs, but hey it beats being depressed! I would also say these were for me very pro-cognitive and powerful nootropics and made me feel very sharp in my brain. Again this effect of making me feeling constantly wired in my brain made it easier to sleep at night if I took it in the morning, but I guess it can be very different for everyone and I was never taking more than a small dose.
Both pramipexole and cabergoline are very strong at the D2 and D3 receptors despite prami being described as a D3 agonist and cabergoline as a D2 agonist. So if this is the leading cause of the antidepressant effects it makes sense that both could work. I've also tried ropinirole and it also did a lot but its even shorter half-life was definitely noticable. That said cabergoline definitely had more side-effects than pramipexole for me, like giving me more headaches and making my skin feel warm and harder to sleep. I guess cabergoline is more for those who don't tolerate pramipexole for other reasons and that pramipexole should preferably be tried first? I also tried it because I thought I was having an allergic reaction to pramipexole.
Hope you didn't mind me chiming in here with my experiences, I am in no way a MD or expert but on a topic with so little information I thought I'd share my experience and hope it helps someone.
Edit: Also it's not just pramipexole and cabergoline but I've heard other dopamine agonists such ad piribedil, rotigotine and ropinirole helping others!! You can find case reports and studies of all of these helping depression people in the literature as well! The super dirty dopamine agonist bromocriptine also has multiple studies with collection of case reports describing it as being very effective for depression! I think one even compares it to the TCA imipramine with favourable results.
I think for a serious disease like treatment resistant depression where there are tons of gap in knowledge and poor understanding of it and having to experiment with so many different drugs, case reports and anecdotes from clinicians treating TRD and experiences of patients with TRD it is important to take that into account more than what randomized control studies say. 👍
@@jacobski7216 I'm always continuing to learn and bring you guys the most recent research. I think at this point we need to continue the process of finding new ways of treating a debilitating disease process.
Can cause heart fibrosis, wouldn't use it long term
I rather be gambling etc 😊than depressed in bed
Good BHAI 😂😂😂 Hum India Wale
trading depression for a movement disorder... no thank you.
????