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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 23 of 23. This is the beginning of the thread.
Posted by jparsell82` on September 16, 2004, at 19:51:15
Has anyone had any experience with Requip? It being a D2/D3 agonist(with higher affinity for D3 than D2) and also having moderate affinity for opioid receptors, I would think it would be a good choice for social anxiety and depression. I know some people have posted here before about the similar Mirapex, but Mirapex doesn't have the additional opioid effect although it's probably more potent than Requip in regards to D2/D3 receptors. I think I read on here before the problem with Mirapex is it worked at first for Social Phobia and then eventually pooped out... possibly because of receptors being desensitized. I'm also taking Effexor and Klonopin. One study I read on Effexor said it increases the responsiveness of the dopaminergic(mainly D3) systems.... so perhaps the Effexor would potentiate the Requip and/or prevent receptor desensitization. Anyways, this is all a bunch of rambling but I was curious to see if anyone had any comments.
Posted by kingcolon on February 28, 2006, at 1:01:22
In reply to Requip for Social Phobia/Depression?, posted by jparsell82` on September 16, 2004, at 19:51:15
I'm on Requip as augmenting agent with Cymbalta and Lamictal for resistant depression. I also have social phobia. It was started because of apathy and amotivation on just Cymbalta and Lamictal, although the Lamictal did help improve my overall depression. It has worked very well for both the motivation problems and apathy (3 months so far, without any poop out), has definite mood elavating effects, and also has made me more comfortable in social settings and somewhat more aggressive in approaching people.
There are only two studies using this agent in depression; a link to one is below.
Posted by SFY on March 18, 2006, at 13:19:59
In reply to Re: Requip for Social Phobia/Depression? » jparsell82`, posted by kingcolon on February 28, 2006, at 1:01:22
> I'm on Requip as augmenting agent with Cymbalta and Lamictal for resistant depression. I also have social phobia. It was started because of apathy and amotivation on just Cymbalta and Lamictal, although the Lamictal did help improve my overall depression. It has worked very well for both the motivation problems and apathy (3 months so far, without any poop out), has definite mood elavating effects, and also has made me more comfortable in social settings and somewhat more aggressive in approaching people.
> There are only two studies using this agent in depression; a link to one is below.
>
> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15999953&query_hl=3&itool=pubmed_docsum
>What kind of dosage are you on for the Requip?
Posted by kingcolon on March 18, 2006, at 19:56:11
In reply to Re: Requip for Social Phobia/Depression? » kingcolon, posted by SFY on March 18, 2006, at 13:19:59
> > I'm on Requip as augmenting agent with Cymbalta and Lamictal for resistant depression. I also have social phobia. It was started because of apathy and amotivation on just Cymbalta and Lamictal, although the Lamictal did help improve my overall depression. It has worked very well for both the motivation problems and apathy (3 months so far, without any poop out), has definite mood elavating effects, and also has made me more comfortable in social settings and somewhat more aggressive in approaching people.
> > There are only two studies using this agent in depression; a link to one is below.
> >
> > http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15999953&query_hl=3&itool=pubmed_docsum
> >
>
> What kind of dosage are you on for the Requip?
>
>
>
> The studies used mean dosages of either 1.5 mg daily, or about 3.0 mg daily. I had an effect on as little as 1.0 mg daily, but trying to improve on it went gradually up to 3 mg daily. Unfortunately I experienced some palpitations on the higher dose, so I now am on 2 mg daily and seem to be doing OK. The total dose should be given in 2 or three divided doses.(eg, 1 mg two or three times a day)Glad you got my message. Hope to hear more if you try it! Very few psychiatrists have any experience using the dopamine agonists due to the few studies yet using them, but I think there is real potential to help many people.
Posted by SFY on March 20, 2006, at 12:12:54
In reply to Re: Requip for Social Phobia/Depression? » SFY, posted by kingcolon on March 18, 2006, at 19:56:11
How long was it before you saw any effect from the 1.0 mg dose and how long did the improved effect take from your increased dosages?
Thanks!
Posted by kingcolon on March 21, 2006, at 22:15:59
In reply to Re: Requip for Social Phobia/Depression? » kingcolon, posted by SFY on March 20, 2006, at 12:12:54
> How long was it before you saw any effect from the 1.0 mg dose and how long did the improved effect take from your increased dosages?
>
> Thanks!
It took about 5 days to have an effect with each dose increase, maxing out in about 2 weeks. Therefore would not increase further until at least 2 weeks have gone by at a given dose. Start with 0.25 mg twice a day for 2-4 weeks, then increase to 0.75 mg a day for another 2 weeks, then 1.0 mg, with further increases of 0.5 mg every 2 weeks as tolerated. Split the doses into two or three.Check these out.
http://www.biopsychiatry.com/pramropbi.htm
Posted by SFY on March 22, 2006, at 12:47:01
In reply to Re: Requip for Social Phobia/Depression?, posted by kingcolon on March 21, 2006, at 22:15:59
Thanks for the info. I just took my first dose yesterday. I had a fast heartbeat (but not frighteningly so) about 30 mins. after but it subsided in about 20 mins. I'm looking forward to see where it takes me.
BTW, you can get a full copy of the CJP study here:
http://www.cpa-apc.org/Publications/Archives/CJP/2005/may/BCCassano.asp
Posted by kingcolon on March 22, 2006, at 16:58:01
In reply to Re: Requip for Social Phobia/Depression? » kingcolon, posted by SFY on March 22, 2006, at 12:47:01
> Thanks for the info. I just took my first dose yesterday. I had a fast heartbeat (but not frighteningly so) about 30 mins. after but it subsided in about 20 mins. I'm looking forward to see where it takes me.
>
> BTW, you can get a full copy of the CJP study here:
> http://www.cpa-apc.org/Publications/Archives/CJP/2005/may/BCCassano.aspThanks so much for the reference; I had a PDF version that was difficult to read.
By the way, are you on other antidepressants? Were your main issues nonresponse, or an apathy syndrome?
I think I mentioned before that I had some palpitations on 3 mg a day, less on 2 mg a day, and rarely on 1.5 mg a day which I am now on. This side effect is not apparently common, at least as listed in the PDR, so hopefully you won't have it. The low blood pressure on standing can be a problem, and may be associated with rapid heart rate on changes of position until the body readjusts. Just go slow. Keep me informed!
Posted by SFY on March 22, 2006, at 19:39:42
In reply to Re: Requip for Social Phobia/Depression?, posted by kingcolon on March 22, 2006, at 16:58:01
> By the way, are you on other antidepressants? Were your main issues nonresponse, or an apathy syndrome?
> I think I mentioned before that I had some palpitations on 3 mg a day, less on 2 mg a day, and rarely on 1.5 mg a day which I am now on. This side effect is not apparently common, at least as listed in the PDR, so hopefully you won't have it. The low blood pressure on standing can be a problem, and may be associated with rapid heart rate on changes of position until the body readjusts. Just go slow. Keep me informed!I'm on nortriptyline (so I'm already familiar with orthostatic hypotension). It helps my depression but I still have this lingering apathy, low motivation, and anhedonia. I'm hoping that the Requip will have some effect on this. Besides my depression and dysthymia I also have Social Anxiety (though more avoidant than physicall anxious) with low self-esteem, harm avoidance, lack of novelty seeking, and high rejection sensitivity. This all points to dopamine issues so yet another reason to try the Requip.
I didn't have any issues with the rapid heartbeat today so that's a good sign. And I'm titrating up rather slowly starting at .25 mg/day and going up .25 mg each week or two up to .75 mg/day at first. I'll see how that works after two weeks and, if need be, add more.
Posted by Tony P on March 24, 2006, at 0:02:28
In reply to Re: Requip for Social Phobia/Depression? » kingcolon, posted by SFY on March 22, 2006, at 19:39:42
> Besides my depression and dysthymia I also have Social Anxiety (though more avoidant than physicall anxious) with low self-esteem, harm avoidance, lack of novelty seeking, and high rejection sensitivity.
Sounds like you've been reading my diary!!
I am very interested in both your experiences, as I have had little success with the usual ADs since Serzone was taken off the market. I have mixed anxiety/depression, and Effexor just made me more anxious (a _lot_ more). I have thought for some time that dopamine is the poor sister in AD therapy at the moment.
I saw the CJP abstract on biopsychiatry.com, but on checking out the side effects of Requip I was scared off by the possibility of falling asleep unpredictably. Does this occur at the doses you're talking about?
My p/doc is open to alternatives but I won't be seeing him again until the beginning of May. In the mean time I am tapering off the Lamictal I have been on for the past two years, partly to get a new baseline, and partly because I'm not convinced it's doing anything for me. However, if Lamictal and Requip are a good combo, I may want to rethink that.
Posted by kingcolon on March 24, 2006, at 9:07:47
In reply to Re: Requip for Social Phobia/Depression?, posted by Tony P on March 24, 2006, at 0:02:28
> > Besides my depression and dysthymia I also have Social Anxiety (though more avoidant than physicall anxious) with low self-esteem, harm avoidance, lack of novelty seeking, and high rejection sensitivity.
>
> Sounds like you've been reading my diary!!
>
> I am very interested in both your experiences, as I have had little success with the usual ADs since Serzone was taken off the market. I have mixed anxiety/depression, and Effexor just made me more anxious (a _lot_ more). I have thought for some time that dopamine is the poor sister in AD therapy at the moment.
>
> I saw the CJP abstract on biopsychiatry.com, but on checking out the side effects of Requip I was scared off by the possibility of falling asleep unpredictably. Does this occur at the doses you're talking about?
>
> My p/doc is open to alternatives but I won't be seeing him again until the beginning of May. In the mean time I am tapering off the Lamictal I have been on for the past two years, partly to get a new baseline, and partly because I'm not convinced it's doing anything for me. However, if Lamictal and Requip are a good combo, I may want to rethink that.At lower doses, Requip and Mirapex haven't been associated with sudden sleep problems. I don't feel sedated at all on Requip
Effexor used to make me anxious as well. Lexapro dulled me. Cymbalta, which I am now on along with Lamictal (and more recently the Requip)has not been anxiety producting. If anything, it feels more like a pure SSRI, although a little more activating. At therapeutic doses, it has more noradrenergic properties than Effexor, but also the serotonergic properties ("balanced"). Lamictal was added to augment either the Lexapro, or now the Cymbalta, and was quite helpful initially, but lost some effectiveness with time. I began to have an apathetic state, which is why we tried adding a dopamine agonist. The Requip had both a motivating effect (ability to do stuff that was both mundane and pleasurable to me)and a definite antidepressant effect (better self esteem and more confidence in social situations),
I plan to continue all three meds for now and leave things alone that seem to work.
Posted by SFY on March 25, 2006, at 11:20:07
In reply to Re: Requip for Social Phobia/Depression?, posted by Tony P on March 24, 2006, at 0:02:28
> Sounds like you've been reading my diary!!
>
> I am very interested in both your experiences, as I have had little success with the usual ADs since Serzone was taken off the market. I have mixed anxiety/depression, and Effexor just made me more anxious (a _lot_ more). I have thought for some time that dopamine is the poor sister in AD therapy at the moment.
>
> I saw the CJP abstract on biopsychiatry.com, but on checking out the side effects of Requip I was scared off by the possibility of falling asleep unpredictably. Does this occur at the doses you're talking about?
>
> My p/doc is open to alternatives but I won't be seeing him again until the beginning of May. In the mean time I am tapering off the Lamictal I have been on for the past two years, partly to get a new baseline, and partly because I'm not convinced it's doing anything for me. However, if Lamictal and Requip are a good combo, I may want to rethink that.Right now, I'm still slowly titrating up on the Requip. It will be at least 2 or 3 weeks before I get up to a reasonable dose at which I can see any effects. I'll keep you posted.
Posted by kingcolon on March 25, 2006, at 13:39:34
In reply to Re: Requip for Social Phobia/Depression? » Tony P, posted by SFY on March 25, 2006, at 11:20:07
Regarding Lamictal, it is functionally an NMDA antagonist, by its glutamate antagonism. I believe there is some data on the glutamate system modulating the dopamine system, and I recollect that antiglutaminergic agents potentiated dopamine. I'll look into it further. In any event, if that were the case a combo of Lamictal and a dopamine agonist like Requip might be more effective than either alone.
Posted by SLS on March 25, 2006, at 14:15:33
In reply to Re: Requip for Social Phobia/Depression?, posted by kingcolon on March 25, 2006, at 13:39:34
> Regarding Lamictal, it is functionally an NMDA antagonist, by its glutamate antagonism. I believe there is some data on the glutamate system modulating the dopamine system, and I recollect that antiglutaminergic agents potentiated dopamine. I'll look into it further. In any event, if that were the case a combo of Lamictal and a dopamine agonist like Requip might be more effective than either alone.
I think Lamictal might be a glutamate release inhibitor as well as a sodium channel blocker.
- Scott
Posted by kingcolon on March 29, 2006, at 10:42:35
In reply to Re: Requip for Social Phobia/Depression?, posted by SLS on March 25, 2006, at 14:15:33
How are you doing on Requip?
You mentioned you were on nortriptylline. My thought is that the TCA's were never found to be helpful in SP. Nevertheless, this one would be more activating than others. Perhaps Effexor or Cymbalta would be a better choice; at least you would get the benefit of the activating effects of norepinephrine, as well as the anti-SP effects of the serotonergics. I don't understand why the mixed TCA's don't work in SP, but the NSRI's do.
Posted by SFY on March 29, 2006, at 12:36:09
In reply to Re: Requip for Social Phobia/Depression?, posted by kingcolon on March 29, 2006, at 10:42:35
I'm still slowly ramping up my dosage - I'm on .50 mg/day now. I seem to have an increase in orthostatic hypotension plus some gastrointestinal upset for a couple of days. But nothing unbearable.
Thanks for the meds recommendation. Right now I'm focusing on relieving my dysthymia b/c my SP is somewhat tied into the anhedonia it produces.
Posted by dcruik518 on June 16, 2008, at 17:10:52
In reply to Re: Requip for Social Phobia/Depression? » Tony P, posted by SFY on March 25, 2006, at 11:20:07
I hope this post is still alive, or at any rate that people are still interested in using Requip and other dopamine agonists for social anxiety, dysthymia, etc. I've been on Requip for nearly a month now and I have to say that it worked great in the beginning but seems to have lost some of its effectiveness now. I have a couple theories about why. The first is I started taking Pristiq which is the new and improved form of Effexor XR. Effexor always made me anxious in the past and I suspect this stuff does the same thing, but I'm willing to give it one more week. Second, I believe I've been taking way too high a dose of Requip all along--about 6mg/day. At first my body could handle it, but I believe the stuff gradually builds up to higher and higher levels in your blood, so that what use to make me feel good now makes me really groggy and sort of depressed. I've gone down to just 2mg at night and am doing just a little better. Unfortunately, the pills I have are tiny 2mg ones that I can't really split evenly. I'm just hoping I'll feel better once I get off the Pristiq or desvenlafaxine--a rip off in my opinion. ~D
Posted by blueboy on June 17, 2008, at 9:22:38
In reply to Re: Requip for Social Phobia/Depression? » SFY, posted by dcruik518 on June 16, 2008, at 17:10:52
I take .5 mg Requip when my Restless Leg Syndrom kicks up (so to speak). I have noticed that I seem to sleep a little better than normal.
This may turn out to be a drug used to treat Bipolar, since Mirapex is such a hot drug for BP II right now. I actually split the 1mg pills with my teeth. They really do all they can to keep you from splitting them, sigh, by putting that bump in the middle, but you can get pretty close to an even split with practice :)
Effexor was the worst drug I ever took. I know there must be people it works for, so this is just me (and I'm BP II, not primarly depressive).
Posted by dcruik518 on June 17, 2008, at 11:29:35
In reply to Re: Requip for Social Phobia/Depression?, posted by blueboy on June 17, 2008, at 9:22:38
Blueboy,
Thanks for responding to my post and sharing your experience. Do you notice any mood-stabilizing or anti-depressant effects from the Requip? Have you tried taking a very small amount during the day?
Also for the group, I have a couple of questions:
Has anyone tried both Requip and Mirapex?
If so, what were the major differences? Which worked better for you?
Thanks, D.C.
Posted by blueboy on June 18, 2008, at 13:42:36
In reply to Re: Requip for Social Phobia/Depression?, posted by dcruik518 on June 17, 2008, at 11:29:35
> Blueboy,
>
> Thanks for responding to my post and sharing your experience. Do you notice any mood-stabilizing or anti-depressant effects from the Requip? Have you tried taking a very small amount during the day?
>I haven't noticed any. I do think I sleep slightly better with Requip, even aside from the RLS. But I only have taken it at night -- actually, almost always I have gotten out of bed to take it.
> Also for the group, I have a couple of questions:
>
> Has anyone tried both Requip and Mirapex?
>
> If so, what were the major differences? Which worked better for you?
>I don't know if I said this before, but I've tried both for RLS and both were perfect for that, with no side effects.
btw, I'm going to ask my pdoc about adding Mirapex to my drug schedule when I see him in 2 weeks. I'm just now titrating up on Lamictal so I don't know what he'll think.
Posted by Dopamine123 on June 20, 2008, at 21:35:34
In reply to Re: Requip for Social Phobia/Depression? » kingcolon, posted by SFY on March 22, 2006, at 19:39:42
I found that requip had some serious cognitive side effects. It severely impaired my judgement, insight, concentration and overall executive functioning. That is why I don't think it is an ideal drug. It stimulates those d2/d3 receptors, but it leaves the d1 receptor in the prefrontal cortex understimulated. Be careful about that aspect. If it works for you, great. Just watch out for that side effect because it is sometimes difficult to realize.
I think the poor insight is why it can increase compulsive behaviors like gambling. Your reward center is being overstimulated but your frontal lobe is underfunctioning so you get mindless compulsive pleasure seeking.
Posted by garylee on June 22, 2008, at 19:32:54
In reply to Re: Requip for Social Phobia/Depression?, posted by blueboy on June 17, 2008, at 9:22:38
> I take .5 mg Requip when my Restless Leg Syndrom kicks up (so to speak). I have noticed that I seem to sleep a little better than normal.
>
> This may turn out to be a drug used to treat Bipolar, since Mirapex is such a hot drug for BP II right now. I actually split the 1mg pills with my teeth. They really do all they can to keep you from splitting them, sigh, by putting that bump in the middle, but you can get pretty close to an even split with practice :)
>
> Effexor was the worst drug I ever took. I know there must be people it works for, so this is just me (and I'm BP II, not primarly depressive).
>
>I have tried Ropinerole and Pramipexole for my Bipolar II/NOS. Had the best results (very near remission!) with the Mirepex. Ropinerole was pretty good also but not quite as. I believe Pramipexole has more affinity for the D3 receptor which (very basicly) seems to control an antidepressant effect. I hit the highest dose, 6mg, 1.5mg x 3 a day. Didn't suffer any side effects at all.
Trivistal is also a good one to try. It's from the makers of Amineptine, French company, that's why it's not approved in the States. According to their website it has an even greater affinity to the D3 than Pramipexole.
If you want to split tabs, then try findin a pill spliter from your local chemist. They are a few quid and split the tab with a razor blade exactly in half.
Gary Lee
Posted by cactus on June 23, 2008, at 15:45:01
In reply to Re: Requip for Social Phobia/Depression?, posted by garylee on June 22, 2008, at 19:32:54
Ropinirole (requip/repreve) definitely worked for me for my social phobia/depression/anxiety/panic and sleep, these were extra in built properties that I wasn't expecting because it was prescribed for restless leg syndrome. I thought I had hit the jackpot.
Unfortunately it made me sick though, even though I titrated up very slowly. My sleep doc wanted me up to 4mg but I never made it past 1.5mg due to excessive nausea and occasional vomiting. If you are going to try a DA, start low and raise your dose very slowly. Taking a large dose straight away will do nothing but make you sick, so follow the instructions about dosage. The low starting doses are very effective.
I was happy to put up with this because I felt so good during the day, but in the end I just got so sick of puking and feeling nauseated all night that I had to give it away after a few months. It's not a good look to puke into your CPAP, let alone dangerous if you're asleep. That never happen to me but it did worry me, I do worry about stupid things.
I was also starting to show signs of augmentation in the restless leg department. So back to clonazepam it was. This doesn't happen to everyone though and if you are looking for something different to try it might just be right for you. It's also very expensive as I'm sure you all know.
It works very quickly for RLS and depression, etc.... It was the fastest acting mood enhancement I have ever experienced, RLS was instant and depression was about 2-3 days, which I didn't know about and wasn't expecting. The improved sleep was another added bonus. The ropinirole made me sleepy, I'm a terrible sleeper but it did improve it considerably. The nights where I still had trouble sleeping at least it wasn't from funky leg action.
I would recommend it to anyone who has failed with the usual meds for social phobia/depression. If they can refine DA's even more and improve them, I'd definitely give them another go. No TCA, SSRI, SNRI, AP has ever really helped me.
I now take modafinil 200mg, which is great for loads of things too and clonazepam. Good luck people and I hope you find something that works for you. Peace. C
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