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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by ben on January 23, 2002, at 10:10:35
Hi
I tried Levodopa to Paxil because of restless legs (unclear diagnosis yet) from Sept.- December 62.5 mg up to 125 mg at night. It is still unclear if I have RLS or periodic limb movements (PLS) so we decided to tapper of it. Now I am off (for 2 weeks) and feel more fatigue and depressed in the morning and during the day. The problem is that I had to come off Paxil too (from 30 mg in 6 weeks) because I developped a bad liver reaction (like a hepatitis) from Paroxetine. My liver is okay since I am off ! Could the Madopar have been an interesting augmentation adjunct to the SSRIs or do I really have RLS/PLS ? I read of dopamine depletion under long term SSRI treatment ! Should I go back to Madopar ??? At the moment I try Aurorix but dont feel stimulated !
See also:
"http://www.dr-bob.org/babble/20020116/msgs/90853.html" >
many thanks for your thoughts an inputs
Posted by TSA West on January 24, 2002, at 1:55:10
In reply to Re: Levodopa as an augmentation strategy ?!, posted by ben on January 24, 2002, at 0:49:00
Greetings Ben,
Buproprion (Wellbutrin) would be a novel choice for you due to its stimulating properties and reuptake inhibition of dopamine.
I was thinking you could also try venlafaxine (Effexor) because there is no known dopamine depletion with it and it may inhibit the reuptake of dopamine at high doses. Some people report stimulation from it; others do not.
If all your doctor determines that you can try is an anti-RLS drug then consider Mirapex (pramipexole), which has studies done on it for major depression and bipolar depression.
Good luck Ben,
tSa WeSt
Posted by ben on January 24, 2002, at 2:45:25
In reply to Re: Levodopa as an augmentation strategy ?! » ben, posted by TSA West on January 24, 2002, at 1:55:10
Hi TSA
I tried Venlafaxine more than a year ago up to 150 mg. I had allways headaches, was hungry (weight gain) and was awfully sweating. I tokk it to 20-40 mg Seropram and thats perhaps the clou why I had more side effects ?! Perhaps I should give it a try alone ?! But i think sticking to Moclobemide could be worth either because improvement does take often more than 2 or 3 weeks with ADs in general. I read esp. of Moclobemide that mood improvements do kick in often after 4 weeks, first you feel only more energized (could lead to agitation, anxiety, sleep probs...). I didnt try Serzone (Nefazodone) because I got sedation of all ADs with a sedating potential (Remeron kocked me out, as well as Surmontil) This summer I tried Zyprexa as a adjunct. Took only 1.25 mg at night and was knocked out for next day (dizziness, fatigue, sleepy...). What about Prozac (Fluoxetine) ? I would try it but I am afraid of side effects and the long wash out if it doesnt work !
> Greetings Ben,
>
> Buproprion (Wellbutrin) would be a novel choice for you due to its stimulating properties and reuptake inhibition of dopamine.
>
> I was thinking you could also try venlafaxine (Effexor) because there is no known dopamine depletion with it and it may inhibit the reuptake of dopamine at high doses. Some people report stimulation from it; others do not.
>
> If all your doctor determines that you can try is an anti-RLS drug then consider Mirapex (pramipexole), which has studies done on it for major depression and bipolar depression.
>
> Good luck Ben,
> tSa WeSt
Posted by TSA West on January 24, 2002, at 3:11:36
In reply to Re: Levodopa as an augmentation strategy ?!, posted by ben on January 24, 2002, at 2:45:25
How long have you been on the Moclobemide? What dose of Moclobemide do you take? If you have been on it for more than 4 weeks at 600 mg or more and still have the drowsiness then switch to something else.
Assuming moclobemide does not work for you:
Seropram and Paxil are in the same medication family (SSRI). Since both of those did not work well for you, you should move to a different family of medications. Secondary tricyclics such as desipramine or nortriptyline would be nice, considering their price is cheap and they have few side-effects. Anti-epileptics with antidepressant properties may be useful, such as Lamictal (lamotrigine) or Neurontin (gabapentin).
Another idea would be to switch to high-dose BuSpar (buspirone). All of these medications will help you sleep and are proven effective in depression.Every antidepressant takes 4 weeks to work--even Moclobemide. Moclobemide's washout period is rather short, perhaps 2 weeks, so you may start a new medication shortly.
Best wishes to you and your family,
TSA West
Posted by ben on January 24, 2002, at 8:12:21
In reply to Ben: Moclobemide, TCAs, Anticonvulsants,SSRIs » ben, posted by TSA West on January 24, 2002, at 3:11:36
Thanks for your reply
This is my 10 th day on moclobemide. I dont feel any stimulating effects. First week on 150 mg/d now on 300 mg/d. My head isnt clear at all, foggy and drowsiness and strange tension.
I was on Paxil (as you can read), Celexa, Zoloft and many others AD with limited success. Lamictal was bad (sedating) at even low dose (5 mg). Tricyclics are not safe for my (heart !).> How long have you been on the Moclobemide? What dose of Moclobemide do you take? If you have been on it for more than 4 weeks at 600 mg or more and still have the drowsiness then switch to something else.
>
> Assuming moclobemide does not work for you:
>
> Seropram and Paxil are in the same medication family (SSRI). Since both of those did not work well for you, you should move to a different family of medications. Secondary tricyclics such as desipramine or nortriptyline would be nice, considering their price is cheap and they have few side-effects. Anti-epileptics with antidepressant properties may be useful, such as Lamictal (lamotrigine) or Neurontin (gabapentin).
> Another idea would be to switch to high-dose BuSpar (buspirone). All of these medications will help you sleep and are proven effective in depression.
>
> Every antidepressant takes 4 weeks to work--even Moclobemide. Moclobemide's washout period is rather short, perhaps 2 weeks, so you may start a new medication shortly.
>
> Best wishes to you and your family,
> TSA West
Posted by OldSchool on January 24, 2002, at 14:44:42
In reply to Levodopa (Madopar) for fatigue/RLS relief., posted by ben on January 23, 2002, at 10:10:35
> Hi
>
> I tried Levodopa to Paxil because of restless legs (unclear diagnosis yet) from Sept.- December 62.5 mg up to 125 mg at night. It is still unclear if I have RLS or periodic limb movements (PLS) so we decided to tapper of it. Now I am off (for 2 weeks) and feel more fatigue and depressed in the morning and during the day. The problem is that I had to come off Paxil too (from 30 mg in 6 weeks) because I developped a bad liver reaction (like a hepatitis) from Paroxetine. My liver is okay since I am off ! Could the Madopar have been an interesting augmentation adjunct to the SSRIs or do I really have RLS/PLS ? I read of dopamine depletion under long term SSRI treatment ! Should I go back to Madopar ??? At the moment I try Aurorix but dont feel stimulated !
> See also:
> "http://www.dr-bob.org/babble/20020116/msgs/90853.html" >
>
>
> many thanks for your thoughts an inputsI have never heard of levodopa being used for restless legs syndrome, fatigue or EPS. Levodopa is a serious medication usually reserved for parkinsons disease. If it was me, Id try other medications for restless legs or EPS type problems. Anti-cholinergics are good, as are some of these dopamine agonists like Amantadine, Mirapex, bromocriptine, etc.
Moclobemide has some dopamine in it and that might be a good drug for mild movement disorder problems. Levodopa sounds pretty extreme to me unless you have real deal parkinsons disease. Keep in mind that levodopa can have some pretty strong psychiatric side effects in a person who doesnt have parkinsons. It can induce psychosis, hallucinations, paranoia, confusion, etc.
Old School
Posted by Anna P. on January 24, 2002, at 15:23:26
In reply to Re: Levodopa (Madopar) for fatigue/RLS relief., posted by OldSchool on January 24, 2002, at 14:44:42
> > Hi
Can madopar be used for depression/fatigue if there aren't any other options left?Anna P.
> >
> > I tried Levodopa to Paxil because of restless legs (unclear diagnosis yet) from Sept.- December 62.5 mg up to 125 mg at night. It is still unclear if I have RLS or periodic limb movements (PLS) so we decided to tapper of it. Now I am off (for 2 weeks) and feel more fatigue and depressed in the morning and during the day. The problem is that I had to come off Paxil too (from 30 mg in 6 weeks) because I developped a bad liver reaction (like a hepatitis) from Paroxetine. My liver is okay since I am off ! Could the Madopar have been an interesting augmentation adjunct to the SSRIs or do I really have RLS/PLS ? I read of dopamine depletion under long term SSRI treatment !
Posted by TSA West on January 24, 2002, at 16:55:45
In reply to Re: Levodopa (Madopar) for fatigue/RLS relief., posted by Anna P. on January 24, 2002, at 15:23:26
There are always other options left. Please give me a list of the medicines you have tried and I will give you 5 more viable medication options...
Your servant,
TSA West> > > Hi
> Can madopar be used for depression/fatigue if there aren't any other options left?
Posted by ben on January 25, 2002, at 2:22:53
In reply to Re: Levodopa (Madopar) for fatigue/RLS relief., posted by OldSchool on January 24, 2002, at 14:44:42
Levodopa is approved to treat RLS in Switzerland as in many other countries. I can give you the monography. Levodopa has a very short half life and thats why it is predestinated to treat RLS during the night.
Levodopa can do nasty psychiatric side effects, but in low dose it can be a mood booster (remember MAOIs and Venlafaxine do affect dopamine too ! and they are often used to treat serious depression !) SSRIs are leading sometimes to dopamine depletion (- > anhedonia, apathy) and Levodopa can be used in this cases ! It is very selden yet, but some pdocs are using this strategy. Bromocriptinecan make nasty psychiatric side effects to !> > Hi
> >
> > I tried Levodopa to Paxil because of restless legs (unclear diagnosis yet) from Sept.- December 62.5 mg up to 125 mg at night. It is still unclear if I have RLS or periodic limb movements (PLS) so we decided to tapper of it. Now I am off (for 2 weeks) and feel more fatigue and depressed in the morning and during the day. The problem is that I had to come off Paxil too (from 30 mg in 6 weeks) because I developped a bad liver reaction (like a hepatitis) from Paroxetine. My liver is okay since I am off ! Could the Madopar have been an interesting augmentation adjunct to the SSRIs or do I really have RLS/PLS ? I read of dopamine depletion under long term SSRI treatment ! Should I go back to Madopar ??? At the moment I try Aurorix but dont feel stimulated !
> > See also:
> > "http://www.dr-bob.org/babble/20020116/msgs/90853.html" >
> >
> >
> > many thanks for your thoughts an inputs
>
> I have never heard of levodopa being used for restless legs syndrome, fatigue or EPS. Levodopa is a serious medication usually reserved for parkinsons disease. If it was me, Id try other medications for restless legs or EPS type problems. Anti-cholinergics are good, as are some of these dopamine agonists like Amantadine, Mirapex, bromocriptine, etc.
>
> Moclobemide has some dopamine in it and that might be a good drug for mild movement disorder problems. Levodopa sounds pretty extreme to me unless you have real deal parkinsons disease. Keep in mind that levodopa can have some pretty strong psychiatric side effects in a person who doesnt have parkinsons. It can induce psychosis, hallucinations, paranoia, confusion, etc.
>
> Old School
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