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  1. #1
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    Default Pramipexole + Amisulpride?

    Hi everyone.


    It's been a while since I've posted on MM. Hope everyone here is still well.


    Currently withdrawing from a bunch of stuff including atomoxetine and memantine and a bunch of herbs/supplements. Formally diagnosed BP2, main issues these days are motivation, cognition/memory, seasonal mood issues, attention regulation, social phobia/motivation, and sleep. So lots of prefrontal hypoactivity essentially. Strattera worked at the beginning when I started it this year, but it has pooped out.


    WIll be staying on Pramipexole ER 2.25, Vyvanse 40mg (lowest semi-effective dose, been tapering down for the past year), and 2mg guanfacine.


    Convinced my doc to let me try Amisulpride, low dose, due to what i've read over the years about it's effectiveness in mood issues, the fact that it's not a SSRI, and the fact that it may work on dopamine in a novel way. Amisulpride looks like a good one to try also given the role 5ht7 plays in sleep and cognition/memory/mood.


    Been on mirapex various times over the years, this latest round its been about 6-8 weeks. It may be helping but just a bit, hard to tell.


    Curious as to a few things:


    1) Best way to start amisulpride -- both so it's not a "shock" to the dopaminergic system given i'm already on Mirapex and Vyvanse (i'm 220lbs, so vyvanse 40mg is barely enough to be noticable, and I still take a few nicotine lozanges).


    Read a few conflicting things that starting from say 50 or 100 and going DOWN gives it a stronger action. Others say titrate up from 25mg. Not clear. Anyone have experience or insight into the psychopharmacology?


    2) Possible conflict with Mirapex or Vyvanse -- mirapex especially. I have read a few threads here that have been going on re: Mirapex and quite frankly I am pretty freaked out. Been on Mirapex a few times over the years, though never probably longer than 6-9 months. It does seem effective for me, at least at the beginning. And I always taper off pretty slowly. But this DAWS stuff is scary and have certianly struggled with anhedonia and motivation issues in the past.


    3) Any other updated personal experiences with amisulpride alone or in combo. How long did it take to kick in? Any risk of mania? Novel subjective experience compared to other A/D or stimulants? Any sense of cognition improving due to 5ht7?


    Thanks!
    Satsumass

  2. #2
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    Unfortunately I don't have anything to add regarding amisulpride, however I am curious about how chronic Guanfacine is treating you. Chronic Alpha-2 agonism (Guanfacine is an Alpha-2A agonist) can induce depression, which would be counterproductive given your symptoms. Have you noticed any such correlation between your depressive symptoms and Guanfacine? Have you tried discontinuing Guanfacine for any period of time to see if some of your other symptoms abate?

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    Just started on guanfacine a few weeks ago. I suspect there may be some negative mood induction, but its hard to tell as I wasn't feeling so hot and mood was already on a downward trajectory just given the season...i will watch for this though.

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    Quote Originally Posted by Satsumass View Post
    Just started on guanfacine a few weeks ago. I suspect there may be some negative mood induction, but its hard to tell as I wasn't feeling so hot and mood was already on a downward trajectory just given the season...i will watch for this though.
    Keep an eye on it. How are the positive effects for you? I've always been intrigued by it.

    Also, what are your thoughts on Memantine? I noticed you were withdrawing for it, so I'm assuming it wasn't all that helpful?



    As for Amisulpride, many of the older threads show hyperprolactinemia as one of the biggest downsides. It might be interesting in conjunction with Pramipexole, though. A quick search of PubMed shows mixed results in attenuating the hyperprolactinemia side effects with DA agonists, so it may be tricky to balance the two if it works at all. With so many overlapping dopaminergic medications in the mix, you're getting deep into unexplored territory. If your doctor is on board I'd say it's worth a trial at least.

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    Memantine really helped me when i was really crazy. I have been quite hesitant to go off of it. it has subtle but meaningful and positive effects, at least at hte beginning. Though I question whether all I really needed was a few weeks of the "memantine titration up" feeling -- temporary disassociation probably helped me when I was dealing with severe sleep deprivation pre-treamtent for sleep apnea 18 months ago. Been slowly titrating down from 20mg all year. Am definitely a bit concerned about going off completely but I may be ascribing too much to this...I have a tendency to see things as "magic bullets".

    I'm definitely concerned about amisulpride side effects. Hopefully mirapex works, hopefully I don't go psychotic, we shall see. Someone else (and actually my doctor) suggested abilify as an option to do what amisulpride does, but not sure...been on it before at 5-10-15mg, and really want as little DA antagonism as possible post synaptically. Unclear to me whether anything isolates that, plus 5ht7 antagonism, as well as amisulpride. Thoughts?

    Guanfacine has a lot of interesting theoretical rational, i'm sure you've read Amy A-something work at Yale I think. Hard to tell but I need as much prefrontal cognitive improvement as possible. Definitely think it helps with staying on task and reducing distraction. As for motivation, anhedonia -- no effect as of yet. Possible assistance for sleep and memory (doc really suggested it for sleep, improving early morning awakening and mind spinning).

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    Quote Originally Posted by Satsumass View Post
    Memantine really helped me when i was really crazy. I have been quite hesitant to go off of it. it has subtle but meaningful and positive effects, at least at hte beginning. Though I question whether all I really needed was a few weeks of the "memantine titration up" feeling -- temporary disassociation probably helped me when I was dealing with severe sleep deprivation pre-treamtent for sleep apnea 18 months ago. Been slowly titrating down from 20mg all year. Am definitely a bit concerned about going off completely but I may be ascribing too much to this...I have a tendency to see things as "magic bullets".
    I'm curious: Why are you discontinuing Memantine then?

    Quote Originally Posted by Satsumass View Post
    I'm definitely concerned about amisulpride side effects. Hopefully mirapex works, hopefully I don't go psychotic, we shall see. Someone else (and actually my doctor) suggested abilify as an option to do what amisulpride does, but not sure...been on it before at 5-10-15mg, and really want as little DA antagonism as possible post synaptically. Unclear to me whether anything isolates that, plus 5ht7 antagonism, as well as amisulpride. Thoughts?
    I think you're pretty deep into unexplored territory with your combinations. You're currently taking a lot of medications with overlapping modes of action, which quickly becomes hard to predict. As long as your doctor is on board, I think it's worth trying. Certainly not as a first-line treatment, but from what I recall you've made the rounds with the usual treatments long ago.

    Quote Originally Posted by Satsumass View Post
    Guanfacine has a lot of interesting theoretical rational, i'm sure you've read Amy A-something work at Yale I think. Hard to tell but I need as much prefrontal cognitive improvement as possible. Definitely think it helps with staying on task and reducing distraction. As for motivation, anhedonia -- no effect as of yet. Possible assistance for sleep and memory (doc really suggested it for sleep, improving early morning awakening and mind spinning).
    I agree that Guanfacine is quite interesting on paper. I've always been interested, but I've steered clear due to the potential for pro-depressive effects with chronic administration.

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    I'm having memory and cognition issues, and I take semi-regularly agmatine. And my doctor agreed, maybe we should simplify. But after the events of the recent week or two i'm wondering if that wasn't such a good idea.

    Yes, I have. BUt it's also a fetish if mine I think. And I have very real issues in my life that haven't been resolved yet. So I guess I never stop searching. But the cognition and attention/motivation/mood issues are really quite disabling at this point. Yesterday off the last of the strattera, but been abusing DXM last few days again (not to the point of being incapacitated though)....

    Can you tell me more about guanfacine's pro-depressive effect, or provide a reference?

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    BUMP. Never got any advice re original post questions -- best dose to start on amisulpride given I'm already on mirapex and low dose vyvanse. Was thinking 50mg but not sure if going up makes it stronger or going down, or what most conservative dose would be for mood/motivation issues would be, given I'm already on mirapex

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