Partial vs. full DA agonist withdrawal

[doctordog]

Hi,

I'd like to try a DA agonist to treat some distressing symptoms that have emerged -- and persisted -- for weeks since withdrawing Mirtazapine. Namely, chronic muscle stiffness, bruxism and akathisia.

My doctor wanted me to take Requip, but I don't really want to mess around with the Parkinsonian full agonists. However, Hydergine (a partial DA agonist) sounds like it might be more benign.

Does anyone know if Hydergine, a partial DA-agonist, might conceivably produce a less severe withdrawal syndrome than e.g. Mirapex, Requip etc.? DAWS terrifies me.

 

[Hammilton]

I would go with ropinirole, it's my preferred DA agonist, but I prefer levodopa more generally. If I were in your shoes, and I suppose were not that far apart, I'd start a course of Sinemet. If you're immediately and profoundly helped, slowly taper. If not, discontinue treatment right away, your problem is probably psychogenic. Actually, it's probably psychogenic, but a short course of Sinemet won't hurt you.

I tried it not that long ago for opioid withdrawal related akathasia, without success.

 

[St3ve]

You could try supplementing with l-tyrosine as well, it's an indirect dopamine precursor it won't mess with your receptors much and simply allow your body to produce dopamine more easily... Not sure if it'd be effective enough though.

 

[ebola?]

I know that I just have to keep saying this, but under normal dietary conditions, tyrosine hydroxylase is saturated, so supplementation isn't particularly worthwhile.

ebola

 

[doctordog]

I would go with ropinirole, it's my preferred DA agonist, but I prefer levodopa more generally. If I were in your shoes, and I suppose were not that far apart, I'd start a course of Sinemet. If you're immediately and profoundly helped, slowly taper. If not, discontinue treatment right away, your problem is probably psychogenic. Actually, it's probably psychogenic, but a short course of Sinemet won't hurt you.

I tried it not that long ago for opioid withdrawal related akathasia, without success.

Woops, lost track of this thread ..

What do you take ropinirole for, Hammilton?

 

[Calleja]

I started taking Pramipexole or Mirapex for RLS about a year ago. I have to say I was quite ambivalent at first but it has worked wonders for me. I know my condition is different than yours but I believe there are some similarities in that it may help with your akathisia and muscle stiffness. My RLS was quite bad in that it was not limited to my legs. Although this may have been related to my poor quality of sleep but after I started taking, I have an increased sense of "constant" energy throughout the day, as before I was suffering from a lot of daytime somnolence.

As far as tolerating it goes, there were some initial side effects and once in a while I will have some nausea or headaches from it. However, if this occurs, it's only for about an hour after I take my pill at night. Although this may not be true for everybody, as they have performed long-term studies on the efficacy of Mirapex.

Lipford, M., & Silber, M. (2012). Long-term use of pramipexole in the management of restless legs syndrome. Sleep Medicine, 13, 1280-1285. Retrieved from http://ac.els-cdn.com/S138994571200...t=1393623421_ef5f7487e4286768fdfda357bce9437b

It seems that over time, it loses its effectiveness and people require higher doses, which increases chances of side effects. So, it's kinda mixed results. I understand not everyone may have such a positive outcome as myself but my main point is don't be so haste to rule out full DA agonists like Mirapex because depending on exactly what symptoms your having, it really could help.

 

[doctordog]

Thanks for sharing your experience, Calleja. Are you taking an extended-release version or Mirapex, or only dosing standard-release at night?

Since most of the DA agonists have short-ish half-lives, I'd have to be dosing during the day as well, increasing chances of somnolence etc. And like you say, tolerance can develop, leaving me in an even worse position if I have to eventually withdraw.

I did see a neurologist who diagnosed me with akathisia. However, he doesn't think the DA agonists would be of much use. He wanted to prescribe Propranolol (which helped a little, but had awful side-effects) .. but since it can seriously exacerbate depression in me, he's referred me to a psychiatrist with a special interest in neurological disorders.

I have some Hydergine arriving next week and will tentatively try a low dose.

 

[Hammilton]

I used it for stiffness and bradykinesia related to manganism.

I've started having some freezing recently that I found disconcerting, I've woken in the morning to find that my calf muscle was stuck. Tried moving it, got no where, I rolled over sat up, and it sort of ratcheted as I moved it, then it was like nothing happened.

 

[Calleja]

I take the normal standard-release once an hour or so before bedtime. I started with .250 g and worked my way up to 1.5 g. Also, I would imagine if you were to stop taking this or any other DA agonist, your doctor should gradually taper you down so that withdrawal symptoms should not be excessive.

Your doctor may be quite right that DA agonists may not work or at least how they work for people with RLS. They've shown that the "restlessness" of akathisia is different, as it has been shown that seeing movement can reduce the urge to move but that's not the case for RLS patients.

I really hope the Hydergine works for you but if you ever stroll down the road of full DA agonists, another potentially beneficial thing about Mirapex is that it has been shown to have some anti-depressive properties. Mirapex in addition to Prozac shows better effectiveness for treating depression than Prozac alone. Anyways best of hope to you.