Mirapex (pramipexole)
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Q:  Mirapex (pramipexole)

Dear Dr. Phelps,
         I am forty years old and have been diagnosed with bipolar II. I am being tapered off of Depakote slowly .  I am going off this med because of that weight gain thing. (thirty lbs in one year)  I'm changing to lamictal.  So far I've had no problems.  Recently I found out by having a sleep study done that I have restless leg syndrome.  I am now taking .025mg of Mirapex in the early evening before sleep.  This has help my sleep tremendously!  I now sleep about seven hours at a time without the use of lorazepam that I've used for some time now.  I've read that Mirapex has shown some promise as an antidepressant.  Have you heard anything about that?  My second question is do you think my restless leg disorder problem could have been part of trouble that helped my doctor make my diagnosis of Bipolar II ?  So many of my problems in dealing with life situations were always amplified by my fatigue and irritabilty.  Now that I've been sleeping well I am doing so much better  at work and my family relationships are better than they've been in the past couple of years! I'd be interested in hearing what you might think of my situation.  Thank you for your great column.  Many of my questions have been answered since I've been reading this site.  I didn't mention that I also take 225mg. of Effexor daily hence my question about using the Mirapex as an antidepressant.

Dear Lena -- 
There are quite a few case reports, and one open series (meaning the same group of researchers is looking at the same group of patients over time) .  A review of these data interprets the results as showing some promise for Mirapex (pramipexole) as an antidepressant add-on, much like the role it's in for you.  Here are that review's conclusions: 

Pramipexole, used as an adjunct to antidepressants or mood stabilizers, appeared to be effective and safe in the treatment of unipolar and bipolar depression. These uncontrolled, retrospective, naturalistic pilot data require confirmation by controlled research before conclusions can be made.Sporn

Otherwise I'd say you're in unexplored territory and I'd be a little worried (I'd be more worried except how can one really justify any more than the usual level of worry-in-unexplored-territory?) about lamotrigine (Lamictal) combined with Mirapex as two different antidepressant pressures with no solid mood stabilizer to resist that.  There are reports of hypomania with both.   That was before I re-read your question and got to the Effexor part!  

On the other hand, sleeping better, even without lorazepam, is definitely going in the right direction.  So, it will be interesting to see how this turns out.  I'll hold off on my usual rant about using treatments we know a lot about before going off using things like this approach, on the presumption that maybe you've already had combinations of low-dose lithium and Depakote, etc. etc.   Good luck to you. 

Dr. Phelps

Published March, 2003


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