Mirapex – A New Medicine for Depression

Mirapex is a little used and powerful antidepressant option for bipolar depression and treatment resistant depression.

Typically prescribed for the treatment of Parkinson’s—a disease characterized by deficient dopamine production in the motor centers of the brain—Mirapex is a dopamine agonist. Mirapex helps Parkinson’s patients by raising their dopamine levels.

Likewise, depression involves a state of relative deficiency of serotonin, norepinephrine, and/or dopamine in the mood centers of the brain. Studies show Mirapex increases dopamine in the mood centers of the brain. Increased dopamine tends to reduce depression symptoms of low energy, low motivation, low pleasure, and slowed thinking and movement.

How can I get New Medicine for Depression?
Although I learned about Mirapex’s usefulness in treating depression in 2003, very few psychiatrists prescribe this new medicine for depression.

I have prescribed Mirapex for bipolar depression and treatment-resistant depression for over 200 patients in the last 2.5 years. Many of these patients have found this new medicine for depression to be very effective.

If you’d like to explore this option for treatment of bipolar disorder or depression, call my office today at 770-458-0007 to schedule an appointment.

Effective New Medicine for Depression
I've worked with several treatment-resistant patients who failed to respond adequately or had adverse reactions to as many as 30 previous medicines. Of course, Mirapex is not for everyone. A significant group of patients have not responded or had side effects that required us to stop the medicine. Careful monitoring is required whenever medications are prescribed.

Patients that have responded to this new medicine for depression have been quite grateful for the relief of their symptoms. They also report the lack of weight gain and sexual side effects that plague the typical antidepressants and mood stabilizers. After Lamictal, Mirapex is the medicine I most often prescribe for bipolar depression.

Learn More about New Medicine for Depression
There have been three controlled clinical trials and a review article that provide growing evidence for the safety and efficacy of Mirapex for treatment of bipolar depression and treatment-resistant depressions.

Mirapex has a large effect size of 0.6-1.1. This means it is a lot more helpful than placebo in bipolar depression and treatment- resistant depression. However, it has not been approved by the FDA for these conditions. It is approved for Parkinson's disease and restless legs syndrome.
Mirapex is well tolerated by most patients, although some patients report side effects such as nausea, tiredness, sedation, headache, or insomnia. Less frequent side effects are abnormal muscle movements, restlessness, sleep attacks, faintness when standing.

Rare, more serious adverse reactions include hallucinations, hypersexuality, excess spending, or compulsive eating. So far, mania, hypomania, and psychosis have occurred at lower frequencies for Mirapex than for traditional antidepressants.

You can read an abstract of the review article at: http://www.ncbi.nlm.nih.gov/sites/entrez

Type this article title into the search window:
Pramipexole in Psychiatry: a Systematic Review of the Literature.

You may also purchase the full text of the original article for $15.

Find out whether Mirapex would be helpful for you. Call 770-458-0007 today to make an appointment.

Darvin Hege, M.D.
www.eveningpsychiatrist.com

New Stop Smoking Methods Available Now

Pharmaceutical solutions as stop smoking methods have been popular for a long time and include the nicotine patch, nicotine gum, or Wellbutrin.

What new Stop Smoking Methods are Available?

A relatively new drug, Chantix is having a profound effect on the smoking population in this country. Most of my patients say using Chantix is the easiest and most effective way to come off cigarettes or wet tobacco.

In fact, Chantix is starting to dent the business of the stop-smoking clinics because results are so much more effective than other methods. I noticed a stop-smoking clinic in a strip shopping center near my office has closed. It reminds me of what happened to the impotence clinics when Viagra came out—most clinics closed.

Stay Informed About New Stop Smoking Methods

Chantix has been out over a year but many people don’t even know about it yet. As a professional psychiatrist, I strive to keep abreast of any new forms of treatment and pass that information along to my patients.

A month ago, I had a patient that I was treating for depression. She felt well informed about how to quit smoking and had tried numerous ways to come off cigarettes over the years. When I mentioned Chantix, she’d never heard of it. She is now celebrating over a month of abstinence on Chantix and is delighted with how easy it was.

Will New Stop Smoking Methods Work for You?

Of course, not everyone is successful with Chantix. Many patients just don’t know how to quit smoking. Others are so discouraged from so many previous failures that they are reluctant to even try another method.

There is usually some clinical reason for failure to quit smoking that can be uncovered if the patient is willing to explore it with me. Some of the most common hurdles are other psychiatric conditions. When these conditions are defined and treated, patients are often successful with Chantix.

The most common obstacles to successfully quitting smoke are depression, anxiety, and/or other co-occurring substance abuse or dependence, such as alcohol, Xanax, or cocaine addictions. (Cigarette smoking is substance dependence. If a person becomes dependent on one substance, they are at high risk of becoming addicted to another substance as well). Untreated ADHD and bipolar disorder are also common contributors. When these conditions are successfully relieved with proper medication, stop smoking success rates improve significantly.

Possible side effects include nausea, headache, and irritability. Rare reports of violence may be related to associated alcohol or drug abuse.

Call 770-458-0007 or make an appointment to discuss using Chantix as a method to stop smoking and/or explore with you what treatable problem may be the root cause of your failure to stop smoking.

New ADHD Medicine

http://www.eveningpsychiatrist.com/aadd.htm
Vyvanse is a new form of Adderall that may have advantages for some patients. The advantages may be a more consistent improvement in ADHD symptoms throughout the day and may last longer than the extended release Adderall. There may be less abuse potential as well.

Vyvanse is a prodrug. A prodrug is not an active medication until it is metabolized in the body. Vyvanse is a compound of a protein and amphetamine. In the body amphetamine is split off from the protein and becomes active and goes to the brain. This splitting off is a chemical reaction that is rate limited. Therefore the amphetamine is released at a consistent, controlled rate that prevents spikes and dips of brain amphetamine concentrations throughout the day. When there is a spike, side effects of jitteriness, tremor, or edginess occur. When there is a dip, focus and productivity decrease. The brain level of the medication falls only after all the Vyvanse has been metabolized. The duration of the benefits lasts for 12 hours or longer if the dose given is high enough for the patient.

The risk of abuse is reduced because the amphetamine is bound to the protein. It is very difficult for drug abusing individuals to free the amphetamine and get it into the bloodstream by snorting or injecting it.

The FDA approved Vyvanse this summer for the indication of ADHD based on studies done in children and adolescents. We expect it to be effective and safe for adults with ADHD as well.

Vyvanse comes in 30, 50, and 70 mg dosages. We expect patients to benefit most and tolerate it best if their dosage of Vyvanse approximates 2-2.5 times their current total daily dosage of extended release and/or immediate release Adderall, especially for patients who have been taking multiple doses per day to have at least 12 hours of therapeutic blood levels per day.

If you are not already one of our patients, please call for an appointment to be evaluated so we can discuss these potential benefits for you.

Darvin Hege, M.D.

For more information about Vyvanse:
http://eveningpsychiatrist.blogspot.com/2008/01/vyvanse-update-on-first-100-patients.html and
http://www.eveningpsychiatrist.com/aadd.htm