Posted 26 May 2009 - 09:53 PM
I've looked over the M&M thread, very interesting stuff.
Pramipexole update:
(skip this paragraph if you want to get to the results)
I feel a lot of strange states normally, and with medication like this I'm looking for a game changer; something that enables me to radically alter my behavior for the better (less lethargic, less anxious, more assertive) and fundamentally changes my cognitive and emotional experience (less obsession, more confidence and optimism, hedonic tone, a sense of passion, more intense response to both pleasurable and intellectual stimuli), In that vein no psychotropic medication has yet induced these types of sensations; Provigil induced a modest increase in "busy-body" type behaviors, and also curbed appetite-- sometimes to the extent that I would suddenly realize I had gone up to 20 hours without eating anything. One day when I was on Wellbutrin and Zoloft (under whose auspices my academic career took a shit and died) I accidentally dosed twice, and felt a sudden optimism and happiness, and also noticed while in intro guitar class that my arpeggios were much more fluid. Motor command is among the litany of my deficits. These are about the only positive effects medications have ever had on me. Fortunately (if you look at it that way) all obligations in my life have come to a grinding halt for the next couple of weeks, and so I have this period of time completely free to cope with whatever adverse effects PPX might have. On the flip side of things, I really don't feel comfortable imposing any more obligations upon myself until I can achieve some measure of improvement.
With this in mind, I have been on pramipexole since last Thursday (this being my fifth day on it). I started with 0.5mg in the late afternoon, and would feel somnolent afterwords. This was usually resolved by a nap at some point, whose length it appears has gotten shorter as the regimen proceeds. I also initially developed a flop sweat and some nausea after the first two days of dosing, but this has lowered considerably. On Monday I was still awake at 4a.m. (my sleep cycle is horrendously erratic, unresponsive to melatonin) and felt some of the old night-panic that grips me from time to time. I decided I'd escalate the dose and took 0.5mg them and slept, then took 0.25mg in the late afternoon. I went to bed at 2a.m. last night and woke up at 4 noticing an odd vibratory sensation waking me up. It was highly pleasurable, but not sexual in nature. My perception was different, and I think it was because the autoreceptor agonism was wearing off and I was getting a little hint of rebound. I tried testing my motor command (via sequenced finger movements) while lying there in bed for a minute, and found that it wasn't at all improved. My perception was slightly altered, and I felt more confident, but the bulk of it wore off within a minute. Like I said, I go through a lot of odd states but rarely are they positive in nature.
I've committed myself now to a t.i.d dosing schedule, 0.25mg each day until the 8th day, at which point I'll double the night, then the afternoon, then the morning dose over the next three days until I've hit 0.5mg t.i.d. I'll give that another two weeks or so.
after that the treatment algorithm is as follows:
-no response to PPX: scale down dose and switch to RIMA's. Consider scaling back up once on RIMA's
-mild response: scale up dosage up to 5.0mg over the next ~6 weeks. The M&M thread cited a study on dose-dependent response as an antidepressant, but with a high dropout rate. Escalating slowly on a t.i.d. schedule should be beneficial. Augment with RIMA's when maximum dose has been reached.
-moderate response: same as above, but no augmentation necessary. More aggressive dose escalation, and titrate to optimum dose.
-strong response: maintain dosage, and get on with my life.
LongeCity
