risk of mania or hedonic dysregulation syndrom with ER or IR pramipexole

[Sikrouf]

hello

does anyone have a paper or experience with trying out the 2 version of prami and seeing an increase of mania (broadly defined) or hedonic dysregulation syndrom with either IR or ER pramipexole?

i would wager the ER release is less prone to such effets but i've got nothing to base this on

thanks

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[clozareal]

seems like switching from IR to ER increases risk of this but rare and only case reports.

Dopamine dysregulation syndrome in Parkinson's disease patients with unsatisfactory switching from immediate to extended release pramipexole: a further clue to incentive sensitization mechanisms? - PubMed

A small proportion of patients with Parkinson's disease (PD), chronically under dopamine replacement therapy, may undergo an addiction-like behavioral disturbance, named dopamine dysregulation syndrome (DDS). This behavioral disorder is characterized by the increase of doses beyond those...

pubmed.ncbi.nlm.nih.gov

Auditory Musical Hallucinations Associated With Extended-Release Pramipexole in an Elderly Patient With Parkinson's Disease

Auditory musical hallucinations (AMHs) are rare complex auditory hallucinations in Parkinson's disease (PD) that have been limited previously. The characteristics of AMHs in PD remain uncertain. We describe a 72-year-old woman with PD who presented with ...

www.ncbi.nlm.nih.gov

 

[clausewitz2]

I have had this happen with one person I had on pramipexole for really treatment-resistant depression. We were titrating steadily up and she kept doing better with every dose increase (going from spending all staring into space and ruminating about how no one had ever really loved her, never leaving the house and hiding from neighbors v. inviting family over and starting various home improvement projects like replacing a storm door by herself). Then all of a sudden we hit 1.75 and her sleep fell off a cliff (like down to 3 hrs a night), she got extremely pressured, and would burst into tears every time she happened to see a news report or anyone mentioned the existence of the police before swinging right back into excitedly talking about how she was going to install a new sink in the span of maybe 30 seconds. Her husband told her she was talking far too much and she agreed that she never seemed to be able to ever stop while she was awake and that just maybe she had too much energy.

We cut her back down ultimately to 1.5 and this didn't go away completely (previously mild-mannered, she exploded at her PCP when he did what admittedly was a poor job explaining the implications of Stage III renal disease) but her sleep got more into the 6 hour range and she could focus on one thing at a time, so she decided some degree of instability was worth it to avoid the crushing despair of the previous twenty years. This came roaring back during a period in which she was unable to get her pramipexole filled for a couple weeks but once she was back on it she felt much better again. Her 6 hours were from 9 PM to 3 AM and she was just...very awake the rest of the day but she found this pleasant, if sometimes slightly boring.

Never really used the ER clinically, sorry.

 

[When is graduation again?]

I have had this happen with one person I had on pramipexole for really treatment-resistant depression. We were titrating steadily up and she kept doing better with every dose increase (going from spending all staring into space and ruminating about how no one had ever really loved her, never leaving the house and hiding from neighbors v. inviting family over and starting various home improvement projects like replacing a storm door by herself). Then all of a sudden we hit 1.75 and her sleep fell off a cliff (like down to 3 hrs a night), she got extremely pressured, and would burst into tears every time she happened to see a news report or anyone mentioned the existence of the police before swinging right back into excitedly talking about how she was going to install a new sink in the span of maybe 30 seconds. Her husband told her she was talking far too much and she agreed that she never seemed to be able to ever stop while she was awake and that just maybe she had too much energy.

We cut her back down ultimately to 1.5 and this didn't go away completely (previously mild-mannered, she exploded at her PCP when he did what admittedly was a poor job explaining the implications of Stage III renal disease) but her sleep got more into the 6 hour range and she could focus on one thing at a time, so she decided some degree of instability was worth it to avoid the crushing despair of the previous twenty years. This came roaring back during a period in which she was unable to get her pramipexole filled for a couple weeks but once she was back on it she felt much better again. Her 6 hours were from 9 PM to 3 AM and she was just...very awake the rest of the day but she found this pleasant, if sometimes slightly boring.

Never really used the ER clinically, sorry.

Interesting case. Have you considered a circadian sleep rhythm disorder for the continued sleep problems? She may benefit from bright light exposure in the evening.

 

[aim-agm]

I have had this happen with one person I had on pramipexole for really treatment-resistant depression. We were titrating steadily up and she kept doing better with every dose increase (going from spending all staring into space and ruminating about how no one had ever really loved her, never leaving the house and hiding from neighbors v. inviting family over and starting various home improvement projects like replacing a storm door by herself). Then all of a sudden we hit 1.75 and her sleep fell off a cliff (like down to 3 hrs a night), she got extremely pressured, and would burst into tears every time she happened to see a news report or anyone mentioned the existence of the police before swinging right back into excitedly talking about how she was going to install a new sink in the span of maybe 30 seconds. Her husband told her she was talking far too much and she agreed that she never seemed to be able to ever stop while she was awake and that just maybe she had too much energy.

We cut her back down ultimately to 1.5 and this didn't go away completely (previously mild-mannered, she exploded at her PCP when he did what admittedly was a poor job explaining the implications of Stage III renal disease) but her sleep got more into the 6 hour range and she could focus on one thing at a time, so she decided some degree of instability was worth it to avoid the crushing despair of the previous twenty years. This came roaring back during a period in which she was unable to get her pramipexole filled for a couple weeks but once she was back on it she felt much better again. Her 6 hours were from 9 PM to 3 AM and she was just...very awake the rest of the day but she found this pleasant, if sometimes slightly boring.

Never really used the ER clinically, sorry.

Thank you for sharing this case! Fascinating that a ~15% change in dose had such a marked clinical effect. If not for the renal disease, would you consider Lithium to ameliorate the manic symptoms and augment antidepressant effect?

 

[Crayola227]

Interesting case. Have you considered a circadian sleep rhythm disorder for the continued sleep problems? She may benefit from bright light exposure in the evening.

Really? She sounds wound up enough already. I would be concerned it would interfere with her sleep at this point.

 

[When is graduation again?]

Really? She sounds wound up enough already. I would be concerned it would interfere with her sleep at this point.

It depends why she has trouble with sleep and what her current symptoms are. If it is a circadian sleep issue, then correcting that might contribute to better sleep and improve some the residual symptoms. I don't know if she has a circadian issue, since I don't know the specifics of the sleep concern, but I do have advanced sleep-wake phase disorder (falling asleep around 8pm waking up at 2 am). Turning on the lights in my house from 7-9pm was amazing for improving my sleep, especially since it's so much darker now outside. To clarify, I don't think she needs formal bright light therapy, but just turning the lights on throughout her house could be helpful.

 

[Sikrouf]

It depends why she has trouble with sleep and what her current symptoms are. If it is a circadian sleep issue, then correcting that might contribute to better sleep and improve some the residual symptoms. I don't know if she has a circadian issue, since I don't know the specifics of the sleep concern, but I do have advanced sleep-wake phase disorder (falling asleep around 8pm waking up at 2 am). Turning on the lights in my house from 7-9pm was amazing for improving my sleep, especially since it's so much darker now outside. To clarify, I don't think she needs formal bright light therapy, but just turning the lights on throughout her house could be helpful.

Unless i missed something you dont become phase advance overnight, if anything maybe the dose couldve been swaped from evening to morning if it wasnt already the case ?