Augmentation and mood swings

[kathleenbutts]

Was on Mirapex for over 15 years. It has stopped working with a ramp up of .75mg. I have finally gotten off Mirapex after cutting down about a week ago and was told to try Requip .25mg, which I'm doing right now.

I know I am in augmentation. Can't see Dr. for another week. In the meantime I'm either sitting in a hot bath or crying or both. I am on Wellbutrin XL. Something is not working. I'm afraid to stop the small amount of Requip............but I also have a prescription for Clonzaepam to help sleep and a script for Hydrocodone/Act 10/325 which is adding to the mood swings, I think. I would love to absolutely flush all meds away................how long does this emotional roller coaster last??? Any help??

[sleepdancer2]

I wish I could help you with the meds, but I am not versed on reasons to take or not take them. Been there myself and dealt with augmentation, and yes, it is utterly miserable. I stayed on Mirapex far too long simply because I dreaded (feared) what the weaning process and transition to Requip might be like. The transition was rough and the Requip soon was problematic as well. I can only suggest you do any weaning or stopping of any meds in a very calculated manner. I let my clouded thinking lead me into stopping Mirapex abruptly once and it was not pretty. I remember those days all too well, even though I've been able to be off all meds for my my PLMD and WED/RLS for almost 4 years now. I'm using a TENS Unit for my legs and it's been a tremendous help. I doubt it would help with any other parts of the body that might be affected, but it has quieted my legs enough to get some sleep and the other things kinda fell in line once I was resting better and not so sleep deprived. Good luck going forward. I feel your pain. Here's a link to a video clip of me when I was suffering augmentation. https://www.youtube.com/watch?v=jE7WA_5c73c

[ViewsAskew]

There is no way ropinerole at .25 mg is going to help you in your current state. you need two to three times the amount of ropinerole to do the same job as pramipexole. You might as well not take it. As long as you are taking it, you may not stop the rollercoaster.

It take from 4 or 5 days (with NO DAs) up to 3 or 4 weeks for the worst of it to be over. It's very difficult, as you know.

Are any of these other drugs new? If so, you may want to talk to a pharmacist and see how you might stop them. If you've been taking them for awhile, stopping them may be more complex.

[Frunobulax]

Dr. Buchfuhrer mentioned that he prefers to stop his patients "cold turkey". So I guess he thinks that weaning dopamine agonists will just prolong the suffering. Clonazepam, in my experience, won't help with the WED symptoms - it will help only if you suffer from insomnia even though your legs are calmed.

I guess the Hydrocodone is your best chance. Are you sure that the mood swings are caused by the Hydrocodone? Mood swings are a classic side effect of dopamine agonist withdrawal.

[sleepdancer2]

Stopping a dopamine agonist abruptly from a high dose (high dose may be key) caused me to develop an odd variant of synesthesia, where the brain glitches and mixes the senses. When I saw my neurologist he said the abrupt stop was the cause of my symptoms. Within a few days after stopping I got this glitch that when I viewed any impact, I felt intense pain in my groin up into my belly. Couldn't watch the grandkids playing at the park, watch action shows on TV, etc. without distress. I especially could watch things like the funny blooper videos that show accidents and falls. Too painful. The doctor had me go back on the Mirapex and incrementally increase the dose, then wean back off appropriately. Did not stop my symptoms. Over time it has decreased in frequency and intensity, but it still happens. I don't know the science behind what happens when a med is stopped in a manner not recommended by the manufacturer, but if I had stopped at the advice of my doctor and not my own stupidity I would not have been pleased. Maybe the doctor that was mentioned was speaking of stopping from a lower dose.

[ViewsAskew]

High doses definitely should not be stopped abruptly.

People with WED shouldn't ever be on high doses, but often we are. Dr Buchfuhrer never uses high doses and he does suggest stopping cold turkey. Most doctors who publish and who are on the Foundation's medical advisory board suggest cold turkey (and use low doses).

I don't know what the cutoff should be. I'll write to Dr B and ask.

sleepdancer2 - what was your dose and of which drug?

[sleepdancer2]

It was Mirapex. Can't remember the dose but if I run across some medical documentation I'll come back and post. I do remember I'd had 2 or 3 increases after the initial starting dose. And I remember a new doctor saying it was more than they prefer to have a patient on.

[ViewsAskew]

It was Mirapex. Can't remember the dose but if I run across some medical documentation I'll come back and post. I do remember I'd had 2 or 3 increases after the initial starting dose. And I remember a new doctor saying it was more than they prefer to have a patient on.

That would be great. I'd like to write to Dr B with your details and also ask what he and the other docs who are on the medical advisory board think is the cutoff for stopping cold turkey vs titrating down.

[Frunobulax]

Stopping a dopamine agonist abruptly from a high dose (high dose may be key) caused me to develop an odd variant of synesthesia, where the brain glitches and mixes the senses. [...]

This sounds pretty bad.

I'm not saying that cold turkey is the way to go. I think this is an open topic, and we have no reliable data if stopping people "cold turkey" has more or less side effects than tapering. And by open I mean "really open", and not "we know what's probably true, but have no sufficient hard data". There are several papers reporting on severe withdrawal reports even if medication was tapered.

In general, tapering should be the preferred way and is most likely "safe" (in the sense that it has no additional side effects compared to cold turkey), but the resolvement of augmentation may be significantly longer when tapering.

[ViewsAskew]

Stopping a dopamine agonist abruptly from a high dose (high dose may be key) caused me to develop an odd variant of synesthesia, where the brain glitches and mixes the senses. [...]

This sounds pretty bad.

I'm not saying that cold turkey is the way to go. I think this is an open topic, and we have no reliable data if stopping people "cold turkey" has more or less side effects than tapering. And by open I mean "really open", and not "we know what's probably true, but have no sufficient hard data". There are several papers reporting on severe withdrawal reports even if medication was tapered.

In general, tapering should be the preferred way and is most likely "safe" (in the sense that it has no additional side effects compared to cold turkey), but the resolvement of augmentation may be significantly longer when tapering.

There is a documented/real issue with stopping DAs when taking higher doses - technical name is Dopamine Agonsit Withdrawal Syndrome (catchy, isn't it?) http://www.medscape.com/viewarticle/778433 .

There is no issue when you stop taking them and you are at lower doses. The key here, to me, is that we do not know that dividing line. Many of us have stopped them abruptly - at lower doses - cleanly. and, we often tell people they can/should. As you said, it significantly reduces augmentation issues.

I emailed Dr B about it today. I expect I'll hear from him - unless he's traveling - in the near future.

[ViewsAskew]

Dr B responded to me. He said that he knows of no research related to RLS/WED and DAWS. Which is what I found when I searched. Because of that, no one knows about dosage. He did say that he has rarely seen it, however, and routinely (as typified by his responses on rlshelp.org) tells WED patients to simply stop it cold turkey.

I think part of the issue is that a doctor such as Dr B never prescribes more than .25 mg of pramipexole, for example, and such a low dose isn't going to cause issues. The issue is with doctors who aren't aware of augmentation issues and do not know that higher doses are almost always problematic.

[Polar Bear]

I know that tapering a DA stretches out the horrid withdrawal period, but I'd be really afraid to go cold turkey on a high dose for fear of something unexpected happening.

[ViewsAskew]

I know that tapering a DA stretches out the horrid withdrawal period, but I'd be really afraid to go cold turkey on a high dose for fear of something unexpected happening.

I agree - I think most of us are unlikely to be in that situation, though. We rarely hear of people on what I'd call high doses. For example, the max for ropinerole (using the old criteria) for WED/RLS was 4 mg a day. For Parkinson's? It's 24 mg!!!!! In the info about clinical trials, it says, "In clinical trials of patients being treated for RLS with doses up to 4 mg once daily, REQUIP (ropinirole hcl) was discontinued without a taper."

[Frunobulax]

Dr B responded to me. He said that he knows of no research related to RLS/WED and DAWS. Which is what I found when I searched. Because of that, no one knows about dosage. He did say that he has rarely seen it, however, and routinely (as typified by his responses on rlshelp.org) tells WED patients to simply stop it cold turkey.

Well, I certainly experienced withdrawal symptoms after stopping pramipexole (1mg/day). I have heard the line of reasoning "it's common in PD, but we haven't observed in WED" before - I see no reason why side effects of dopamine agonists should affect only PD patients, even if they have higher doses.

[ViewsAskew]

Dr B responded to me. He said that he knows of no research related to RLS/WED and DAWS. Which is what I found when I searched. Because of that, no one knows about dosage. He did say that he has rarely seen it, however, and routinely (as typified by his responses on rlshelp.org) tells WED patients to simply stop it cold turkey.

Well, I certainly experienced withdrawal symptoms after stopping pramipexole (1mg/day). I have heard the line of reasoning "it's common in PD, but we haven't observed in WED" before - I see no reason why side effects of dopamine agonists should affect only PD patients, even if they have higher doses.

I think we're talking about different things. Withdrawal symptoms are much different from this syndrome. DAWS is a recognized syndrome that often never goes away.