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Alright.. so I didn't know this, but apparently too much Dopamine can cause Mania even in those who don't have BP. Is this correct?

Two, how do you tell? Sure, there are the Manic symptoms.. but mixed with my depression ones, it just becomes this big mess.

For example I feel this inner go, go ,go all the time; but I sleep 12-16 hours a day. I'm depressed, quick to tear, and often tired all the time. I also feel energized (yes that does conflict with the above.. so to clarify it's like being on coffee at night and tired and ready to go to bed). I'm acting over-enthusiastic and want to do everything at once, and don't want to do anything at all.

And then of course the question, is it a bad thing?

Mania is not good. Period. But tempered by depression.. not being true mania, and looking for anything that will save your life.. should it necessarily be stopped? I've run out of options. My life is on the line. I'm not being dramatic. If the meds don't work I'm going to kill myself. Period. There's my combo, MAOI's, and ECT. Then that's it. I would have tried everything. If I can somehow manage the highs and lift myself to a normal point out of depression. Doesn't that mean something? I don't know if I'm going to become not-depressed... but don't I owe it to myself to try? I'm terrified of this not working. Is a little mania that bad when compared to dying? How can I not try it? There's a huge possibility that I'll just get used to it and it won't be a problem. Like when I took too much serotonin and verged on serotonin syndrome.. but stabilized just fine. I simply got used to it and all was ok. I just don't know.

I welcome any and all opinions. Harsh, easy, timid, questioning, etc. All of it.

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I don't think the relationship between dopamine and mania is that clearly direct and causal. But, assorted meds can definitely elicit mania in people who aren't bipolar. Looking at your rx list, several of your meds, either in combination or by themselves, could be contributing. Amitriptyline, abilify, trazadone, mirapex, straterra, armour thyroid, and L-dopa, could all be playing a part.

What you've got going on doesn't sound so much like mania, more of a mixed state. And those are truly hideous. The thing is, there are always more options with meds. Whether it's trying new ones, or giving some you've tried before another shot, in different combimations. And there's therapy. I don't know aht kinds of therapy you've tried, but there are so many different approaches, you could well find something that works for you, even if you haven't yet.

I'm guessing you've already gotten at least one second opinion, but if you haven't, you really, really, should. If it's been a while, get another one. I'm not saying yours isn't great, just that sometimes a new set of eyes can have some new ideas, and having more options could only be a good thing.

Talk to your pdoc about what's going on, if you haven't already. She might very well be able to suggest a med tweak that would help.

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Yeah, I did mean more of a Mixed state. I moreso meant some Mania thrown into the mix - just having both Hypo and Manic symptoms be possible, without going all-out Manic.

I've had alot of therapy. I love it. It does make me feel better short-term, but I wouldn't go so far as to say that it's really helping. It's mainly a case of knowing how I could be and trying as hard as I can to get there. Not thought wise - med wise. I know what I've lost, and I have to get back there. I felt human, and minor things didn't throw me off the deep end like they do now. Ultimately, I just can't keep going just to keep going. Not anymore. After trying to kill myself (one time only) and making a small mistake (easily fixed) I was lost. Stayed in bed for four months. Then I posed a question to myself. I have two options: kill myself, or try again. I chose to try again. I don't want to die, I just can't stand to live either. Now I've exhausted my options for the most part. So I'm worried and scared. I need this to work, in any was possible.

As for second opinions, I've had 5. Two recommended ECT - 3 outright said they didn't know what else to do. I've also had every test I can think of to rule out a physical cause. Everything came out perfect. After the course I'm on now, I plan to see three pdocs and outright ask if they have any other ideas of med combos or additions/replacements. If they don't I'm turning to Ensam, then Selegiline, followed by Parnate.

What do you think?

BTW, I know this post is veering to other board sections. Please keep it here for the time being, then it can be moved to another depending on where this goes.

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Cetkat,

I'm so sorry to hear you've been feeling so low, for so long. I think trying MAOI's is a great idea. I've heard they are very effective, often used IP on the most severely depressed. As to ECT, I think if the alternative is suicide you've really got nothing to lose by trying it. It's controversial. There are those who think it's safe and those who think it can do harm to the brain but... This sounds awful and in no way am I condoning suicide, but if I was in the situation of having exhausted all other options but ECT, was worried about permanent SE but thinking suicide was imminent, I would think if ECT didn't work, or did damage I couldn't live with, suicide would still be an option, and at least I would have tried. That may have came out wrong and if so, I'm sorry.

I really hope the MAOIs (or something) helps soon :)

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I tried Ensam before going the ECT route, but it just wasn't cutting it. Then again, neither did the ECT; it just played hell with my memory, including some long-term memories. I had ECT 12 times and it was always the same: 1 groggy day followed by a great day, then a day of horrible depression. It worked great for all the other folks I know that had ECT, with just some very recent memory loss.

Tommy

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If you are mixed, then all those antidepressant like meds might not be helping. When is the last time you tried Depakote? Depakote, Lamictal and Lithium helped pull me out of mixed/rapid cycling. I had some Seroquel in there, too. Adding and then switching Dep for Tegretol did the trick. A Depakote combo of some sort is worth trying.

I'm sorry you are going through this. Truly. It can be awful and very hard to press on. But, you know, the longer it has been, the sooner until it stops. Don't give up. You will find what works or it will peter out on its own.

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There is no consensus of the cause of mania, but, actually most deal with excitatory nerve firing, which lends me to link it to glutamate excess if anything. That is how some bipolar people take psycho-stimulants of the dopamine transporter agonist variety. I have some off-key variant of bipolar disorder and take them. They don't incite any sort of thing that would be classified as a mania in me. Of course, I am not recommending that for you, as I am no doctor. But, I am just saying that mania is likely not exclusively dopaminergic.

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Cetkat,

I'm so sorry to hear you've been feeling so low, for so long. I think trying MAOI's is a great idea. I've heard they are very effective, often used IP on the most severely depressed. As to ECT, I think if the alternative is suicide you've really got nothing to lose by trying it. It's controversial. There are those who think it's safe and those who think it can do harm to the brain but... This sounds awful and in no way am I condoning suicide, but if I was in the situation of having exhausted all other options but ECT, was worried about permanent SE but thinking suicide was imminent, I would think if ECT didn't work, or did damage I couldn't live with, suicide would still be an option, and at least I would have tried. That may have came out wrong and if so, I'm sorry.

I really hope the MAOIs (or something) helps soon :)

No, I know exactly what you mean. I actually had a post years ago (no longer on the boards) that dealt with exactly that. If all treatment failed and I had to choose between death or a life of pain, I would choose death. I did this from a logical standpoint and challenged everybody to come up with an argument that proved my standpoint flawed & resulted with the logical thing to do as to live. (It's kind of hard to explain without the post) Anyway, nobody could. In fact I got a few, you're rights. So yeah. I was really hoping they could too. Sometimes I hate being right. I am definitely without a doubt going to try ECT as a last resort.

If it were me, I would probably try emsam and some other MAOIs if possible before going the Ect route... Anna

Yep, part of the plan.. absolutely. I'm at the point where if I could take every med there is all at once and have it work, I'd gladly do just that.. regardless of consequences. Unfortunately things don't work that way.

I tried Ensam before going the ECT route, but it just wasn't cutting it. Then again, neither did the ECT; it just played hell with my memory, including some long-term memories. I had ECT 12 times and it was always the same: 1 groggy day followed by a great day, then a day of horrible depression. It worked great for all the other folks I know that had ECT, with just some very recent memory loss.

So you're still depressed and have exhausted all options? Or did something else work besides the MAOI's and ECT?

If you are mixed, then all those antidepressant like meds might not be helping. When is the last time you tried Depakote? Depakote, Lamictal and Lithium helped pull me out of mixed/rapid cycling. I had some Seroquel in there, too. Adding and then switching Dep for Tegretol did the trick. A Depakote combo of some sort is worth trying.

I'm sorry you are going through this. Truly. It can be awful and very hard to press on. But, you know, the longer it has been, the sooner until it stops. Don't give up. You will find what works or it will peter out on its own.

I've done Tegretol, but not Depakote.. hmm.. I've always thought of that one as a straight up BP med. How would you suggest adding it in there? As for the antidepressants, they're working on a low level. I was suicidal without them. When they were added I stopped. Plus I didn't have anything at all like a mixed state prior to adding the Strattera and Mirapex.. so I can pretty much contribute it to them.. Now whether or not it's due just to them or an interaction of the combo i'm on, no idea.

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There is no consensus of the cause of mania, but, actually most deal with excitatory nerve firing, which lends me to link it to glutamate excess if anything. That is how some bipolar people take psycho-stimulants of the dopamine transporter agonist variety. I have some off-key variant of bipolar disorder and take them. They don't incite any sort of thing that would be classified as a mania in me. Of course, I am not recommending that for you, as I am no doctor. But, I am just saying that mania is likely not exclusively dopaminergic.

Ok.. read up on that a bit. http://en.wikipedia.org/wiki/Glutamic_acid Not the best source by far, but I'm having trouble getting into studies. One, I'm confused about whether excess glutamate helps or hurts memory. Two, does it affect the Ca level or just interact with it? Three, being a GABA precursor, would the fact that I've taken Neurontin and did not have this kind of reaction mean anything? And four, is there a test for the level?

Thanks.

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There is no consensus of the cause of mania, but, actually most deal with excitatory nerve firing, which lends me to link it to glutamate excess if anything. That is how some bipolar people take psycho-stimulants of the dopamine transporter agonist variety. I have some off-key variant of bipolar disorder and take them. They don't incite any sort of thing that would be classified as a mania in me. Of course, I am not recommending that for you, as I am no doctor. But, I am just saying that mania is likely not exclusively dopaminergic.

Ok.. read up on that a bit. http://en.wikipedia....i/Glutamic_acid Not the best source by far, but I'm having trouble getting into studies. One, I'm confused about whether excess glutamate helps or hurts memory. Two, does it affect the Ca level or just interact with it? Three, being a GABA precursor, would the fact that I've taken Neurontin and did not have this kind of reaction mean anything? And four, is there a test for the level?

Thanks.

I wouldn't think of things so much in terms of "excess" amounts of neurotransmitters. It is more subtle than that. Perhaps take a look on articles on the NMDA Receptors. Those are the main excitatory receptors in the brain. They are activated by glutamate. So excess glutamate might not be as accurate as an overall "over-excitement" of the neurons in the brain. Ca is an ion that is associated with determining the flux across the neuronal membrane, which determines if a neurotransmitter like glutamate gets passed on or not. The reason that is brought up, is that many mood stablilizers act by damping down the flux (difference in concentration between inside and outside the neuron end), and ions like Ca and Na are involved, especially with Lamictal and Tegretol/Trileptal(its cousin). Other ways of dampening the "Storm" is with things that are inhibitory. While there are excitatory NMDA receptors, there are inhibitory GABA receptors, which, well, slow down brain activity. Agents that enhance GABA receptor activation, like Depekote, Neurontin, and sedatives like benzos, are useful in fighting mania this way. There is no known tests for this. Perhaps a PET scan could measure the activation of NMDA receptors over those of "normal people." It wouldn't be blood-test-able as the blood-brain barrier exists.

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There is no consensus of the cause of mania, but, actually most deal with excitatory nerve firing, which lends me to link it to glutamate excess if anything. That is how some bipolar people take psycho-stimulants of the dopamine transporter agonist variety. I have some off-key variant of bipolar disorder and take them. They don't incite any sort of thing that would be classified as a mania in me. Of course, I am not recommending that for you, as I am no doctor. But, I am just saying that mania is likely not exclusively dopaminergic.

Ok.. read up on that a bit. http://en.wikipedia....i/Glutamic_acid Not the best source by far, but I'm having trouble getting into studies. One, I'm confused about whether excess glutamate helps or hurts memory. Two, does it affect the Ca level or just interact with it? Three, being a GABA precursor, would the fact that I've taken Neurontin and did not have this kind of reaction mean anything? And four, is there a test for the level?

Thanks.

I wouldn't think of things so much in terms of "excess" amounts of neurotransmitters. It is more subtle than that. Perhaps take a look on articles on the NMDA Receptors. Those are the main excitatory receptors in the brain. They are activated by glutamate. So excess glutamate might not be as accurate as an overall "over-excitement" of the neurons in the brain. Ca is an ion that is associated with determining the flux across the neuronal membrane, which determines if a neurotransmitter like glutamate gets passed on or not. The reason that is brought up, is that many mood stablilizers act by damping down the flux (difference in concentration between inside and outside the neuron end), and ions like Ca and Na are involved, especially with Lamictal and Tegretol/Trileptal(its cousin). Other ways of dampening the "Storm" is with things that are inhibitory. While there are excitatory NMDA receptors, there are inhibitory GABA receptors, which, well, slow down brain activity. Agents that enhance GABA receptor activation, like Depekote, Neurontin, and sedatives like benzos, are useful in fighting mania this way. There is no known tests for this. Perhaps a PET scan could measure the activation of NMDA receptors over those of "normal people." It wouldn't be blood-test-able as the blood-brain barrier exists.

Ok, I think I'm following you. So if this is the case, would Neurontin be beneficial? Could it also void out any of the mood effects of what else I'm taking?

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^As I eluded to, no one can pinpoint what each individual's "chemical problem" is. Maybe you do well with Na and Ca ion agents. Maybe GABAergics like Neurontin are the trick? There is really no way to tell without trying the med. However, I must warn you, using Neurontin as monotherapy for bipolar disorder is not that popular (yet.) There just hasn't been enough evidence yet.

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wow that is a good question cetkat, one that would certainly have me thinking for days to come about it.

but my first reaction is i look at your medlist.

l-tyrosine is good, but for me i found it useless to take everyday. or rather it works when taken over a long period of time rather than for just a few days.

if trazodone is working for ya all the best with that, but it caused heart flutterings for me similar to a problem i had with zyrtec.

my second reaction is this does seem to be a true mixed type episode

my only subjective opinion of this is from when i started taking, invega, i was so depressed from the drug, it literally knocked the shit outta me, even until the next day, but at the same time i was restless.

but this is nothing like you were talking about cause u were enthusiastic, i get like that sometimes, mainly from the neurontin i take, but i tell myself hey i need that kick in the pants every now and then. so i deal with it.

i guess i can be somewhat mood incongruent, in which my body should be telling me sleep sleep sleep, or something to the like. but for some reason there is a disconnect, or i say no to taht suggestion.

almost like when someone hasnt slept yet somewhow it doesnt affect them the way it should.

yes neurontin monotherapy for bipolar is totally not warranted, but it does help people with bipolar mixed, on the depressive side, get to feel a little better.

but just looking at your meds, if you wanted something for you to not be as excited, i wouldnt go for neurontin or even lyrica. these medicines are used for fibromyalgia, so they can equally and just as well be energizing to most people.

so i see the reason your taking nadolol is on the basis of helping your ADHD alongwith the strattera, but you only take it PRN. maybe you should look into calcium channel blockers, they are sometimes used offlabel in the treatment of panic disorder and bipolar disorder. and they could definitely calm you down a bit if you were thinking that you may be a little too hyped up.

they recently just raised the standards or rules needed to be taken or abided by to get ECT, so i think it's MAOI's(selegeline specifically or others or bust.) i say selegeline becuz it has the least MAOI interactions out of all of them selegiline is taken by patch.

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wow that is a good question cetkat, one that would certainly have me thinking for days to come about it.

but my first reaction is i look at your medlist.

l-tyrosine is good, but for me i found it useless to take everyday. or rather it works when taken over a long period of time rather than for just a few days.

if trazodone is working for ya all the best with that, but it caused heart flutterings for me similar to a problem i had with zyrtec.

my second reaction is this does seem to be a true mixed type episode

my only subjective opinion of this is from when i started taking, invega, i was so depressed from the drug, it literally knocked the shit outta me, even until the next day, but at the same time i was restless.

but this is nothing like you were talking about cause u were enthusiastic, i get like that sometimes, mainly from the neurontin i take, but i tell myself hey i need that kick in the pants every now and then. so i deal with it.

i guess i can be somewhat mood incongruent, in which my body should be telling me sleep sleep sleep, or something to the like. but for some reason there is a disconnect, or i say no to taht suggestion.

almost like when someone hasnt slept yet somewhow it doesnt affect them the way it should.

yes neurontin monotherapy for bipolar is totally not warranted, but it does help people with bipolar mixed, on the depressive side, get to feel a little better.

but just looking at your meds, if you wanted something for you to not be as excited, i wouldnt go for neurontin or even lyrica. these medicines are used for fibromyalgia, so they can equally and just as well be energizing to most people.

so i see the reason your taking nadolol is on the basis of helping your ADHD alongwith the strattera, but you only take it PRN. maybe you should look into calcium channel blockers, they are sometimes used offlabel in the treatment of panic disorder and bipolar disorder. and they could definitely calm you down a bit if you were thinking that you may be a little too hyped up.

they recently just raised the standards or rules needed to be taken or abided by to get ECT, so i think it's MAOI's(selegeline specifically or others or bust.) i say selegeline becuz it has the least MAOI interactions out of all of them selegiline is taken by patch.

Blart, it's nothing personal, but please refrain from commenting on my topics. It's too hard for me to follow what you're saying and it just confuses me. Thank you.

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Just read the last two paragraphs, i was rambling there for a while.

What i meant was: yes neurontin monotherapy for bipolar is totally not warranted, but it does help people with bipolar mixed, on the depressive side to get to feel a little better.

but just looking at your meds, if you wanted something for you to not be as excited, i wouldnt go for neurontin or even lyrica. these medicines are used for fibromyalgia, so they can equally and just as well be energizing to most people.

I looked into the reason you're taking nadolol is on the basis of helping your ADHD alongwith the strattera, but you only take it PRN. maybe you should look into calcium channel blockers, they are sometimes used offlabel in the treatment of panic disorder and bipolar disorder. and they could definitely calm you down a bit if you were thinking that you may be a little too hyped up.

I'm just suggesting calcium channel blockers as some form of therapy, alongwith looking into the MAOI's as the others had suggested.

they recently just raised the standards or rules needed to be taken or abided by to get ECT, so i think it's MAOI's(selegeline specifically or others or bust.) i say selegeline becuz it has the least MAOI interactions out of all of them selegiline is taken by patch.

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Just read the last two paragraphs, i was rambling there for a while.

What i meant was: yes neurontin monotherapy for bipolar is totally not warranted, but it does help people with bipolar mixed, on the depressive side to get to feel a little better.

but just looking at your meds, if you wanted something for you to not be as excited, i wouldnt go for neurontin or even lyrica. these medicines are used for fibromyalgia, so they can equally and just as well be energizing to most people.

I looked into the reason you're taking nadolol is on the basis of helping your ADHD alongwith the strattera, but you only take it PRN. maybe you should look into calcium channel blockers, they are sometimes used offlabel in the treatment of panic disorder and bipolar disorder. and they could definitely calm you down a bit if you were thinking that you may be a little too hyped up.

I'm just suggesting calcium channel blockers as some form of therapy, alongwith looking into the MAOI's as the others had suggested.

they recently just raised the standards or rules needed to be taken or abided by to get ECT, so i think it's MAOI's(selegeline specifically or others or bust.) i say selegeline becuz it has the least MAOI interactions out of all of them selegiline is taken by patch.

I appreciate your attempt, but I think it would be best to focus on other people's posts rather than mine. This is totally my deal, but it would make me feel so much better if you didn't respond to my posts as it throws me off. Can you do that for me please?

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If you are mixed, then all those antidepressant like meds might not be helping. When is the last time you tried Depakote? Depakote, Lamictal and Lithium helped pull me out of mixed/rapid cycling. I had some Seroquel in there, too. Adding and then switching Dep for Tegretol did the trick. A Depakote combo of some sort is worth trying.

I'm sorry you are going through this. Truly. It can be awful and very hard to press on. But, you know, the longer it has been, the sooner until it stops. Don't give up. You will find what works or it will peter out on its own.

I've done Tegretol, but not Depakote.. hmm.. I've always thought of that one as a straight up BP med. How would you suggest adding it in there? As for the antidepressants, they're working on a low level. I was suicidal without them. When they were added I stopped. Plus I didn't have anything at all like a mixed state prior to adding the Strattera and Mirapex.. so I can pretty much contribute it to them.. Now whether or not it's due just to them or an interaction of the combo i'm on, no idea.

Since you mentioned that the mixed stuff started after Strattera and Mirapex, I have to ask. What happens if you stop them?

Cetkat, you're on a lot of drugs. What's causing what has to be near impossible to say. You probably do have some bad interactions going on. It's unlikely that everything is working. I would expect that your challenge now is to figure out what you can do without, regroup, focus your cocktail. I don't say this lightly. I've been on polypharm since I was diagnosed. It is a good approach but it has its limits. So, don't go down the road here wondering what to add. Think in terms of swapping and possibly reducing instead.

Btw, Mirapex was not doing for me what I thought it was. I had to stop due to edema and was surprised how little the change was. Not saying that med will work that way for you. I just bet that some of yours will.

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Since you mentioned that the mixed stuff started after Strattera and Mirapex, I have to ask. What happens if you stop them?

I'm not sure.. I would assume that the mixed stuff would go away. It's not bothering me so much now.. it's still there but tempered. Probably due more to me controlling it than it changing. I am however oversleeping and feeling tired all the time again, so things are going back to normal for the most part.

Cetkat, you're on a lot of drugs. What's causing what has to be near impossible to say. You probably do have some bad interactions going on. It's unlikely that everything is working. I would expect that your challenge now is to figure out what you can do without, regroup, focus your cocktail. I don't say this lightly. I've been on polypharm since I was diagnosed. It is a good approach but it has its limits. So, don't go down the road here wondering what to add. Think in terms of swapping and possibly reducing instead.

I agree with you for the most part. The positive thing is that I've added/changed one thing at a time the whole way (with the only exception being the Strattera/Mirapex which I did together in a blind attempt to avoid muscular problems associated with too much dopamine - this is totally a guess/theory not based on anything scientific). I basically figured it may do that, but moreso would enhance the dopamine in general as much as possible (akin to taking Cymbalta and Prozac at the same time to increase Serotonin) so it was worth a shot. But anyway, by doing that I've been able to attribute side effects to certain meds. However, there's obviously a very good possibility that new reactions could be a simple case of the new med clashing with an old one. I'll give anything a thought.. but it doesn't seem like it would be prudent to add Depakote, however I'm more than willing to listen to your reasons why.

Other than (possibly - I'm not sold on this since it's rather weak for me) Remeron (which I actually forgot about but was in my paperwork http://www.crazyboards.org/forums/index.php/topic/35768-medicating-based-on-receptors/page__p__391078__hl__%2Bmedicating+%2Bbased+%2Bon+%2Breceptors__fromsearch__1#entry391078 ) there's nothing else I'm seeking to add to the equation. And even then only after giving the Strattera/Mirapex combo a few months to do their best.

Since Saphris has come out, I believe.. assuming that I don't feel better in the next few months with what I'm on.. that I'll lower the Abilify half-way, add the Saphris half-way and decide on which med to take depending on whether I get better or worse.

I'm not looking to stay on so many meds ultimately. I'm just trying everything possible to focus on the points that helped in the past in an attempt that they will help again. If none of this works then I'm off to Ensam. If it does, then I'll start paring things down to see what's helping and what's not.

Btw, Mirapex was not doing for me what I thought it was. I had to stop due to edema and was surprised how little the change was. Not saying that med will work that way for you. I just bet that some of yours will.

I agree. I really hope that things will get to the point where I have the opportunity to do that.

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