Question: I am 62 years old with severe OCD, RLS, difficult to treat depressive syndrome, and considered a mild bipolar disorder. My neurologist and psychiatrist of the past 8 years has seen me ongoing ove rate years, although visits have sometimes been bi yearly or yearly as the years go on.
I have tried many bipolar drugs and noticed to many side effects and to much body swelling, feet, face hands.
We eventually settled on years of long therm treatment with Lithium 600 mg daily, Mirapex 1.5 mg at bedtime and Prosace 80 mg daily. We did see great improvement in general depression. I have never been severe manic or suicidal. I had the "epstein Barr chronic fatigue disease onset starting with a strep throat and mononucleosis when I was age 27. I was an RN at the time. I became permanently disabled from that time onwards. I have continued with the bunch of usual symptoms over the years from that. But I have also found the psychiatric treatment to have been helpful for the depression. I have since always shown signs of "food allergies: meaning swelling in my face, hands, body, feet legs, pitting in legs. my overall blood tests and physical exams over the years showed no other diseases. My allergy testing showed no official histamine allergic reactions. We have settled on the idea that the original viral disease of unknown origin, may have stayed as a retro virus and caused me to have more of a "chemical, food sensitivity reaction" to many foods and some chemicals at times. Foods that I react to means I have to eliminate and try to figure out what causes the sensitivity reactions. SO this does complicate evaluating the side effects from the psychiatric medications.
I took the psychiatric meds for these at least 8 years now. I was recently traveling and have been helping my elderly mother, and did not get to refill my prescriptions in time. I went at least 2-3 weeks without taking my meds. To which I have all tees years always taken them on time and as directed.
I noticed gradual worsening depression, like the feeling of the old chronic fatigue, sleeping with no relief reom overwhelming exhaustion. After a few weeks without my meds begin reordered, as my doctor in XXXXXXX was unwilling to reorder them as he had not seen me in a year due to my travels, and I became to busy helping my mother, so I had this unplanned lapse before going to an urgent care to see a Doctor yesterday.
The Doctor was a PA and willing to refill the 3 meds for another 1 1/2 months, but knew I was pretty knowledgeable about them and didi not seem to know too much about them.
In my good intended haste, I ate enough to hope to stave off any nausea and I took 150 mg of the lithium, and took 20 mg of the prosaic. I think this was an ok starting dose for those. I forgot how we had always done detailed titration of the Mirapex, and instead I simply took 1 1/2 mg of the mirapex at bedtime, my usual does all these years. Within a few hours I had a lot of side effects. I should have gone to ER but thought it would pass, and it haas lessened a lot in the past 24 hours. During the first 24 hours, probably due to suddenly restarting he Mirapex at full dosage, I began to have chills, a low grade fever of 99, a very odd hot/cold feeling in my limbs, odd dreams, and a lot of nausea. I have felt weak with the usual but worse orthostatic hypotension feeling of " can't stand in one place without feeling a passing out like feeling." I kept yawning, a side effect I have had from these meds, but way worse. yawning and eyes watering and some swelling ( not unusual swelling) I stayed in bed all day, to weak , drank a lot of fluids, and notice now, at the 24 hour mark, I am now a lot better. I think it will pass now with time. I should have gone to ER. But seem okay now.
My concerns are that over these 8 years I have had a lot of the horrible symptoms and side effects caused by these 3 drugs. I fit a lot of these really serious side effects, especially with the Mirapex. I had the sudden muscle contractions of the whole body, ove rate years, I had the compulsive shopping, the sexual worsening, and eye sight worsening a lot, ( I see an optomologist who is following me) and the constant yawning, ataxia, worsened memory, watering yes with all the yawning, dry eyes, a continual swelling, although usually the swelling improves with omitting causative foods, I am suspecting some swelling could be a result of the meds, one of them or who knows. I also had told my doctor about these symptoms, especially about falling asleep easily in the middle of any activity, and about insomnia. I was having more and more problem with insomnia, which I interpret as worse mania due to the high prozac dose. I ran a therapeutic blood level of Lithium, but a the low end of therapeutic. I think the balance was off between the 2 meds. The worst is my concern for the mirapex. It seemed to initially help the depression. It only helped the full body RLS about 1/3. It was lot of pain when not under control. Very complex. May be good to reevaluate meds, but, I am concerned about how many side effects I had on the mirapex and the Prosac. I know I need to see a knowledgeable MD again regarding these meds.
But I am wondering for now if I am now recovering enough from the sudden re start of the full dose, 1 1/2 mg Mirapex? It feels this way. Although I still feel mild nausea, but better. All day I could do nothing. That is not like me. Now I am better as I usually at least will pick up the laptop. Today not even that.
I realize I can not stop these drugs cold turkey. I think some of them have had too many side effects and are not good for me to be continuing, especially the muscle stiffness episodes that occurred at times once a day, and the yawning severity, eye sight,increased watery eyes and nose, worsened a lot since the he stared the Mirapex to fast, and any contribution to my sensitivities or autoimmune reaction to foods, but could also have been happening from some of these 3 meds. I want most to treat any RLS that results from the SRI's and to keep the sleeping depression under control. Those are my 3 goals at this point regarding the meds.
I am a bad typist, and tired at this point. I understand I have complex. Case. Mostly how to proceed in tapering, coming off of, restarting, or replacing these 3 meds???
Thank you XXXXXXX XXXXXXX
YYYY@YYYY

I am additionally willing to pay for one time questions to any other specialties as well, if you want to have a GP and add also a consulting group such as a med knowledgable psychiatrist and also a neurologist, an autoimmune specialist, and
and anyone with any actual current knowledge about the mystery retro virus chronic fatigue fibromyalgia disease. Thank you. please let me know I will add the pay pal payments. Thank you. XXXXXXX XXXXXXX
YYYY@YYYY

Thank you for your answer. I want to clarify that the dose of Mirapex that I restarted after being off of it for 2-3 weeks, was the initial dose of "one and one half mg, not a half of a mg." I have felt very ill from this and was reading that low grade fever could be a bad sign of NM? Anyway it is passing. SO do I need an antidote at an ER, or will it just keep passing?
The severe yawning, watery eyes and stuffy nose, and the insomnia, and the sometimes daily involuntary muscle contraction of the the voluntary muscles in the whole body, sounds like that neuro malignant syndrome which can cause death in 20 percent of patients. I had this over the past 2 years, but not so much lately.
I have also lived in southern XXXXXXX so have also been in a hot tropical climate while on these 3 meds ongoing, if that is of any additional help. I am now in Connecticut with my mother and plan to return home to XXXXXXX California for a year or more, before returning to XXXXXXX I will see my neuropsychiatrist upon return to XXXXXXX
Also I wonder about the Mirapex. I have had so much ataxia, daytime somnolence,, and pretty severe night time insomnia, feeling like mania i.e. online shopping etc. So maybe titrate to lower doses, or replace the Mirapex with something else? And what is the way to titrate the mirapex up or down? Some nausea today but better. I did eat before taking the meds 2 nights ago. But the mirapex was way to high to restart at one and one half mg from not taking it for 2-3 weeks? Take tiny amounts to come down in dosage? I will try to see my doctor when I get back hime to XXXXXXX CA, in about one and one half months from now. I am happy to pay more money for these complex questions, my Pay Pal can be charged.
My apologies for such a complex case. Thank you. XXXXXXX XXXXXXX
YYYY@YYYY

Thank you so much, your answers have been really very, very helpful.
I feel complete except one last question. Regarding the involuntary, voluntary muscle rigidity I have been getting during sleep or rest, over past few years off and on, lasts about 30 seconds each time, is this from the mirapex or the other drugs? Is it in any way a part of the malignant syndrome even though it does not fit the whole picture? Is it a danger to get that rigidity in the voluntary muscles from one of these drugs?
Thank you so much. Please may I pay for this extra time? Please ask for a pay pal payment if you wish, as I feel all your help is way worth well over the money I have paid.
Thank you, XXXXXXX XXXXXXX
YYYY@YYYY

Forgot to clarify this addendum;
it is an involuntary rigidity, overtaking, all at once, the entire body, involving the voluntary muscles. I stretch or move a little, and then it kicks in, lasting about 30 or so seconds each time. Like a stretch that tightens up all the voluntary skeletal muscles. I think it is from too much of one of the 3 meds, my guess is the Mirapex, but I do not know which med is causing this. But I see it could be a possible danger if it would not subside. And it is mentioned in the lists of the neuro malignant syndrome? XXXXXXX XXXXXXX
YYYY@YYYY