So my mother was diagnosed some years ago with PD. Her only symptom was perhaps walking slowly. She was about 77. Her neuro put her on 200mg/day of Sinemet about 2 years ago. She is now 80. During that time she seemed to have very low energy and often felt sleepy immediately after a dose. She slept much of the day and night, always feeling tired. Not sure how much positive effect the Sinemet offered her walking since she still walked somewhat slowly.

FFW to April 2012. Her neuro, without much reason bumps her dose to 300mg/day. Then within 2 weeks of that, her sleeping starts to get interupted overnight, she gets pain in her arms, she starts to feel like her balance is worse, her anxiety increases, etc. She now gets an occassional mild tremor/dyskenesia (not sure med induced or not).

Her neuro told her a few weeks ago to cut her meds by 50% reducing by 50mg/week over 3 weeks.

Within the third week of that process she started to have serious issues with sleeping and feeling lousy. I did some research and I then found the book Once Upon A Pill: Patient Experiences With Dopamine-enhancing Drugs and Supplements. by Janice Walton-Hadlock.

I was shocked. I have read about 400 pages so far and it concerns me that the Sinemet needs to be reduced at the right speed, not too slow or too fast. If too fast, you risk death (I forget the name of the issue here), and too slow and you risk chronic addiction, according to Janice, as your endogenous dopamine levels rise in response to cutting your meds, and combined with the DED overshoot the "on" zone into the dangerous zone, causing brain damage.

We just met with my mom's neuro who agreed (DED=dopamine enhancing drug):
- DEDs effects can take longer to clear from the brain than from the bloodstream (hence the bloodstream halflife is only so useful)
- DED effects can take some unknown amount of weeks to clear from the brain
- DEDs can result in overmedication
- the brain can kick in endogenous dopamine once the DED is cleared from the brain

Where she did not agree is that by cutting to a lower level of DED dosage, and staying there can result in overmedication as the brain starts to create endogenous dopamine.

Maybe I missed something in the book or elsewhere but why would the body's endogenous dopamine creation fine tune itself at a lower usage? Won't you always have overshoots and undershoots?

My problem is that my mother doesn't seem to have ons/offs in direct response to meds. She gets tired right after Sinemet doses (taken breakfast, lunch and dinner) and then has trouble needing to urinate all night that can keep interfere with sleep. Not really any shaking for example.