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Ben, Nancy, and others who commented off-list: Your inquiries are similar enough to justify this 'blanket' response: The question of PD drug choices is a long story of much scientific debate, which I suspect may go on forever. Even if I were qualified to give medical advice, I don't have the time to tell it fairly; but here are a few points that come to mind: -Instead of consensus among authorities, there is more like a spectrum of opinion, with big differences regarding efficacy and adverse risks of any particular drug or combination. -The response of any individual patient to a given drug protocol is different from all the others; magic for one may be a dismal failure for another, and several trials may be needed to find the best fit. -The new agonist Pramipexole (the example cited) is good for CD as well as the common motor symptoms of PD; but I suspect that just about anything which counteracts the loss of dopamine may also help. -Functions of the various neurotransmitters (or their artificial replacements) probably overlap. Serotonin, the usual target of treatment for CD, may affect motor function as well. One extreme in the spectrum of learned opinion is that raising availability of serotonin (by, for example, Prozac) alone may be effective in PD. And the neurotransmitter dopamine, which mediates motor function, certainly has antidepressant qualities as well. -A famous airplane designer coined the slogan: "Simplicate, And Add More Lightness", and that goes for PD therapy too. Every drug, even the "gold standard" Sinemet, has its own set of evil side effects for a few unfortunate users and, IMHO, the fewer I can get away with, the better. I don't like the threat that levodopa (in Sinemet) may hasten the progression of my PD, or cause dyskinesias that could be disabling. But I also don't like having to quit driving because of sudden sleep blackouts from Pramipexole, troubling delusions or hallucinations from Parlodel, or worsening of motor symptoms by any of the antidepressants, and so on. -Just as in any other life decision, the choice of drugs for treating PD involves tradeoff of benefits vs risks. And because the PD patient has more time than any doctor to observe his own reactions, he should participate actively in deciding which course of treatment to follow. Cheers, Joe -- J. R. Bruman (818) 789-3694 3527 Cody Road Sherman Oaks, CA 91403-5013