Pramipexole augmentation in treatment-resistant major depressive disorder

Abstract

Evaluation of: Cusin C, Iovieno N, Iosifescu DV et al. A randomized, double-blind, placebo-controlled trial of pramipexole augmentation in treatment-resistant major depressive disorder. J. Clin. Psychiatry 74(7), e636–e641 (2013).

To overcome limited efficacy in antidepressants, clinicians may choose augmentation, switching to a different antidepressant, or a combination of different antidepressant drugs based on the individual patient’s clinical circumstances. Among such options for difficult-to-treat major depressive disorder (MDD) patients, augmentation therapy with atypical antipsychotics, psychostimulants, dopamine agonists, serotonin 1A partial agonists, lithium, and thyroid hormones are commonly used in clinical practice. In fact, augmentation therapy has some clinical merits and is more convenient than switching medications and combination approaches for treating MDD. One such augmentation agent, pramipexole has been proposed, and has been implicated in the development and treatment of MDD. Recently, randomized controlled trials with pramipexole augmentation have been conducted and have demonstrated that pramipexole is a safe and potentially efficacious augmentation strategy. This article will discuss currently available clinical trial data and the potential role of pramipexole in MDD treatment, including clinical significance, limitations, and future research directions.

Keywords::

• augmentation
• clinical trial
• depression
• efficacy
• pramipexole

Financial & competing interests disclosure

This study was supported by a grant of the Korean Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (A120004). The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Cusin and colleagues have found that the use of pramipexole augmentation (PA) was significantly associated with improvement of depressive symptoms, compared with placebo augmentation.

• In addition, PA was beneficial for controlling sexual dysfunction caused by antidepressant treatment.

• Currently available pooled-data suggest that pramipexole should be more beneficial in treatment of bipolar depression than unipolar depression, although available data was quite limited, which should be better determined with more clinical trial data.

• Advanced clinical trials in methodological aspects will be needed to achieve better understanding about the exact role of PA in the treatment of major depressive disorder due to relative lack of clinical trial data till today.