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Re: mirapex as treatment for depression

Posted by andrewb on August 19, 1999, at 19:30:12

In reply to mirapex as treatment for depression, posted by marjorie on August 19, 1999, at 17:13:19

> Hi,
> I have received advice from a psychiatrist that I should
> perhaps try Mirapex for my depression. I have been on
> many, many different medications and combinations but
> nothing has work (although Nardil did help some). The
> advice was a dopamine agonist. But my HMO will not
> authorize the medication unless I can find case reports
> supporting this use of Mirapex. Does anyone know of such
> reports or where I might find them. The Psychiatrist
> I'm working with asked me to find the studies on the internet
> if I could - but I'm not having any luck. Please help
> if you know anything.

Here is some information on pramipexole, tradename Mirapex, copied from the American Jornal of Psychiatry website (
If you do start using Mirapex, please let us know how it goes. I'm sure others at this site would be very interested in hearing of your experiences with it.
Am J Psychiatry 156:798, May 1999
1999 American Psychiatric Association

Letter to the Editor

Pramipexole in Refractory Bipolar Depression

New York, N.Y., MARK A. FRYE, M.D. and

To the Editor: Pramipexole, a direct dopamine agonist with D3 receptor selectivity, recently approved by the FDA for the treatment of Parkinson's
disease (1), has been reported to be as effective as fluoxetine in the treatment of major depression (unpublished 1997 study by Corrigan and Evans)
and an effective neuroleptic adjunct for the negative symptoms of schizophrenia (2). We report two cases of treatment-resistant bipolar depression
where improvement followed augmentation with pramipexole.

Mr. A, a 50-year-old man with a 23-year history of bipolar I disorder and over 15 hospitalizations, had recurrent dysphoric
manias and major depressions with reversed vegetative signs. There was a remote period of cocaine abuse and a dense family
history of bipolar illness. Past manias had responded poorly to lithium, carbamazepine, and valproate monotherapies or
combinations. Incidents of depression persisted despite regimens of bupropion; however, low doses of sertraline triggered
mania. Depressions previously responded to ECT but resisted a course of 40 bilateral treatments. Mr. A's condition was stable
for over 1 year on a high-dose regimen of lamotrigine and clonazepam, until he was rehospitalized for anergic depression that
was unresponsive to lithium augmentation. Pramipexole was begun at a dose of 0.25 mg/day and increased over 10 days to
0.75 mg/day. Within 1 week, marked improvement was noted in mood and activity. Euthymia was achieved, and Mr. A
remained without side effects at his 8-week follow-up.

Mr. B, a 33-year-old artist with a 15-year history of bipolar I illness and alcohol abuse (in remission), had 14 hospitalizations
for both psychotic depressions and manias. His episodes improved minimally with lithium, carbamazepine, valproate,
verapamil, and gabapentin alone and in combination with adjunctive typical neuroleptics and benzodiazepines. Sertraline,
tricyclics, and one course of ECT were ineffective for his depressions. Nortriptyline and venlafaxine each induced dysphoric
mania and cycling. Bupropion plus lithium and lamotrigine provided substantial improvement until he developed a tolerance
after 2 months.

Olanzapine, topiramate, and lamotrigine controlled mania and cycling until severe depression recurred, with reversed vegetative
signs, prompting a trial of pramipexole. Mr. B was given a 1-mg/day dose of pramipexole; after 6 weeks, a marked
antidepressant response occurred, and the drug was well tolerated except for transient, dose-related nausea. Subsequently, a brief
depressive exacerbation resolved itself without medication changes. Mr. B's functional improvement, with only low-grade
depression and no cycling, continued through his 6-month follow-up.

The greater density of D3 receptors in the mesolimbic areas (3) involved in mood regulation may relate to pramipexole's efficacy in
psychomotor-retarded conditions (i.e., negative symptoms, Parkinson's disease, depression). Controlled studies of pramipexole, in doses of
0.2510.25 mg/day over 48 weeks (2, unpublished 1997 study by Corrigan and Evans), are encouraged to clarify dose-related acute and long-term
efficacy in bipolar depression, possible side effects (e.g., insomnia, fatigue, dyskinesias, orthostatic hypotension, hallucinations), potential
induction of mania/psychosis, and preferential response in atypical versus melancholic depression.


1.Parkinson Study Group: Safety and efficacy of pramipexole in early Parkinson disease: a randomized dose-ranging study. JAMA 1997;
2.Kasper S, Barnas C, Heiden A, Volz HP, Laakmann G, Zeit H, Pfolz H: Pramipexole as adjunct to haloperidol in schizophrenia: safety
and efficacy. Eur Neuropsychopharmacol 1997; 7:6570
3.Levesque D, Diaz J, Pilon C, Martres MP, Giros B, Souil E, Schott D, Morgat JL, Schwartz JC, Sokoloff P: Identification,
characterization, and localization of the dopamine D3 receptor in rat brain using 7-[3H]hydroxy-N,N-di-n-propyl-2-aminotetralin. Proc
Natl Acad Sci USA 1992; 89:81558159




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