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Review
. 2023 Apr 19;13(4):1043.
doi: 10.3390/life13041043.

Pramipexole Augmentation for Treatment-Resistant Unipolar and Bipolar Depression in the Real World: A Systematic Review and Meta-Analysis

Antonio Tundo  1 , Sophia Betro'  1 , Rocco de Filippis  1 , Fulvia Marchetti  1 , Daniele Nacca  1 , Roberta Necci  1 , Marica Iommi  2
Affiliations
Review

Pramipexole Augmentation for Treatment-Resistant Unipolar and Bipolar Depression in the Real World: A Systematic Review and Meta-Analysis

Antonio Tundo et al. Life (Basel). .

Abstract

Background: Pramipexole is a dopamine full agonist approved for the treatment of Parkinson's disease and restless legs syndrome. Its high affinity for the D3 receptor and neuroprotective, antioxidant, and anti-inflammatory activity provides a rationale for the treatment of depression. In this paper, we review studies on the effectiveness and safety of antidepressant pramipexole augmentation in treatment-resistant depression.

Methods: This comprehensive systematic review and meta-analysis of observational studies on pramipexole-antidepressant augmentation included patients with resistant unipolar and bipolar depression. The primary outcome measure was the treatment response, measured at the study endpoint.

Results: We identified 8 studies including 281 patients overall, 57% women and 39.5% with bipolar disorder and 60.5% with major depressive disorder. The mean follow-up duration was 27.3 weeks (range 8-69). The pooled estimate of treatment response was 62.5%, without significant differences between unipolar and bipolar depression. Safety was good, with nausea and somnolence the most frequent side effects.

Conclusions: The findings of this systematic review, needing further confirmation, show that off-label use of pramipexole as augmentation of antidepressant treatment could be a useful and safe strategy for unipolar and bipolar treatment-resistant depression.

Keywords: bipolar depression; dopamine agonists; pramipexole; systematic review; treatment resistant depression; unipolar depression.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the selected studies.
Figure 2
Figure 2
Forest plot with the total pooled estimates of treatment response and by diagnosis. Cassano et al., 2004 [80]; Fawcett et al., 2016 [85]; Hori et al., 2012 [49]; Inoue et al., 2010 [81]; Lattanzi et al., 2002 [82]; Perugi et al., 2001 [83]; Sporn et al., 2000 [84]; Tundo et al., 2022 [86].
Figure 3
Figure 3
Forest plot showing the total pooled estimates of remission and by diagnosis. Cassano et al., 2004 [80]; Fawcett et al., 2016 [85]; Hori et al., 2012 [49]; Inoue et al., 2010 [81]; Perugi et al., 2001 [83]; Tundo et al., 2022 [86].
See this image and copyright information in PMC

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