Dopamine Agonists for Bipolar Depression

(Posted 4/2008)

Based on the data below, at this point this seems an option worth considering only when relatively desperate.

Published studies as of 4/2008 (not an exhaustive search; just used PUB MED and Google):

Lead Author Agent Design aver­age final dose Results Bad stuff
Aiken pramip­exole (Mira­pex) Review of uncon­trolled trials 1.6 mg evi­dence of benefit Minor: Nausea, headache, sleepiness
Weight: no effect
Risk of psychosis
Risk of patho­logic gambling
Risk of inducing mania? sugges­tive cases
Zarate prami­pexole Random­ized trial 60% respon­ded,
versus 9% on placebo
One patient devel­oped hypo­mania —
versus two on placebo
Goldberg prami­pexole Random­ized trial 1.7 mg 67% respon­ded,
versus 20% on placebo
One patient devel­oped hypo­mania
(none on placebo)
Clinical­Trials.gov identifier: NCT­00314821
ropin­irole Random­ized trial Presum­ably nega­tive?
not pub­lished, com­pleted in 2006, not in GSK registry

The first few times I tried these medications, side effects far outweighed the benefits, so I’ve backed off, waiting for further data or others’ experience. Several case reports of mania on pramipexole has been published; here’s one. (Even good old aripiprazole has been associated with pathologic gambling just recently! Gaboriau )