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) 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 )

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