Pramipexole for Treatment Resistant Depression

How to use Pramipexole

• Selective D3 agonist thought to be related to hedonic drive. 
• FDA approved for Parkinson’s disease and restless leg syndrome 
• 5 randomized controlled trials indicating effectiveness in depression as monotherapy or adjunctive therapy and in bipolar disorder as adjunctive therapy with a mood stabilizer 
• Side effects; nausea, hypotension, and fatigue, titrate slowly and give the dose at night 
• Start with 0.125-0.25 mg QHS and rise by 0.25 mg every 5-7 days towards a target dose of 0.75-2 mg QHS 
• Watch for hedonistic homeostatic dysregulation (HDD) including pathological gambling and shopping