Adjunctive dopamine agonists in treatment-resistant bipolar II depression:an open case series

Objective: Previous studies and case observations have suggested that dopam ine agonists (DAAs) such as pramipexole (PPX) and ropinirole (RPN) might be effective for major depression, but their adjunctive use in treatment-resi stant bipolar II depression has not yet been specifically addressed. Method : A chart review was conducted on 18 patients with a DSM-III-R bipolar NOS (Bipolar II) major depressive episode who were admitted to the day-hospital of the Department of Psychiatry at the University of Pisa. DAAs were added to ongoing treatments with conventional antidepressants and mood stabilize rs to which patients had no responded after a period of at least 8 weeks. C linical state and adverse effects were assessed at each visit. Final improv ement in CGI scores of 1 or 2 were considered as responders. Results: Mean DAA trial duration was 17.6 (sd = 7.8, range 4-34) weeks, with a mean final dose of 1.23 +/- 0.32 mg/day (range, 0.75-1.50 mg/day) for PPX, and 2.97 /- 0.99 mg/day (range, 1.50-5.00 mg/day) for RPN. DAAs were well tolerated and did not show any negative interaction with concomitant psychotropic med ications. Only one patient became worse (final CGI = 5), and had to interru pt PPX due to nausea, increased agitation and irritability. Eight patients (44.4%) were considered responders (4 with PPX and 4 with RPN): 5 showed ma rked improvement (CGI = 1), and 3 showed moderate improvement (CGI = 2); an other 5 (27.8%) manifested a transient response not sustained up to the end . The initial and final scores of CGI severity scale for all patients (resp onders and non-responders combined) were, respectively, 5.33 +/- 0.7 and 3. 94 +/- 1.3 (mean +/- S.D). The mean change according to the CGI severity sc ale was statistically significant (t = 4.74. p < 0.0002). Conclusion: From the results, PPX and RPN appear to be well tolerated and potentially useful in the adjunctive treatment of drug-resistant bipolar II depression.