title: Addition of a dopamine agonist, cabergoline, to a serotonin-noradrenalin reuptake inhibitor, milnacipran as a therapeutic option in the treatment of refractory depression: two case reports.
abstract: We illustrate 2 patients with depression who attained dramatic improvement of energy loss and fatigue when treated with cabergoline, a dopamine agonist, and milnacipran, a serotonin-noradrenalin reuptake inhibitor. Although the biologic basis of energy, motivation, and fatigue in association with depression remains unknown, some reports suggest that the decrease of noradrenalin and dopamine in the brain are particularly related to these symptoms. Therefore, treatment strategy that enhances these two monoamine neurotransmissions may be appropriate for getting a boost in energy and eliminating fatigue in patients with depression. These cases suggest that further studies are warranted to confirm the potential benefit of this strategy in the treatment of patients with depression who failed to attain complete remission due to residual symptoms including energy loss and fatigue refractory to previous treatments.
authors.affiliation: Department of Neuro-Psychiatry, Akita University School of Medicine, 1-1-1 Hondo, Akita, Japan. hito_takahashi@hotmail.com
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Takahashi
authors.forename: Keizo
authors.initials: K
authors.lastname: Yoshida
authors.forename: Hisashi
authors.initials: H
authors.lastname: Higuchi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Shimizu
authors.forename: Takeshi
authors.initials: T
authors.lastname: Inoue
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Koyama
mesh_terms: D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use; D000328:Adult; D000077465:Cabergoline; D003521:Cyclopropanes / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D018491:Dopamine Agonists / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D004873:Ergolines / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use
chemical_list: D018759:Adrenergic Uptake Inhibitors; D000077465:Cabergoline; D003521:Cyclopropanes; D018491:Dopamine Agonists; D004873:Ergolines; D000078764:Milnacipran; D017367:Selective Serotonin Reuptake Inhibitors