Pramipexole in psychiatry: a systematic review of the literature.
OBJECTIVE
To assess the risks and benefits of pramipexole in psychiatric populations.


METHODS
A PubMed search was performed using the keywords pramipexole and ropinirole, which identified 500 articles.


METHODS
All clinical studies in psychiatric populations were included in the primary review (24 articles). Studies involving other populations were then reviewed to evaluate potential risks and benefits not identified in the psychiatric studies.


METHODS
Effect sizes were calculated from controlled studies. Rates of intolerable side effects and manic switching were estimated by pooled analysis of controlled and uncontrolled studies.


RESULTS
Pramipexole has a large effect size (0.6-1.1) in the treatment of both bipolar and unipolar depression with a low short-term rate of manic switching in bipolar patients (1% mania, 5% hypomania). The pooled discontinuation rate for all reasons was 9%. Pramipexole is neuroprotective and exerts beneficial effects on sleep architecture. Pramipexole is associated with 3 rare but serious side effects: sleep attacks, which have only occurred in Parkinson's disease; compulsive behaviors and pathologic gambling, which have occurred in Parkinson's disease and restless legs syndrome; and psychosis, which has occurred in both psychiatric and neurologic populations.


CONCLUSIONS
Pramipexole is an important therapeutic option for treatment-resistant bipolar and unipolar depression; further studies are warranted to evaluate its safety in psychiatric patients.
Aiken
Chris B
CB
Department of Psychiatry, Wake Forest University School of Medicine, Winston-Salem, NC, USA. christopher.aiken.med.99@aya.yale.edu
D000818:Animals; D000978:Antiparkinson Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D052160:Benzothiazoles / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000139:chemically induced / Q000188:drug therapy*; D003192:Compulsive Behavior / Q000139:chemically induced; D003866:Depressive Disorder / Q000188:drug therapy*; D018491:Dopamine Agonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use*; D004347:Drug Interactions; D004351:Drug Resistance; D006261:Headache / Q000139:chemically induced; D006801:Humans; D009325:Nausea / Q000139:chemically induced; D010300:Parkinson Disease / Q000188:drug therapy; D000077487:Pramipexole; D011605:Psychoses, Substance-Induced / Q000209:etiology; D012893:Sleep Wake Disorders / Q000139:chemically induced
D000978:Antiparkinson Agents; D052160:Benzothiazoles; D018491:Dopamine Agonists; D000077487:Pramipexole