Perugi G, Toni C, Ruffolo G, Frare F, Akiskal H
Department of Psychiatry, University of Pisa, Italy.
Pharmacopsychiatry. 2001 Jul;34(4):137-41. doi: 10.1055/s-2001-15872.
Previous studies and case observations have suggested that dopamine agonists (DAAs) such as pramipexole (PPX) and ropinirole (RPN) might be effective for major depression, but their adjunctive use in treatment-resistant bipolar II depression has not yet been specifically addressed.
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 stabilizers to which patients had no responded after a period of at least 8 weeks. Clinical state and adverse effects were assessed at each visit. Final improvement in CGI scores of 1 or 2 were considered as responders.
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, 0.75-1.50mg/day) for PPX, and 2.97+/-0.99mg/day (range, 1.50-5.00mg/day) for RPN. DAAs were well tolerated and did not show any negative interaction with concomitant psychotropic medications. Only one patient became worse (final CGI = 5), and had to interrupt PPX due to nausea, increased agitation and irritability. Eight patients (44.4%) were considered responders (4 with PPX and 4 with RPN): 5 showed marked improvement (CGI = 1), and 3 showed moderate improvement (CGI = 2); another 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 (responders and non-responders combined) were, respectively, 5.33+/-0.7 and 3.94+/-1.3 (mean +/- S.D). The mean change according to the CCI severity scale was statistically significant (t=4.74. p < 0.0002).
From the results, PPX and RPN appear to be well tolerated and potentially useful in the adjunctive treatment of drug-resistant bipolar II depression.
以往的研究和病例观察表明，诸如普拉克索（PPX）和罗匹尼罗（RPN）等多巴胺激动剂（DAA）可能对重度抑郁症有效，但它们在难治性双相II型抑郁症的辅助治疗中的应用尚未得到专门探讨。
对18例被诊断为DSM-III-R双相NOS（双相II型）重度抑郁发作的患者进行了病历回顾，这些患者入住了比萨大学精神病学系的日间医院。在患者使用常规抗抑郁药和心境稳定剂进行至少8周的治疗后仍无反应的情况下，添加DAA。每次就诊时评估临床状态和不良反应。CGI评分最终改善为1或2分的患者被视为有反应者。
DAA试验的平均持续时间为17.6（标准差=7.8，范围4 - 34）周，PPX的平均最终剂量为1.23±0.32毫克/天（范围，0.75 - 1.50毫克/天），RPN的平均最终剂量为2.97±0.99毫克/天（范围，1.50 - 5.00毫克/天）。DAA耐受性良好，与同时使用的精神药物未显示任何负面相互作用。只有一名患者病情恶化（最终CGI = 5），因恶心、激越和易怒加剧而不得不中断PPX治疗。8名患者（44.4%）被视为有反应者（4名使用PPX，4名使用RPN）：5名显示明显改善（CGI = 1），3名显示中度改善（CGI = 2）；另外5名（27.8%）表现出短暂反应但未持续到最后。所有患者（有反应者和无反应者合并）的CGI严重程度量表的初始和最终评分分别为5.33±0.7和3.94±1.3（平均值±标准差）。根据CCI严重程度量表的平均变化具有统计学意义（t = 4.74，p < 0.0002）。
从结果来看，PPX和RPN似乎耐受性良好，在难治性双相II型抑郁症的辅助治疗中可能有用。
