Dionys V, Sienaert P
Tijdschr Psychiatr. 2021;63(9):658-664.
Bipolar depression is a common clinical problem and forms a major challenge in clinical practice as there is a paucity of treatment options.
To review the evidence for pramipexole as a treatment option in treatment-resistant bipolar depression.
A PubMed search was performed using the search terms bipolar disorder or mood disorder or depressive disorder, treatment resistant and pramipexole or dopamine agonist. There were no limits on publication year. Furthermore, we contacted authors of included articles to help develop clinical recommendations for the use of pramipexole in bipolar depression.
Our results consist of 4 meta-analyses which are also systematic reviews. 2 RCTs, 1 open label trial, 2 naturalistic studies; 2 retrospective studies. The first RCT showed a significantly higher response compared to placebo (67% vs 20%), but not for remission (20% vs. 16%). A second RCT reported higher response and remission results with pramipexole compared to placebo (60% vs. 9%, 40% vs. 9%). Pramipexole was generally well tolerated.
The use of pramipexole in treatment resistant bipolar depression appears promising, but remains understudied. There is a need for randomized controlled trials.
双相抑郁是常见的临床问题，由于治疗选择有限，在临床实践中构成了重大挑战。
综述普拉克索作为难治性双相抑郁治疗选择的证据。
使用检索词双相情感障碍或心境障碍或抑郁障碍、难治性以及普拉克索或多巴胺激动剂在PubMed进行检索。对发表年份无限制。此外，我们联系了纳入文章的作者，以协助制定普拉克索用于双相抑郁的临床建议。
我们的结果包括4项荟萃分析，这些分析也是系统评价。2项随机对照试验、1项开放标签试验、2项观察性研究、2项回顾性研究。第一项随机对照试验显示，与安慰剂相比，反应率显著更高（67%对20%），但缓解率无差异（20%对16%）。第二项随机对照试验报告，与安慰剂相比，普拉克索的反应率和缓解率更高（60%对9%，40%对9%）。普拉克索总体耐受性良好。
普拉克索用于难治性双相抑郁似乎有前景，但仍研究不足。需要进行随机对照试验。
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