Pergolide: an antidepressant adjuvant for mood disorders?

Pergolide, a dopamine (DA) agonist, can be a useful adjunct to antidepressant pharmacotherapy, both with tricyclic antidepressants and with monoamine oxidase inhibitors (MAOIs). Pergolide improved or very much improved (as measured by the Clinical Global Impressions Global Improvement Scale) 11 of 20 previously refractory unipolar and bipolar patients. Patients typically described an improvement in their mood, interest, and energy within a week. The range of effective dosage is from 0.25 mg to 2 mg, typically 0.5 mg to 1 mg. Pergolide does not work alone. There must be a concomitant antidepressant, either MAOI or non-MAOI type. Nausea and vomiting are sometimes treatment-limiting side effects. Hypomania is a risk but is quickly and permanently reversible by lowering the pergolide dose. The treatment implication for the future is that potent DA agonists such as pergolide may have a role as antidepressant adjuvants. This possibility is in contrast to the negative impressions of weaker DA agonists used alone.