PsychRounds: The Psychiatry Podcast Pramipexole (Mirapex): Treatment Resistant Depression
Aug 27, 2025
Pramipexole, known for treating Parkinson's, is explored for its unexpected role in treatment-resistant depression. The discussion dives into its mood-enhancing effects and unique mechanisms tied to motivation. Safety concerns arise, particularly regarding side effects like impulse control issues. A revealing study highlights pramipexole's potential as an augmentation therapy for depression, showcasing significant symptom improvement. The conversation also emphasizes the risks and benefits of dopamine agonists, urging safe practices in patient management.
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Dopamine Agonist Mood Signal
- Pramipexole showed early psychiatric signals from Parkinson's patients improving mood, energy, and anhedonia.
- Early randomized and open-label trials suggested meaningful antidepressant effects with moderate effect sizes.
D3 Selectivity Explains Motivation Effects
- Pramipexole is a D2/D3 agonist with strong D3 selectivity linked to motivation and reward.
- Its D3 affinity likely explains its targeting of anhedonia and drive in depression.
Titrate Low And Adjust For Kidneys
- Start pramipexole low (0.25–0.5 mg) and titrate every 3–4 days toward typical study ranges of 2–5 mg daily.
- Adjust dosing for renal impairment and prefer slow titration to reduce side effects.
