4 replies to this topic

[medievil]

Combining a dopamine agonist and selective serotonin reuptake inhibitor for the treatment of depression: A double-blind, randomized pilot study.

Franco-Chaves JA, Mateus CF, Luckenbaugh DA, Martinez PE, Mallinger AG, Zarate CA Jr.

Source

Experimental Therapeutics and Pathophysiology Branch, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA.

Abstract


BACKGROUND:

Antidepressants that act on two or more amine neurotransmitters may confer higher remission rates when first-line agents affecting a single neurotransmitter have failed. Pramipexole, a dopamine agonist, has antidepressant effects in patients with major depressive disorder (MDD). This pilot study examined the efficacy and safety of combination therapy with pramipexole and the selective serotonin reuptake inhibitor (SSRI) escitalopram in MDD.
METHODS:

In this double-blind, controlled, pilot study, 39 patients with DSM-IV MDD who had failed to respond to a standard antidepressant treatment trial were randomized to receive pramipexole (n=13), escitalopram (n=13), or their combination (n=13) for six weeks. Pramipexole was started at 0.375mg/day and titrated weekly up to 2.25mg/day; escitalopram dosage remained at 10mg/day. The primary outcome measure was the Montgomery-Asberg Depression Rating Scale (MADRS).
RESULTS:

Subjects receiving pramipexole monotherapy had significantly lower MADRS scores than the combination group (p=0.01); no other primary drug comparisons were significant. The combination group had a substantially higher dropout rate than the escitalopram and pramipexolegroups (69%, 15%, 15%, respectively). Only 15% of patients in the combination group tolerated regularly scheduled increases of pramipexolethroughout the study, compared with 46% of patients in the pramipexole group.
LIMITATIONS:

Group size was small and the treatment phase lasted for only six weeks.
CONCLUSIONS:

The combination of an SSRI and a dopamine agonist was not more effective than either agent alone, nor did it produce a more rapid onset of antidepressant action. Combination therapy with escitalopram and pramipexole may not be well-tolerated.

[BioFreak]

Too bad they used a dopamine agonist that uses d2/3 receptors only (wikipedia). So all this study says that its not worthwhile with a partial dopamine agonist.

I wish they had done this with some dopamine agonist that targets all dopamine receptors and is as strong on them as dopamine or stronger.

Thanks for posting it.

[medievil]

Yeah rotigotine should be studied more, especially for anhedonia and ADHD too.

Rotigotine wich im testing also targets D4.

On its own prami has terrific potential, i suspect that combined supression of phasic sero and DA counteracts the benefits.

Trivastal was effective for my anhedonia as a aside.

[BioFreak]

Or better yet, a DRI (so all dopamine receptors get activated in a natural fashion because its dopamine activating them, just as serotonin activating serotonin receptors in a natural fashion, unlike serotonin agonists) as strong as the SSRI given so the respective neurotransmitters raise linear at the same rate. But I guess thats not easy to control/observe (increasing dopamine in the same amount as increasing serotonin) so there will always be some question marks left.
Still, it would be interesting.

[medievil]

I personally combine lexapro with desoxy and MDPV i find them more therapeutic then releasing agents wich is very interesting, MDPV for me with desoxy isnt addictive psychosis powder as most people, they are most dopaminergic wich prob explains why i like them that much.

Im experimenting with roti on top, alltogheter got hypomanic for 5 min but phenytoin took care of that.