Background Several studies suggest that pramipexole, a dopamine agonist approved for the treatment of Parkinson’s disease and restless legs syndrome, may possess antidepressant properties.

Purpose The objective was to assess the off-label prescriptions for pramipexole in a psychiatry unit during 2012.

Results Of 16 patients included, 6 were being treated for recurrent depression and 10 for bipolar depression. The mean age was 55 years. All had suffered treatment-resistant depression for an average of 23 years [3–35 years].

The mean maximum dose of pramipexole used was 1.43 mg/day [0.36–4.06 mg/day].

Three quarters of the patients had a concomitant antidepressant; one quarter only received pramipexole added to a mood stabiliser. Furthermore, 6 patients out of 16 had electroconvulsive therapy.

Patients were hospitalised for a mean of 56 days, for 34 of which they took pramipexole. Clinical mood improvement was observed for 13 patients (81%). At the endpoint, 10 patients were still taking pramipexole with a mean dose of 1.12 mg/day [0.36–2.1 mg/day].

Pramipexole was associated with 5 adverse events: 3 hypomanic states that did not meet hypomania criteria, controlled by a dose reduction, and 2 brief psychotic episodes requiring withdrawal of pramipexole treatment.

In 2012, 1044 patients were hospitalised in the hospital for unipolar or bipolar depression; about 1% were treated with pramipexole.

These results need to be interpreted with caution because of the small number of subjects and the short time of the analysis. Moreover, our sample was heterogeneous because five patients had already been treated with pramipexole before the start of the study.

However, the results are in line with the literature: mood improvements can be attributed to pramipexole combined with an antidepressant or a mood stabiliser, in unipolar or bipolar depression, but adverse maniac effects must be considered.

Conclusions Pramipexole may be a therapeutic option for treatment-resistant depression. The short-term results are positive but require close follow-up and more studies are necessary.

No conflict of interest.