Pramipexole and Electroconvulsive Therapy in Treatment-Resistant Depression

Background Major depressive disorder (MDD) is a common disease. Despite appropriate antidepressant treatment, approximately one third of patients do not achieve adequate response. In these patients, electroconvulsive therapy (ECT) is a possible option. Nevertheless, some symptoms may persist even after ECT. Method This is a comparative retrospective study assessing the efficacy and safety of pramipexole in the treatment of resistant depression, in combination to ECT or after a partial ECT efficacy. Results We recruited 14 patients with severe MDD. Nine patients received ECT and pramipexole conjointly, the latter being introduced after a mean number of 18 ECT sessions. Five patients received pramipexole after failure of ECT. Montgomery-Asberg Depression Rating Scale and Clinical Global Impression scores all improved significantly after the initiation of pramipexole (jointly with ECT or alone). Moreover, the combination of ECT plus pramipexole was well tolerated. Only 1 patient presented a hypomanic episode, which resolved spontaneously. Conclusions Pramipexole is a therapeutic option for MDD resistant to ECT. It could be used jointly to ECT or after a partial remission with ECT. More studies are needed to precisely describe the optimal combination of sequential use of ECT and pramipexole in treatment-resistant MDD.