Pramipexole Augmentation for Treatment-Resistant Unipolar and Bipolar Depression in the Real World: A Systematic Review and Meta-Analysis

BACKGROUND

Pramipexole is a dopamine full agonist approved for the treatment of Parkinson's disease and restless legs syndrome. Its high affinity for the D3 receptor and neuroprotective, antioxidant, and anti-inflammatory activity provides a rationale for the treatment of depression. In this paper, we review studies on the effectiveness and safety of antidepressant pramipexole augmentation in treatment-resistant depression.

METHODS

This comprehensive systematic review and meta-analysis of observational studies on pramipexole-antidepressant augmentation included patients with resistant unipolar and bipolar depression. The primary outcome measure was the treatment response, measured at the study endpoint.

RESULTS

We identified 8 studies including 281 patients overall, 57% women and 39.5% with bipolar disorder and 60.5% with major depressive disorder. The mean follow-up duration was 27.3 weeks (range 8-69). The pooled estimate of treatment response was 62.5%, without significant differences between unipolar and bipolar depression. Safety was good, with nausea and somnolence the most frequent side effects.

CONCLUSIONS

The findings of this systematic review, needing further confirmation, show that off-label use of pramipexole as augmentation of antidepressant treatment could be a useful and safe strategy for unipolar and bipolar treatment-resistant depression.

The relevance of continuous blood pressure monitoring in examining the relationship of memory efficiency with blood pressure characteristics

The study of the relationship between hypertension and cognitive decline is characterized by various difficulties of realization and, as a consequence, by incongruent results. One of the reasons for these difficulties may be explained by the occasional method of measurement of blood pressure (once a day). This study presents the results obtained in 27 normotensive and mild hypertensive subjects of both sexes (ages between 20 and 77 years) with a continuous blood pressure monitoring for 24 h. A noninvasive sphygmomanometric technique was used employing a portable recorder programmed to take a measure every 30 min. Both objective and subjective measures of memory, measures of attention efficiency, and IQ were correlated to the blood pressure measures. Continuous monitoring data of blood pressure were analyzed according to a model that included a macroscopic descriptive analysis, a microscopic rhythmometric analysis, and a microscopic integrative analyses where the effects of the interaction between level and duration of excess and the time of the day when the excess eventually appeared were considered. Results evidenced no differences in cognitive efficiency between those subjects identified with the traditional occasional measurement of blood pressure as hypertensives of mild severity and the normal subjects. Cognitive efficiency of our subjects was found correlated, independently from the clinical diagnosis, with the time of peak and with the duration of excess of their blood pressure when the results of the analyses on the continuous monitoring of blood pressure were considered.

Chronic obstructive pulmonary disease and associated patterns of memory decline

The relationship between chronic obstructive pulmonary disease (COPD) and cognitive functioning was analyzed in a study with 50 aging patients. A complex pattern of interactions was identified between emotional and cognitive functioning and chronic respiratory disease when the effects of age, sex, type and severity of disease were controlled. These patients did not show any global and diffuse cognitive impairment. Only a portion of COPD patients (about 30%) evidenced memory impairment which was confined to immediate memory. Memory impairment found in these patients did not appear to be associated with those changes present in the aging process but was mainly related to those specific clinical and instrumental parameters which are considered valid indicators of respiratory efficiency. Two types of cognitive and emotional problems were identified. A progressive stage-dependent set of characteristics was associated with the course of the disease and a fluctuating, probably reversible state-dependent set of characteristics was associated with the temporary condition of the patients during the period of examination. Patients who had received more recent medical treatment or who were under protection of vaccination for influenza showed a better cognitive and emotional efficiency.

The Italian version of the Alzheimer's Disease Assessment Scale (ADAS): psychometric and normative characteristics from a normal aged population

The Alzheimer's Disease Assesment Scale (ADAS) was specifically proposed for the clinical assessment of patients suffering from dementia and is used in different countries. The Italian version of ADAS is presented in this paper together with the description of criteria used in transforming the American edition in the Italian edition. Psychometric and normative data are illustrated and discussed. A sample of 95 healthy volunteers of both sexes ranging in age from 50 to 79 years were recruited from the general population in different parts of Italy and from different social and educational levels. Their performance on the ADAS was analysed by sex, age, and educational level. Results indicated a specific influence of subjects' educational level on the Cognitive Subscale Total Score of ADAS and the need for an adequate correction was evidenced. The two objective measures of memory which constitute, together with the Cognitive Subscale Total Score, the cognitive subscale of ADAS were sensitive to both age and educational level, requiring corrections. The factor structure of the cognitive subscale of ADAS confirms the validity of distinguishing between the clinical-functional scores, which are summarized by the Cognitive Subscale Total Score (CSTS), from those of the objective memory tasks, which are kept separate and used to quantify specific memory characteristics. The main components of the CSTS were 3 factors. The first factor was