Most psychiatrists have at least heard of pramipexole (Mirapex) by now, and many of us have actually prescribed it. The Journal of Clinical Psychiatry recently published a short and sweet review of its potential uses in psychiatry. The remark- able thing about this review is that the writer has no funding from Boehringer Ingelheim Pharmaceuticals or any other drug company, making it a trustworthy source of information (Aiken CB, J Clin Psychiatry 2007;68:1230-1236).

Pramipexole is FDA approved for Parkinson’s disease and restless leg syn- drome (RLS), but three placebo controlled trials have shown that it can be helpful as monotherapy for major depression or adjunctive treatment for bipolar depression. Pramipexole is a dopamine agonist, most- ly stimulating the D3 receptor in the mesolimbic area of the brain, i.e., the emotional area. It comes in multiple strengths, including 0.125 mg, 0.25 mg, 0.5 mg, 1 mg, and 1.5 mg tablets. If you want to give a try for patients with RLS or affective disorder, start at 0.25 mg QHS, and very gradually (about weekly) increase by 0.25 mg increments. Shoot for 0.25-0.75 mg in RLS, higher for depres- sion (mean dose in the studies was 1.6 mg/day). Common side effects: nausea, headache, sedation. Rare side effects: pathological gambling, psychosis, and sleep attacks. No drug-drug interactions, and it is cleared entirely by the kidneys.