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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. [ABSTRACT FROM AUTHOR]

Six in ten patients with obsessive-compulsive disorder (OCD) do not respond to the first-line treatments with serotonin reuptake inhibitor (SRI) or cognitive behavioural therapy including exposure and response prevention (CBT/ERP), and several do not respond to second-line treatments, i.e., SRI-second generation antipsychotic (SGA) or SRI-CBT/ERP augmentation. Evidence on third-line treatments is inconsistent. We investigated the 1-year response to SRI-CBT/ERP-SGA combination in patients with severe treatment-resistant OCD, who failed to respond to SRI and to SRI-SGA or SRI-CBT/ERP augmentation. Twenty-eight patients were consecutively recruited and treated with SRI (drug(s) and doses previously administered), SGA (risperidone median dosage 1 mg/day in 14 cases, aripiprazole median dosage 3 mg/day in 14 cases) and CBT/ERP (median hours 32.5). Exclusion criteria: mental retardation and organic brain syndrome. The mean Y-BOCS total score reduction at 12 months was 28.2%, 60.7% of patients improved, 46.4% partially responded, 32.1% responded, and 28.6% remitted. Patients previously resistant to SRI-SGA and SRI-CBT/ERP did not significantly differ in the rates of improvement, partial response, response and remission. This study suggests that SRI-SGA-CBT/ERP combination could be useful for severe treatment-resistant OCD. Small sample size is a limitation. Up to 6 in 10 patients with OCD do not respond to first line treatments (CBT/ERP or SRIs) and several to second-line treatments (SRI-SGA or SRI CBT/ERP augmentation). In our study, patients with OCD resistant to the first and the second line treatment improved (61%), partially responded (46%), responded (32%), or remitted (29%) combining SRI, SGA and CBT/ERP. In our patients the SRI-SGA-CBT/ERP augmentation improved working/school, social and family impairment. SRI-SGA-CBT/ERP augmentation is easier to use than other treatments for severe treatment-resistant OCD. [ABSTRACT FROM AUTHOR]

Objective: The co-occurrence of obsessive-compulsive disorder (OCD) in patients with schizophrenia (SCH) or schizo-affective disorder (SAD) is frequent and disabling. Data on the effectiveness of serotonin reuptake inhibitors in patients with SCH or SAD and OCD comorbidity are limited and controversial, and to date no study exploring the effectiveness of cognitive-behavioral therapy (CBT) for patients with this comorbid condition has been conducted. The purposes of this open naturalistic study were to examine the adherence to, and the effectiveness of CBT for OCD in patients with stabilized SCH or SAD. Method: Twenty-one consecutive patients with SCH or SAD and OCD comorbidity were enrolled. CBT for OCD was conducted in a naturalistic setting. Primary outcomes were: adherence rate (percentage of patients who did not drop out during the trial), and the OCD remission rate, (Y-BOCS total score < 16). Secondary outcomes were OCD response (a decrease ≥ 25% in the total Y-BOCS score from baseline to 1 year), and improvement (CGI-I score of ≤ 2). An intent-to-treat analysis was conducted. Results: Five patients (23%) dropped out from the study. At one year, 52% (11/21) of the patients were rated as much or very much improved; 33% (7/21) were responders, and 19% (4/21) were remitters. Conclusions: Our findings showed good CBT adherence for SCH/SA patients with OCD comorbidity, and suggest that CBT may be a helpful treatment strategy for OCD in these difficult-to-treat patients. [ABSTRACT FROM AUTHOR]

No abstract available Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

No abstract available Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

No abstract available Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]