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Add-on pramipexole for anhedonic depression : study protocol for a randomised controlled trial and open-label follow-up in Lund, Sweden

Lindahl, Jesper LU ; Asp, Marie LU ; Ståhl, Darya LU ; Tjernberg, Johanna LU ; Eklund, Moa LU ; Björkstrand, Johannes LU ; van Westen, Danielle LU orcid ; Jensen, Jimmy LU ; Månsson, Kristoffer and Tornberg, Åsa LU orcid , et al. (2023) In BMJ Open 13(11).
Abstract

INTRODUCTION: Many depressed patients do not achieve remission with available treatments. Anhedonia is a common residual symptom associated with treatment resistance as well as low function and quality of life. There are currently no specific and effective treatments for anhedonia. Some trials have shown that dopamine agonist pramipexole is efficacious for treating depression, but more data is needed before it could become ready for clinical prime time. Given its mechanism of action, pramipexole might be a useful treatment for a depression subtype characterised by significant anhedonia and lack of motivation-symptoms associated with dopaminergic hypofunction. We recently showed, in an open-label pilot study, that add-on pramipexole is a... (More)

INTRODUCTION: Many depressed patients do not achieve remission with available treatments. Anhedonia is a common residual symptom associated with treatment resistance as well as low function and quality of life. There are currently no specific and effective treatments for anhedonia. Some trials have shown that dopamine agonist pramipexole is efficacious for treating depression, but more data is needed before it could become ready for clinical prime time. Given its mechanism of action, pramipexole might be a useful treatment for a depression subtype characterised by significant anhedonia and lack of motivation-symptoms associated with dopaminergic hypofunction. We recently showed, in an open-label pilot study, that add-on pramipexole is a feasible treatment for depression with significant anhedonia, and that pramipexole increases reward-related activity in the ventral striatum. We will now confirm or refute these preliminary results in a randomised controlled trial (RCT) and an open-label follow-up study.

METHODS AND ANALYSIS: Eighty patients with major depression (bipolar or unipolar) or dysthymia and significant anhedonia according to the Snaith Hamilton Pleasure Scale (SHAPS) are randomised to either add-on pramipexole or placebo for 9 weeks. Change in anhedonia symptoms per the SHAPS is the primary outcome, and secondary outcomes include change in core depressive symptoms, apathy, sleep problems, life quality, anxiety and side effects. Accelerometers are used to assess treatment-associated changes in physical activity and sleep patterns. Blood and brain biomarkers are investigated as treatment predictors and to establish target engagement. After the RCT phase, patients continue with open-label treatment in a 6-month follow-up study aiming to assess long-term efficacy and tolerability of pramipexole.

ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethical Review Authority and the Swedish Medical Products Agency. The study is externally monitored according to Good Clinical Practice guidelines. Results will be disseminated via conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER: NCT05355337 and NCT05825235.

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publishing date
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Contribution to journal
publication status
published
subject
in
BMJ Open
volume
13
issue
11
article number
e076900
pages
9 pages
publisher
BMJ Publishing Group
external identifiers
  • scopus:85178515674
  • pmid:38035737
ISSN
2044-6055
DOI
10.1136/bmjopen-2023-076900
language
English
LU publication?
yes
additional info
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.
id
93bc3bfa-d802-4d80-ae47-5cd0457b2cf3
date added to LUP
2023-12-03 11:12:43
date last changed
2024-04-12 19:58:48
@article{93bc3bfa-d802-4d80-ae47-5cd0457b2cf3,
  abstract     = {{<p>INTRODUCTION: Many depressed patients do not achieve remission with available treatments. Anhedonia is a common residual symptom associated with treatment resistance as well as low function and quality of life. There are currently no specific and effective treatments for anhedonia. Some trials have shown that dopamine agonist pramipexole is efficacious for treating depression, but more data is needed before it could become ready for clinical prime time. Given its mechanism of action, pramipexole might be a useful treatment for a depression subtype characterised by significant anhedonia and lack of motivation-symptoms associated with dopaminergic hypofunction. We recently showed, in an open-label pilot study, that add-on pramipexole is a feasible treatment for depression with significant anhedonia, and that pramipexole increases reward-related activity in the ventral striatum. We will now confirm or refute these preliminary results in a randomised controlled trial (RCT) and an open-label follow-up study.</p><p>METHODS AND ANALYSIS: Eighty patients with major depression (bipolar or unipolar) or dysthymia and significant anhedonia according to the Snaith Hamilton Pleasure Scale (SHAPS) are randomised to either add-on pramipexole or placebo for 9 weeks. Change in anhedonia symptoms per the SHAPS is the primary outcome, and secondary outcomes include change in core depressive symptoms, apathy, sleep problems, life quality, anxiety and side effects. Accelerometers are used to assess treatment-associated changes in physical activity and sleep patterns. Blood and brain biomarkers are investigated as treatment predictors and to establish target engagement. After the RCT phase, patients continue with open-label treatment in a 6-month follow-up study aiming to assess long-term efficacy and tolerability of pramipexole.</p><p>ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethical Review Authority and the Swedish Medical Products Agency. The study is externally monitored according to Good Clinical Practice guidelines. Results will be disseminated via conference presentations and peer-reviewed publications.</p><p>TRIAL REGISTRATION NUMBER: NCT05355337 and NCT05825235.</p>}},
  author       = {{Lindahl, Jesper and Asp, Marie and Ståhl, Darya and Tjernberg, Johanna and Eklund, Moa and Björkstrand, Johannes and van Westen, Danielle and Jensen, Jimmy and Månsson, Kristoffer and Tornberg, Åsa and Svensson, Martina and Deierborg, Tomas and Ventorp, Filip and Lindqvist, Daniel}},
  issn         = {{2044-6055}},
  language     = {{eng}},
  month        = {{11}},
  number       = {{11}},
  publisher    = {{BMJ Publishing Group}},
  series       = {{BMJ Open}},
  title        = {{Add-on pramipexole for anhedonic depression : study protocol for a randomised controlled trial and open-label follow-up in Lund, Sweden}},
  url          = {{http://dx.doi.org/10.1136/bmjopen-2023-076900}},
  doi          = {{10.1136/bmjopen-2023-076900}},
  volume       = {{13}},
  year         = {{2023}},
}