Journal Digest

A case series published in the February issue of the American Journal of Psychiatry found that pramipexole—a selective D3 receptor agonist approved for the treatment of Parkinson’s disease and restless legs syndrome—may be an effective adjunctive therapy for treatment-resistant depression.

Researchers in the Department of Psychiatry at the University of New Mexico School of Medicine administered pramipexole (0.25 mg/day to 5.0 mg/day) to 42 patients aged 25 to 84 with treatment-resistant depression for two weeks to 60 months. All patients took pramipexole while maintaining their treatment regimen for depression.

Overall, 76 percent of the patients showed a meaningful clinical response (achieving remission or a reduction of symptoms), which persisted over a 16-month follow-up period, while 24 percent were intolerant or nonresponsive to pramipexole. Effective pramipexole dosages ranged from 0.75 mg/day to 5.0 mg/day, with a mean effective dosage of pramipexole in responders and remitters of 2.46 mg/day. Intolerance was encountered early, often at a low dosage and usually due to nausea.

The authors wrote that although the case series was not a planned study, with patients being managed and evaluated clinically without rating scales or structured interviews, the results “support the notion that pramipexole—and potentially other dopamine agonists—are of value for patients in a treatment-resistant depressive episode. Appropriate precautions, careful patient monitoring, and gradual dosage escalation are advised.”

Pramipexole has not been approved by the Food and Drug Administration for the treatment of depression.

In contrast to stereotypes that American Indians have elevated rates of alcohol consumption, a study by researchers from the University of Arizona has found American Indians have lower or comparable rates of drinking to whites.

The researchers analyzed data from more than 4,000 American Indians and 170,000 whites who participated in the National Survey on Drug Use and Health (NSDUH) between 2009 and 2013.

According to study results from NSDUH, approximately 17 percent of both American Indians and whites were defined as binge drinkers (having five or more drinks per day ranging from one to four days in a month), and about 8 percent of both groups were considered to be heavy drinkers (having five or more drinks per day during more than five days per month). In addition, approximately 60 percent of American Indians surveyed reported no alcohol use compared with 43 percent of whites. Complementary alcohol abstinence, light/moderate drinking, and excessive drinking analyses were conducted using Behavioral Risk Factor Surveillance System data from 2011 to 2013; the findings corroborated those from NSDUH.

“Of course, debunking a stereotype doesn’t mean that alcohol problems don’t exist. All major U.S. racial and ethnic groups face problems due to alcohol abuse, and alcohol use can vary with geographic location, age, and gender,” lead author James Cunningham, Ph.D., said in a press statement. “But falsely stereotyping a group regarding alcohol can have its own unique consequences,” which could include a decreased willingness by patients within the group to discuss alcohol-related problems with their doctors due to fear of embarrassment.

An increasing rate of weight loss from midlife to late life may be a marker for mild cognitive impairment (MCI), according to a report published February 1 in JAMA Neurology.

Researchers from the Mayo Clinic tracked the cognitive health of 1,895 “cognitively normal” participants 70 and older every 15 months for an average of 4.4 years. Height and weight were measured at each evaluation, and the maximum weight and height in midlife (mean age, 58.6 years) was obtained from patient medical records.

Over the 4.4 years, 524 participants developed MCI. The mean rate of weight change per decade from midlife to study entry was greater for participants who developed MCI versus those who remained cognitively normal. A greater decline in weight per decade was associated with an increased risk of MCI after adjusting for sex, education, and the presence of apolipoprotein E ε4 allele.

Results from a study published last month in Obstetrics & Gynecology suggests that women taking serotonin-norepinephrine reuptake inhibitors (SNRIs) during the final month of pregnancy may be at an increased risk for excessive bleeding following labor.

The study included information on more than 300,000 pregnancies in British Columbia that took place between 2002 and 2011. Women were categorized according to whether they were exposed to selective-serotonin reuptake inhibitors (SSRIs) or SNRIs in at least 15 of the last 30 days of pregnancy (late pregnancy), exposed to the medications during the last five months of pregnancy but not in the last 30 days (midpregnancy), or no exposure.

Results showed that exposure to SNRIs during the last month of pregnancy was associated with an increased risk for postpartum hemorrhaging (adjusted odds ratio=1.76). However, there was no significant relationship between SSRI use in the final month of pregnancy and postpartum hemorrhage (adjusted odds ratio=1.09). Midpregnancy exposure to SNRIs or SSRIs was not associated with an increased risk for postpartum hemorrhaging. ■