Michael Browning

Comparative efficacy of antidepressant augmentation with amantadine vs pramipexole in treatment-resistant unipolar depression: A randomised controlled trial Augmentation strategies for treatment-resistant depression (TRD) are limited, with strongest evidence for atypical antipsychotics. Given emerging insi…

Pramipexole vs. quetiapine vs. amantadine in TRD. Interesting open label, short term RCT using a surprisingly low dose (I suspect that the reported dose of 37.5mg of pramipexole is a typo and it should be 0.375mg)
www.sciencedirect.com/science/arti...

Incidence and Nature of Antidepressant Discontinuation Symptoms This systematic review and meta-analysis examines the presence and incidence of discontinuation symptoms in individuals who stop taking antidepressants.

V important meta-analysis doi.org/10.1001/jama...: Discontinuation symptoms 1 week post stopping antidepressants was below the threshold for clinically significant discontinuation syndrome. Later worse mood is likely depression relapse @jfhayes.bsky.social @sameerjauhar.bsky.social.

🎊Recently, colleagues from across the @NIHRresearch Mental Health Translational Research Collaboration (MH-TRC) gathered for a celebration of progress and partnership in mental health research.

➡️ oxfordhealthbrc.nihr.ac.uk/nihr-mental-...

Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis All antidepressants were more efficacious than placebo in adults with major depressive disorder. Smaller differences between active drugs were found when placebo-controlled trials were included in the...

It is generally higher than you see with ssris. This paper reports the odds of dropping out due to intolerance for lots of antidepressants vs placebo (page 154 of appendix). By comparison, the or in our study was 4.4.
www.thelancet.com/article/S014...

Thanks Rick

GRATEFUL to @nihr.bsky.social for funding this work and @oxhealthbrc.bsky.social for support.
Pramipexole is clearly not a first line treatment for depression, but these results demonstrate that it can be a useful option for our most treatment-resistant patients! 6/6

TRANSPARENCY: There are challenges to using pramipexole: 20% stopped pramipexole due to side effects vs 5% placebo. Most common: nausea, headache, dizziness, sleep problems. 5/6

HYPOTHESIS: We targeted dopamine D2/3 receptors with pramipexole instead of the usual serotonergic approach. Dopamine is crucial for reward/pleasure - and anhedonia (can't feel pleasure) is often what persists even after other depression symptoms improve. 4/6

Background: About 30% of our patients don't respond to first-line antidepressants. We recruited people with chronic depression (median 8.5 years) who had tried 3-4 medications without success. These are the patients we struggle to help most. 3/6

FINDINGS: In our randomized controlled trial (n=150), patients receiving pramipexole showed:
• 6.4-point reduction in QIDS scores vs 2.4 for placebo (p<0.0001)
• 44% response rate vs 16% placebo
• 28% remission vs 8% placebo Effect size d=0.87 - this is substantial! 2/6

Pramipexole augmentation for the acute phase of treatment-resistant, unipolar depression: a placebo-controlled, double-blind, randomised trial in the UK In this trial involving participants with treatment-resistant depression, pramipexole augmentation of antidepressant treatment, at a target dose of 2·5 mg, demonstrated a reduction in symptoms relativ...

Our new study published in TheLancetPsych! We found that pramipexole augmentation substantially reduced depressive symptoms in patients with treatment-resistant depression over 48 weeks of treatment. This is an important advance in how we treat depression! 1/6
www.thelancet.com/journals/lan...

Current vacancies

Delighted to announce this position www.northlondonmentalhealth.nhs.uk/current-vaca.... It's part of the Mental Health Mission Mood Disorders Research Clinic Network, aiming to support clinical trials in mood disorders in the UK. Should be very interesting! oxfordhealthbrc.nihr.ac.uk/mhm/mood-dis...

RELMED.ac.uk is now open to recruitment. This @wellcometrust.bsky.social-funded study wellcome.org/research-fun... will ask whether reinforcement learning tasks are differentially sensitive to dopaminergic and serotonergic antidepressants.

It's love Rick.