For anyone interested in pramipexole, I contacted the famous psychiatrist in the US known to use it for treatment-resistant depressed and bipolar patients suffering predominantly from anhedonia. Here’s his answer, which is encouraging, , followed by my original email:
From Jan Fawcett ( email@example.com)
"Charles - Pramipexole is reasonably successful (nothing works all the time) look in my article for the response rates and duration of follow-up. I dose it all at night (as explained in my publication) I have followed patients up to 6 years without a relapse. Stimulants added to MAOI medications (Fawcett 1991) don’t seem as likely to develop tolerance, but it is difficult to get patients off of stimulants without a relapse. Re-read my paper and most of your questions will be answered. There are side effects in some cases. Jan Fawcett"
My original e-mail:
"Hi Dr. Fawcett, I suffer from anhedonia very badly and recently found out about pramipexole (I found your articles and youtube conference). However, I was wondering about two things:
How successful does it seem to be? Meaning, does it help only SOME anhedonics, or nearly all? And if so, do the benefits seem to be long-lasting? (or do many patients eventually develop tolerance to pramipexole?)
Do you recommend dosing it 3 times a day, or 1 time a day? (in some article you say one time, in others you say 3 times a day)
Lastly, I know you also prescribe stimulants to anhedonic patients but from what I’ve read there is definitely a risk of developing tolerance to the effects and therefore a need to constantly increase the dose to maintain the benefits. That said, I invite you to look at the scientific and anecdotal reports of people using nmda antagonists like memantine along their opiate and stimulant use to prevent tolerance. Thank you, Charles"
The article he is referring to is the first article of the two that I linked above in my original post. Here’s another article I found which he wrote which you can also look at (it’s the one that caused me to be unsure about the dosing schedule. In it, you see he starts by giving pramipexole T.I.D (thrice daily) and then later ends up giving it HS (at bedtime/once a day) Here’s the link for that article:
You can also have a look at the youtube webinar in which he describes in some detail successful cases he’s treated with pramipexole. Here’s the link for that one: