Question

Would you suggest dopamine agonists as a primary treatment of depression? Why or why not?

Answer 1

Dopamine is a neurotransmitter associated with pleasurable activities. Depression is quite often characterized by inability to enjoy pleasurable activities, helplessness, hopelessness, suicidal ideation etc. The bio psychosocial model suggests that in a depressed patient there is abnormality with dopamine release and absorption at the synaptic clefts. However the question is whether dopamine agonist can be used as a primary treatment option. Here one need to consider a lot other factors associated with depression. Firstly consider a case of depressive episode of a patient having bipolar mood disorder . Even in the case of bipolar mood disorder, further subcategories of rapid cycle as well as episode of overlapping depression and manic cycle can exist. Mania being mood disorder characterized with elated mood, euphoria etc , use of dopamine agonist can play havoc to the existing condition. Other major consideration is whether depression is severe with psychotic episode. If the patient is on say lithium or any other anti psychotic medication, effect of dopamine agonist may not be desirable in all the cases. Considering the case of dysthymia, or recurrent depression , if the patient has maladaptive /self defeating negative automatic thoughts or he /she is in an environment where access to pleasurable activities are not available (criminal neighborhood,, subjected to continued harassment etc ) without providing solution to those problems or necessary psychotherapy, dopamine agonist intervention may not be fruitful. But for patients whose depressive episode is purely associated with unexplainable mood changes (biological) or that due to seasonal affective disorder, use of dopamine agonist as primary treatment might yield results. Use of dopamine agonist for depression as a result of other medical conditions or Comorbid with other medical conditions or other mental health problems should be subjected to considerations of the existing condition. Hence rather than using dopamine agonist as an umbrella treatment option for depression, it should be considered in a case wise manner.