Treatment resistant depression in a young female successfully treated with a combination of ketamine and pramipexole – A case report

Treatment resistant depression (TRD) is a term used to define a failure of treatment, despite having two or more adequate trials of antidepressant medication. Our case study focuses on the struggles to achieve sustainable remission in a young adult female and how the condition impacted her overall quality of life. The patient underwent numerous interventions including use of different classes of antidepressant medications, mood stabilizers, therapy, and ECT (electroconvulsive therapy) before she found sustainable improvement with biweekly IV ketamine infusions along with oral pramipexole. Although there are multiple pathways that lead to depression, we hypothesize that this combination may have addressed a state of ‘dopamine deficiency’ in the mesolimbic dopaminergic pathway that led to improvement in the patient's depressive symptoms. In addition, the paper also attempts to rationalize these findings based on a preclinical study done on mice undergoing forced swim tests (FST), that shows the synergistic effects on D2/3 receptors by combining these two drugs.