Background Bipolar depression is a common clinical problem and forms a major challenge in clinical practice as there is a paucity of treatment options.
Aim To review the evidence for pramipexole as a treatment option in treatment-resistant bipolar depression.
Method A PubMed search was performed using the search terms bipolar disorder or mood disorder or depressive disorder, treatment resistant and pramipexole or dopamine agonist.  There were no limits on publication year.  Furthermore, we contacted authors of included articles to help develop clinical recommendations for the use of pramipexole in bipolar depression.
Results Our results consist of 4 meta-analyses which are also systematic reviews. 2 RCTs, 1 open label trial, 2 naturalistic studies; 2 retrospective studies. The first RCT showed a significantly higher response compared to placebo (67% vs 20%), but not for remission (20% vs. 16%). A second RCT reported higher response and remission results with pramipexole compared to placebo (60% vs. 9%, 40% vs. 9%). Pramipexole was generally well tolerated.
Conclusion The use of pramipexole in treatment resistant bipolar depression appears promising, but remains understudied. There is a need for randomized controlled trials.