Diagnosis of renal failure (eGFR Diagnosis of Intellectual disability, dementia, or other circumstances leading to difficulties to understand the implications of participating in the study and to give informed consent.History of Impulse-control disorder or current ADHD diagnosis.Ongoing involuntary psychiatric treatment.Ongoing substance use disorder (last 12 month).High suicidality assessed by the researcher with medical degree.Ongoing pregnancy, breastfeeding or planning for pregnancy.Patients with bipolar disorder must have a mood-stabilizing drug treatment. Ongoing treatment with at least one antidepressant drug ≥ 4 weeks without major changes in dosage.Symptoms of anhedonia Total-score Symptoms of depression Total-score ≥ 18, measured by Montgomery-Åsberg Depression Rating Scale (MADRS).Diagnosis of unipolar depression bipolar disorder in depressive phase or dysthymia.Condition or diseaseĭepression, Bipolar Depression, Unipolar Dysthymia Anhedonia To understand the neurobiology of anhedonia in depression and to identify treatment predictors, the investigators also do assessments of anhedonia-related neurocircuitry using (f)MRI and blood biomarkers. In this proof-of-concept pilot study the investigators test the anti-anhedonic and antidepressant effects of add-on pramipexole using an "enriched population study design" including only depressed patients with significant anhedonia. Based on its mechanism of action, pramipexole might be efficacious in a subtype of depression characterized by anhedonia and lack of motivation - symptoms linked to dopaminergic hypofunction. Pramipexole, an agonist to the dopamine -receptor 3, is an established treatment of Parkinson's disease. Anhedonia is common in depression and associated with treatment resistance. Anhedonia - the inability to experience pleasure from, or the lack of motivation to carry out, usually enjoyable activities - is an endophenotype within the depression spectrum, with a distinct pathophysiology of dopaminergic mesolimbic projections. The heterogeneity of depression suggests that different neurocircuits and pathophysiological mechanisms are involved. Why Should I Register and Submit Results?.
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