A naturalistic retrospective chart review of all patients given pramipexole for bipolar depression in addition to their mood stabilizers was undertaken. Sixteen patients were followed for an average of 6.7 +/- SD 9.0 months. Half of the patients stopped the pramipexole an average of 2 months after starting it. For all patients, depressed mood, and the total profile of depressive symptoms improved significantly within 4 weeks and remained significantly improved for as long as 36 weeks. Both global function (GAF), and global impression (CGI) improved with pramipexole. Irritability and insomnia both increased slightly initially, and then subsided. There were no changes in mania ratings for up to 36 months. Long-term outcome of adjunctive pramipexole appears to be adequate, with apparent maintenance of effect for over 9 months.