Assessing the Roles of Stimulants/Stimulant-like Drugs and Dopamine-agonists in the Treatment of Bipolar Depression
Mood Disorders (SM Strakowski, Section Editor)
First Online: 24 July 2013 DOI:
Cite this article as: Dell’Osso, B., Ketter, T.A., Cremaschi, L. et al. Curr Psychiatry Rep (2013) 15: 378. doi:10.1007/s11920-013-0378-z Part of the following topical collections: Topical Collection on Mood Disorders Abstract
Bipolar depression is considered the most difficult-to-treat phase of bipolar disorder, in relation to its pervasiveness and efficacy and/or tolerability limitations of available treatments. Indeed, most mood stabilizers and atypical antipsychotics are not as effective in ameliorating depressive compared with manic symptoms, and entail substantial tolerability limitations. However, the use of antidepressants is highly controversial, as their efficacy appears less robust in bipolar compared with unipolar depression. In addition, antidepressants, in spite of generally having adequate somatic tolerability, in BD may be associated with a higher risk of manic/hypomanic switch, suicidality and rapid cycling. Among alternative pharmacological strategies, compounds with stimulant and pro-dopaminergic effects, such as methylphenidate, modafinil, armodafinil and pramipexole, have showed potential antidepressant activity, even though their use in clinical practice has been limited by the paucity of controlled evidence. This article seeks to review available evidence about the use of the aforementioned compounds in the treatment of bipolar depression. Findings from reviewed studies suggested that pro-dopaminergic compounds, such as pramipexole and stimulants/stimulant-like agents, deserve consideration as adjunctive therapies in bipolar depressed patients, at least in some subgroups of patients. Nevertheless, caution regarding their use is recommended as further clinical trials with larger samples and longer follow-up periods are necessary to clarify the roles of these medications in bipolar depression.
Keywords Bipolar depression Stimulants Dopamine agonists Pramipexole Methylphenidate Modafinil Armodafinil Mood disorders Psychiatry
This article is part of the Topical Collection on
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