Current Psychiatry Reports

, 15:378

Assessing the Roles of Stimulants/Stimulant-like Drugs and Dopamine-agonists in the Treatment of Bipolar Depression

  • Bernardo Dell’Osso
  • Terence A. Ketter
  • Laura Cremaschi
  • Gregorio Spagnolin
  • A. Carlo Altamura
Mood Disorders (SM Strakowski, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Mood Disorders


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.


Bipolar depression Stimulants Dopamine agonists Pramipexole Methylphenidate Modafinil Armodafinil Mood disorders Psychiatry 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Bernardo Dell’Osso
    • 1
  • Terence A. Ketter
    • 2
  • Laura Cremaschi
    • 1
  • Gregorio Spagnolin
    • 1
  • A. Carlo Altamura
    • 1
  1. 1.Department of PsychiatryUniversity of Milan, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA

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