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Stimulants for depression: On the up and up?

journal contribution
posted on 2016-03-01, 00:00 authored by G S Malhi, Y Byrow, D Bassett, P Boyce, M Hopwood, W Lyndon, R Mulder, R Porter, Ajeet SinghAjeet Singh, G Murray
The use of traditional psychostimulants (methylphenidate and dexamphetamine) and stimulant-like drugs (modafinil and armodafinil) for the treatment of depression is a growing concern given the lack of research evidence supporting their effectiveness. The current article describes the role of stimulants in treating depression--specifically their risks and benefits and their potential use alongside antidepressants. Clinically, the rapid amelioration of depressive symptoms with traditional psychostimulants is often dramatic but short-lived, and this suggests that they likely operate via different mechanisms to conventional antidepressants. More importantly, there is little evidence from randomised controlled trials supporting their efficacy in treating depression, although modafinil has been shown to be effective in reducing prominent depressive symptoms, such as fatigue. Research is urgently required to clarify psychostimulants' mechanisms of action and to evaluate their long-term benefits and risks in the treatment of major and bipolar depression. Ultimately, specificity of action needs to be determined to inform the sophisticated clinical use of psychostimulants in the management of depression. Until then they should only be prescribed if absolutely necessary, and even then their prescription should be facilitatory and time limited unless it is for investigational purposes.

History

Journal

Australian & New Zealand journal of psychiatry

Volume

50

Issue

3

Pagination

203 - 207

Publisher

Sage

Location

London, Eng.

ISSN

0004-8674

eISSN

1440-1614

Language

eng

Publication classification

C1 Refereed article in a scholarly journal; C Journal article

Copyright notice

2016, Royal Australian and New Zealand College of Psychiatrists