Are psychostimulants a treatment option in mania?
Mania and attention-deficit hyperactivity disorder (ADHD) show a high degree of symptom overlap and comorbidity. Clinical trials and case reports indicate that psychostimulants do not or only rarely trigger or aggravate manic episodes but can even produce rapid and pronounced antimanic effects. An explanatory model is presented here in which the sensation seeking, hyperactive behaviour observed in mania and ADHD is interpreted as an autoregulatory attempt to stabilize vigilance by increasing external stimulation. Accordingly, patients with both mania and ADHD show rapid declines to lower vigilance levels (e.g., sleep spindles in EEG) under resting conditions with low external stimulation. The "paradoxical" antimanic effect of psychostimulants possibly results from their vigilance stabilizing properties.
Hegerl
U
U
Department of Psychiatry, University of Leipzig, Leipzig, Germany. Ulrich.Hegerl@medizin.uni-leipzig.de
Sander
C
C
Olbrich
S
S
Schoenknecht
P
P
D000818:Animals; D001288:Attention / Q000187:drug effects / Q000502:physiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000503:physiopathology; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000503:physiopathology; D001921:Brain / Q000187:drug effects / Q000503:physiopathology; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008959:Models, Neurological
D000697:Central Nervous System Stimulants