title: Psychostimulants in moderate to severe affective disorder: a systematic review of randomized controlled trials.
abstract: BACKGROUND
  Despite antidepressant therapy of appropriate trial duration and dose optimization, 50-60% of depressed patients have an adequate treatment response, whereas only 35-40% achieve remission. Psychostimulants have been suggested as potential candidates to promote acceleration of response and to alleviate residual symptoms of depression.
  
  
  OBJECTIVE
  In this review results from randomized clinical trials (RCTs) exploring the efficacy of psychostimulants in the treatment of major depressive disorder (MDD) were analyzed to clarify the current empirically founded evidence for clinical approaches involving psychostimulants.
  
  
  METHODS
  Literature research via PubMed retrieved 846 articles. 18 RCTs reporting on the use of psychostimulants in the treatment of adult patient populations, suffering from moderate-severe depression and having no other concomitant medical illnesses, were included in this review. 14 articles provided results for unipolar depression, two for bipolar depression, whereas two articles presented mixed samples of unipolar and bipolar patients.
  
  
  RESULTS
  Five different psychostimulants were evaluated: modafinil, methylphenidate, dexamphetamine, methylamphetamine and pemoline. Two studies examining modafinil demonstrated significant ameliorating characteristics pertaining to symptoms of depression. No clear evidence for the effectiveness of traditional psychostimulants in the therapeutic management of MDD was found. In general the quality of included trials was poor since the majority was of short-term duration, comprising relatively small sample sizes and some, especially older studies, were methodologically flawed.
  
  
  CONCLUSIONS
  Clearly larger well designed placebo-controlled studies with longer follow-up accompanied by evaluations of tolerance/dependence are warranted before psychostimulants can be recommended in routine clinical practice for the treatment of MDD.
authors.affiliation: University of Copenhagen , Blegdamsvej 3, DK-2200 Copenhagen , Denmark.
authors.forename: Leda
authors.initials: L
authors.lastname: Abbasowa
authors.forename: Lars V
authors.initials: LV
authors.lastname: Kessing
authors.forename: Maj
authors.initials: M
authors.lastname: Vinberg
mesh_terms: D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012107:Research Design
chemical_list: D000697:Central Nervous System Stimulants