title: Assessing the roles of stimulants/stimulant-like drugs and dopamine-agonists in the treatment of bipolar depression.
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.
authors.affiliation: Department of Psychiatry, University of Milan, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy. bernardo.dellosso@policlinico.mi.it
authors.forename: Bernardo
authors.initials: B
authors.lastname: Dell'Osso
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
authors.forename: Laura
authors.initials: L
authors.lastname: Cremaschi
authors.forename: Gregorio
authors.initials: G
authors.lastname: Spagnolin
authors.forename: A Carlo
authors.initials: AC
authors.lastname: Altamura
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D018491:Dopamine Agonists / Q000627:therapeutic use*; D006801:Humans
chemical_list: D000928:Antidepressive Agents; D000697:Central Nervous System Stimulants; D018491:Dopamine Agonists