title: Stimulants for depression: On the up and up?
abstract: 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.
authors.affiliation: Discipline of Psychiatry, Kolling Institute of Medical Research, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia gin.malhi@sydney.edu.au.
authors.forename: Gin S
authors.initials: GS
authors.lastname: Malhi
authors.affiliation: CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, St Leonards, NSW, Australia.
authors.forename: Yulisha
authors.initials: Y
authors.lastname: Byrow
authors.affiliation: School of Medicine, Fremantle, University of Notre Dame Australia, Fremantle, WA, Australia School of Psychiatry and Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.
authors.forename: Darryl
authors.initials: D
authors.lastname: Bassett
authors.affiliation: Discipline of Psychiatry, Sydney Medical School and Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Philip
authors.initials: P
authors.lastname: Boyce
authors.affiliation: Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Hopwood
authors.affiliation: Sydney Medical School, The University of Sydney, Sydney, NSW, Australia Mood Disorders Unit, Northside Clinic, Greenwich, NSW, Australia Director ECT Services Northside Group Hospitals, Greenwich, NSW, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Lyndon
authors.affiliation: Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand.
authors.forename: Roger
authors.initials: R
authors.lastname: Mulder
authors.affiliation: Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand.
authors.forename: Richard
authors.initials: R
authors.lastname: Porter
authors.affiliation: School of Medicine, Deakin University, Geelong, VIC, Australia.
authors.forename: Ajeet
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia.
authors.forename: Greg
authors.initials: G
authors.lastname: Murray
mesh_terms: D000661:Amphetamine / Q000009:adverse effects* / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D001559:Benzhydryl Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use*; D003863:Depression / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy; D003913:Dextroamphetamine / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use; D000077408:Modafinil; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents; D001559:Benzhydryl Compounds; D000697:Central Nervous System Stimulants; D008774:Methylphenidate; D000661:Amphetamine; D000077408:Modafinil; D003913:Dextroamphetamine
keywords: amphetamine; depression; methylphenidate; modafinil; stimulants