title: Use of Stimulants in Bipolar Disorder.
abstract: Several international guidelines indicate stimulants, including methylphenidate (MPH), amphetamines and derivatives, modafinil, and armodafinil among the second-third-line choices for bipolar depression. Efficacy of stimulants has been also reported for the management of residual depressive symptoms such as fatigue and sleepiness and for the management of affective, cognitive, and behavioral symptoms in children and adult bipolar patients with comorbid ADHD. Few case reports show positive results with MPH in the treatment of resistant mania. Finally, MPH might be an option in some bipolar forms observed in psychiatric presentations of frontotemporal dementia and traumatic brain injury. In spite of these preliminary observations, the use of stimulants in bipolar patients is still controversial. Potential of misuse and abuse and mood destabilization with induction of (hypo)manic switches, mixed states, and rapid cycling are the concerns most frequently reported. Our aims are to summarize available literature on this topic and discuss practical management implications.
authors.affiliation: Department of Experimental and Clinic Medicine, Section of Psychiatry, University of Pisa, Via Roma 67, 56100, Pisa, Italy. giulio.perugi@med.unipi.it.|Institute of Behavioural Science "G.De Lisio", Pisa, Italy. giulio.perugi@med.unipi.it.
authors.forename: Giulio
authors.initials: G
authors.lastname: Perugi
authors.affiliation: Dipartimento di Neuroscienze, Psicologia, Area del Farmaco e Salute del Bambino (NEUROFARBA), University of Florence, Florence, Italy.|CREA, Research and Clinical Centre, San Sebastiano Foundation, Florence, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Vannucchi
authors.affiliation: Psychiatric Service, General Hospital of Bressanone, Brixen, Italy.
authors.forename: Fulvio
authors.initials: F
authors.lastname: Bedani
authors.affiliation: Psychiatric Service, General Hospital of Bressanone, Brixen, Italy.
authors.forename: Ettore
authors.initials: E
authors.lastname: Favaretto
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D000070642:Brain Injuries, Traumatic / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D015897:Comorbidity; D061218:Depressive Disorder, Treatment-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D057180:Frontotemporal Dementia / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D019966:Substance-Related Disorders / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants
keywords: Bipolar disorder; Comorbidity; Methylphenidate; Stimulants