Use of adjunctive stimulants in adult bipolar depression
Open accessAbstract
Bipolar depression represents a high priority research field, due to its pervasiveness, and high economic and personal (suicidality, impaired function, quality of life) costs, and the limited evidence base to inform therapeutics. Mood stabilizers and second-generation antipsychotics for bipolar depression are commonly only partially effective, and their side-effects may overlap with depressive symptoms such as hypersomnia, daytime drowsiness, fatigue, psychomotor retardation, and weight gain. Moreover, the use of antidepressants in bipolar depression is controversial due to concerns regarding the risks of inefficacy or switching to mood elevation. Stimulants and related compounds such as modafinil and armodafinil have on occasion been used as adjuncts in bipolar depressed patients with encouraging results, but their use is limited by the paucity of systematic evidence of efficacy and safety. The present review aims to provide an updated perspective on the use of stimulants and stimulant-like medications in adult bipolar depression, considering not only recent randomized controlled trials, but also open naturalistic studies, in order to clarify the strengths and limitations of using these agents.
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The final maintaining treatment was buprenorphine, lithium, methylphenidate, and delorazepam together with weekly sessions of third generation Cognitive Behavioural Therapy with integration of Mindfulness and Acceptance and Commitment Therapy.
“The final maintaining treatment was the following: buprenorphine [27, 28], lithium [29], methylphenidate [30, 31], and delorazepam [32] together with weekly sessions of third generation of Cognitive Behavioural Therapy (CBT) with integration of Mindfulness and Acceptance and Commitment Therapy [33] (see Table 1).”
From A Medical Resident with a History of Alcohol Abuse and Suicidal Ideation: A Challenge for Both Psychiatry and Occupational Medicine in the Context of the First Wave of the COVID-19 Pandemic (2022) · cites this paper as [30]
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- Authors
- Dell'Osso, B., & Ketter, T. A.
- Affiliations
- Stanford Medicine (US)
- ORCID
- Ketter, Terence A.
- Venue
- The International Journal of Neuropsychopharmacology
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-04-13
- Volume
- 16
- Issue
- 01
- Pages
- 55-68
- ISSN
- 1461-1457 (ISSN-L)
- 1469-5111
- OpenAlex
- W2105251314
- Cited by
- 31
- References
- 117
- Citations by year
- 2026: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2020: 1 · 2019: 1 · 2018: 3 · 2017: 6 · 2016: 2 · 2015: 5 · 2014: 4 · 2013: 3 · 2012: 1
- FWCI
- 0.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The International Journal of Neuropsychopharmacology (publishedVersion)
- PubMed (publishedVersion)
- Archivio Istituzionale della Ricerca (Universita Degli Studi Di Milano) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- bipolar depression, stimulants, modafinil, armodafinil, adjunctive therapy, antidepressant efficacy, mood stabilizers, atypical antipsychotics, adverse effects, mood improvement
- MeSH terms
- Modafinil, Adult, Central Nervous System Stimulants, Benzhydryl Compounds, Bipolar Disorder, Drug Therapy, Combination, Humans, Methylphenidate, Antipsychotic Agents
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