Dr. Bob's Psychopharmacology Tips

Stimulants for depression

Date: 30 Nov 95 23:10:10 EST
From: Troy Caldwell <75112.1676@compuserve.com>
Subject: Stimulants for depression

Stimulants are effective in augmenting antidepressants for the treatment of depression. My favorite one here is methamphetamine (Desoxyn) 5-10 mg tid (short acting works better than the "gradumets"). It seems to have more mood effect than either dextroamphetamine (Dexedrine) or methylphenidate (Ritalin), though occasionally someone will do better on Ritalin. The worst thing about Desoxyn is it costs more.

From: MKomrad@aol.com
Date: Fri, 7 Mar 1997 22:33:54 -0500 (EST)
Subject: Stimulants for depression

In a message dated 3/7/97 12:08:37 PM, RICHMOND.JANET_S@BOSTON.VA.GOV wrote:

Mark Komrad noted the fashion in the 1980s of using methylphenidate to treat the depressions of elderly and/or medically ill pts. Whether or not we're behind the times, here at Boston VA, methylphenidate is still our first choice for such patients. SSRIs seem to take too long to work and upward titration of dose takes longer than methylphenidate. We've seen marked improvement in 2-4 days with methylphenidate.

From: PEARLMAN.CHESTER_A_DR@BOSTON.VA.GOV
Subject: Stimulants for depression
Date: 12 Mar 97 08:45 EST

Since stimulants were the first antidepressants to be used, their limitations were obvious in later direct comparisons with TCAs and MAOIs. They were resurrected for special populations and found to have great utility because of rapid onset and few side effects when they worked. Similarly, use to augment partial responses to SSRIs and other antidepressants is now fairly common. I have followed about 20 patients for 5-20 yrs who have had sustained improvement with methylphenidate or amphetamine alone after failing other drugs. Some have shown a slow development of tolerance over several years requiring dose increase, but others have not. The most extreme example is a woman who started with 5 mg/d of amphetamine for misdiagnosed narcolepsy at age 35 and now takes 100 mg/d in her early 70s with no side effects and evidence of decompensation with efforts to reduce dose (and significant difficulty paying for the medication).

Date: Tue, 06 May 1997 07:45:44 +0200
From: William Boyer <wboyer@emory.edu>
Subject: Stimulants for depression

I have been impressed with the reliable anti-manic activity of stimulants. Their antidepressant activity seems a lot more spotty. One patient responded nicely to pemoline. He was in a chronic, depressed, low-energy state which seemed (although I can't prove it) related to his valproic acid. Two manic patients cycled rapidly into depression (of course they might have anyway). There are case reports suggesting that stimulants can induce mania, but small studies which suggest that mood stabilizers block the drugs' euphoriant effects.

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