he use of psychostimulants in the therapy
oftreatment-resistant
depression in addition to conven-tional
antidepressants is not very common and hasbeen
criticized by some authors. In Germany, Austria,and Switzerland, depression is
not a listed indicationfor
the use of psychostimulants. In contrast, at theZurich Psychiatric University
Hospital, dextroam-phetamine
and ritalin have been used since the thir-ties
to treat severe cases of
treatment-resistantdepression, especially
in the presence of prominentfatigue
and apathy, and psychostimulants are now wellestablished
as an adjuvant therapy. This
articlereviews
the literature on the use of psychostimulantsin
treatment-resistant depression and discusses thefindings
relative to therapeutic efficacy, side effects,and
frequency of dependency from a retrospectivestudy
carried out in 65 patients of our hospital treatedwith
psychostimulants.P h a r m a c o l o g i c a l
a s p e c t sPsychostimulants
in the therapy of
treatment-resistant depression Review
of the literature and findings from a
retrospective study in 65 depressed patientsGabriele
Stotz, MD, PhD; Brigitte Woggon, MD; Jules Angst, MD
Author
affiliations: Psychiatric University Hospital Munich,
Germany (Gabriele Stotz); Zurich University Psychiatric Hospital, Switzerland
(Brigitte Woggon, Jules Angst)Address
for correspondence: Dr Gabriele Stotz, Psychiatric University
Hospital, Nußbaumstr 7, 80336 München, Germany.
(e-mail: stotz@psy.med.uni-muenchen.de) 1
6 5Gabriele
STOTZThe use
of psychostimulants as an adjuvant therapy in treatment-resistant depression is
not very common nowa-days
and has been the subject of much criticism. This article gives a brief review
of the literature and reports onthe
findings from a retrospective study carried out in 65 depressed patients treated
with psychostimulants(amphetamine
and methylphenidate) in addition to conventional antidepressants. Thirty-eight
out of 65patients
showed significant improvement, in particular with respect to energy, mood, and
psychomotor activ-ity.
The best response to psychostimulants was seen in inhibited types of depression
and in combination witha
tricyclic antidepressant. None of the patients developed drug dependency. The
incidence of side effects waslow,
and agitation and restlessness improved with an additional short-term treatment
with benzodiazepines.It
is concluded that the rapid onset of action (2-3 hours) after administration may
help cover the therapeuticlatency
period of conventional antidepressants and probably potentiates their effect.
In view of their potentialbenefits
in treatment-resistant depressive states, psychostimulants should be tried more
often. Keywords: psychostimulant;
adjuvant therapy; treatment-resistant depression; combination with tricyclics;
dependency; rapid onset; potentiation of antidepressant effectT
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