Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

Ng, Bradley; O'Brien, Angela

doi:10.1192/apt.bp.107.004879

Cited by 9 publications

(4 citation statements)

References 65 publications

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“…Parker and Brotchie (1) have recently described benefit from the use of psychostimulants (dexamphetamine and methylphenidate) in a large uncontrolled case series of patients with melancholic or bipolar depression with varying degrees of treatment resistance. Their positive findings are similar to other uncontrolled studies of psychostimulants in populations, including those with medical comorbidities or in palliative care, with affective disorders (2). There has always been caution in endorsing the routine use of psychostimulants due to the lack of robust positive findings in randomized controlled trials (3), but the patients described by Parker and Brotchie may not necessarily enter such clinical trials.…”

supporting

confidence: 86%

Psychostimulants and treatment resistant depression

2009

Acta Psychiatr Scand

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supporting

confidence: 86%

Psychostimulants and treatment resistant depression

2009

Acta Psychiatr Scand

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“…The reasons for declining prescription of psychostimulants in the past 2 years were varied, but there was a trend for clinicians who had never prescribed psychostimulants to indicate that the treatment was not part of their clinical practice and that there was no evidence base for their efficacy. Indeed, the paucity of robust trial evidence for psychostimulant monotherapy in depression has been highlighted in recent review articles, including a Cochrane systematic review and meta‐analysis 1,13,14 …”

Section: Discussionmentioning

confidence: 99%

The role of psychostimulants in psychogeriatrics: a New Zealand survey

2009

Psychogeriatrics

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Background: Psychostimulants, including dexamphetamine, methylphenidate and modafinil, have been in use to varying degrees in general psychiatry for over 70 years, especially in psychogeriatrics. While there is some evidence for their clinical effectiveness in depression, they are not considered standard treatments in major depression or other affective disorders. This objective of this study was to ascertain the current prescribing practices of psychostimulants by psychogeriatricians in New Zealand. Methods: An anonymous survey was sent electronically to all psychogeriatricians in New Zealand, covering the following areas: (1) career demographics; (2) frequency of prescription of psychostimulants for depression; (3) types of psychostimulants, dosages and scheduling; (4) target symptoms; (5) the use of psychostimulants as a monotherapy or an augmentation agent; (6) trial duration and clinical response; and (7) side effects. Results: Thirty-six surveys were returned, giving an overall response rate of 84%. Two-thirds of clinicians had prescribed psychostimulants for depression at one point in their practice, dropping to 44% in the past 2 years (44%). Overall, the practice was infrequent and there were no difference in years of practice between those who had prescribed and those who had not prescribed psychostimulants. Methylphenidate was almost exclusively used, either as a monotherapy or as an augmentation agent with standard antidepressants. The length of treatment with a psychostimulant was variable and clinical side effects were infrequent, and included agitation/anxiety, insomnia and confusion. Conclusions: The prescribing of psychostimulants for depression by New Zealand psychogeriatricians is infrequent and the response rates and side effects observed were both consistent with the published literature. Their use was generally limited to treatment-resistant depression, when standard antidepressants were intolerable, or in complex clinical situations. While not a prominent biological treatment in psychogeriatrics, this class of medication remains a therapeutic option for the frail, the medically ill or those in palliative care situations.

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“…When prescribed and monitored by medical professionals, amphetamines serve as effective treatments for conditions such as ADHD, narcolepsy, and, in some cases, treatment-resistant depression. Their therapeutic applications include enhanced wakefulness, improved cognitive control, reduced fatigue, and mood elevation ( Stotz et al, 1999 ; Berman et al, 2009 ; Ng and O’Brien, 2009 ).…”

Section: Resultsmentioning

confidence: 99%

Amphetamines in child medicine: a review of ClinicalTrials.gov

Alalalmeh,

Hegazi,

Shahwan

et al. 2023

Front. Pharmacol.

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Background: Globally, the use of amphetamines as therapeutic agents in pediatric medicine is a crucial area of concern, especially given the population’s vulnerability.Methods: On 6 August 2023, a search was conducted on ClinicalTrials.gov using “amphetamine” as the keyword. Two independent examiners screened trials against set criteria, including a focus on amphetamine, completion status, an interventional approach, and included children. Ongoing or observational studies were excluded. Data extracted from the qualified trials encompassed primary objectives, participant counts, study duration, and outcomes, with the aim of analyzing children disorders treated by amphetamine.Results: On 6 August 2023, a search of the ClinicalTrials.gov database with the term “amphetamines” identified 179 clinical trials. After extensive exclusion criteria, 19 trials were ultimately selected for analysis. The predominant condition under investigation was attention deficit hyperactivity disorder (ADHD), present in 84.2% of studies. Key study characteristics included: phase 4 trials (36.8%), randomized allocation (63.2%), and the parallel intervention model (42.1%). Masking techniques varied, with no masking in 42.1% of studies, and double and quadruple masking both accounting for 21.1%. Geographically, 78.9% of the studies’ participants were from the United States.Conclusion: This study highlights the notable therapeutic potential of amphetamines in pediatric ADHD populations and emphasizes the importance of recognizing potential side effects and addiction risks. As pharmacogenomics offers the prospect of personalized treatments, there is potential to increase therapeutic efficacy and decrease adverse reactions. It is vital to balance these benefits against the inherent risks, understanding the need for continued research to optimize the use of amphetamines in medicine.

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Beyond ADHD and narcolepsy: psychostimulants in general psychiatry

Cited by 9 publications

References 65 publications

Psychostimulants and treatment resistant depression

Psychostimulants and treatment resistant depression

The role of psychostimulants in psychogeriatrics: a New Zealand survey

Amphetamines in child medicine: a review of ClinicalTrials.gov

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