Psychostimulants in the treatment of depression - A review of the evidence

Psychostimulants have euphoric and alerting properties that suggest their usefulness in treating depressive disorders; however, problems with tolerance and dependence with some drugs militate against their widespread therapeutic use where more acceptable licensed alternatives are available. The introduction of modafinil, a stimulant not associated with tolerance and dependence, has re-awakened interest in psychostimulants as antidepressants. The available literature, while containing somewhat inconsistent data of rather poor quality, does suggest that psychostimulants have useful antidepressant properties and are usually well tolerated. They may be useful as adjuncts to standard antidepressants in refractory depression, but have particular utility in conditions where a prompt therapeutic effect is desired and where tolerance and dependence are less of a concern. Such conditions include the treatment of depression in terminal illness and in extreme old age. Psychostimulants, although now largely discarded as treatment options for depression, deserve careful consideration as potential therapeutic agents in specific patient subgroups.