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Q: Amphetamines for Treatment of Depression ?
Hi Dr. Phelps: My Psychiatrist has recently prescribed Ritalin La in addition
to my Wellbutrin and Zonegran for treatment of my Bipolar
Depression. We have tried other combinations of SSRI's, Topomax,etc. with
little success.This is the most recent mix. When I asked him why the
amphetamine, he said to work in combination with the Wellbutrin to increase
the Dopamine to decrease the depression. I have been unable to find any info
in the current literature with regard to the use of amphetamines for the
treatment of unipolar or bipolar depression except one sentence stating that
they are not very effective. There is a plethora of information related to use
of Methylphenidate for treatment of ADHD. Do you know of any knew information
suggesting use of amphetamines for treatment of depression? Should I be
questioning my psychiatrist further? By the way, I do not have a history of
any substance abuse problem. Thank you for your time.
Sincerely,
Dear Ms. B --
For years people have tried this strategy, namely giving stimulants to "boost"
a response to antidepressant medications, or sometimes by themselves,
particularly in more elderly folks. But you're right, there are very limited
data to support that practice in unipolar depression; much more data
support using lithium in that role, or even T3 thyroid hormone. And all that
is in unipolar disorder. How about in bipolar
disorder? Well, that's pretty far off the map (e.g the APA bipolar disorder
treatment guidelines, or TMAP) but not outrageous.
However, I'll pass along to you both my general rule
in case it might be worth considering. In general in bipolar disorder, unless
a person is just depressed all the time, with no evidence of
cycling or current hypomania (like agitation, anxiety, irritability, easy
tearfulness over almost nothing ("mood lability"), or insomnia; to name a few
symptoms that often are not considered "mania"), I've had much better luck
treating even the depression part of bipolar disorder by using mood
stabilizers with antidepressant effects (e.g. lithium, lamotrigine, possibly
T3/T4 thyroid hormone); or sometimes even just plain old mood stabilizers
without any antidepressant effect, just to stop any remaining cycling or
hypomanic component and wait for the depression to resolve when it's not being
"pushed" by hypomania; than by trying to treat the depression alone with
antidepressants.
Even Risperidone has some antidepressant effects, and
topiramateMcIntyre
-- i.e. things that people generally don't think of as useful for depression
as such, but which also have some risk of making cycling worse, by the same
token. So these can be used along with mood stabilizers, rather than
antidepressants, when there seems to be a risk of causing cycling with
antidepressant treatments.
Zonegran is pretty far off the usual map as well, as
far as "mood
stabilizers" go (take that link for a "map" of the usuals and a link to
the APA and TMAP guidelines). But if you've already had most or all of those,
your doctor could be a smart, leading edge kind of guy. Hopefully, if he has
time, he can help you understand the logic and the evidence for his treatments
if you "question him further" (here are some thoughts on
talking with
doctors, in that regard).
Dr. Phelps
Published October, 2003 |