Psychostimulants for managing unipolar and bipolar treatment-resistant melancholic depression: a medium-term evaluation of cost benefits

J Affect Disord. 2013 Oct;151(1):360-4. doi: 10.1016/j.jad.2013.05.093. Epub 2013 Jun 27.


Background: We earlier reported an open study of 50 unipolar and bipolar treatment resistant depressed patients indicating that psychostimulants may have differential superiority for the melancholic depressive sub-type. We designed an extension study to examine cost benefits of psychostimulants more closely for those only with melancholic depression.

Method: The sample comprised patients clinically diagnosed with melancholic depression who had failed to respond to and/or experienced significant side-effects with at least two antidepressants. Data were collected for 61 unipolar and 51 bipolar II patients receiving a psyschostimulant for a mean interval of 69 weeks. Benefits and side-effects were assessed.

Results: Effectiveness ratings were similar across unipolar and bipolar sub-sets. Psychostimulants were judged as 'very' effective for 20% of patients and 'somewhat' effective for 50%. Forty percent judged the psychostimulant as being 'as effective' or as 'superior' to previously prescribed antidepressants, and worthy of being maintained. Significant side-effects were experienced by 40% of patients, requiring medication to be ceased in 12%. Twenty percent of the bipolar patients experienced a worsening of highs.

Limitations: The study was uncontrolled and retrospective, no formal rater-completed or patient-completed interval measures of severity were completed, while diagnostic judgments about melancholic depression and bipolar disorder were clinically judged.

Conclusions: This open study suggests that psychostimulants may be efficacious antidepressant options for managing unipolar and bipolar melancholia, often seemingly having very rapid onset and generally requiring only low doses, and arguing the need for controlled studies in melancholic patients.

Keywords: Bipolar disorder; Melancholic depression; Psychostimulant; Treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bipolar Disorder / drug therapy*
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / economics
  • Central Nervous System Stimulants / therapeutic use*
  • Cost-Benefit Analysis
  • Depression / drug therapy*
  • Depressive Disorder, Treatment-Resistant / drug therapy*
  • Dextroamphetamine / adverse effects
  • Dextroamphetamine / economics
  • Dextroamphetamine / therapeutic use
  • Drug Costs
  • Female
  • Humans
  • Male
  • Methylphenidate / adverse effects
  • Methylphenidate / economics
  • Methylphenidate / therapeutic use
  • Middle Aged
  • Retrospective Studies
  • Young Adult


  • Central Nervous System Stimulants
  • Methylphenidate
  • Dextroamphetamine