Use of Stimulants in Bipolar Disorder

Curr Psychiatry Rep. 2017 Jan;19(1):7. doi: 10.1007/s11920-017-0758-x.


Several international guidelines indicate stimulants, including methylphenidate (MPH), amphetamines and derivatives, modafinil, and armodafinil among the second-third-line choices for bipolar depression. Efficacy of stimulants has been also reported for the management of residual depressive symptoms such as fatigue and sleepiness and for the management of affective, cognitive, and behavioral symptoms in children and adult bipolar patients with comorbid ADHD. Few case reports show positive results with MPH in the treatment of resistant mania. Finally, MPH might be an option in some bipolar forms observed in psychiatric presentations of frontotemporal dementia and traumatic brain injury. In spite of these preliminary observations, the use of stimulants in bipolar patients is still controversial. Potential of misuse and abuse and mood destabilization with induction of (hypo)manic switches, mixed states, and rapid cycling are the concerns most frequently reported. Our aims are to summarize available literature on this topic and discuss practical management implications.

Keywords: Bipolar disorder; Comorbidity; Methylphenidate; Stimulants.

Publication types

  • Review

MeSH terms

  • Adult
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Attention Deficit Disorder with Hyperactivity / psychology
  • Bipolar Disorder / diagnosis
  • Bipolar Disorder / drug therapy*
  • Bipolar Disorder / psychology
  • Brain Injuries, Traumatic / diagnosis
  • Brain Injuries, Traumatic / drug therapy
  • Brain Injuries, Traumatic / psychology
  • Central Nervous System Stimulants / adverse effects
  • Central Nervous System Stimulants / therapeutic use*
  • Child
  • Comorbidity
  • Depressive Disorder, Treatment-Resistant / diagnosis
  • Depressive Disorder, Treatment-Resistant / drug therapy
  • Depressive Disorder, Treatment-Resistant / psychology
  • Frontotemporal Dementia / diagnosis
  • Frontotemporal Dementia / drug therapy
  • Frontotemporal Dementia / psychology
  • Humans
  • Randomized Controlled Trials as Topic
  • Substance-Related Disorders / drug therapy
  • Treatment Outcome


  • Central Nervous System Stimulants