OBJECTIVE To investigate the effectiveness of stimulants in patients with depression, by using naturalistic outcome measures, such as psychiatric admissions, psychiatric bed-days and incidents of intentional self-harm or suicide attempts. METHODS Via linkage of the Danish nationwide health registers, we identified all patients with a diagnosis of depression initiating stimulants, including methylphenidate, modafinil, amphetamine, dexamphetamine or lisdexamphetamine, from 1995 to 2012. We used a mirror-image model to test whether redemption of a stimulant prescription was associated with a reduction in psychiatric admissions, inpatient days and incidents of intentional self-harm or suicide attempts. Specifically, the number of these outcomes in the 2 years leading up to redemption of a stimulant prescription was compared to the two subsequent years. Similar outcomes were used in a reverse mirror-image model to investigate the effect of stimulant termination. RESULTS A total of 3354, 935 and 105 patients diagnosed with depression redeemed prescriptions for methylphenidate, modafinil or amphetamine/dexamphetamine/lisdexamphetamine, respectively. Initiation of methylphenidate was not associated with a significant change in psychiatric admissions (mean: -0.02 admissions, p = 0.11) or inpatient days (mean: 0.13 days, p = 0.74). Similar findings were made for modafinil and the amphetamines. In addition, no clinically relevant change in psychiatric admissions or inpatient days was found after termination of a stimulant. After initiation of methylphenidate, the incidents of self-harm or suicide attempts were reduced by 54%, from 68 to 31 events (p = 0.004). No significant change in incidents of self-harm or suicide attempts were found for modafinil or the amphetamines. CONCLUSION This nationwide study, using naturalistic outcomes, does not support the use of stimulants in patients with depression. However, the use of methylphenidate was associated with a 54% reduction in incidents of self-harm or suicide attempts, indicating that methylphenidate may potentially be useful in patients with depression with suicidal- or self-harming behaviour. However, further studies are needed, before any firm conclusions can be made.

中文翻译：

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在抑郁症中使用兴奋剂：一项自我对照的登记研究的结果。

目的通过使用自然结果指标，例如精神病院入院，精神病就寝日和故意自残或自杀未遂事件，研究兴奋剂对抑郁症患者的有效性。方法通过丹麦全国卫生注册机构的链接，我们从1995年至2012年鉴定了所有诊断为抑郁症引发兴奋剂的患者，包括哌醋甲酯，莫达非尼，苯丙胺，右旋苯丙胺或赖斯二苯丙胺。刺激性处方与减少精神科住院，住院天数和故意自残或自杀未遂事件有关。特别，比较了导致兴奋剂处方赎回的2年中这些结局的数量与随后的两年。在反向镜像模型中使用了相似的结果来研究刺激物终止的效果。结果共有3354、935和105位被诊断患有抑郁症的患者分别兑换了哌醋甲酯，莫达非尼或苯丙胺/右苯丙胺/赖斯苯丙胺的处方。哌醋甲酯的开始与精神病住院（平均：-0.02入院，p = 0.11）或住院天数（平均：0.13天，p = 0.74）的显着变化无关。莫达非尼和苯丙胺的研究结果相似。此外，在终止兴奋剂后，未发现精神科住院或住院天数的临床相关变化。哌醋甲酯开始后，自残或自杀未遂事件减少了54％，从68起减少到31起（p = 0.004）。莫达非尼或苯丙胺的自残或自杀未遂事件未见明显变化。结论这项基于自然结果的全国性研究不支持在抑郁症患者中使用兴奋剂。但是，哌醋甲酯的使用可使自残或自杀未遂事件减少54％，这表明哌醋甲酯可能对患有自杀或自残行为的抑郁症患者有用。但是，在做出任何肯定的结论之前，需要进一步的研究。莫达非尼或苯丙胺的自残或自杀未遂事件未见明显变化。结论这项基于自然结果的全国性研究不支持在抑郁症患者中使用兴奋剂。但是，哌醋甲酯的使用可使自残或自杀未遂事件减少54％，这表明哌醋甲酯可能对患有自杀或自残行为的抑郁症患者有用。但是，在做出任何肯定的结论之前，需要进行进一步的研究。莫达非尼或苯丙胺的自残或自杀未遂事件未见明显变化。结论这项基于自然结果的全国性研究不支持在抑郁症患者中使用兴奋剂。但是，哌醋甲酯的使用可使自残或自杀未遂事件减少54％，这表明哌醋甲酯可能对患有自杀或自残行为的抑郁症患者有用。但是，在做出任何肯定的结论之前，需要进一步的研究。表明哌醋甲酯可能对患有自杀或自残行为的抑郁症患者有用。但是，在做出任何肯定的结论之前，需要进一步的研究。表明哌醋甲酯可能对患有自杀或自残行为的抑郁症患者有用。但是，在做出任何肯定的结论之前，需要进一步的研究。