BackgroundDepression is considered to be the most difficult to treat phase of bipolar disorder as patients experience residual symptoms causing long-term disability. This work aims to explore the role of add-on stimulant and stimulant-like medication in resistant bipolar depression patients.MethodsSystematic review of add-on stimulants and stimulant-like drugs in resistant bipolar depression by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Analysis was performed using the random-effects models. Heterogeneity was evaluated with Cochran’s Q and I2 statistics.ResultsSix randomized controlled trials of add-on modafinil, armodafinil, and lisdexamphetamine (LDX) (n = 813) vs placebo (n = 815) in the treatment of resistant bipolar depression were included. These drugs were more likely to induce remission from an episode of resistant bipolar depression (relative risk [RR] = 1.37; 95% confidence interval [CI]: 1.06-1.77; number needed to treat for an additional beneficial outcome = 16). Moreover, they did not induce more dropouts than placebo (RR = 1.04; 95% CI: 0.91-1.18), nor did they increase the risk of adverse effects (53/772 vs 41/771) at the end of treatment (RR = 1.30; 95% CI: 0.81-2.10; number needed to treat for an additional harmful outcome = 62). Suicidality and manic switch were not affected by active treatment. Heterogeneity was low (Cochran’s Q: P > .05), but sometimes with a large CI.ConclusionsLDX, modafinil, and armodafinil seem to offer a reasonably well-tolerated and safe treatment in resistant bipolar depression. Treatment guidelines should, therefore, be revised to include these medications earlier in the therapeutic algorithm for resistant acute bipolar depression. Further research is, however, necessary for the elucidation of the clinical usefulness of these and other similar compounds.

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抗性双相抑郁症的精神兴奋剂和兴奋剂类药物的辅助治疗：系统评价和荟萃分析

背景抑郁症被认为是双相情感障碍最难治疗的阶段，因为患者会出现导致长期残疾的残留症状。本工作旨在探讨附加兴奋剂和类兴奋剂药物在耐药性双相抑郁症患者中的作用。 -分析（PRISMA）指南。使用随机效应模型进行分析。异质性用 Cochran's Q 和一世2统计数据。结果纳入了六项附加莫达非尼、阿莫达非尼和赖右安非他明 (LDX) (n = 813) 与安慰剂 (n = 815) 治疗耐药性双相抑郁症的随机对照试验。这些药物更有可能诱导耐药性双相抑郁发作的缓解（相对风险 [RR] = 1.37；95% 置信区间 [CI]：1.06-1.77；额外有益结果需要治疗的人数 = 16）。此外，与安慰剂相比，它们并没有引起更多的辍学（RR = 1.04；95% CI：0.91-1.18），也没有增加治疗结束时出现不良反应的风险（53/772 vs 41/771）（RR = 1.30；95% CI：0.81-2.10；额外有害结果需要治疗的人数 = 62）。自杀和躁狂转换不受积极治疗的影响。异质性低（Cochran's Q：磷> .05)，但有时 CI 较大。结论 LDX、莫达非尼和 armodafinil 似乎为耐药性双相抑郁症提供了一种耐受性良好且安全的治疗方法。因此，应对治疗指南进行修订，以便在耐药性急性双相抑郁症的治疗流程中更早地纳入这些药物。然而，进一步的研究对于阐明这些和其他类似化合物的临床用途是必要的。