Dopaminergic modulators

What are dopaminergic modulators?

There is increasing interest in dopamine dysfunction being a putative mechanism underlying the pathogenesis of bipolar disorder. Dopaminergic modulators include stimulants (methylphenidate, amphetamine, and lisdexamphetamine), stimulant-like agents (modafinil and armodafinil), and dopamine agonists (pramipexole). These agents increase dopaminergic neurotransmission and are thought to be useful in the treatment of depressive episodes in bipolar disorder, but not in the context of other psychiatric conditions, and they are also being tested for mania symptoms.

What is the evidence for dopaminergic modulators?

For depression, moderate to high quality evidence suggests a small effect of greater clinical response with lisdexamphetamine, pramipexole, armodafinil, modafinil, dexamphetamine, or methylphenidate compared to placebo. Moderate quality evidence also suggests there may be increased remission rates with adjunctive dopaminergic modulators, apart from pramipexole.

For mania, moderate quality evidence suggests medium-sized effects of greater remission rates with adjunctive cariprazine and high-, but not low-dose aripiprazole.

There was an increased risk of nausea with dopaminergic agents than placebo, but no increased risk of switching to mania, no insomnia, restlessness, suicidality, or treatment withdrawal with dopaminergic agents.

June 2020

Last updated at: 3:35 am, 1st July 2020
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