Dopaminergic modulators

What are dopaminergic modulators for bipolar disorder?

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), dopamine agonists (pramipexole), and partial dopamine agonists (aripiprazole, cariprazine, and brexpiprazole). 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. They are also being tested for mania symptoms.

What is the evidence for dopaminergic modulators?

For depression, moderate to high quality evidence finds a small effect of greater clinical response with lisdexamphetamine, pramipexole, armodafinil, modafinil, dexamphetamine, or methylphenidate than with placebo. There may also be increased remission rates with adjunctive dopaminergic modulators, including in those with treatment-resistant bipolar depression. For mania, moderate quality evidence finds 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 compared to placebo, and no increased risk of switching to mania, insomnia, restlessness, suicidality, or treatment withdrawal.

November 2021

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Last updated at: 4:38 pm, 29th November 2021
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