The role of psychostimulants in psychogeriatrics: A New Zealand survey

Abstract

Background: Psychostimulants, including dexamphetamine, methylphenidate and modafinil, have been in use to varying degrees in general psychiatry for over 70 years, especially in psychogeriatrics. While there is some evidence for their clinical effectiveness in depression, they are not considered standard treatments in major depression or other affective disorders. This objective of this study was to ascertain the current prescribing practices of psychostimulants by psychogeriatricians in New Zealand. Methods: An anonymous survey was sent electronically to all psychogeriatricians in New Zealand, covering the following areas: (1) career demographics; (2) frequency of prescription of psychostimulants for depression; (3) types of psychostimulants, dosages and scheduling; (4) target symptoms; (5) the use of psychostimulants as a monotherapy or an augmentation agent; (6) trial duration and clinical response; and (7) side effects. Results: Thirty-six surveys were returned, giving an overall response rate of 84%. Two-thirds of clinicians had prescribed psychostimulants for depression at one point in their practice, dropping to 44% in the past 2 years (44%). Overall, the practice was infrequent and there were no difference in years of practice between those who had prescribed and those who had not prescribed psychostimulants. Methylphenidate was almost exclusively used, either as a monotherapy or as an augmentation agent with standard antidepressants. The length of treatment with a psychostimulant was variable and clinical side effects were infrequent, and included agitation/anxiety, insomnia and confusion. Conclusions: The prescribing of psychostimulants for depression by New Zealand psychogeriatricians is infrequent and the response rates and side effects observed were both consistent with the published literature. Their use was generally limited to treatment-resistant depression, when standard antidepressants were intolerable, or in complex clinical situations. While not a prominent biological treatment in psychogeriatrics, this class of medication remains a therapeutic option for the frail, the medically ill or those in palliative care situations. © 2009 The Author. Journal compilation © 2009 Japanese Psychogeriatric Society.