At the time of treatment, the patients were either hospitalized (inpatients) or undergoing ambulatory treatment as outpatients. The patients who had received psychostimulants were

identified from the hospital pharmacy records, which list the names of all patients having received drugs classified as narcotics. In earlier years, classifications of mental diseases Inhibitors,research,lifescience,medical such as the International Classification of Diseases (ICD) or Diagnostic and Statistical Manual of Mental Disorders (DSM) were not yet available, and diagnoses were descriptive only. Therefore, the classification in this retrospective study had to be done on a syndrome basis. The types of depression for which the patients had been treated with psychostimulants because of their refractory character were (in order of descending frequency): inhibited depression (50), anxious depression (39), agitated depression (21), depression with Inhibitors,research,lifescience,medical selleck chemicals somatization (21), neurotic depression (20), bipolar disorder (16), and depressive states in schizoaffective disorders (4) with overlapping in symptomatology. Because of the small number of subjects (65 patients, 17 treated with amphetamines, 35 with methylphenidate, and 13 treated with both amphetamines and methylphenidate), and because a separate statistical analysis of patients treated with amphetamines and those treated with methylphenidate failed to show any significant difference between

both groups, Inhibitors,research,lifescience,medical it was decided to subsume treatment with amphetamines and with methylphenidate as “treatment with psychostimulants” for the purpose of the study. The average total duration of psychopharmacological treatment (conventional Inhibitors,research,lifescience,medical antidepressants and psychostimulants) was 128 months (10 years, with a median of 84 months (7 years). Seventeen patients were treated with amphetamine, 35 with methylphenidate, and 13 with both amphetamine and methylphenidate, either concomitantly or one after the other. Regarding conventional antidepressant therapy, prior to receiving psychostimulant Inhibitors,research,lifescience,medical treatment,

3 patients had been administered one, 6 patients two, 10 patients three, 6 patients four, and 39 patients five or more antidepressants at various dosages. In 35 of the 65 patients, additional treatment modalities (such as sleep deprivation therapy, light, therapy, and ECT) had been used. Psychostimulants were given in combination Rolziracetam with tricyclic antidepressants in 48 cases, with SSRTs in 35 cases, with MAOIs in 8 cases, with lithium in 35 cases, and with carbamazepine in 22 cases. (Some patients received two or more antidepressants and mood stabilizers, in combination with the psychostimulants.) Dosage was titrated individually and modified during therapy. Patients treated with amphetamines received an average dosage of between 5 and 10 mg per day, the minimum being between 5 and 10 mg, and the maximum 20 mg per day. The average dosage of methylphenidate was 10 to 20 mg per day, with a minimum of 10 mg, and maximum of 40 mg per day.