Rationale: Psychostimulants, including methylphenidate (MPH), are the mainstay of pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) in adults. Even though MPH is the most commonly used medication for ADHD these days, there are relatively few resources available that provide comprehensive insight into the pharmacological and clinical features of the compound. Objective: The aim of this paper is to provide an up-to-date outline of the pharmacology and clinical utility of MPH for ADHD in adult patients. Methods: While conducting the narrative review, we applied structured search strategies covering the two major online databases (MEDLINE and Cochrane Central Register of Controlled Trials). In addition, we performed handsearching of reference lists of relevant papers. Results: Methylphenidate exhibits multimodal mechanism of action, working primarily as a dopamine and noradrenaline reuptake inhibitor. It also protects the dopaminergic system against the ongoing ‘wearing off’ (by securing a substantial reserve pool of the neurotransmitter, stored in the presynaptic vesicles). In placebo-controlled trials, MPH was shown to be moderately effective both against the core ADHD symptoms (standardized mean difference [SMD], 0.49; 95% confidence interval [CI], 0.35–0.64), and the accompanying emotion regulation deficits (SMD, 0.34; 95% CI, 0.23–0.45). The most common adverse events related to long-term treatment with MPH are decreased appetite (~ 20%), dry mouth (15%), heart palpitations (13%), gastrointestinal infections (~ 10%), and agitation/feeling restless (~ 10%). Conclusions: There is substantial body of evidence to suggest that MPH is an effective and safe treatment option for adults with ADHD.

To assess the prevalence of soft bipolar features in a sample of women with postpartum depressive symptoms, as well as to compare the sociodemographic and obstetric characteristics of subjects with bipolar or unipolar postpartum depressive symptomatology. Four hundred and thirty-four participants were enrolled in this cross-sectional study. Postpartum depression (PPD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), while the Mood Disorder Questionnaire (MDQ) was used to screen for bipolarity features. Of the 434 participants, 66 (15.2%) scored ≥ 13 points on the EPDS, thus fulfilling the screening criteria, and 103 scored ≥ 7 points on the MDQ. In comparison with non-depressed subjects, the women who scored positively on the EPDS were significantly more likely to exhibit symptoms of bipolar spectrum disorders (38 vs. 21%; chi-square test, p = 0.015). Women with bipolar PPD symptomatology were significantly younger than those exhibiting unipolar PPD symptoms (31.0±4.8 years vs. 28.5±4.1 years; t-test, p = 0.03). The groups did not differ in terms of obstetric characteristics. Our findings suggest that patients with PPD symptomatology may be more likely to exhibit soft bipolarity features as compared with non-depressed women.

Lumateperone is a novel antipsychotic recently approved for the treatment of schizophrenia. Its unique pharmacological profile includes modulation of serotonergic, dopaminergic, and glutamatergic neurotransmission, differentiating it from other second-generation antipsychotics. This paper explores the pharmacological features and clinical potential of lumateperone across neuropsychiatric conditions. A review of current literature, including pharmacokinetic and pharmacodynamic studies, was conducted. It focused on lumateperone’s mechanism of action and receptor-binding profile, and clinical trials assessing its efficacy and safety in schizophrenia and other psychiatric disorders. Lumateperone demonstrates high affinity for 5-HT_2A receptors, moderate affinity for D₂ receptors, and low affinity for H₁ and 5-HT_2C receptors. It acts as a presynaptic D₂ agonist and a postsynaptic antagonist, contributing to a favorable side-effect profile with reduced extrapyramidal symptoms. Clinical trials suggest that lumateperone is effective in reducing both positive and negative symptoms of schizophrenia, with minimal metabolic and cardiovascular risks. It is also being explored as an adjunctive therapy for major depressive disorder and bipolar depression. Lumateperone presents a promising therapeutic option for schizophrenia with a novel mechanism of action and a favorable safety profile. Its potential application in other psychiatric conditions warrants further investigation, particularly in treatment-resistant populations.

This conceptual narrative review explores the intricate dynamics of the ‘stimulant paradox’ in adult ADHD, highlighting the timing-dependent trade-offs associated with stimulant medication. The paradox underscores the complexity of balancing therapeutic benefits against potential side effects, contingent on the timing of administration. Chronopharmacotherapy emerges as a promising framework, integrating circadian and homeostatic processes with pharmacokinetic and pharmacodynamic considerations. This approach suggests that aligning medication timing with individual biological rhythms may optimize outcomes, although the conceptual nature of this integration remains non-prescriptive. ADHD coaching is examined as a complementary strategy, focusing on the development of skill-oriented routines that are sensitive to timing. This adjunctive support may facilitate the practical implementation of chronopharmacotherapy principles, enhancing adherence and effectiveness. Figures and heuristics within the review serve as illustrative tools intended to guide understanding rather than dictate clinical practice. The review identifies critical areas for future research, emphasizing the need for empirical investigation into optimal clock-time windows, phase measures, and chronotype stratification. Additionally, assumptions regarding medication formulations warrant further scrutiny to refine timing-sensitive interventions in adult ADHD management.