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Methylphenidate in depressed medically ill patients
P B Rosenberg1, I Ahmed, S Hurwitz
1Tufts-New England Medical Center Department of Psychiatry, Boston, Mass. 02111.
Background:
The purpose of the authors' study was to evaluate the efficacy of methylphenidate in the medically ill depressed patients and to examine the factors that appear to affect therapeutic response and side effects.
Method:
Hospital charts were reviewed for 29 patients who received trials of methylphenidate for treatment of depressive disorders while admitted to a medical/surgical unit.
Results:
Of the 29 patients, 16 (55%) had moderate or marked improvement, all within 2 days of commencing treatment with the maximal dose. Of the 25 nondelirious patients, 16 (64%) had moderate or marked improvement, and the presence of delirium was significantly associated with decreased response. Therapeutic response was significantly correlated with maximum methylphenidate dose. Side effects were noted in 8 (28%) patients; most side effects were mild (tachycardia or agitation), and all reversed after the medication was discontinued.
Conclusions:
Methylphenidate provides a safe and effective alternative to tricyclic antidepressants in medically ill populations but appears to be less effective in the presence of delirium.
Insights
Methylphenidate effectively treated depression in medically ill patients, with most improvement occurring rapidly. Delirium presence reduced treatment effectiveness, but side effects were mild and reversible.
Area of Science:
- Psychiatry
- Pharmacology
- Internal Medicine
Background:
- Depression is common in medically ill patients.
- Treatment options for this population can be limited.
Purpose of the Study:
- Evaluate methylphenidate efficacy in medically ill depressed patients.
- Identify factors influencing therapeutic response and side effects.
Main Methods:
- Retrospective chart review of 29 medically ill patients with depressive disorders.
- Analysis of methylphenidate treatment response and adverse events.
Main Results:
- 55% of patients showed moderate to marked improvement.
- Response was faster at maximal methylphenidate dosage.
- Delirium was associated with decreased treatment response.
- Mild side effects (tachycardia, agitation) were reversible.
Conclusions:
- Methylphenidate is a safe and effective treatment for depression in medically ill patients.
- Efficacy may be reduced in patients with delirium.
- Offers an alternative to traditional antidepressants.