Methylphenidate in terminal depression

Major depressive disorder in 26 hospice inpatients was managed with a trial of methylphenidate (mean daily dosage, 17.7 mg). A therapeutic response was achieved in 46% of the sample. However, a significant response was obtained in only 7% of those patients who subsequently died of their terminal illness within 6 weeks. Higher dosage psychostimulants may be indicated in the last weeks of life of the terminally ill. Alternatively "vital exhaustion" may account for the poor response rate in the treatment of depression in patients with advanced malignancy.