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www.medscape.com
March 04, 2015
The combination of the methylphenidate (multiple brands) and the
antidepressant citalopram (multiple brands) may
accelerate the rate of response in elderly patients with
depression, new research suggests.
A randomized, placebo-controlled study conducted by
investigators at the University of California, Los Angeles
(UCLA) showed that most patients who responded to the treatment
achieved remission within the first month.
Importantly, the investigators note, the combined therapy did
not increase side effects.
"The combination can shorten time to remission to 1 to 4 weeks
in patients who are depressed," lead author Helen
Lavretsky, MD, professor of psychiatry in residence and director
of the Late- Life Mood, Stress, and Wellness
Research Program at UCLA's Geffen School of Medicine, told
Medscape Medical News.
The study was published online February 13 in the American
Journal of Psychiatry.
Slower Response
Elderly patients with depression have a slower response to
antidepressants sometimes as long as 12 to 16 weeks
as well as lower rates of remission.
"Methylphenidate and other stimulants have had a known fast
onset of action, up to 72 hours in depressed patients,
and that was a rationale for use in this study," said Dr
Lavretsky.
The study is the first randomized, placebo-controlled trial to
evaluate the combination of methylphenidate and the
selective serotonin reuptake inhibitor (SSRI) citalopram for
depression in the elderly in comparison with monotherapy
with either drug, the authors noted.
For the double-blind trial, 143 outpatients whose average age
was 69.7 years and who were diagnosed with major
depression in accordance with DSM-IV-TR criteria were randomly
assigned to one of three treatment groups:
methylphenidate plus placebo (n = 48), citalopram plus placebo
(n = 48), and the combination of citalopram plus
methylphenidate (n = 47).
Patients were treated with daily doses ranging from 20 mg to 60
mg for citalopram (mean, 32 mg) and from 5 mg to
40 mg for methylphenidate (mean, 16 mg).
At 16 weeks, all groups met the primary outcome measure of
significant improvement in depression severity (P
