Augmenting Antidepressants with Methylphenidate for Patients with Geriatric Depression

As a group, depressed patients who are elderly are more likely than younger patients to show some cognitive impairment and are less likely to respond to antidepressant medication. Stimulants have been used in such older patients to augment antidepressant effects and increase “vitality,” although no controlled trials have demonstrated effectiveness. In a 16-week, double-blind, controlled trial, 143 depressed patients free of psychotropic medications for ≥2 weeks (Hamilton Rating Scale for Depression score, ≥16; mean age, 70; women, 55%; white, 76%) were randomized to citalopram plus placebo, flexibly scheduled methylphenidate plus placebo, or methylphenidate plus citalopram.

More than 40% of participants met criteria for treatment resistance. Mean doses were about 16 mg/day for methylphenidate, 35 mg/day for citalopram alone, and 32 mg/day for combination citalopram. Remission rates at 16 weeks were linearly associated with citalopram dose (range: no citalopram, 30%; 60 mg/day, 69%) but not with methylphenidate dose. Notably, 16-week remission rates were significantly higher in the combination group (62%) than in the citalopram-alone group (42%) or the methylphenidate-alone group (29%). Combination treatment was associated with a significantly higher remission rate at 4 weeks. Although each treatment group improved on some neurocognitive subtests, mean between-group scores did not differ significantly.