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Methylphenidate/Citalopram Combination Therapy Appears To Accelerate Treatment Response In Geriatric Major Depressive Disorder

A combination of methylphenidate (MPH) and citalopram is relatively well tolerated by elderly patients with depression and may induce a rapid response even among treatment-refractory patients, according to a new study.

Evidence suggests that antidepressant response is less adequate in patients aged 70 years and older compared with younger patients, and augmentation with a rapidly acting agent to accelerate antidepressant response may be beneficial for the elderly.

However, the number of controlled studies of antidepressant response in older patients is limited. To evaluate the potential of methylphenidate to accelerate antidepressant response to citalopram, Helen Lavretsky, MD, of the University of California School of Medicine, Los Angeles, United States and colleagues performed a 10-week, open-label, structured trial in 11 patients with geriatric major depressive disorder.

Treatment with MPH (2.5 mg twice daily) and citalopram (20 mg daily) was initiated simultaneously after baseline assessment. MPH dosage was doubled every 3 days until patients reached a 10 mg daily dose during the first week of treatment, and tapered in 2.5 mg decrements twice daily during the final 2 weeks. Dosage for both drugs was adjusted based on individual response.

Of the participating patients, 9 completed the study, with 6 patients meeting the criteria for accelerated treatment response (Hamilton Rating Scale for Depression score less than 10 and Clinical Global Impressions-Improvement scale score of 1 or 2 by treatment day 14), and 2 more patients responding by week 3.

Patients achieving a rapid response required mean daily doses of 26.67 mg of citalopram and 9.17 mg of MPH, while subjects without rapid response received a mean daily dose of 28.57 mg of citalopram and 14.29 mg of MPH.

Between 1 and 4 side effects were reported by all subjects. The observed side effects were mild to moderate in severity and included sedation (1 patient), impaired concentration (1 patient), nausea (1 patient), anxiety (2 patients), muscle twitching (1 patient), polyuria (3 patients), diarrhoea (1 patient), dry mouth (1 patient), and hypersalivation (1 patient).

Interestingly, 3 patients with a history of preexisting anxiety used lorazepam as an adjunct medication during the trial and had unfavourable outcomes.

"Based on our limited experience, patients with preexisting anxiety may have no or only limited benefit from the use of the combination of citalopram and MPH, even with the concomitant use of lorazepam," the researchers said.

The results of the trial warrant further investigation in randomised, double-blind, placebo-controlled study, they conclude.

J Clin Psychiatry 2003 Dec;64:12:1410-4. "Combined Treatment With Methylphenidate and Citalopram for Accelerated Response in the Elderly: An Open Trial"

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