Combined Treatment With Methylphenidate and Citalopram for Accelerated Response in the Elderly: An Open Trial

Background: Accelerated antidepressant treatment response may be particularly beneficial for older patients, yet there are few data to inform clinical practice. We evaluated the potential of methylphenidate to accelerate antidepressant response to citalopram and the safety and tolerability of the combined treatment in patients with geriatric major depressive disorder.

Method: We studied 11 elderly outpatients aged 70 years and older who were diagnosed with DSM-IV major depressive disorder in a 10-week, open-label, structured trial (July 2001-July 2002). Methylphenidate was tapered and discontinued during weeks 9 and 10. Response was defined as a Hamilton Rating Scale for Depression (HAM-D) score of less than 10. The daily dose of citalopram ranged between 20 and 40 mg, and the daily dose of methylphenidate ranged between 5 and 20 mg.

Results: Nine patients completed the study. Six patients met criteria for accelerated response (HAM-D score < 10 and Clinical Global Impressions-Improvement scale score of 1 or 2 by treatment day 14), and 2 more patients responded by week 3. One patient was a nonresponder. The mean (SD) citalopram dose for all subjects was 27.5 (10.3) mg and the mean (SD) methylphenidate dose was 12.2 (4.9) mg. The observed side effects were mild to moderate in severity and included sedation, nausea, anxiety, polyuria, dry mouth, and hypersalivation.

Conclusion: Methylphenidate augmentation of citalopram may be a safe and viable strategy for accelerating antidepressant response in elderly depressed patients. The results of this open-label trial need to be confirmed in a placebo-controlled trial.