Stimulants and Geriatric Depression May be Underused.
A well designed study showed that adding methylphenidate (Ritalin and others) to citalopram (Celexa) improve the likelihood of complete remission from depression in older patients.
In general older depressed patients are more likely to have some cognitive impairment and are less likely to respond to antidepressants. A number of reports suggests that adding stimulants to antidepressants can increase “vitality and energy,” but there were no controlled trials to show that it works.
In this study of hundred and 43 depressed older patients (average age of 70), of whom 40% met criteria for “treatment resistance,” those patients randomized to receive the combination of methylphenidate (average dose of 16 mg a day) plus citalopram (average dose of 32 mg a day) did significantly better than those randomized to receive just methylphenidate or those randomized to receive just citalopram.
16 week remission rates in the combined group were 62% compared with 42% in the citalopram only group and 29% in the methylphenidate only group. Somewhat surprisingly, although each group improved on neurocognitive testing, there were not significant differences between the groups in terms of cognitive improvement, which highlights the fact that this effect did not have to do with improving cognition.
It’s worth noting that methylphenidate can increase blood levels of citalopram, although this is unlikely to explain the result because just increasing citalopram dose does not improve treatment outcomes in the way that adding methylphenidate did in this study.