Rothenhäusler H B, Ehrentraut S, von Degenfeld G, Weis M, Tichy M, Kilger E, Stoll C, Schelling G, Kapfhammer H P
Department of Psychiatry, Ludwig-Maximilians-University Medical School and Klinikum Grosshadern, Munich, Germany.
J Clin Psychiatry. 2000 Oct;61(10):750-5. doi: 10.4088/jcp.v61n1007.
Mechanical ventilation is often required to support patients in the intensive care unit (ICU) with life-threatening cardiovascular, respiratory, or neuromuscular disorders. Occasionally, difficulties related to weaning patients from this support occur owing to depression. The traditional and newer-generation antidepressant drugs have a relatively long latency of response that interferes with rehabilitation attempts in the ICU. Psychostimulants such as methylphenidate show a rapid onset of antidepressant activity and a benign side effect profile.
As consulting psychiatrists in the consultation-liaison service of a university hospital, we treated 7 patients with complex ICU courses presenting prolonged mechanical ventilation and psychomotor retardation associated with markedly depressed mood (DSM-IV criteria) by giving them methylphenidate. Methylphenidate was started on the first day at a dose of 2.5 mg p.o. in the morning and was increased by 2.5 mg each day with twice-a-day dosing in the morning and at noon until the patient responded or showed side effects. A maximum dose of 15 mg/day was not exceeded. Outcome evaluation was performed using the Clinical Global Impressions scale.
Five (71 %) of 7 patients showed marked or moderate improvement in mood and activity within 3 to 4 days, and discontinuation of ventilator support was achieved within 8 to 14 days. Side effects with these 5 patients were not encountered. Of the remaining 2 patients (29%), 1 developed psychomotor agitation and anxiety within 4 days. Another patient showed only minimal improvement with regard to activity.
Methylphenidate might be a rapidly effective and safe treatment for depression in difficult-to-wean patients hospitalized for life-threatening medical illness in the ICU. Implications for future research for this population of patients warrant formal randomized, prospective, clinical case-control evaluation.
重症监护病房（ICU）中患有危及生命的心血管、呼吸或神经肌肉疾病的患者常常需要机械通气来维持生命。偶尔，由于抑郁，患者在撤机过程中会遇到困难。传统和新一代抗抑郁药物的反应潜伏期相对较长，这会干扰ICU中的康复尝试。诸如哌甲酯之类的精神兴奋剂显示出快速起效的抗抑郁活性且副作用较小。
作为一所大学医院会诊联络服务部门的会诊精神科医生，我们对7例患有复杂ICU病程的患者进行了治疗，这些患者存在长时间机械通气以及与明显抑郁情绪相关的精神运动迟缓（符合DSM-IV标准），我们给予他们哌甲酯治疗。哌甲酯于第一天早上口服2.5毫克开始给药，每天增加2.5毫克，分两次在早上和中午给药，直到患者有反应或出现副作用。最大剂量不超过15毫克/天。使用临床总体印象量表进行结果评估。
7例患者中有5例（71%）在3至4天内情绪和活动有显著或中度改善，并在8至14天内成功撤机。这5例患者未出现副作用。其余2例患者（29%）中，1例在4天内出现精神运动性激越和焦虑。另1例患者在活动方面仅略有改善。
对于在ICU因危及生命的疾病住院且难以撤机的患者，哌甲酯可能是一种快速有效且安全的抑郁症治疗方法。对这一患者群体未来研究的意义值得进行正式的随机、前瞻性临床病例对照评估。
