Methylphenidate in depressed medically ill patients.

BACKGROUND

The purpose of the authors' study was to evaluate the efficacy of methylphenidate in the medically ill depressed patients and to examine the factors that appear to affect therapeutic response and side effects.

METHOD

Hospital charts were reviewed for 29 patients who received trials of methylphenidate for treatment of depressive disorders while admitted to a medical/surgical unit.

RESULTS

Of the 29 patients, 16 (55%) had moderate or marked improvement, all within 2 days of commencing treatment with the maximal dose. Of the 25 nondelirious patients, 16 (64%) had moderate or marked improvement, and the presence of delirium was significantly associated with decreased response. Therapeutic response was significantly correlated with maximum methylphenidate dose. Side effects were noted in 8 (28%) patients; most side effects were mild (tachycardia or agitation), and all reversed after the medication was discontinued.

CONCLUSIONS

Methylphenidate provides a safe and effective alternative to tricyclic antidepressants in medically ill populations but appears to be less effective in the presence of delirium.