Geriatric Research, Education, and Clinical Center, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
Pharmacy Department, Durham Veterans Affairs Health Care System, Durham, North Carolina, USA.
Int J Geriatr Psychiatry. 2021 Sep;36(9):1304-1312. doi: 10.1002/gps.5536. Epub 2021 Apr 7.
Geriatric depression is common and is often associated with coexisting medical illnesses, cognitive dysfunction, or both. Treatment with pharmacotherapy is usually required, and many patients may not respond to initial therapy. Thus, there is a need for adjunctive treatment options. The objective of this systematic review is to assess the efficacy and safety of methylphenidate (MPH) in the treatment of geriatric depression.
PubMed (1946-December 2020) and Embase (1947-December 2020) were queried using the following search terms: geriatrics, aged, geriatric patient, or elderly and depressive disorder, depression, major depression or late-life depression, and MPH. Studies were included if they were a randomized-controlled trial or open-label trial that investigated use of MPH for treatment of depression in adults aged 60 years and older.
After screening per the inclusion criteria, five prospective trials were included. All studies found improvement in depressive symptoms with use of MPH or MPH combined with citalopram. Study durations ranged from 8 to 16 weeks and MPH dosing ranged from 5 to 90 mg per day.
Based on the reviewed literature, MPH appears to be most effective when combined with citalopram and used short-term. MPH should be initiated at a low dose and titrated up to 10 or 20 mg per day based on response. Larger, long-term trials are needed to further define the role of MPH in this population.
老年抑郁症很常见，常与并存的医学疾病、认知功能障碍或两者同时存在有关。通常需要药物治疗，许多患者可能对初始治疗没有反应。因此，需要辅助治疗选择。本系统评价的目的是评估哌醋甲酯（MPH）治疗老年抑郁症的疗效和安全性。
使用以下搜索词在 PubMed（1946 年-2020 年 12 月）和 Embase（1947 年-2020 年 12 月）中进行检索：老年医学、年龄、老年患者或老年人和抑郁障碍、抑郁症、重度抑郁症或老年抑郁症，以及 MPH。如果研究是一项随机对照试验或开放标签试验，调查 MPH 用于治疗 60 岁及以上成年人的抑郁症，则将其纳入研究。
根据纳入标准进行筛选后，纳入了五项前瞻性试验。所有研究均发现 MPH 或 MPH 联合西酞普兰治疗可改善抑郁症状。研究持续时间从 8 周到 16 周不等，MPH 剂量从 5 毫克到 90 毫克/天不等。
根据已审查的文献，MPH 与西酞普兰联合使用且短期使用时效果最佳。应从低剂量开始使用 MPH，并根据反应逐渐增加至 10 或 20 毫克/天。需要更大、长期的试验来进一步确定 MPH 在该人群中的作用。
