The antidepressant response to tricyclics in major depressives is accelerated with adjunctive use of methylphenidate.

Standard tricyclic antidepressant (TCA) treatment usually entails response latencies of 2 to 4 weeks. To accelerate the antidepressant response, methylphenidate (MPH) was administered together with standard antidepressants in an open label trial. Twenty inpatients (9 females, 11 males) met DSM-III-R criteria for major depressive episode (15 unipolar and 2 bipolar), depression NOS (n = 2), or Research Diagnostic Criteria for schizoaffective illness, depressed type (n = 1). Following evaluation for depression, patients received an open-label oral MPH stimulation trial (MST), in 1 or 2 dosages of 5 to 15 mg at 0900 and 1000 hours. Twenty patients with positive MST response were treated with TCAs combined with MPH (5-15 mg/d). Therapeutic response was defined as 50 percent decline in the Hamilton Rating Scale for Depression. Six of 20 (30%) patients responded after 1 week of combination TCA-MPH, and 10 of 16 (63%) after 2 weeks. Adverse effects of the combination treatment included: dizziness and orthostatic blood pressure changes (n = 3), dry mouth (n = 3), increased anxiety (n = 3), and hypomania (n = 1). The severity of adverse effects required cessation of the MPH in 3 patients. Elevated self-ratings of anxiety were associated with lack of improvement after both 1 and 2 weeks. Adjunctive MPH appears to accelerate response to tricyclics in this systematically conducted open trial, and adverse effects of the TCA-MPH combination were usually tolerable. Positive response on the MST may be predictive of beneficial therapeutic outcome, especially in depressed patients without high anxiety levels.(ABSTRACT TRUNCATED AT 250 WORDS)