A Potential Clinical Use for Methylphenidate with Tricyclic Antidepressants

Wharton, Ralph N.; Perel, James M.; Dayton, Peter G.; Malitz, Sidney

doi:10.1176/ajp.127.12.1619

Cited by 127 publications

(25 citation statements)

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“…Psychostimulants also have significant effects on dopamine neurotransmission, and they have been used to augment TCAs, MAOIs, SSRIs, and SNRIs [71,72,73,74,75,76,77]. Clinicians typically use methylphenidate (20–80 mg/day) or dextroamphetamine (10–40 mg/day) in divided doses.…”

Section: Augmentation Studiesmentioning

confidence: 99%

Current Status of Augmentation and Combination Treatments for Major Depressive Disorder: A Literature Review and a Proposal for a Novel Approach to Improve Practice

Fava

Rush

2006

Psychother Psychosom

134

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Most patients with major depressive disorder (MDD) do not reach symptom remission. These patients with residual symptoms have worse function and worse prognosis than those who remit. Several augmentation and combination treatments are used to either increase the chances of achieving remission or to eliminate/minimize residual depressive symptoms. Evidence for these pharmacological approaches rests primarily on open, uncontrolled studies, and there are clearly not enough controlled studies. Clinicians should carefully weigh these different treatment options to increase their patients’ chances of achieving and sustaining remission from depression. This paper will review the pertinent studies and will propose a novel approach to improve practice involving the use of augmentation or combination strategies at the outset of initial treatment to primarily enhance the chances of remission through synergy and/or a broader spectrum of action. This novel approach could potentially enhance retention and/or increase remission rates since the lack of response with antidepressant monotherapy may lead many depressed patients with little or no benefit to drop out of treatment, precluding the subsequent use of augmentation or combination strategies altogether. In addition, the emergence of certain side-effects (e.g., agitation, insomnia) or the persistence of some initial baseline symptoms (e.g., anxiety, insomnia) may lead to premature discontinuation from monotherapy in the absence of concomitant use of augmenting pharmacological options targeting these symptoms.

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Section: Augmentation Studiesmentioning

confidence: 99%

Current Status of Augmentation and Combination Treatments for Major Depressive Disorder: A Literature Review and a Proposal for a Novel Approach to Improve Practice

Fava

Rush

2006

Psychother Psychosom

134

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“…There is a long tradition of their use and they are still used in treating depressed patients. Wharton et al [95] reported the successful treatment of 7 depressed patients refractory to adequate imipramine treatment with the addition of methylphenidate. Their hypothesis was that methylphenidate decreased the metabolism of imipramine and increased its serum level which was supported by the finding of Glassman et al [96].…”

Section: Treatmentmentioning

confidence: 99%

Treatment-Resistant Depression

Ananth

1998

Psychother Psychosom

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Our ability to treat depression has improved with the availability of receptor-specific and chemically diverse groups of antidepressants. Even now, most of the short-term studies indicate that about 20% of depressed patients remain resistant to treatment. Therefore, it is important to properly assess the treatment-resistant depressed (TRD) patients and to separate the truly refractory patients from those inadequately treated. Undiagnosed medical conditions should be eliminated. TRD is neither a clinically nor a biologically identifiable entity. As there are no established methods for the treatment of TRD, all options should be considered. The clinician can be enriched by the knowledge of the treatment modalities available, and yet, in treating an individual patient, clinical skills, intuitive judgment, family history of response to drugs and side effects, all play a vital role. Several of the approaches described in the paper indicate available methods and their merits in general but there is no way of ascertaining by which particular method a patient should be treated. The three common methods of treatment are substitution of one antidepressant drug for another, combination therapies and augmentation techniques. These are based on clinical experiences and not research findings. Therefore the treatment of TRD patients is more an art than a science. The physician should assess all the psychopathological, phenomenological and psychosocial variables to appropriately treat an individual patient.

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“…Stimulants have been used to augment the antidepressant response to tricyclic antidepressants (Wharton et al, 1971;Gwirtsman et al, 1994;Drimmer et al, 1983), monoamine oxidase inhibitors (Fawcett et al, 1991), and combinations of tricyclics and MAOIs (Feighner et al, 1985). Data regarding stimulant augmentation of the SSRIs have been limited to isolated case reports (Wiener and Kennedy, 1985;Joyce, 1986;Cohen, 1993;McGlohn and Bostwick, 1995;Line, 1989;Gupta et al, 1992).…”

Section: Discussionmentioning

confidence: 99%