Citalopram, Methylphenidate, or Their Combination in Geriatric Depression: A Randomized, Double-Blind, Placebo-Controlled Trial

Abstract

Objective We evaluated the potential of methylphenidate to improve antidepressant response to citalopram in elderly depressed patients with respect to clinical and cognitive outcomes. Methods We conducted a 16-week randomized double-blind placebo-controlled trial for geriatric depression in 143 older outpatients diagnosed with major depression comparing treatment response in three groups: 1) methylphenidate and placebo (N=48); 2) citalopram and placebo (N=48); 3) methylphenidate and citalopram (N=47). Primary outcome was defined as the change in depression severity. Remission was defined as Hamilton Depression Rating Scale (HDRS-24) score of 6 or below. Secondary outcomes included measures of anxiety, apathy, quality of life, and cognition. Results Citalopram daily doses ranged between 20–60 mg (mean 32 mg); methylphenidate daily doses ranged between 5–40 mg (mean 16 mg). All groups showed significant improvement in the severity of depression. However, the improvement in depression severity and the clinical global impression was more prominent in the methylphenidate and citalopram group compared to methylphenidate and placebo and citalopram and placebo (P<0.05). Additionally, the rate of improvement in the methylphenidate and citalopram group was significantly faster than that in the citalopram and placebo in the first 4 weeks of the trial. The groups did not differ on cognitive improvement or the number of side-effects. Conclusions Combined treatment with citalopram and methylphenidate demonstrated an enhanced clinical response profile in the mood and wellbeing, and the rate of response compared to either drug. All treatments led to an improvement in cognitive functioning, without additional benefit from the use of methylphenidate.

Medication for Attention-Deficit/Hyperactivity Disorder and Risk for Depression: A Nationwide Longitudinal Cohort Study

“…Although the comorbidity between ADHD and depression is common, the evidence from clinical trials of ADHD medication (e.g., stimulants) are as yet too limited to warrant their use as treatment adjuncts for depression in selected patient groups (30). A recent clinical trial reported that the addition of methylphenidate to citalopram demonstrated an enhanced clinical response profile in mood and well-being, as well as a higher rate of remission, in older patients (31). Whether such effect would extend to other age groups warrants further investigation.…”

ADHD in old age: a review of the literature and proposal for assessment and treatment

“…In a recent RCT, methylphenidate was added to the treatment with citalopram in 143 older people with depression [91]. Dosages of citalopram varied between 20-60mg/day, and of methylphenidate between 5-40 mg/day.…”

Recognition and treatment of neuropsychiatric disturbances in Parkinson’s disease

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