Randomized, double‐blind, placebo‐controlled study of methylphenidate for the treatment of depression in SSRI‐treated cancer patients receiving palliative care

Abstract

Objective To determine the effectiveness of methylphenidate for depression treatment in advanced cancer patients. Methods An 18-day randomized, double-blind, placebo-controlled clinical trial of methylphenidate for treatment of depression in selective serotonin reuptake inhibitor (SSRI)-treated patients with advanced cancer in hospice or receiving palliative care. The primary outcome was depression remission, defined as a ≥50% reduction in score on the Montgomery-Asberg Depression Rating Scale. Results Among 47 enrolled participants, 35 were randomized. At study day 18, 85% of the methylphenidate and 60% of the placebo group were in depression remission (p = 0.22). Mean time to depression remission was 10.3 days [standard error (SE) 1.8] in the methylphenidate and 8.1 (SE 1.3) in the placebo group (p = 0.48). The mean baseline score for the Hospital Anxiety and Depression Scale (HADS) was 10.4 in each group and decreased by 3.6 (SE 1.1) in the methylphenidate and 2.3 (SE 1.2) in the placebo group (p = 0.51) by day 18. Once in remission, 1 methylphenidate and 5 placebo participants relapsed to depression (p=0.18). There was no difference in mortality between the groups during the trial. Trial results were limited by small sample size attributed to difficulties in recruiting terminally ill patients. Conclusions This trial failed to demonstrate that methylphenidate treatment in SSRI-treated patients had a significant effect on depression remission in advanced cancer patients. This study underscores the difficulties in conducting trials for symptom management in patients with shortened life expectancy.

Clinical observation on the benefits of antidepressant intervention in advanced cancer patients

“…In addition, sertraline has the potential to induce antitumor cell proliferation activity and is considered the first choice for antianxiety and depression therapy in tumor patients. [ 18 ] The main side effects associated with sertraline were nausea and vomiting, dizziness, and drowsiness. Moreover, there was no interaction between sertraline and common antitumor therapies.…”

The use of antidepressants in oncology: a review and practical tips for oncologists

“…There is some evidence to support their use in the treatment of anorexia, impaired attention and concentration, opiate-induced sedation and pain [26,27], at low doses that avoid side-effects (Table 1) [28]. However, evidence of their efficacy in the treatment of depression is not clear [29], with some positive results in some studies [30], but not in others [31]. Because of their sympathomimetic effects, caution is advised in patients with hypertension or arrhythmias.…”

Enhancing the revelation of key genes and interaction networks in non‐small cell lung cancer with major depressive disorder: A bioinformatics analysis

“…5,6 Unfortunately, lung cancer tends to be one of the neglected cancers that impacted by psychological stress. 7 Among these psychological stresses, depression is a critical and familiar factor characterized by symptoms such as low mood, diminished interest, reduced self-esteem, and impaired daily functioning. 8 Compared to other cancer patients, lung cancer patients are more likely to experience depression.…”