THE ANTIDEPRESSANT RESPONSE TO TRICYCLICS IN MAJOR DEPRESSIVES IS ACCELERATED WITH ADJUNCTIVE USE OF METHYLPHENIDATE

Standard tricyclic antidepressant (TCA) treatment usually entails resp onse latencies of 2 to 4 weeks. To accelerate the antidepressant respo nse, methylphenidate (MPH) was administered together with standard ant idepressants in an open label trial. Twenty inpatients (9 females, 11 males) met DSM-III-R criteria for major depressive episode (15 unipola r and 2 bipolar), depression NOS (n = 2), or Research Diagnostic Crite ria for schizoaffective illness, depressed type (n = 1). Following eva luation for depression, patients received an open-label oral MPH stimu lation trial (MST), in 1 or 2 dosages of 5 to 15 mg at 0900 and 1000 h ours. Twenty patients with positive MST response were treated with TCA s combined with MPH (5-15 mg/d). Therapeutic response was defined as 5 0 percent decline in the Hamilton Rating Scale for Depression. Six of 20 (30%) patients responded after 1 week of combination TCA-MPH, and 1 0 of 16 (63%) after 2 weeks. Adverse effects of the combination treatm ent 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 pat ients. Elevated self-ratings of anxiety were associated with lack of i mprovement after both 1 and 2 weeks. Adjunctive MPH appears to acceler ate response to tricyclics in this systematically conducted open trial , and adverse effects of the TCA-MPH combination were usually tolerabl e. Positive response on the MST may be predictive of beneficial therap eutic outcome, especially in depressed patients without high anxiety l evels. Although these findings are preliminary, further corroboration by controlled studies may have significant implications for reducing t he latency of pharmacotherapeutic response to antidepressants.