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Smith KR, Kahlon CH, Brown JN, et al. Methylphenidate use in geriatric depression: A systematic review. Int J Geriatr Psychiatry. 2021 Mar 22. doi: 10.1002/gps.5536. (Systematic review)

OBJECTIVES: Geriatric depression is common and is often associated with coexisting medical illnesses, cognitive dysfunction, or both. Treatment with pharmacotherapy is usually required, and many patients may not respond to initial therapy. Thus, there is a need for adjunctive treatment options. The objective of this systematic review is to assess the efficacy and safety of methylphenidate (MPH) in the treatment of geriatric depression.

METHODS: PubMed (1946-December 2020) and Embase (1947-December 2020) were queried using the following search terms: geriatrics, aged, geriatric patient, or elderly and depressive disorder, depression, major depression or late-life depression, and MPH. Studies were included if they were a randomized-controlled trial or open-label trial that investigated use of MPH for treatment of depression in adults aged 60 years and older.

RESULTS: After screening per the inclusion criteria, five prospective trials were included. All studies found improvement in depressive symptoms with use of MPH or MPH combined with citalopram. Study durations ranged from 8 to 16 weeks and MPH dosing ranged from 5 to 90 mg per day.

CONCLUSIONS: Based on the reviewed literature, MPH appears to be most effective when combined with citalopram and used short-term. MPH should be initiated at a low dose and titrated up to 10 or 20 mg per day based on response. Larger, long-term trials are needed to further define the role of MPH in this population.

Discipline Area Score
Psychiatry 6 / 7
Geriatrics 6 / 7
Family Medicine (FM)/General Practice (GP) 6 / 7
General Internal Medicine-Primary Care(US) 6 / 7
Internal Medicine 6 / 7
Occupational and Environmental Health 4 / 7
Comments from MORE raters

Family Medicine (FM)/General Practice (GP) rater

There is a very small number of studies; the focus on adding more medication takes attention away from the root cause of depression in older patients, loneliness?

General Internal Medicine-Primary Care(US) rater

The evidence is of very poor quality. There is not enough security to recommend the use of methylphenidate in the geriatric population.

Geriatrics rater

Tight criteria so there are not many studies included, the last being in 2015. Therefore, the evidence base has not really advanced in decades, but it remains a viable clinical option in geriatric depression, especially when other medications and interventions do not help or have excessive side effects.

Occupational and Environmental Health rater

Depression in older patients is a challenging clinical problem. Many primary care providers will attempt to initiate therapy with office-based counseling and SSRIs and SSNIs. Other therapies including use of TCAs usually requires referral to a specialist or another physician more experienced with these modalities. Treatment with a psychoactive stimulant such as methylphenidate would certainly fall into the latter category. In any case, more research is definitely needed to properly assess the efficacy and safety of such treatment.
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