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Citalopram plus methylphenidate improves mood in older adults with depression

Citalopram plus methylphenidate improved mood and well-being quicker and had higher remission rates in older adults with depression than monotherapy, according to recent data.

“Combination treatment with citalopram plus methylphenidate resulted in higher remission rates and shorter time to remission than citalopram monotherapy (62% compared with 42%), with no significant difference in frequency of adverse events,” the researchers wrote.

The double-blind, randomized, placebo-controlled trial compared the results of three treatment options for geriatric depression in 143 older adults with a mean age of 69.7 years who were diagnosed with major depression. Patients were assigned either methylphenidate plus placebo (n = 48), citalopram plus placebo (n = 48) or citalopram plus methylphenidate (n = 47) for 16 weeks.

Remission rates were highest in the citalopram and methylphenidate group at 61.7% compared to 41.7% in the citalopram monotherapy group and 29.2% in the methylphenidate group.

From baseline to the fourth week, citalopram plus methylphenidate had a faster decrease in Hamilton Depression Rating Scale (HAM-D) scores than the citalopram monotherapy (P = .03) group, but not with methylphenidate monotherapy. After the first 4 weeks, HAM-D scores declined quicker in the citalopram plus methylphenidate group compared with patients who were only assigned methylphenidate (P = .04) but not compared with patients who were assigned citalopram. Patients in the citalopram group also had faster decline of HAM-D scores compared with patients in the methylphenidate group (P = .03).

Analyses comparing patients’ remission status, partial response status and nonresponse status showed citalopram plus methylphenidate was the preferred treatment (P = .04).

The secondary outcomes showed that 84.4% of patients assigned citalopram plus methylphenidate improved much or very much compared with patients assigned one drug (P = .001). Citalopram plus methylphenidate treatment was also found to improve well-being (P = .01). However, there were no changes in anxiety, apathy or psychological resilience in any of the groups. Changes in cognitive improvement were similar across the groups.

 “The combination treatment may offer a means of improving the efficacy and rate of response to treatment in late-life depression,” the researchers concluded. – by Stephanie Viguers

Disclosure: Lavretsky received support from the Forest Research Institute and the Alzheimer’s Research and Prevention Foundation. Please see the full study for a list of all other authors’ relevant financial disclosures.