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Citalopram, methylphenidate improves depression, cognitive performance in geriatrics

The use of citalopram combined with methylphenidate improved depression severity, cognitive performance and remission rates in geriatric patients compared to either treatment alone, according to results from this randomized double-blind placebo-controlled trial.

“These findings potentially offer clinicians guidance on the use of these drugs to achieve faster remission in depressed older adults, although they may not translate into higher remission rates over longer treatment periods,” Helen Lavretsky, MD, and colleagues wrote in their study.

Lavretsky and colleagues identified 143 patients (average age = 69.7 years) who were diagnosed with major depression. The patients were interviewed by telephone and were included in the trial after scoring greater than or equal to 16 on the 24-item Hamilton Depression Rating Scale (HAM-D) and greater than or equal to 26 on the Mini-Mental State Examination (MMSE).

During the 16-week trial, patients were separated into three groups that received either citalopram and placebo (n = 48), methylphenidate and placebo (n = 48), or citalopram combined with methylphenidate (n = 47). The citalopram plus placebo groups received a mean of 35 mg of the drug per day, the methyphenidate and placebo group received 16.4 mg of the drug per day and patients in the combined citalopram and methylphenidate treatment group received a mean of 32.3 mg of citalopram and 16.2 mg of methylphenidate daily. There were no significant differences between doses in any treatment groups.

The researchers found that, while all groups had improved depression severity scores and Clinical Global Impressions improvement scores, the citalopram plus methylphenidate group performed significantly better when compared to the methylphenidate or citalopram groups. HAM-D scores significantly decreased within the first four weeks in the citalopram plus methylphenidate group when compared to the group taking citalopram and placebo, but not methylphenidate and placebo (P = .03). After week four, the HAM-D score for the combination citalopram plus methylphenidate group significantly decreased compared to the group taking methylphenidate and placebo, but not citalopram and placebo (P = .04).

Citalopram dosage was strongly linked to patients reaching remission, according to the researchers. Only 29.8% of those who received methylphenidate plus placebo (no citalopram) achieved remission, while 41.9% of patients who received 20 mg/day, 56.4% who received 40 mg/day and 69.2% of those who received 60 mg/day of citalopram achieved remission (P = .02). The researchers found no association between methylphenidate dosage and remission (P = .02).

Regarding Clinical Global Improvement scores, 84.4% of the combination citalopram plus methylphenidate group either improved much or very much compared to 56.7% of patients in the citalopram and placebo group and 39.4% of patients in the methylphenidate and placebo group (P = .001).

“Overall, the outcomes are encouraging for mental health providers, given the limited number of successful treatment strategies available to enhance antidepressant response with additional benefits in function in geriatric depression,” Lavretsky and colleagues wrote. – by Jeff Craven

Disclosure: Lavretsky reports receiving research 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.