Combined treatment with methylphenidate and citalopram for accelerated response in the elderly: An open trial
Combined treatment with methylphenidate and citalopram for accelerated response in the elderly: An open trial
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DOI：
10.4088/jcp.v64n1202
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发表时间：
2003-12-01
影响因子：
5.3
通讯作者：
Reynolds, CF
中科院分区：
文献类型：
--
作者：
Lavretsky, H;Kim, MD;Reynolds, CF
背景：加速抗抑郁治疗反应可能对老年患者特别有益，但很少有数据可供临床实践参考。我们评估了哌醋甲酯加速西酞普兰抗抑郁反应的潜力，以及老年重度抑郁症患者联合治疗的安全性和耐受性。 方法：我们在一项为期 10 周、开放标签、结构化试验（2001 年 7 月至 2002 年 7 月）中研究了 11 名 70 岁及以上、被诊断患有 DSM-IV 重度抑郁症的老年门诊患者。在第 9 周和第 10 周期间，哌醋甲酯逐渐减量并停药。缓解定义为汉密尔顿抑郁量表 (HAM-D) 评分低于 10。西酞普兰的日剂量范围为 20 至 40 mg，哌醋甲酯的日剂量范围为 5 至 20 mg。结果：9 名患者完成了研究。 6 名患者符合加速缓解标准（HAM-D 评分 < 10，治疗第 14 天临床总体印象改善量表评分为 1 或 2），另外 2 名患者在第 3 周出现缓解。 1 名患者无缓解。所有受试者的平均 (SD) 西酞普兰剂量为 27.5 (10.3) mg，平均 (SD) 哌醋甲酯剂量为 12.2 (4.9) mg。观察到的副作用严重程度为轻度至中度，包括镇静、恶心、焦虑、多尿、口干和唾液过多。结论：哌甲酯联合西酞普兰可能是加速老年抑郁症患者抗抑郁反应的安全可行的策略。这项开放标签试验的结果需要在安慰剂对照试验中得到证实。
Background: Accelerated antidepressant treatment response may be particularly beneficial for older patients, yet there are few data to inform clinical practice. We evaluated the potential of methylphenidate to accelerate antidepressant response to citalopram and the safety and tolerability of the combined treatment in patients with geriatric major depressive disorder.Method: We studied 11 elderly outpatients aged 70 years and older who were diagnosed with DSM-IV major depressive disorder in a 10-week, open-label, structured trial (July 2001-July 2002). Methylphenidate was tapered and discontinued during weeks 9 and 10. Response was defined as a Hamilton Rating Scale for Depression (HAM-D) score of less than 10. The daily dose of citalopram ranged between 20 and 40 mg, and the daily dose of methylphenidate ranged between 5 and 20 mg.Results: Nine patients completed the study. Six patients met criteria for accelerated response (HAM-D score < 10 and Clinical Global Impressions-Improvement scale score of I or 2 by treatment day 14), and 2 more patients responded by week 3. One patient was a nonresponder. The mean (SD) citalopram dose for all subjects was 27.5 (10.3) mg and the mean (SD) methylphenidate dose was 12.2 (4.9) mg. The observed side effects were mild to moderate in severity and included sedation, nausea, anxiety, polyuria, dry mouth, and hypersalivation.Conclusion: Methylphenidate augmentation of citalopram may be a safe and viable strategy for accelerating antidepressant response in elderly depressed patients. The results of this open-label trial need to be confirmed in a placebo-controlled trial.