Apathy methylphenidate

Stimulants. Methylphenidate (Ritalin) and dextroamphetamine (Dexedrine) are the most widely used and perhaps the most effective medications when treating post-TBI apathy. They act by enhancing the activity of dopaminergic, noradrenergic and, to a certain extent, serotonergic brain systems. Stimulants act quickly to relieve the core symptoms of apathy, and they may also improve the impairments in attention and short-term memory that often follow TBl. Please refer to Chapter 8 for more information about the stimulants. 

Stimulants such as amphetamine and methylphenidate have been used to treat depression for many years. Stimulants should not be used alone, except perhaps in geriatric patients with prominent apathy, medically ill patients with depression, or patients with poststroke depression (Lingam et al. 1988). However, psychostimulants are useful for augmentation of antidepressant therapy in refractory depression, and they are generally safe, even for most patients with cardiac disorders. The nonamphetamine stimulant modafmil was found to be helpful in a recent placebo-controlled study involving 311 patients with partial response to SSRIs (Fava et al. 2005). 

There is a clinical impression that psychostimulants may be helpful in HIV- or AIDS-related affective syndromes (487, 488). Thus, methylphenidate 10 to 20 mg per day (up to 40 mg per day) or dextroamphetamine 5 to 15 mg per day (up to 60 mg per day) has been helpful in patients with mild depression who also show symptoms of social withdrawal, fatigue, and apathy, as well as mild cognitive impairment. At times, the combination of low-dose antidepressant and psychostimulant may be more effective and less likely to induce adverse CNS effects. 

Methylphenidate also has been used to treat other medical conditions. For example, it has been used as a short-term treatment for depression in the medically ill, as an adjunct to conventional antidepressants for patients with major depressive disorder, and in combination with opiates for pain control. Methylphenidate has been prescribed to reduce apathy in patients with dementia or other brain diseases (28,34,35). 

Amphetamines methylphenidate cocaine Agitation, hypertension, tachycardia, delusions, hallucinations, hyperthermia, seizures, death Apathy, irritability, increased sleep time, disorientation, depression... 

Herrmann N, Rothenburg LS, Black SE, Ryan M, Liu BA, Busto UE, Lanctot KL. Methylphenidate for the treatment of apathy in Alzheimer s disease. Prediction of response using dextroamphetamine challenge. J Clin Psychopharmacol 2008 28 296-301. 

Jafarinia M, Mohammadi MR, Modabbemia A, Ashrafi M, Khajavi D, Tabriz M, et al. Bupropion versus methylphenidate in the treatment of children with attention-deficit/hyperactivity disorder randomized double-blind study. Hum Psychopharmacol Clin Exp 2012 27 411-8. Rosenberg PB, Lanctot KL, Drye LT, Hermann N, Scherer RW, Bachmann DL, ADMET Investigators, et al. Safety and efficacy of methylphenidate for apathy in Alzheimer s disease a randomized, placebo-controUed trial. J Clin Psychiatry 2013 74 810-6. 

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