Depressed mood methylphenidate

Amphetamines are synthetic sympthetomimetic amines that are powerful CNS stimulators, of few of which, in particular dextroamphetamine (8.1.2.2) and methylphenidate (8.1.2.6), are sometimes used for treating depressive conditions. They elevate mood, stimulate motor activity, vigilance, and allow one to concentrate better. However, depending on the dosage and personality of the patient, it may cause various degrees of euphoria, which frequently leads to dependence and addiction. 

Some CNS stimulants such as amphetamines and methylphenidate are sometimes used for elevating mood in patients with depression. However, unlike the antidepressants examined in Chapter 7, these compounds only elevate the level of excitement of the CNS and cannot affect depression, and therefore the terms antidepressant and psychostimulant should be differentiated. 

ECT should be considered for more severe forms of depression (e.g., those associated with melancholic and psychotic features, particularly when the patient exhibits an increased risk for self-injurious behavior) or when there is a past, well-documented history of nonresponse or intolerance to pharmacological intervention. Limited data indicate that bipolar depressed patients may be at risk for a switch to mania when given a standard TCA. A mood stabilizer alone (i.e., lithium, valproate, carbamazepine, lamotrigine), or in combination with an antidepressant, may be the strategy of choice in these patients. Some elderly patients and those with acquired immunodeficiency syndrome may also benefit from low doses of a psychostimulant only (e.g., methylphenidate) (see also Chapter 14, The HIV-Infected Patient ). Fig. 7-1 summarizes the strategy for a patient whose depressive episode is insufficiently responsive to standard therapies. 

Ritalin and related generic methylphenidate drugs are available by prescription for individuals six years and older. Ritalin is distributed in 5, 10, and 20 mg tablets. In addition to ADHD, methylphenidate is used for several other medical conditions. It continues to be used for narcolepsy. It has also been used in treating depression, especially in elderly populations. Methylphenidate has been suggested for use in the treatment of brain injury from stroke or brain trauma it has also been suggested to improve appetite and the mood of cancer and HIV patients. Another use is for pain control and/or sedation for patients using opiates. 

Methylphenidate is similar to amphetamine and, like amphetamine, stimulates the central nervous system (CNS), which consists of the brain and spinal cord. Stimulant drugs affect mood and alertness, and depress food appetite by increasing levels of several neurotransmitters in the brain. Although the exact therapeutic mode of action of methylphenidate is not known, the drug has been shown to elevate levels of some of these neurotransmitters, primarily dopamine and norepinephrine (noradrenaline). 

Methylphenidate increases dopamine levels in the CNS, which then may be converted to norepinephrine in adrenergic terminals. This may result in mood elevation. The use of this drug, however, is limited to treatment-refractory cases or when standard medical therapies are nol tolerated, as CNS stimulants may aggravate coexisting anxiety or agitation in depressed patients. 

Sometimes doctors prescribe methylphenidate (Ritalin) or dextroamphetamine (Dexedrine) to treat a mood disorder called dysthymia that is less severe, but more chronic, than major depression. They work more quickly than antidepressants to pep you up, increasing energy and facilitating attention and concentration. Common side effects include nervousness, insomnia, constipation, headache, and changes in heart rate. 

A 61-year-old man with major depression was prescribed sertraline 50 mg daily without response. Three months later the dose was increased to 100 mg daily and methylphenidate 2.5 mg daily was started. TEs symptoms improved and the dose of methylphenidate was increased to 2.5 mg twice daily and then 5 mg twice daily. After several days at the higher dose, the patient experienced visual hallucinations and confusion. The methylphenidate was discontinued and a day later the psychosis resolved. He was maintained on sertraline 100 mg daily and his mood and motivation remained good. ... 

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