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A phase II study of methylphenidate for depression in advanced cancer
Jade Homsi, MD
Harry R. Horvitz Center for Palliative Medicine (a World Health Organization Demonstration Project in Palliative Medicine), Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
Kristine A. Nelson, MD
Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
Nabeel Sarhill, MD
Department of Internal Medicine, St. Vincent Charity Hospital, Cleveland, Ohio
Lisa Rybicki, MS
Department of Biostatistics and Epidemiology, Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
Susan B. LeGrand, MD
Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
Mellar P. Davis, MD, FCCP
Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
Declan Walsh, MSc, FACP, FRCP (Edin)
Harry R. Horvitz Center for Palliative Medicine, Cleveland Clinic Taussig Cancer Center, Cleveland, Ohio
This study evaluated the use of methylphenidate for depression in advanced cancer.
Design: Phase II open-label prospective study.
Eligibility criteria: No previous use of methylphenidate or current use of other antidepressants.
Evaluation: Depression and response to treatment were determined by asking the patient: "are you depressed?" Patients were assessed at baseline and at days 3, 5, and 7.
Treatment: Starting dose was 5 mg at 8:00 a.m. and 12:00 noon. The dose was titrated for lack of response on any of the assessment days.
Response criteria: A negative response to the question: "are you depressed?"
Results: Some 41 patients were enrolled and 30 (15 men, 15 women) completed the study. Median age was 68 years (range: 30-90). Methylphenidate was stopped for six patients because of side effects and five were not evaluable; 21 responded to 10 mg/day on day 3; the other nine responded to 20 mg/day on day 5; 29 maintained their positive response through day 7. Anorexia, fatigue, concentration, and sedation also improved in some. All who completed the study had tolerable side effects, none of which caused treatment to stop.
Conclusions: Methylphenidate is effective for depression in advanced cancer. A starting dose of 10 mg in divided doses is effective in most patients. Dose escalation may be needed. Improvement occurs within three days. Close monitoring of side effects is recommended.
Key Words: antidepressants • cancer • depression • existential issues • methylphenidate • psychiatric symptoms • psychological symptoms • symptom management
American Journal of Hospice and Palliative Medicine®, Vol. 18, No. 6,
403-407 (2001)
DOI: 10.1177/104990910101800610
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