To the Editor: In the Clinical Crossroads article1 discussing an 82-year-old woman with poststroke
depression, Dr Robinson does not mention methylphenidate hydrochloride as
a treatment option. Controlled trials have shown that methylphenidate is a
safe, effective option for treating depressed, medically ill older patients.2 Its major advantage over other antidepressants
is its relatively rapid onset of action, usually 2 to 3 days. Tricyclic antidepressants
also may cause anticholinergic adverse effects and, unlike methylphenidate,
increased risk of seizures. Methylphenidate is also helpful for withdrawn,
apathetic older patients.3 Thus, it may
be used in patients who are not motivated to participate in physical therapy
after a stroke. The evidence suggesting that methylphenidate is effective
for poststroke depression comes mainly from case reports and uncontrolled
studies. In 1 prospective trial of 21 stroke patients, those treated with
methylphenidate had significantly lower Hamilton Depression Rating Scale scores.4
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