In Reply: As Drs Agrawal and Worzniak point
out, the evidence supporting the utility and safety of methylphenidate in
the treatment of patients with poststroke depression includes, predominantly,
case reports and open trials.1,2
The only published double-blind, placebo-controlled trial of methylphenidate
in poststroke patients did not examine poststroke depression.3
Although the patients reported a significantly greater improvement in Hamilton
Depression Rating Scale score and Zung Self-Rating Depression Scale score
when treated with methylphenidate compared with placebo, the patients were
not selected for the existence of either major or minor depression and their
depression treatment response was not measured.
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