Treatment of Depression With Methylphenidate in Patients Difficult to Wean From Mechanical Ventilation in the Intensive Care Unit
J Clin Psychiatry 2000;61(10):750-755
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Background: Mechanical ventilation is often
required to support patients in the intensive care unit (ICU)
with life-threatening cardiovascular, respiratory, or
neuromuscular disorders. Occasionally, difficulties related to
weaning patients from this support occur owing to depression. The
traditional and newer-generation antidepressant drugs have a
relatively long latency of response that interferes with
rehabilitation attempts in the ICU. Psychostimulants such as
methylphenidate show a rapid onset of antidepressant activity and
a benign side effect profile.
Method: As consulting psychiatrists in the
consultation-liaison service of a university hospital, we treated
7 patients with complex ICU courses presenting prolonged
mechanical ventilation and psychomotor retardation associated
with markedly depressed mood (DSM-IV criteria) by giving them
methylphenidate. Methylphenidate was started on the first day at
a dose of 2.5 mg p.o. in the morning and was increased by 2.5 mg
each day with twice-a-day dosing in the morning and at noon until
the patient responded or showed side effects. A maximum dose of
15 mg/day was not exceeded. Outcome evaluation was performed
using the Clinical Global Impressions scale.
Results: Five (71%) of 7 patients showed marked
or moderate improvement in mood and activity within 3 to 4 days,
and discontinuation of ventilator support was achieved within 8
to 14 days. Side effects with these 5 patients were not
encountered. Of the remaining 2 patients (29%), 1 developed
psychomotor agitation and anxiety within 4 days. Another patient
showed only minimal improvement with regard to activity.
Conclusion: Methylphenidate might be a rapidly
effective and safe treatment for depression in difficult-to-wean
patients hospitalized for life-threatening medical illness in the
ICU. Implications for future research for this population of
patients warrant formal randomized, prospective, clinical