A DRUG COMBINATION FOR RELIEVING DEPRESSION

I often get good results from using methylphenidate along with a selective serotonin reuptake inhibitor (SSRI) to treat depression. Is there any reason methylphenidate can’t be used to alleviate the depression that accompanies long-standing Parkinson’s disease?
—Birkle Eck, MD, St. Louis

There may well be some role for methylphenidate in patients with Parkinson’s disease; however, its use for comorbid depression is unclear. A recent study showed that when methylphenidate was given along with levodopa, the effects of levodopa were potentiated (Ann Neurol. 2004;55:766-773). The effects on mood, though, were minimal. Earlier research found that the euphoric effects of methylphenidate are blunted in Parkinson’s patients (J Neurol Neurosurg Psychiatry. 1989;52:724-731). There is a case report on the use of methylphenidate to treat apathy in a patient with Parkinson’s disease (J Neuropsychiatry Clin Neurosci. 2002;14:461-462) but little additional evidence. Keep in mind, too, that methylphenidate cannot be used with selegiline, an agent often used in the adjunctive treatment of Parkinson’s disease, because there is a risk of precipitating hypertensive crisis.
—Daniel G. Tobin, MD (115-10)

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