Ritalin (methylphenidate)

Ritalin

• -more effective than sertraline in improving cognitive function and maintaining alertness in patients with traumatic brain injury (Lee H 20 p97)
• better tolerated than sertraline (ibid.)
• -found effective in hypoactive delirium, apathy, depressive syndrome (Meyers BJ 148 1738)
• -accelerates antidepressant response in elderly (Lavretsky H 64 1410)
• -useful in depressed or apathetic geriatric patients (Jansen IH 49 474)
• -effective against fatigue in AIDS patients (Breitbart W 161 411)
• -useful in depression in terminally ill cancer patients (Macleod AD 16 193)
• -augments effects of antidepressants particularly improving apathy and fatigue (Masand PS 7 89)
• -in medically ill depressed elderly, is safe and effective; quick onset of action (2-5 days) (Emptage RE 30 151)
• -80% of poststroke depressed elderly had an antidepressant response; few side effects (Lazarus LW 53 447)
• -together with exercise, has a positive effect on fatigue, cognitive function, and functional ability in melanoma patients on interferon-alpha (Schwartz AL 29 E85)
• -substantial improvement in bipolar illness patients with residual depression and sedation, without switch into mania or medication abuse (Carlson PJ 6 416)
• -patient-controlled methylphenidate in advanced cancer patients led to significant improvements in fatigue , overall wellbeing, anxiety, appetite, pain, nausea, depression, and drowsiness, with no serious side effects (Bruera E 21 4439)

How ritalin works:
• -suppresses sleep, thus may cause partial sleep deprivation if taken early in the morning (sleep deprivation has an antidepressant effect);
• -suppresses REM sleep (has this property in common with other antidepressant treatments including SSRIs, tricyclics, exercise, electroconvulsive treatment);
• -dopamine

side effects of ritalin:
• nervousness, insomnia (if taken in the evening), appetite decrease (in non-depressed patients), increase in BP, heart rate (usually not clinically important); palpitations (may need to decrease dose)

indications:
• depression, fatigue, apathy states characterized by excessive sleep or spending excessive time in bed.

timing:
• -since REM sleep peaks in the morning (possibly around 8 am if the patient is asleep at that time) it is preferable to give the medication well before 8 am to maximize the possibility of significantly decreasing REM sleep.
• -Since it has a short half-life, may need to give a second dose around noon.

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