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August 23/30, 2000

Treatment of Poststroke Depression

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(8):959. doi:10.1001/jama.284.8.956

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 Methylphenidate is also helpful for withdrawn, apathetic older patients.3 Thus, it may be used in patients who are not motivated to participate in physical therapy after a stroke.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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