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November 4, 1983

Treatment of Depression

Author Affiliations

St Louis University School of Medicine

JAMA. 1983;250(17):2286. doi:10.1001/jama.1983.03340170024016

To the Editor.—  Dr Ostow's letter (1983;249:1825) concerning the use of dextroamphetamine and methylphenidate hydrochloride in the treatment of depression fails to justify rationally their routine use, even just for induction of antidepressant relief until the effect of another antidepressant agent (tricyclic or monoamine oxidate inhibitor drugs) occurs. While there is some evidence that some CNS stimulants may be helpful in some depressive conditions,1 more studies have shown that many types of depressed patients do not experience any more benefit from either of these drugs than from a placebo.2-4 Both of these medications, even in lower doses, can cause worsening of the primary symptoms of depression, ie, anorexia, weight loss, anxiety, and agitation.4,5 True, in some cases there is improvement when methylphenidate is used with a tricyclic, but the mechanism for this improvement in these cases has not been carefully elucidated. This may be the result of