title: Treatment of depression with methylphenidate in patients difficult to wean from mechanical ventilation in the intensive care unit.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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 case-control evaluation.
authors.affiliation: Department of Psychiatry, Ludwig-Maximilians-University Medical School and Klinikum Grosshadern, Munich, Germany. rothenh@kons.med.uni-muenchen.de
authors.forename: H B
authors.initials: HB
authors.lastname: Rothenhäusler
authors.forename: S
authors.initials: S
authors.lastname: Ehrentraut
authors.forename: G
authors.initials: G
authors.lastname: von Degenfeld
authors.forename: M
authors.initials: M
authors.lastname: Weis
authors.forename: M
authors.initials: M
authors.lastname: Tichy
authors.forename: E
authors.initials: E
authors.lastname: Kilger
authors.forename: C
authors.initials: C
authors.lastname: Stoll
authors.forename: G
authors.initials: G
authors.lastname: Schelling
authors.forename: H P
authors.initials: HP
authors.lastname: Kapfhammer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000628:therapy; D016896:Treatment Outcome; D015300:Ventilator Weaning / Q000009:adverse effects / Q000379:methods*; D012122:Ventilators, Mechanical / Q000009:adverse effects*
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate