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 Methylphenidate is also helpful for withdrawn, apathetic older patients.³ Thus, it may be used in patients who are not motivated to participate in physical therapy after a stroke.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

Dosages range from 2.5 to 10 mg, . . . [Full Text of this Article]

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An 82-Year-Old Woman With Mood Changes Following a Stroke
Robert G. Robinson
JAMA. 2000;283(12):1607-1614.
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