Management of Depression in ALS with the use of Methylphenidate and Sertraline

• Published in: The American journal of geriatric psychiatry 2022-04, Vol.30 (4), p.S123-S124
• Main Authors: Talati, Nikunj, Toledo, Theresa, Akinyemi, Esther
• Format: Article
• Language: English
• ISSN: 1064-7481; 1545-7214
• DOI: 10.1016/j.jagp.2022.01.030

Amyotrophic lateral sclerosis (ALS) is now a well-known disease that was first described by Charcot in the 19th century. It is a relentlessly progressive neurodegenerative disorder, with voluntary muscle action progressively affected, people may experience muscle weakness, disability, and eventually death. The loss of motor neurons results in the primary clinical symptoms and produces impairment affecting limb, bulbar, axial, and respiratory function. The focus of research and treatment has been on the loss of motor neurons, but equally debilitating and associated problems with ALS include mood alterations such as depression and anxiety. Initial depression has been associated with shorter survival time. Quality of life appears to be more dependent on psychological factors such as depression and hopelessness being common in ALS patients. Quality of life can be improved with treatment of depression in ALS patients, however, there are no controlled trials supporting certain pharmacological treatments. One patient we describe here has been diagnosed with ALS without prior depressive symptoms until diagnosis. Patient was tried on citalopram and wellbutrin combintation without much clinical resonse. At this time, referral was made to the psychiatric clinic and patient had already been started on methylphenidate treatment alone without additional SSRI. We describe our algoritihm into finding the patient and his family the treatment that was most responsive for him. Combination treatments with SSRI and methylphenidate has demonstrated enhanced clinical response in mood, well-being, higher rate of remission, and enhancement in cognitive functioning in the geriatric population. Here, we used combintation treatment of methylphenidate with sertraline and observed benefical response including improvements in mood, anxiety, motivation, apathy, energy, and concentration. To the best of our knowledge, there are no case reports that have reported methylphenidate or stimulants in general as treatment adjunct to antidepressants for depressive symptoms in ALS. This patient responded to sertraline and methylphenidate combination at relatively low doses. The use of stimulants was tried in a single patient, so more studies will be needed to confirm the utility of this class of medications and combination in the ALS population with depressive mood symptoms. Further literature on treatment of depression in ALS is needed including different pharmacological measures and treatment mo