Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial

• Published in: BMC psychiatry 2021-11, Vol.21 (1), p.582-582, Article 582
• Main Authors: Paulus, Martin P, Kuplicki, Rayus, Victor, Teresa A, Yeh, Hung-Wen, Khalsa, Sahib S
• Format: Article
• Language: English
• Subjects: Adherence; Antidepressants; Antidepressive Agents - therapeutic use; Attention Deficit Disorder with Hyperactivity - drug therapy; Bayes Theorem; Bayesian analysis; Behavior; Brain research; Central Nervous System Stimulants - therapeutic use; Citalopram; Computational neuroscience; Computational psychiatry; Dopamine; Dopamine receptors; Dosage and administration; Double-Blind Method; Drug therapy; Drug therapy, Combination; Escitalopram; Habits; Health care; Humans; Major depressive disorder; Memory; Mental depression; Mental disorders; Mental health; Methylphenidate; Methylphenidate - therapeutic use; Methylphenidate hydrochloride; Norepinephrine; Patient compliance; Pharmacotherapy; Pilot Projects; Placebos; Psychiatry; Remission (Medicine); Stimulant; Traumatic brain injury; Treatment Outcome
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-021-03583-7

Adherence to treatment, i.e. the extent to which a patient's therapeutic engagement coincides with the prescribed treatment, is among the most important problems in mental health care. The current study investigated the influence of pairing an acute positive reinforcing dopaminergic/noradrenergic effect (methylphenidate, MPH) with a standard antidepressant on the rates of adherence to medication treatment. The primary objective of this study was to determine whether MPH + escitalopram resulted in higher rates of medication adherence relative to placebo + escitalopram. Twenty participants with moderate to severe depression were 1-1 randomized to either (1) 5 mg MPH + 10 mg escitalopram or (2) placebo + 10 mg escitalopram with the possibility for a dose increase at 4 weeks. A Bayesian analysis was conducted to evaluate the outcomes. First, neither percent Pill count nor Medication Electronic Monitoring System adherence showed that MPH was superior to placebo. In fact, placebo showed slightly higher adherence rates on the primary (7.82% better than MPH) and secondary (7.07% better than MPH) outcomes. There was a less than 25% chance of MPH augmentation showing at least as good or better adherence than placebo. Second, both groups showed a significant effect of treatment on the QIDS-SR with a median effect of an 8.6-point score reduction. Third, neither subjective measures of adherence attitudes nor socio-demographic covariates had a significant influence on the primary or secondary outcome variables. These data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression. CLINICALTRIALS. NCT03388164 , registered on 01/02/2018.