Abstract
Objective: The authors evaluated the effectiveness and safety ofmethylphenidate (MPD) for geriatric patients with vascular depression(VD).
Methods: We reviewed all charts of geriatric patients with VD (over 60years old) at Kamo Psychiatry Medical Center and Hiroshima-Nishi
Medical Center treated with MPD between April 2001 and March 2007.
Hamilton Rating Scale for Depression (HAM-D) was administered atbaseline and 4 weeks after the initiation of MPD augmentation.
Results: 81.8% (9/11) of the patients with VD improved by MPD
augmentation with antidepressants based on HAM-D criteria. Themean total scale of HAM-D at baseline was 19.4±11.9 and that of HAMD after the MPD augmentation was 2.9±5.8. This value was statisticallysignificant (p < 0.01). The mean dose of MPD was 9.1±2.9 mg/day(range=5-20mg/day) and none of the patients had adverse reactions ofMPD.
Conclusions: This study suggested that MPD was effective and safe forgeriatric patients with VD.

Introduction
Alexopoulos and Krishnan introduced the term “vascular depression(VD)” for both post-stroke depression (PSD) and MRI-defined VD.1,2
We previously reported that MRI-defined VD is more resistant totreatment than depression without cerebral infarctions.3

Methylphenidate (MPD) is a mild central stimulant of thephenylethylamine category, a potent dopamine, norepinephrine, andserotonin releaser.4 Wallance et al demonstrated the efficacy of MPD inolder, medically-ill depressed patients by double-blind, placebocontrolled trial.5

Lazarus et al reported a retrospective study showing 80% of thepatients of PSD improved during MPD treatment.6 We recently showed
2 cases of MRI-defined VD who dramatically improved with thetreatment using MPD,7 however, there has been no controlled study
evaluating the effects of MPD for VD, especially for MRI-defined VD.

We reported here our clinical experience with the use of MPD for
geriatric VD patients including MRI-defined VD.

Methods
Participants: We reviewed all charts of geriatric patients with VD (over60 years old) at Kamo Psychiatry Medical Center and Hiroshima-Nishi
Medical Center treated with MPD between April 2001 and March 2007.
Each patient was diagnosed as major depression by DSM-III-R or DSMIV-TR. Patients were excluded if they had a diagnosis of dementia, otherpsychiatric illnesses, neurological illnesses, and any contraindications tocranial MRI.
 MRI scanning procedures: The diagnosis of MRI-defined VD wasprospectively defined as a deep white matter hyperintensity (DWMH)
score of 2 or 3, or a subcortical hyperintensity (SCH) score of 3 according
to the Coffey classification system.2 The diagnosis of PSD was also
defined as a DWMH score of 2 or 3, or a SCH score of 3, with the previousstroke event of brain infarction.
 Assessments: we collected the demographics shown in Table1. We also
assessed the dose and duration of MPD treatment, incidence of adverse
reactions, whether MPD improved symptoms. A 21-item Hamilton Rating
Scale for Depression (HAM-D) was administered at baseline and 4 weeks
after the initiation of MPD augmentation. A decrease of 50% or greaterfrom the baseline score on HAM-D was considered a response to treatment.
Results
Eleven VD patients treated with MPD were identified. Demographic
characteristics of the patients at baseline are exhibited in Table1.
 The mean dose of MPD was 9.1±2.9 mg (range = 5-20mg), and themean duration of treatment was 73.9±71.7 weeks (range 8.7-243.8weeks).
 81.8% (9/11) of the patients were responders for MPD based on
HAM-D criteria.
 The mean total scales of HAM-D at baseline was 19.4±11.9 and thatof HAM-D after the MPD augmentation was 2.9±5.8 (Table2), which
was statistically significant (p < 0.01).
 The symptoms of “insomnia”, “work & interests”, “retardation”,“somatic symptoms”, and “loss of weight” were significantly
improved (p<0.01-0.00001). The symptom of “loss of weight” wasmost improved (p < 0.00001).
 Two of 11 patients were non-responders for MPD, and no subjects
had adverse reactions.
Table1: Demographics of the patients at baseline (N=11)

age * (y)gendermale (n)female (n)diagnosis
MRI-defined VD (n)PSD (n)age of first mood episode * (y)antidepressant use(n)mood stabilizer use (n)thyroid hormone use (n)number of antidepressant for each patient*dose of each antidepressant†* (mg/day)duration of antidepressant treatment* (weeks)79.3±7.82
2/11
9/11
9/11
2/11
77.3±9.0
11/11 (100%)
0/11 (0%)
2/11 (18.2%)
2.45±1.56 (range=1-6)
67.9±31.830±24.2 (range=1-72)

MRI; magnetic resonance imaging, VD; vascular depression, PSD; post stroke
depression, *; mean±S.D, y ; years old, †; imipramine equivalents.

Conclusions
This study showed that augmentation therapy by using
MPD was effective for geriatric patients with VD.

All patients including non-responders showed no adversereaction of MPD.

The doses of MPD should be kept as low as possible toprevent the psychotic side effects and addiction of MPD,
and it might be better that MPD is tapered off or switchedto other dopamine agonists which are expected sameeffects as MPD,8 after the crucial symptoms wereimproved.

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