Methylphenidate may be safely used in patients with MDD
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Use of methylphenidate in adult patients with major depressive disorder (MDD) appears to be safe, being associated with reduced hospitalization or emergency visits without increasing the risk of suicidality, mania, or recurrence, according to a retrospective study.
Researchers used the TriNetX Global Collaborative Network to identify adult patients with MDD who initiated methylphenidate. These patients were matched with patients who did not receive methylphenidate (control). Those who had attention-deficit/hyperactivity disorder, bipolar disorder, mania, or recent psychiatric destabilization were excluded.
The primary outcome was a composite of all-cause hospitalization or emergency room visits. Hospitalization, emergency visits, suicidal behaviour, manic episodes, and recurrence of MDD were also evaluated as secondary outcomes.
The analysis included 3,211 matched pairs (mean age 55.8 years, 58 percent female). Over 1 year of follow-up, the composite outcome occurred in 574 patients in the methylphenidate group vs 694 of those in the control group (hazard ratio, 0.85, 95 percent confidence interval, 0.76–0.95).
No significant between-group differences were observed for hospitalization, emergency visits, suicidal behaviour, manic episodes, or MDD recurrence.
Subgroup analyses by sex, age, and antidepressant class yielded consistent results.
Although longer follow-up is needed, the findings support the psychiatric safety of methylphenidate as an adjunctive treatment in MDD, the researchers said.