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

BMC Psychiatry. 2021 Nov 19;21(1):582. doi: 10.1186/s12888-021-03583-7.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: These data do not support the use of MPH to increase adherence to antidepressant medication in individuals with moderate to severe depression. CLINICALTRIALS.

Gov identifier: NCT03388164 , registered on 01/02/2018.

Keywords: Adherence; Computational neuroscience; Computational psychiatry; Pharmacotherapy; Stimulant.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antidepressive Agents / therapeutic use
  • Attention Deficit Disorder with Hyperactivity* / drug therapy
  • Bayes Theorem
  • Central Nervous System Stimulants* / therapeutic use
  • Double-Blind Method
  • Escitalopram
  • Humans
  • Methylphenidate* / therapeutic use
  • Pilot Projects
  • Treatment Outcome

Substances

  • Antidepressive Agents
  • Central Nervous System Stimulants
  • Methylphenidate
  • Escitalopram

Associated data

  • ClinicalTrials.gov/NCT03388164