NASHVILLE, TENN. – Treatment with methylphenidate safely reduced fatigue and depression in hospice patients in a controlled study with 30 patients.
“Treatment with methylphenidate may restore coping modalities that are compromised in patients with advanced illness,” Dr. Christopher Kerr and associates reported in a poster at the annual meeting of the American Academy of Hospice and Palliative Medicine. “Methylphenidate's efficacy appeared to go beyond improving depression, because depression was not the sole factor that predicted a reduction in fatigue,” they said. The drug's efficacy exceeded acting as a stimulant because it also reduced anxiety and promoted sleep.
The study included patients with a terminal illness who had symptoms of fatigue for at least 2 weeks and a fatigue score of at least 4 on the Edmonton Symptom Assessment Scale (ESAS). The study excluded patients with a history of seizures or cardiac arrhythmias, patients with dementia, psychosis, cognitive impairment, severe hepatic or renal dysfunction, and patients treated with antidepressant medication.
Patients were randomized to treatment with 5 mg of methylphenidate b.i.d. or placebo for 2 weeks. The methylphenidate dosage could be increased by 5 mg/day every few days based on patient responses and adverse effects. During the study, the dosage of methylphenidate used ranged from 10 mg to 40 mg/day. Patients were assessed after 3, 7, and 14 days of treatment.
After 14 days, the average ESAS fatigue score among the 15 patients treated with methylphenidate fell from 7.4 at baseline to 2.69, a statistically significant difference. Among the 15 patients treated with placebo, the average score fell from 6.93 at baseline to 6.58, a nonsignificant difference, reported Dr. Kerr, medical director of Hospice Buffalo (N.Y.) Home Care, and his associates.
The patients showed a similar pattern of changes in fatigue when assessed by two other measures: the Piper Fatigue scale, and the Visual Analog Scale for Fatigue. Reductions in fatigue among patients getting methylphenidate occurred in a dose-dependent manner, and began to appear 3 days after the start of treatment.
The drug also was effective at reducing depression scores. Among the patients treated with methylphenidate, the average score on the Beck Depression Inventory scale fell by 22% after 14 days of treatment, compared with baseline, the average score on the Center for Epidemiologic Studies-Depression Scale fell by 33%, and the average ESAS depression score fell by 35%. Changes from baseline in the placebo group were much smaller.
Improvements also were seen in additional scores measured with the ESAS, including scores for well-being, anxiety, and pain. Methylphenidate treatment did not significantly improve functional status.
Vital signs were not changed in patients taking methylphenidate for 2 weeks, and adverse effects were minor. The drug was not discontinued in any patient because of toxicity. Methylphenidate treatment was associated with worsening nausea.