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

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 dopaminer...

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Autores principales:	Martin P. Paulus, Rayus Kuplicki, Teresa A. Victor, Hung-Wen Yeh, Sahib S. Khalsa
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Adherence Computational psychiatry Stimulant Computational neuroscience Pharmacotherapy Psychiatry RC435-571
Acceso en línea:	https://doaj.org/article/da31d9960fa94f9db8584e665b2dd666
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spelling	oai:doaj.org-article:da31d9960fa94f9db8584e665b2dd6662021-11-21T12:05:14ZMethylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial10.1186/s12888-021-03583-71471-244Xhttps://doaj.org/article/da31d9960fa94f9db8584e665b2dd6662021-11-01T00:00:00Zhttps://doi.org/10.1186/s12888-021-03583-7https://doaj.org/toc/1471-244XAbstract 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.Martin P. PaulusRayus KuplickiTeresa A. VictorHung-Wen YehSahib S. KhalsaBMCarticleAdherenceComputational psychiatryStimulantComputational neurosciencePharmacotherapyPsychiatryRC435-571ENBMC Psychiatry, Vol 21, Iss 1, Pp 1-14 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Adherence Computational psychiatry Stimulant Computational neuroscience Pharmacotherapy Psychiatry RC435-571
spellingShingle	Adherence Computational psychiatry Stimulant Computational neuroscience Pharmacotherapy Psychiatry RC435-571 Martin P. Paulus Rayus Kuplicki Teresa A. Victor Hung-Wen Yeh Sahib S. Khalsa Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial
description	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.
format	article
author	Martin P. Paulus Rayus Kuplicki Teresa A. Victor Hung-Wen Yeh Sahib S. Khalsa
author_facet	Martin P. Paulus Rayus Kuplicki Teresa A. Victor Hung-Wen Yeh Sahib S. Khalsa
author_sort	Martin P. Paulus
title	Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial
title_short	Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial
title_full	Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial
title_fullStr	Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial
title_full_unstemmed	Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial
title_sort	methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial
publisher	BMC
publishDate	2021
url	https://doaj.org/article/da31d9960fa94f9db8584e665b2dd666
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Methylphenidate augmentation of escitalopram to enhance adherence to antidepressant treatment: a pilot randomized controlled trial

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