Table 1. Therapeutic use of stimulants in elderly with major depression.

Author/ Year	Design of Study	Drug	Therapeutic Use	Instrument Tool	Main Result
Pickett, 1990	5 year retrospective patient record study (N=129)	Dextroamphetamine (average maximal daily dose of 8.2 mg/day) and methylphenidate (maximal daily dose averaging 9mg/day)	Geriatric depressive disorders secondary to medical illness	DSM III, Lack of objective tool to assess improvement	A hundred and twenty-nine patients using dextroamphetamine and 25 patients on methylphenidate for depression were reviewed. One hundred and five patients (81%) experienced some improvement on psychostimulant treatment and 85 patients (66%) were rated as markedly or moderately improve.
Lazarus, 1992	3 weeks no randomized, no placebo controlled Clinical Trial (N=10)	Methylphenidate (mean dose of 17mg daily)	Poststroke depression	DSM III R, HAM-D	According to score on Hamilton Rating Scale for Depression, 80% (8 of 10) of the patients demonstrated a full or partial response. Results indicate that methylphenidate can be safe and effective in poststroke depression.
Lazarus, 1994	Retrospective comparison for at least an average of 14.21 days (N=58)	Methylphenidate (máximum dose of 26.4 mg/day) vs northriptyline (máximum dose of 26.4 mg/day)	Poststroke depression	DSM III R to check if the patient no longer met the criteria after treatment	28 patients had been treated with methylphenidate for an average of 14.21 days, and 30 with nortriptyline for an average of 39.36 days. Improvement rates were similar between the groups but the speed of response was dramatically better in methylphenidate (2.4 days vs 27 days in nortriptyline).
Wallace, 1995	8 days double-blind, placebo-controlled cross over trial (N=16)	Methylphenidate (10 mg/day per 2 days, then 20mg/day per 2 days) vs placebo (for 4 days)	Older, depressed, medically ill patients	DSM III R, HAM-D, Mini-Mental State	The benefit of methylphenidate over placebo was statistically and clinically significant. Treatment and order affected the results. Depressive symptoms were more effectively improved when patients received first methylphenidate and than placebo.
Lavretsky,2001	Open label Clinical Trial for at least 8 weeks (N= 10)	Methylphenidate (mean dose was 12.5 mg daily) and Citalopram (mean dose was 26mg daily)	Major depression	DSM IV, HAM-D, CGI (clinical global impression scale) ECG	Patients were separated in 3 groups: citalopram plus methylphenidate since day 0, citalopram and addition of methylphenidate on day 3, citalopram and addition of methylphenidate after 3 weeks. Combination showed rapid onset of action, effectiveness, and was well tolerated in elderly patients with co existing medical conditions.
Lavretsky, 2003	10 weeks open-label, structured trial (N= 11)	Methylphenidate (ranged between 5 and 20 mg daily) plus citalopram (ranged between 20 and 40mg daily)	Major depression	DSM IV, HAM-D	All patients took citalopram and methylphenidate. Nine of them completed the study, 6 participants met criteria for accelerated response, and 2 patients responded after 3 weeks. One patient was a non responder.
Lavretsky, 2006	10 weeks double-blind, placebo controlled pilot trial (N= 16)	Methylphenidate (15mg/day) plus citalopram (20-40 mg/daily) vs citalopram plus placebo	Major depression	HAM-D, MMSE, CVRF, CIRS-G, UKU side effects	Citalopram plus methylphenidate demonstrated rapid improvement (HDRS equal or less than 10 by day 21) when compared with citalopram plus placebo. It is helpful for patients who need a fast improvement and mainly in resistant depression.
Prowler, 2010	Case Report	Methylphenidate (20mg daily)	Major depression with catatonia	No reported	Elderly patient with catatonic depression was treated with methylphenidate for 4 days with rapid improvement of catatonia. Methylphenidate can be useful in elderly with catatonic depression, apathetic and medically ill patients.
Madhusoodanan, 2014	Case Report	Methylphenidate (5mg daily)	Major depression	CGI-S, CGI-I	Augmentation of mirtazapine with methylphenidate in hospitalized patient, showed significant improvement in 2 weeks. Methylphenidate can be helpful in elderly depressed patients for faster improvement, decrease morbidity and shortening of inpatient treatment.
Lavretsky,2015	16 week randomized, double-blind, placebo- controlled trial (N=143)	Methylphenidate (mean of daily dose was 16mg) plus citalopram (mean of daily dose was 32mg) vs citalopram plus placebo	Major depression	HAM-D	Citalopram plus methylphenidate was superior in enhance mood, well being, and remission rate compared with Methylphenidate plus placebo, citalopram plus placebo or either drugs alone.
Madhusoodanan, 2016	Case Report	Methylphenidate (15 mg daily)	Major depression	CGI-S, HAM-D, GDS	Methylphenidate augmentation for treatment-resistant depression in an elderly patient with a meningioma showed significant improvement in 2 weeks.