Systematic reviews, clinical trials and case series were eligible for inclusion if they evaluated methylphenidate for the treatment of depressive symptoms, fatigue or apathy in older adults (mostly aged ≥65 years), adults receiving palliative care or with terminal illness, or adults with other chronic illnesses. Chronic illnesses could include human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), stroke and traumatic brain injury. No other criteria for inclusion were specified. Studies of adults with bipolar disorder, attention-deficit hyperactivity disorder, narcolepsy, cataplexy, chronic fatigue syndrome and related disorders were excluded. Studies of adults with depression under the age of 65 without comorbid illness were also excluded.
In the included studies, participants mostly had chronic conditions with symptoms such as depression, fatigue and apathy. Chronic conditions included stroke, HIV, AIDs, and traumatic brain injury. A proportion of participants were receiving palliative care for terminal illness, mostly cancer. Patients were receiving rehabilitation, or living at home or with a family member, or hospitalised, or institutionalised. Doses of methylphenidate ranged from 2.5mg to 60mg per day; comparisons in controlled trials were mostly made against placebo. The review identified some of the measures used to score outcomes, including the Zung depression scale, the Hamilton Depression Rating Scale, Functional Independence Measure, Mini Mental State Examination and the Nurses Observation Scale, but for many studies no measurement scales were specified.
Outcomes included depressive symptoms, fatigue and apathy, but also included improvements in function, cognitive function, pain control, sleepiness, anger and social interaction.
The author did not state how studies were selected for the review.