Some authors have reported lack of effect, or even deterioration following the addition of psychostimulants.53-56 Beneficial effects have been described in particular in depression with marked apathy in elderly patients.32,52,57-60 Administration of psychostimulants appears to enhance the efficacy of concomitant (analytically orientated) psychotherapy in elderly patients by facilitating

communication and cooperation through their mood-elevating effects.31 Psychostimulants are suggested to be of significant value in Inhibitors,research,lifescience,medical the management of depression in the elderly as well as in depressed patients with concomitant somatic disorders,14,21,22,60 and good Cytoskeletal Signaling inhibitor results have Inhibitors,research,lifescience,medical been reported in the treatment of secondary depressions

triggered by preexisting somatic diseases.4,21,40,61 Psychostimulants have been shown to be effective in patients with mild depressive symptoms in an outpatient setting.15,55,62 According to Rudolf,49,63 the addition of psychostimulants in patients with treatment-resistant depression receiving conventional antidepressants is superior to electroconvulsive therapy (ECT). Kerenyi et al15 reported methylphenidate to be useful in combination with ECT. Inhibited patients and depressed patients with bipolar disorder seemed to benefit, most, from adjuvant, treatment with psychostimulants.15 The response to psychostimulants in patients suffering Inhibitors,research,lifescience,medical from neurotic and agitated depression seems to be less satisfactory. Nevertheless, there is no contraindication to psychostimulants in agitated depression.64 The combination of psychostimulants with tricyclics and MAOIs has been Inhibitors,research,lifescience,medical a very controversial issue. Some authors have criticized the combination of psychostimulants and MAOIs on the basis of the possible development of an adrenergic crisis or the serotonin syndrome. The Physicians Desk Reference Inhibitors,research,lifescience,medical even warned against such drug combinations in 1983 because of the possibility of hypertensive crises, which,

however, were found to be very rare.35 In contrast with the above reports, several series of open clinical trials showed the combination of psychostimulants MycoClean Mycoplasma Removal Kit and MAOIs to be safe (see review in refs 35, 65-67). More recently, authors such as Chiarello and Cole2 and Little68 have stressed the frequent, effectiveness of the combination of psychostimulants and MAOIs in treatment-resistant depression. Findings from a retrospective study in §5 depressed patients Subjects and methods In a retrospective study, we evaluated all the medical records since the 1950s of patients at the Zurich Psychiatric Hospital who had received psychostimulants because of treatment-resistant depression (defined by Woggon44 as lack of improvement, despite treatment with at least two different antidepressants in adequate dosage for more than 4 weeks). A total of 65 patient records were analyzed (20 males and 45 females).