Methylphenidate for Depressed Cancer Patients Receiving Palliative Care

Inclusion Criteria:

Inclusion:

* Either enrolled in the OHSU radiology/oncology clinic or VA palliative care, and living within 120 miles of the Portland VAMC.
* Life-limiting disease is any type of solid or blood cancer.
* Eighteen years of age or older.
* Life expectancy of 1 year or less as reflected by hospice admission or palliative care status. Although exact life expectancy can not be predicted, actively dying patients with estimated life expectancy of \< 10 days are unlikely to be enrolled.
* Diagnosis of major depression disorder as determined by the Structured Clinical Interview for Diagnosis (SCID).
* Significant depressive cognitive symptomatology as determined by a MADRS greater than 19.
* Currently taking an SSRI but still depressed enough to meet eligibility criteria or not taking SSRI but depressed enough to start on SSRI.
* Willing and able to give informed consent to participate in this study as demonstrated by the MacArthur Competence Assessment Tool for clinical research.
* Speaks/understands English.
* For patients at home who cannot self-administer medications, has a caregiver who can assist with administering medication.

Exclusion Criteria:

Exclusion:

* Dementia or Delirium as determined by the Short Portable Mental Status Questionnaire (SPMSQ) score of less than 7.
* Diagnosis of delirium as determined by the Confusional Assessment Method (CAM).
* Any of the following Brief Psychiatric Rating Scale (BPRS) items rated 4 -, elated mood, suspiciousness, hallucinations, excitement, distractibility or motor hyperactivity.
* Severe insomnia.
* Severe anxiety.
* Significant suicidal ideation.
* History of current mental disorder in which depressive symptoms occur, but for which psychostimulants are contraindicated (schizophrenia and bipolar disorder will be based on history; active psychotic symptoms on selected BPRS items).
* History of stimulant abuse or other active, severe substance abuse.
* Contraindications to methylphenidate or an SSRI including significant cardiac arrhythmias; uncontrolled, severe hypertension; moderate-severe angina; seizure disorder; severe COPD; use of medications such as Levodopa, monoamine oxidase inhibitors, and lithium; diagnosis of narrow-angle glaucoma; or history of SSRI-induced hyponatremia,.
* Physical symptoms including increased blood pressure (DBP greater than 115, SBP greater than 180), pulse greater than 120, irregular pulse, or chest pain consistent with angina.
* Treatment for depression with a non-SSRI antidepressant including Bupropion and Venlafaxine during protocol.
* Known serum creatinine \> 3.0, or severe liver disease as reflected by jaundice or hepatic encephalopathy.
* Unable to swallow pills, however if patient has gastrostomy tube or feeding tube in place the study medicines may be administered by this route. Pills may be poured into food.
* Receiving hospice care in a skilled nursing facility.