The authors followed 10 elderly depressed patients (mean age=79.8 years; in an open trial of methylphenidate (MPH) augmentation of citalopram used to accelerate and enhance their antidepressant response. Eight of the 10 patients demonstrated clinically significant improvement by Week 8. Four of the seven patients with augmentation initiated during the first week of treatment with citalopram met the criteria for rapid response at Week 2. No patient discontinued treatment. These preliminary observations suggest that a combination of MPH and citalopram may be an effective, relatively well tolerated treatment in this patient population and may accelerate onset of action. However, patients may require dosage adjustment for tolerability of this combination.