Antidepressant pharmacotherapy in the treatment of depression in the very old: A randomized, placebo-controlled trial
ABSTRACT This study determined the efficacy of antidepressant medication for the treatment of depression in the "old-old."
This randomized 8-week medication trial compared citalopram, 10-40 mg/day, to placebo in the treatment of patients 75 and older with unipolar depression.
A total of 174 patients who were 58% women with a mean age of 79.6 years (SD=4.4) and a mean baseline Hamilton Depression Rating Scale score of 24.3 (SD=4.1) were randomly assigned to treatment at 15 sites. There was a main effect for site but not for treatment condition. The remission rate, defined as a final Hamilton depression scale score <10, was 35% for the citalopram and 33% for the placebo groups. However, patients with severe depression (baseline Hamilton depression scale score >24) tended to have a higher remission rate with medication than with placebo (35% versus 19%).
In the oldest group of community-dwelling patients to be studied to date, medication was not more effective than placebo for the treatment of depression. However, given the considerable psychosocial support received by all patients, the placebo condition represents more than the ingestion of an inactive pill. Across sites, there was considerable range in response to medication, 18% to 82%, and to placebo, 16% to 80%.
SourceAvailable from: Hyung-Jun Yoon
[Show abstract] [Hide abstract]
ABSTRACT: Baseline severity is a crucial moderator of trial outcomes in adult depression, with the advantage of antidepressants over placebo increasing as severity increases. However, this relationship has not been examined in late-life depression. PubMed, Embase, Web of Science, PsycINFO, and Cochrane were searched for studies published through September 2014. Randomized, acute phase, and double-blind studies comparing an antidepressant group with a placebo group in depressed elderly patients were included. Nineteen studies met all inclusion criteria. Within-group effect sizes revealed significant improvement in antidepressant groups (g=1.35, p<.000), as well as in placebo groups (g=.96, p<.000). Change in depressive symptoms assessed by Hamilton Depression Rating Scale (HDRS) was moderated by baseline severity in antidepressant groups (Z=2.67, p=.008) and placebo groups (Z=4.46, p<.000). However, this would be expected as a result of regression toward the mean, and mean differences between groups did not increase (r=.19, p=.469) as a function of baseline severity. Limited to published data and information was only analyzed at the level of treatment groups. Baseline severity was not associated with an antidepressant-placebo difference and placebo responses are large in the treatment of depressed elderly people. We propose a stepwise approach, i.e., to initially offer elderly depressed patients psychosocial interventions and only consider antidepressants if patients do not respond. Copyright © 2015 Elsevier B.V. All rights reserved.Journal of Affective Disorders 04/2015; 181:50-60. DOI:10.1016/j.jad.2015.03.062 · 3.71 Impact Factor
Article: Depression in the Elderly[Show abstract] [Hide abstract]
ABSTRACT: Key Clinical Points Care of the Asplenic Patient Late-life depression (occurring in persons 60 years of age or older) is common and is often associated with coexisting medical illness, cognitive dysfunction, or both. Depressed older adults are at increased risk for suicide. Asplenic patients in whom fever develops should receive empirical antimicrobial therapy immediately. Screening for depression is important, but positive screening results should be followed by a thorough evaluation to assess patient safety and ensure that treatment is warranted. Either pharmacotherapy or psychotherapy may be used as first-line therapy. Currently available antidepressants show efficacy in depressed older populations, but older adults may be at increased risk for medication side effects. Selective serotonin-reuptake inhibitors (SSRIs) are considered first-line pharmacotherapy. Standardized psychotherapy techniques are also effective for depression in older adults.New England Journal of Medicine 09/2014; 371(13):1228-1236. DOI:10.1056/NEJMcp1402180 · 54.42 Impact Factor