The efficacy of antidepressants in the treatment of late-life depression.
ABSTRACT This review addresses the question of whether there is evidence that antidepressants are more efficacious than placebo in the treatment of late-life depression and what is the rate of response that physician and patient can expect when antidepressant medication is prescribed in a typical clinical setting. To date, 5 placebo-controlled and 10 comparison trials have study designs of sufficient rigor to provide evidence of antidepressant efficacy and effectiveness in the treatment of late-life depression. The results suggest that antidepressant medications are more effective than placebo. However, placebo-controlled trials are not a simple comparison of only medication versus placebo. Rather, the amount of nonspecific psychosocial interventions included in these trials is considerable and often not systematically measured. Trial design also affects outcome: response and remission rates in comparison trials consistently are 20% to 30% higher than those reported in placebo-controlled trials. Clinical trials do not consistently assess the many moderators that are believed to affect treatment outcome in late-life depression, and therefore, comparisons across studies are problematic because of an inability to determine whether patient samples are truly comparable. For future clinical trials to have maximal relevance, study design should evolve to reflect as closely as possible a typical clinical setting especially with respect to frequency and duration of patient visits.
SourceAvailable from: Breno Satler DinizPsychogeriatrics 12/2014; 14(4). DOI:10.1111/psyg.12100 · 1.22 Impact Factor
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ABSTRACT: Recent evidence concerning the efficacy of pharmacological and psychological treatments for depression in older individuals will be reviewed. The evidence base addressing the effectiveness of antidepressants in older individuals has significantly increased over the past few years. In particular, some recent acute trials have failed to show superiority of an active drug over placebo, although there is more consistent evidence for the efficacy of continuation and maintenance antidepressant treatment. As for psychological treatments, problem-solving therapy (PST) appears to be effective in mild depression and in patients with mild executive dysfunction; however, interpersonal psychotherapy (IPT) may be less effective. The evidence base for interventions in refractory depression is surprisingly limited. Several recent studies have adopted a pragmatic approach and have evaluated complex 'case management' approaches, most of which have been positive. Future studies are likely to target primary prevention. Preliminary evidence supporting this approach is summarized.
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ABSTRACT: Objectives: To identify the prevalence of neuropsychiatric disorders, especially DP and CD, on a sample of nursing home residents, relating this prevalence with some aspects of the demographics and psycho pharmacotherapy. Methods: 48 elders from two different nursing homes were selected. The collection of demographic and pharmacological data was made utilizing medical records. The medication was classified according to the Anatomical Therapeutic Chemical Code (ATC) criteria. The Geriatric Depression Scale (GDS 30) and the Mini Mental State Examination (MMSE) tests were utilized to determine the prevalence of DP and CD. Results: It was observed in the sample a high incidence of DP and CD among the researched elders. More schooling individuals tend to present less CD. Individuals with less CD indicatives present less symptomatology for DP. Of all the researched elders, 54,2% are submitted to psycho pharmacotherapy. Of all the consumed medicine, 16,5% belonged to the class of neuropsychiatric medicine. The medicated elders present, in average, a larger symptomatology for DP (12 points/average/GDS) than the non-medicated elders (9,9 points/average/GDS). The inverse occurs in relation to the CD indicatives. The use of psychotropics, especially in association, can have negative effects related to depression and cognition. Discussion: The pharmacotherapy, characterized for the polymedication and chronicity, especially of neuropsychiatric medicines, deserves special attention among elders, because the data suggest a significant relation between the utilization of medicines, singly or in association, and the increase of CD and DP. In addition, the data suggest that DP is a risk factor for CD and DM.African Journal of Psychiatry 09/2014; 17(6):1-9. DOI:10.4172/1994-8220.1000160 · 0.73 Impact Factor