Antidepressant pharmacotherapy in the treatment of depression in the very old: A randomized, placebo-controlled trial

Cornell University, Итак, New York, United States
American Journal of Psychiatry (Impact Factor: 12.3). 11/2004; 161(11):2050-9. DOI: 10.1176/appi.ajp.161.11.2050
Source: PubMed


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%.

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    • "In the very old, SSRIs are more effective than placebo, but only in severe depression. Important differences in results were found with ranges of 18 to 82% for placebo and 16 to 80% for citalopram (Roose et al., 2004). Finally, SSRI reduces the relapse rate significantly (Gorwood et al., 2007), known to be higher in elderly patients (Mitchell and Subramaniam, 2005). "
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    ABSTRACT: Although psychomotor retardation (PR) and cognitive disfunctioning are essential symptoms of elderly depressed patients, the differential effect of treatment with an SSRI in the elderly on these symptoms has hardly got any attention in studies with objective experimental measures. Since effects appear relatively slower in elderly, this study evaluates the effect on cognitive and psychomotor functioning as compared to mood, on four points during a twelve week follow up of monotreatment with escitalopram. 28 non-demented elderly unipolar depressive patients on 5-20mg escitalopram were compared to 20 matched healthy elderly. All participants underwent a test battery containing clinical depression measures, cognitive measures of processing speed, executive function and memory, clinical ratings of PR, and objective computerized fine motor skill-tests at the start and after 2, 6 and 12 weeks. Statistical analysis consisted of a General Linear Model (GLM) repeated measures multivariate analysis of variance of completers to compare the psychomotor and cognitive outcomes of the two groups. Although, apart from the significant mood effect, no interaction effects were found for the psychomotor and cognitive tasks, the means in general show a trend of differential effects in cognitive and psychomotor functions, with smaller effects and delayed timeframes and with presence of subgroups compared to mood effects. Longer follow up studies are necessary to evaluate differential long term effects. In elderly, moderate effects of SSRI treatment on mood precede slow or limited effects on cognition and psychomotor retardation. Copyright © 2015 Elsevier B.V. All rights reserved.
    No preview · Article · Aug 2015 · Journal of Affective Disorders
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    • "Previous trials comparing the treatment response of atypical antipsychotics based on age (<70 years old, ≥70 years old) suggested that older age might predict a poor response to the treatment of delirium [26,40]. Recently, researchers in the field of psychiatry often divide older subjects into two groups (young-old and old-old), with an age of 74 being the cutoff point [41-43]. However, no previous research has compared the response rate to various atypical antipsychotics in the treatment of delirium based on this age grouping. "
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    ABSTRACT: Most previous studies on the efficacy of antipsychotic medication for the treatment of delirium have reported that there is no significant difference between typical and atypical antipsychotic medications. It is known, however, that older age might be a predictor of poor response to antipsychotics in the treatment of delirium. The objective of this study was to compare the efficacy and safety of haloperidol versus three atypical antipsychotic medications (risperidone, olanzapine, and quetiapine) for the treatment of delirium with consideration of patient age. This study was a 6-day, prospective, comparative clinical observational study of haloperidol versus atypical antipsychotic medications (risperidone, olanzapine, and quetiapine) in patients with delirium at a tertiary level hospital. The subjects were referred to the consultation-liaison psychiatric service for management of delirium and were screened before enrollment in this study. A total of 80 subjects were assigned to receive either haloperidol (N = 23), risperidone (N = 21), olanzapine (N = 18), or quetiapine (N = 18). The efficacy was evaluated using the Korean version of the Delirium Rating Scale-Revised-98 (DRS-K) and the Korean version of the Mini Mental Status Examination (K-MMSE). The safety was evaluated by the Udvalg Kliniske Undersogelser side effect rating scale. There were no significant differences in mean DRS-K severity or K-MMSE scores among the four groups at baseline. In all groups, the DRS-K severity score decreased and the K-MMSE score increased significantly over the study period. However, there were no significant differences in the improvement of DRS-K or K-MMSE scores among the four groups. Similarly, cognitive and non-cognitive subscale DRS-K scores decreased regardless of the treatment group. The treatment response rate was lower in patients over 75 years old than in patients under 75 years old. Particularly, the response rate to olanzapine was poorer in the older age group. Fifteen subjects experienced a few adverse events, but there were no significant differences in adverse event profiles among the four groups. Haloperidol, risperidone, olanzapine, and quetiapine were equally efficacious and safe in the treatment of delirium. However, age is a factor that needs to be considered when making a choice of antipsychotic medication for the treatment of delirium.Trial registration: Clinical Research Information Service, Republic of Korea, (, Registered Trial No. KCT0000632).
    Full-text · Article · Sep 2013 · BMC Psychiatry
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    • "As in our original analysis (Meyers et al., 2009), remission was defined as a Ham-D score of <10 at two consecutive assessments. This definition was chosen because the study was designed to recruit equal numbers of younger and older subjects; a HAM-D score of ≤10 has been a standard cut-off point for defining remission in geriatric antidepressant trials (Arean et al., 2010; Kupfer, 2005; Reynolds et al., 1996; Roose et al., 2004) and has been used in ECT studies that have included patients with MDpsy as well as both younger and older patients (Kellner et al., 2006; Petrides et al., 2001; Sackeim et al., 2001). Remission also required the absence of delusions, (SADS delusional item scores of 1) at the second assessment of the two-assessment remission of depression interval. "
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    ABSTRACT: Having failed to respond to an adequate antidepressant treatment course predicts poorer treatment outcomes in patients with major depression. However, little is known about the impact of prior treatment on the outcome of major depression with psychotic features (MDpsy). We examined the effect of prior treatment history on the outcome of pharmacotherapy of MDpsy in patients who participated in the STOPD-PD study, a randomized, double-blind, clinical trial comparing a combination of olanzapine plus sertraline vs. olanzapine plus placebo. The strength of treatment courses received prior to randomization was classified using a validated method. A hierarchy of outcomes was hypothesized based on treatments received prior to randomization and randomized treatment. A high remission rate was observed in subjects with a history of no prior treatment or inadequate treatment who were treated with a combination of olanzapine and sertraline. A low remission rate was observed in subjects who had previously failed to respond to an antidepressant alone and who were treated with olanzapine monotherapy. A low remission rate was also observed in subjects who had previously failed to respond to a combination of an antipsychotic and an antidepressant. Similar to patients with major depression, these results emphasize the impact of prior pharmacotherapy on treatment outcomes in patients with MDpsy.
    Full-text · Article · Feb 2011 · Journal of Psychiatric Research
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