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Alzheimer's, Dementia & Mental Health
Elderly Patients Not Responding to Depression
Therapy Improve with Second Drug
84% of depressed elderly have problems in initial
treatment
June 1, 2007 Up to 84% of the elderly with
depression either fail to respond to the initial treatment or relapse in
the first six to 12 weeks. Chances for these people to recover have been
found to improve with the addition of a second drug to the treatment,
finds a University of Pittsburgh School of Medicine study.
The study found that adding a second drug to the
treatment of depressed participants over the age of 70 who either did
not respond to initial treatment with the antidepressant paroxetine and
interpersonal psychotherapy, or to those who responded to the initial
treatment but quickly relapsed, caused the likelihood of recovery to
rise from 40 percent to 60 percent. Recovery was slower in those who did
not respond to the original treatment.
Depression should not be considered a normal part
of aging. The scientific evidence is growing that there are a number of
effective treatment options available for people of all ages, said Mary
Amanda Dew, Ph.D., professor of psychiatry, psychology and epidemiology
at the University of Pittsburgh and lead author of the study.
The report is published in the June issue of the
American Journal of Psychiatry, the official journal of the American
Psychiatric Association.
The University of Pittsburgh researchers followed
105 adults aged 70 or older who had major depressive disorder and who
did not respond to standardized treatment of paroxetine and
interpersonal psychotherapy, or who did respond but experienced an early
recurrence of depressive symptoms.
Participants were given one of three augmenting
agents: sustained-release bupropion, nortriptyline or
lithium.
Researchers selected the additional agent that each
participant received based on individual medical status and history.
Thirty-six participants either declined new medicine or did not receive
augmentation because of accompanying medical conditions.
Half of the patients who did not respond to the
initial treatment responded to the augmentation therapy. It took a
median 28 weeks for the participants to achieve recovery.
Of the patients who relapsed after the initial
therapy, 67 percent recovered after augmentation over a median recovery
time of 24 weeks.
Of the patients who responded to the first-course
therapy of paroxetine and psychotherapy, 87 percent achieved recovery.
While the recovery rates of those receiving
augmentation are not as high as in those who responded to first-line
therapy, the recovery rates are still high enough to suggest that
augmentation should be tried when older adults depression is not
improving, said Dr. Dew.
Editors Notes:
The study was funded by the National Institute of
Mental Health, one of the National Institutes of Health.
Co-authors include: Ellen M. Whyte, M.D., Eric J.
Lenze, M.D., Patricia R. Houck, M.S., Benoit H. Mulsant, M.D., Bruce G.
Pollock, M.D., Ph.D., Jacqueline A. Stack, M.S.N., Salem Benassi, B.S.,
and Charles F. Reynolds III, M.D., of the University of Pittsburgh. Drs.
Mulsant and Pollock also have appointments at the University of Toronto.
Financial Disclosures: Dr. Dew has received
research support from Astellas Pharma Inc. Dr. Whyte has received
research support in the form of pharmaceutical supplies from Pfizer. Dr.
Lenze has received research support from Pfizer, Johnson & Johnson and
Forest Laboratories. Dr. Mulsant has received research and educational
support from Eli Lilly, Jannsen Pharmaceuticals and Pfizer; speakers
bureau honoraria from Astra Zeneca and Pfizer; and honoraria for other
consulting from Lundbeck and Pfizer. Dr. Pollock received research
support from Jannsen Pharmaceuticals and honoraria for consulting from
Forest Laboratories and Lundbeck. Dr. Reynolds has received research
support in the form of pharmaceutical supplies from GlaxoSmithKline,
Pfizer, Forest Laboratories, Eli Lilly and Bristol-Myers Squibb.
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