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Depressed Elderly Fail to
Improve with Antidepressant
Nov. 26, 2004 - Depressed people 75 or
older are just as likely to improve after an 8-week course with an
inactive, placebo drug as with an antidepressant, new research
indicates.
The study shows that
after a short course of the antidepressant medication citalopram (Celexa),
around one-third of elderly people with depression went into remission
-- the same improvement rate seen in people taking a placebo drug.
However, study author
Dr. Steven P. Roose of the New York State Psychiatric Institute in New
York City cautioned that these findings do not suggest that the
antidepressant is no better than doing nothing at all.
All of the participants
in the study were treated to some kind of "active intervention," he
said. For instance, even placebo-takers received a free medical workup,
an MRI, weekly visits with health professionals, and free rides to and
from their appointments, among other amenities.
Moreover, seeing a
marked improvement in one-third of the people taking the drug shows that
something was likely helping them, Roose noted -- but whether it was the
drug or the supportive environment is not clear, he said.
"The response rate that
you're going to get from medicine is going to depend on the
circumstances in which you give it," Roose said in an interview. "Giving
a placebo is not doing nothing."
Roose added that Forest
Laboratories, which sells Celexa, funded the study. However, he and his
colleagues designed the research, and gathered and analyzed the results,
he noted.
Celexa is a member of a
family of antidepressants known as selective serotonin reuptake
inhibitors (SSRIs). Although SSRIs appear to help many people, they do
not seem to have the same "robust effectiveness" in older adults, Roose
explained.
In contrast, another
type of antidepressants known as tricyclics appear to help the elderly
with depression, but carry a significant risk of side effects such as
cardiovascular problems, the New York researcher said.
To investigate how
Celexa measures up to a placebo drug under optimal conditions, Roose and
his colleagues asked 174 people at least 75 years of age with depression
to take either Celexa or a placebo for 8 weeks, and noted how they
improved.
As Roose and his team
report the results in the American Journal of Psychiatry. "The active
intervention and drugs was no different from the active intervention
plus placebo," Roose told Reuters Health.
He added that among
people with severe depression, Celexa-takers showed much bigger
improvements than people on placebo. However, a close look at the data
showed that the difference likely stems from the fact that people with
severe depression responded less well to the placebo condition.
The difference is "not
because the drug worked so much better, but because the placebo worked
so much worse," Roose noted.
Clearly, more research
is needed to understand how best to treat older adults with depression,
the researcher said.
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