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Depression Not Likely to Return in Elderly Who
Continue Antidepressant
March 18, 2006 - Senior citizens age 70 and older
who continued taking the antidepressant that helped them recover from
their first episode of depression were 60 percent less likely to
experience a new episode of depression over a two-year study period than
those who stopped taking the medication, according to a study funded by
the National Institute of Mental Health (NIMH), part of the National
Institutes of Health. The study helps answer a major question in the
treatment of depression when to discontinue medication.
The study shows that long-term treatment - for at
least 2 years - after a patient is symptom-free is effective in
preventing future depressive episodes.
This study demonstrates the benefits of keeping
older patients on an antidepressant long after they become
symptom-free, said NIMHs director Thomas R. Insel, M.D.
The clinical trial tested whether maintenance
therapy long-term treatment given to patients to enable them to
maintain a symptom-free or disease-free state is effective in
preventing future episodes of depression in patients 70 years and older.
It also tested whether antidepressant medication and psychotherapy were
effective, and whether the extent of patients medical burden had an
impact on rates of recurrence.
According to Charles F. Reynolds III, M.D., and
colleagues at the University of Pittsburgh, the study speaks directly to
the controversy over the benefits and risks of administering long-term
antidepressant treatment to elderly patients who have only one lifetime
occurrence of major depression.
The consensus opinion has been that older patients
experiencing their first episode of depression should be treated to full
remission and then have a limited period of continued treatment for 6 to
12 months, to ensure the stability of the remission and further improve
recovery.
Most geriatric psychiatrists would not have
thought that elderly 70 and older who experienced one episode of
depression were candidates for longer term maintenance treatment of up
to two years, said Reynolds.
They would agree that elderly with two or more
episodes are appropriately prescribed maintenance treatment, but these
data allow us to go one step further and suggest that, in fact, even
those with single episodes fare considerably better out to two years if
they continue use of the medication that got them well.
Patients ages 70 and older with depression who
achieved full remission of symptoms after treatment using a combination
of paroxetine (a selective serotonin reuptake inhibitor) and
interpersonal psychotherapy (IPT) (psychotherapy that focuses on
interpersonal relationships) were administered maintenance treatment,
where researchers tested the effectiveness of different treatment
regimens in keeping patients symptom-free for up to 2 years.
These patients were randomly assigned to one of
four maintenance treatment groups: (1) paroxetine; (2) placebo; (3)
paroxetine and monthly interpersonal psychotherapy (IPT); and (4)
placebo and IPT.
The study found maintenance treatment was effective
in older people with depression.
Across all four treatment groups, rates of
remission significantly differed. Among patients who received paroxetine
in the maintenance phase, 63 percent remained in remission; 42 percent
of those who received placebo remained in remission; 65 percent of
patients who received paroxetine and IPT remained in remission; and 32
percent of patients who received placebo and IPT remained in remission.
Contrary to the researchers hypothesis, which
predicted that IPT would significantly reduce rates of recurrence,
according to the study, IPT did not show preventive efficacy in people
70 years and older.
But that does not mean that other types of
psychotherapy are not effective, said Reynolds. It could be that this
population needs a more structured and focused type of psychotherapy
one that works better with cognitive impairment and greater disability
than does IPT such as problem-solving psychotherapy. Involving
caregivers to a greater extent may also help.
The study also showed that older people with
multiple chronic physical disorders did not do as well on paroxetine as
those with fewer medical problems, although they did show some benefit.
The burden associated with more chronic and disabling diseases often
drives the depression, making it more difficult to treat, the authors
conclude. Despite this, the researchers indicate that maintenance
antidepressant medication may be effective in primary care settings
where patients have multiple chronic diseases
What makes this study so practical is that it
shows you can combine chronic disease management of depression with the
chronic disease management of other illnesses to benefit both the
patients mental illness as well as their physical illness, he said.
The study is part of an overall NIMH effort to
conduct practical clinical trials in real world settings that address
public health issues important to persons affected by major mental
illnesses. It is published in the March 16 issue of the New England
Journal of Medicine.
For more information on depression and how to treat
it in older adults, visit
http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm
and
http://www.nimh.nih.gov/healthinformation/depoldermenu.cfm.
NIMH is part of the National Institutes of Health (NIH),
the Federal Government's primary agency for biomedical and behavioral
research. NIH is a component of the U.S. Department of Health and Human
Services.
The National Institutes of Health (NIH) The
Nation's Medical Research Agency includes 27 Institutes and Centers
and is a component of the U.S. Department of Health and Human Services.
It is the primary federal agency for conducting and supporting basic,
clinical and translational medical research, and it investigates the
causes, treatments, and cures for both common and rare diseases. For
more information about NIH and its programs, visit
http://www.nih.gov.
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