Antidepressant Augmentation Can Be Useful in Treatment Resistant Elderly Patients
Jun 7, 2007 - 4:00:00 PM
, Reviewed by: Dr. Himanshu Tyagi
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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
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Level of Evidence
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2c - Outcomes Research
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Key Points of this article
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Half of the patients who did not respond to the initial treatment responded to the augmentation therapy
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It took a median 28 weeks for the participants to achieve recovery
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Of the patients who relapsed after the initial therapy, 67 percent recovered after augmentation over a median recovery time of 24 weeks
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Of the patients who responded to the first-course therapy of paroxetine and psychotherapy, 87 percent achieved recovery
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Main results
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Despite a lower likelihood of recovery in elderly people receiving augmentation, the recovery by over one-half of such patients suggests the value of augmentation for those able to tolerate it. Need for augmentation presages slower recovery in patients showing initial inadequate response; those requiring it after early relapse recovered more quickly. Strategies to further improve the likelihood and speed of recovery after initial treatment failure are needed.
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Depression in Older Adults
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Depression is not a normal part of aging. Yet depression is a widely under-recognized and under-treated medical illness. Depression often co-occurs with other serious illnesses, such as heart disease, stroke, diabetes, cancer, and Parkinson's disease. Because many older adults face these illnesses as well as various social and economic difficulties, health care professionals may mistakenly conclude that depression is a normal consequence of these problems â an attitude often shared by patients themselves. Source: NIMH
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Epidemiology
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Up to 84 percent of the elderly who experience depression either fail to respond to first-course treatment or relapse during the first six to 12 weeks of treatment.
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By University of Pittsburgh Schools of the Health Sciences,
[RxPG] Adding a medication to a standard treatment regimen for major depressive disorder in the elderly improves chances of recovery in those who do not adequately respond to the first-course therapy or who relapse from it, finds a University of Pittsburgh School of Medicine study published in the June issue of the American Journal of Psychiatry, the official journal of the American Psychiatric Association. Up to 84 percent of the elderly who experience depression either fail to respond to first-course treatment or relapse during the first six to 12 weeks of treatment.
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 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.
| Funding information and declaration of competing interests:
NIH/National Institute of Mental Health
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About Dr. Himanshu Tyagi
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This news story has been reviewed by Dr. Himanshu Tyagi before its publication on RxPG News website. Dr. Himanshu Tyagi, MBBS is the founder editor and manager for RxPG News. In this position he is responsible for content development and overall website and editorial management functions. His areas of special interest are psychological therapies and evidence based journalism.
RxPG News is committed to promotion and implementation of Evidence Based Medical Journalism in all channels of mass media including internet.
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