PITTSBURGH, June 1 – 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.
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; speaker’s 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.
Journal
American Journal of Psychiatry