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How Helpful Are Antidepressants for the Very Old?

There is value in providing medication for very old patients with serious depression.

Although geriatric patients are commonly treated with antidepressants, the lack of pertinent safety and effectiveness data has been a serious gap in the evidence base. These researchers assessed the efficacy of citalopram for geriatric patients with unipolar depression in an industry-funded, 8-week, multisite, double-blind study. A total of 174 community-dwelling patients (age, 75; mean score on the Hamilton Depression Scale [HAM-D], 24.3; 58.1% women), who were recruited through physician referrals or advertisements, were randomized to receive citalopram 20 mg/day (subsequently adjustable to 10-40 mg/day) or placebo and followed almost weekly. Exclusion criteria were serious medical illness, dementia, and Parkinson disease.

Remission (HAM-D score, 10) was achieved by 35% of citalopram recipients and 33% of placebo recipients. Thirty-nine percent of patients were assessed with serious depression (HAM-D scores above the baseline mean); in this group, 35% of citalopram recipients and 19% of placebo recipients achieved remission. Overall, 11% of patients on citalopram and 1% of those on placebo withdrew from the study early due to adverse events. Researchers noted a marked intersite variability in both drug and placebo response rates.

Comment: The authors note that patients in both groups received considerable professional attention, including more than 30 minutes per week with raters and physicians and a free extensive medical workup. Because so many antidepressants are now available and prescribed by primary physicians to elderly depressed patients, one wonders about the representativeness of the untreated patients in this study. The results strongly support the need for additional research into both antidepressant medication and psychosocial interventions for the very old and suggest the value of medication for those with serious depression. My 91-year-old aunt with recurrent unipolar depression will be the first to say that she does much better taking her SSRI than not.

— Joel Yager, MD

Published in Journal Watch Psychiatry December 23, 2004

Citation(s):

Roose SP et al. Antidepressant pharmacotherapy in the treatment of depression in the very old: A randomized, placebo-controlled trial. Am J Psychiatry 2004 Nov; 161:2050-9.

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