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Elderly Depression: Maintenance Treatment Prevents Recurrence

Taking meds after feeling better could prevent elderly depression from returning

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Doctor comforting tearful elderly patient
Clarissa Leahy/The Image Bank/Getty Images
People age 70 and older who experience their first episode of elderly depression are more likely to get long-term benefits if they continue taking an antidepressant for up to two years after they start feeling better.

In a two-year study funded by the National Institute of Mental Health (NIMH), people who experienced elderly depression and continued taking antidepressant medication for a maintenance period were 60 percent less likely to experience a new episode of depression over a two-year period than elderly people who stopped taking the medication when they began to feel better.

"This study demonstrates the benefits of keeping older patients on an antidepressant long after they become symptom-free," said NIMH's director Thomas R. Insel, M.D., in a news release.

When Should a Patient Discontinue Treatment for Elderly Depression?
According to Charles F. Reynolds III, M.D., the study addresses the controversy over the benefits and risks of administering long-term antidepressant treatment to elderly patients who have had only one lifetime occurrence of major depression.

Up to now, experts have agreed that patients with elderly depression who are experiencing their first episode should be treated until they reach full remission (no symptoms for a period of time), and then have a limited period of continued treatment for an additional 6 to 12 months. This would ensure that their remission is stable and would help to further improve their 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.

"[Psychiatrists] 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."

How the Elderly Depression Study was Conducted

  • The clinical trial for elderly depression 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.
  • The elderly depression study also tested the effectiveness of antidepressant medication and interpersonal psychotherapy, which is a specialized form of psychotherapy that focuses on interpersonal relationships.

    The study also looked at whether the extent of patients' other health problems had an impact on rates of elderly depression recurrence.

  • Patients ages 70 and older with depression who achieved full remission of symptoms after treatment using a combination of paroxetine (a serotonin reuptake inhibitor) and interpersonal psychotherapy were administered maintenance treatment where researchers tested the effectiveness of different treatment regimens in keeping patients with elderly depression symptom-free for up to 2 years.
  • These patients were randomly assigned to one of four maintenance treatment groups:
    • Paroxetine only
    • A placebo (an inactive substance; see What is the Placebo Effect?)
    • Paroxetine and monthly interpersonal psychotherapy (IPT)
    • Placebo with IPT

Results of the Elderly Depression Study
The elderly depression study found the 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 patients with elderly depression who received placebo remained in remission
  • 65 percent of patients who received paroxetine and interpersonal therapy remained in remission
  • 32 percent of patients who received placebo and interpersonal therapy remained in remission
Interpersonal Therapy Alone May Not Work as Well for Elderly Depression
One result from the elderly depression study was a surprise to the researchers. Contrary to their hypothesis, which predicted that IPT would significantly reduce rates of recurrence, interpersonal therapy was not as effective 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."

What are the options for people who have elderly depression along with multiple medical problems? See page 2.

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