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-- The longest study of its kind finds that medical treatment of depression in the elderly may not be a short-term proposition.

That's because depression tended to return after older patients completed the six-to-12-month course of antidepressants psychiatrists typically give to people suffering from the illness, researchers report in the March 16 issue of The New England Journal of Medicine.

Short-term antidepressant therapy is "really not good enough" when it comes to treating many elderly patients, says lead researcher Dr. Charles F. Reynolds III, a professor of geriatric psychiatry at the University of Pittsburgh School of Medicine.

Instead, he says, "people need to be offered antidepressant medication for at least two years beyond the end of the episode in order to stay well."

The study was funded by grants from the U.S. National Institute for Mental Health and the National Center for Minority Health and Health Disparities.

Reynolds says depression among the elderly is "a major public health problem in a graying America." Up to 10 percent of elderly people living in the community may be afflicted with the illness, he says, and that number rises to 25 percent among nursing home residents. While depression is linked to physical ailments, the two are not always connected, Reynolds says.

Treatment of a first episode of depression usually involves an antidepressant -- typically one of the selective serotonin reuptake inhibitor class of drugs that includes drugs brand-named Celexa, Paxil, Prozac and Zoloft, among others. Patients are usually placed on one of these drugs for between six months to a year.

Reynold's group tested the long-term effectiveness of this strategy, as well as a nondrug approach, psychotherapy, in a group of 116 patients over 70 years of age. The researchers tracked the mental health of participants for two years after the onset of depression. More than half (55 percent) had consulted their doctors after experiencing their first-ever bout of depression.

Patients received either Paxil (paroxetine) or a placebo, plus either psychotherapy or "clinical management," in which patients discussed their symptoms but received no psychotherapy.

The result: Within two years after the first treatment, depression recurred frequently in all the groups studied. However, rates of relapse were highest among those taking psychotherapy or clinical management alone (68 percent and 58 percent, respectively), and much lower (35 percent) among those taking Paxil plus psychotherapy or clinical management.

Still, a 35 percent relapse rate is troubling, and higher than that seen in younger populations, Reynolds says.

The findings suggest that "even first episodes of depression in old age represent the appearance of a chronic, recurring illness," he says. "We need to take that perspective with our patients and their families, and offer them appropriate treatment."

That "appropriate treatment" most likely involves selective serotonin reuptake inhibitor therapy, Reynolds adds. Although his group used Paxil, "there's no reason to think that other SSRIs wouldn't perform equally well in the same context."

The vast majority of patients who ended up taking Paxil for the full two years of the study showed no side effects, although a few did drop out after experiencing minor discomfort with the drug.

The Pittsburgh trial emphasizes "the importance of maintenance treatment for depression in late life," says Dr. Burton Reifler, a professor of psychiatry at Wake Forest University School of Medicine, and author of an accompanying editorial.

Praising the Pittsburgh study, he notes that "there hasn't been a follow-up that long in any previous controlled trial."

While it's too early to make a "hard-and-fast rule" about the length of time elderly patients may need to be placed on antidepressants, Reifler says the findings should prompt doctors to ask the question, "'Do (many) individuals with depression in late life need to be on medication indefinitely?"'

He says the findings won't come as a total surprise to those who care for the elderly. "Many psychiatrists have already been treating their elderly patients longer," he says, "because clinically, anecdotally, we've seen exactly what this study reports -- that the risk of recurrence is very, very high."

Just why the elderly are more vulnerable than younger patients to relapse remains a mystery, the experts say. And Reynolds stresses that psychotherapy and other nonmedical interventions -- such as exercise and an improved social life -- may still have a vital role to play in battling depression at any age.

The Pittsburgh expert also stresses that, overall, the news from the study is "really good," given the effectiveness of antidepressant medications.

"Treatment works, not only to get people well, but to keep them well," he says.

Source: Harvard IntelliHealth

David Baxter PhD

Late Founder
Short-term antidepressant therapy is "really not good enough" when it comes to treating many elderly patients, says lead researcher Dr. Charles F. Reynolds III

It's rarely helpful in younger patients, either. From my observations, I would suggest that 1 to 1.5 years on the medication is necessary for the patient to sustain any benefits obtained from SSRIs.


Is there evidence to suggest that indeed one would require maintenance therapy indefinitely in order to protect from relapse?

David Baxter PhD

Late Founder
In the elderly? I really don't know.

In general, there are some people who may need to remain on these medications indefinitely but most do not. As i said, after about 12 to 18 months, maybe 24 months in some cases, most people are able to taper off and remain off with low risk for relapse (I'm talking about depression here).
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