Association of antidepressants and other medications with mortality in the residential-care elderly.
To explore the extent to which treatment of depression affects survival, we evaluated the association between use of antidepressant medications and death rates among the residents of a large residential-care facility for the elderly using a retrospective record-review study (N = 624). One year survival, among those taking antidepressants (10.9%), was 11.8% compared to 11.1% among the remainder of the population. A second study followed a group of 32 patients in the same institution who had participated in a therapeutic trial of nortriptyline treatment for major depression. Patients who experienced adverse medical events during treatment exhibited significantly increased mortality; among treatment completers, there was no significant relationship between mortality and therapeutic response. These findings suggest that the inability to tolerate treatment with an antidepressant can be considered a manifestation of physiologic frailty and increased vulnerability to mortality from disease. The previously reported decrease in survival among residential-care patients with major depression is not paralleled by a similar effect in those taking antidepressants. This may reflect selection factors with respect to the ability to tolerate antidepressants, rather an effect of treatment.
Katz
I R
IR
Department of Psychiatry, University of Pennsylvania, Philadelphia Geriatric Center 19104.
Parmelee
P A
PA
Beaston-Wimmer
P
P
Smith
B D
BD
D000368:Aged / Q000523:psychology*; D002318:Cardiovascular Diseases / Q000188:drug therapy; D003000:Clonidine / Q000009:adverse effects / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D004700:Endocrine System Diseases / Q000188:drug therapy; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008605:Mental Health Services / Q000592:standards; D009026:Mortality; D005996:Nitroglycerin / Q000009:adverse effects / Q000627:therapeutic use; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D012112:Residential Facilities; D012114:Residential Treatment
D007328:Insulin; D009661:Nortriptyline; D005996:Nitroglycerin; D003000:Clonidine