Impact of physical illness on quality of life and antidepressant response in geriatric major depression. Fluoxetine Collaborative Study Group.
OBJECTIVE
Because physical illness may influence quality of life, we assessed its impact on functional status and treatment outcome in older depressed patients who participated in a clinical trial, which showed a significantly higher remission rate for fluoxetine over placebo (31.6% vs 18.6%, P < .001).


METHODS
Six-week, randomized, double-blind, placebo-controlled trial of fluoxetine, 20 mg daily.


METHODS
Multiple clinical sites, both university and private.


METHODS
Outpatients (N = 671) were > or = 60 years (mean +/- SD = 67.7 +/- 5.7), met DSM-III-R criteria for unipolar major depression and had baseline scores > or = 16 on the Hamilton Depression Rating Scale.


METHODS
The 36-item short-form health survey (SF-36) was used to measure baseline and posttreatment functional health and well-being. Physical illness was rated by number of current chronic or historical illnesses. Change from baseline to endpoint in the Hamilton Depression Rating Scale total score was used to measure depression outcome.


RESULTS
Most patients reported physical illness: 83% had one or more chronic illness, and 89% had one or more historical illness. Greater numbers of baseline chronic illness indicated worse physical functioning, general health perceptions, and vitality and greater bodily pain and role limitation from physical problems. Historical physical illness was associated with worse physical functioning, vitality, general health perceptions, social functioning, and mental health. Although the number of chronic illnesses did not influence treatment response, historical physical illness was associated with greater fluoxetine response and lower placebo response.


CONCLUSIONS
These findings suggest that both current and previous physical illness are associated with lower quality of life in geriatric depression and that depressed older patients with chronic physical illness respond to antidepressants as well as those without such illness. Recovery from previous physical illness should be explored as a potential predictor of antidepressant treatment outcome.
Small
G W
GW
Center on Aging, University of California, Los Angeles 90024-1759, USA.
Birkett
M
M
Meyers
B S
BS
Koran
L M
LM
Bystritsky
A
A
Nemeroff
C B
CB
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D002908:Chronic Disease / Q000523:psychology*; D015897:Comorbidity; D003866:Depressive Disorder / Q000145:classification / Q000188:drug therapy*; D004311:Double-Blind Method; D005473:Fluoxetine / Q000627:therapeutic use*; D015577:Geriatric Assessment; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life; D012720:Severity of Illness Index
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine