High relapse rate after discontinuation of adjunctive medication for elderly patients with recurrent major depression.
OBJECTIVE
The authors documented outcomes of elderly depressed patients requiring adjunctive medication during acute-phase pharmacotherapy because of slow or partial response to nortriptyline. Twenty-eight patients (17.7%) received inpatient care at some point during acute-phase treatment.


METHODS
Rates of response, relapse, and sustained remission were examined in 158 elderly patients with recurrent major depression, grouped by whether they received brief treatment with adjunctive medication (lithium, perphenazine, or paroxetine) (N = 39) or did not (N = 119).


RESULTS
The group receiving adjunctive medication had a lower rate of response to acute therapy (64.1% versus 83.2%), a higher relapse rate during continuation therapy (52.0% versus 6.1%), and a lower rate of sustained remission (recovery) (48.7% versus 76.5%) than did the group without augmentation.


CONCLUSIONS
Elderly depressed patients requiring augmented pharmacotherapy to achieve remission may need continuation of adjunctive medication to remain well and to avoid early relapse. Alternatively, factors that lead to augmentation in the first place (e.g., heightened anxiety) may also increase the risk of relapse.
Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA. reynoldscf@a1.isd.upmc.edu
C F
CF
Reynolds
E
E
Frank
J M
JM
Perel
S
S
Mazumdar
M A
MA
Dew
A
A
Begley
P R
PR
Houck
M
M
Hall
B
B
Mulsant
M K
MK
Shear
M D
MD
Miller
C
C
Cornes
D J
DJ
Kupfer
D000367:Age Factors; D017668:Age of Onset; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use; D017374:Paroxetine / Q000627:therapeutic use; D010546:Perphenazine / Q000627:therapeutic use; D010919:Placebos; D011613:Psychotherapy; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents; D010919:Placebos; D017374:Paroxetine; D008094:Lithium; D009661:Nortriptyline; D010546:Perphenazine