title: Effect of continuation treatment on residual symptoms in late-life depression: how well is "well"?
abstract: The objectives of this report were (1) to describe residual depressive symptoms in elderly patients during continuation therapy with combined nortriptyline and interpersonal psychotherapy; (2) to determine which symptoms were persistent; (3) to determine the clinical correlates of residual depressive symptoms; and (4) to document distinct response pattern clusters during combined continuation therapy.
  
  
  METHODS
  Box plot analyses of Hamilton depression scores and Global Assessment Scale scores, repeated twice monthly over 4 months, were conducted using data from 105 elderly depressives. Temporal trends in the data were examined via random regression analysis. Individual trajectories for each of the 105 patients were examined for patterns of response during continuation therapy.
  
  
  RESULTS
  We observed a low mean Hamilton rating of 7 (SD = 2.3) at the start of continuation therapy and 5 (SD = 3.0) at the end. Both Hamilton and GAS scores showed modest but significant improvement over time. Hamilton variability was most apparent in symptoms of mood lowering, apathy, anxiety (psychological and somatic), feelings of guilt, anergia, insomnia, and loss of libido; other symptoms (retardation, agitation, hypochondriasis, loss of appetite, loss of weight, suicidal ideation, and loss of insight) showed clear resolution. A diagnosis of RDC situational depression was associated with higher levels of residual symptoms, while level of chronic medical burden, personality dysfunction, and social support were not. Examination of response patterns showed that a quarter of patients experienced one or more brief symptomatic exacerbations.
  
  
  CONCLUSIONS
  On average, an excellent level of symptom resolution was achieved for most patients with Hamilton scores comparable to those seen in healthy elderly controls. These data support a position of therapeutic optimism in late-life depression and underscore full remission as an achievable therapeutic goal.
authors.affiliation: Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Opdyke
authors.forename: C F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: E
authors.initials: E
authors.lastname: Frank
authors.forename: A E
authors.initials: AE
authors.lastname: Begley
authors.forename: D J
authors.initials: DJ
authors.lastname: Buysse
authors.forename: M A
authors.initials: MA
authors.lastname: Dew
authors.forename: B H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: M K
authors.initials: MK
authors.lastname: Shear
authors.forename: S
authors.initials: S
authors.lastname: Mazumdar
authors.forename: D J
authors.initials: DJ
authors.lastname: Kupfer
mesh_terms: D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D002908:Chronic Disease; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D011613:Psychotherapy; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline