Antidepressant response in late-life depression.
When evaluating the literature on the treatment of late-life depression, it is most critical to consider the methodology of each study, specifically: (1) Is the antidepressant treatment adequate with respect to dosing duration? (2) How is response defined, e.g., is it simply a 50% reduction in a scale score, or are there criteria for establishing which patients have truly recovered? (3) Are the outcome data given for both the intent-to-treat and completer analyses? A review of studies that meet a rigorous standard of methodology shows that (1) a therapeutic plasma nortriptyline level consistently produces a 70% to 80% remission rate in depressed patients over 60 years of age, (2) there is some scatter in the remission rates reported for fluoxetine with results ranging from 21% to 50%, and (3) studies of sertraline consistently report a remission rate of 50% or higher. Contrary to the widely held clinical belief, tricyclic treatment is not associated with a higher dropout rate compared with treatment with a serotonin selective reuptake inhibitor (SSRI). However, patients who recovered using tricyclics have lower scores on health-related quality-of-life scales than patients who recovered using SSRIs, and the long-term impact of the "tolerated" side effects of tricyclics, specifically, increased heart rate and anticholinergic effects, may be deleterious.
Department of Psychiatry, Late Life Depression Research Clinic, New York State Psychiatric Institute, Columbia University, New York 10032, USA.
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D015057:1-Naphthylamine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003866:Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D004334:Drug Administration Schedule; D005473:Fluoxetine / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use; D017374:Paroxetine / Q000627:therapeutic use; D010352:Patient Dropouts; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline; D016896:Treatment Outcome
D015057:1-Naphthylamine; D000929:Antidepressive Agents, Tricyclic; D005473:Fluoxetine; D009661:Nortriptyline; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline