How common is resistance to treatment in recurrent, nonpsychotic geriatric depression?
OBJECTIVE
Effective treatments are available for major depressive disorder in later life. The purpose of this study was to elucidate the frequency of treatment resistance among the elderly.


METHODS
Treatment resistance, defined as lack of recovery despite combined pharmacotherapy and psychotherapy, was prospectively examined in 180 elderly patients in an episode of recurrent, nonpsychotic major depression who were referred to a university medical center for treatment. They received open acute and continuation treatment with nortriptyline and interpersonal psychotherapy.


RESULTS
Among the 159 patients who completed acute treatment, 19 (11.9%) did not experience a remission of depression. In addition, nine patients who had achieved remission relapsed during continuation therapy and did not recover despite vigorous treatment. Hence, excluding dropouts, 18.4% of the patients met the criteria for treatment resistance by their lack of response to acute treatment or by relapsing during continuation therapy and not recovering subsequently despite further vigorous treatment.


CONCLUSIONS
The study suggests a relatively low rate of resistance to treatment among depressed geriatric patients referred to a university tertiary care setting.
Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh Medical Center, PA, USA.
J T
JT
Little
C F
CF
Reynolds
M A
MA
Dew
E
E
Frank
A E
AE
Begley
M D
MD
Miller
C
C
Cornes
S
S
Mazumdar
J M
JM
Perel
D J
DJ
Kupfer
D000046:Academic Medical Centers; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004359:Drug Therapy, Combination; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008094:Lithium / Q000627:therapeutic use; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use; D010352:Patient Dropouts; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D011613:Psychotherapy; D012008:Recurrence; D016896:Treatment Outcome; D016312:Treatment Refusal
D000928:Antidepressive Agents; D008094:Lithium; D009661:Nortriptyline