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.
Roose
S P
SP
Department of Psychiatry, Late Life Depression Research Clinic, New York State Psychiatric Institute, Columbia University, New York 10032, USA.
Suthers
K M
KM
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