title: Accelerating antidepressant response in geriatric depression: a post hoc comparison of combined sleep deprivation and paroxetine versus monotherapy with paroxetine, nortriptyline, or placebo.
abstract: Speed of response is an important clinical issue in the treatment of depressed elderly patients. Our objective was to compare rapid response rates in a study combining therapeutic sleep deprivation (TSD) with paroxetine with two earlier randomized, double-blind studies in late-life depression, one of paroxetine versus nortriptyline and another of nortriptyline versus placebo. We measured depressive symptoms with the 17-item Hamilton Rating Scale of Depression (HRSD), defining rapid response as an HRSD < or = 10 by 2 weeks. With combination therapy (TSD + paroxetine), 9 of 13 patients (69%) experienced a rapid response. In the nortriptyline versus paroxetine study, nortriptyline brought about rapid response in 12 of 37 (32%) and paroxetine in 11 of 43 patients (26%). In the third study, rapid response to nortriptyline occurred in 10 of 41 patients (24%) and to placebo in 6 of 39 patients (15%). The overall chi square, including the rate of rapid response to placebo, was 14.87 (P = .005). The chi square on the four active treatment groups, excluding placebo, was 10.28 (P = .016). This preliminary observation suggests that combined therapy with TSD plus paroxetine may be twice as successful at achieving rapid response in elderly depressed patients than conventional monotherapy with medication or placebo. A prospective, placebo-controlled evaluation of this dual therapy is warranted.
authors.affiliation: Department of Psychiatry, University of Pittsburgh Medical Center, Pennsylvania 15213, USA.
authors.forename: T D
authors.initials: TD
authors.lastname: Green
authors.forename: C F
authors.initials: CF
authors.lastname: Reynolds
authors.forename: B H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: B G
authors.initials: BG
authors.lastname: Pollock
authors.forename: M D
authors.initials: MD
authors.lastname: Miller
authors.forename: P R
authors.initials: PR
authors.lastname: Houck
authors.forename: S
authors.initials: S
authors.lastname: Mazumdar
authors.forename: M A
authors.initials: MA
authors.lastname: Dew
authors.forename: D J
authors.initials: DJ
authors.lastname: Kupfer
mesh_terms: D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000188:drug therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005852:Geriatric Psychiatry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000008:administration & dosage*; D017374:Paroxetine / Q000008:administration & dosage*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D012892:Sleep Deprivation
chemical_list: D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors