Which elderly depressed patients remain well on maintenance interpersonal psychotherapy alone?: report from the Pittsburgh study of maintenance therapies in late-life depression.
The aim of this study was to identify elderly depressed patients who can remain well on maintenance Interpersonal Psychotherapy (IPT) alone, after discontinuation of antidepressant medication. Using Cox proportional hazards models, increased severity of depression at pretreatment was associated with increased recurrence rates, to an extent greater in patients maintained on monthly IPT than in those maintained on nortriptyline. The long-term response to maintenance IPT was correctly identified in 20/25 cases by a pretreatment Hamilton score of > or = 20. Fourteen of sixteen patients with pretreatment scores of > or = 20 experienced recurrence of major depression on maintenance IPT, while 6/9 patients with pretreatment scores of less than 20 did not. (Fisher exact P = .01). The same pattern of recurrence in relation to severity was not evident in maintenance placebo, nortriptyline, or combination treatment. In addition, Hamilton scores during continuation treatment were lower (< or = 7) among those who remained well on maintenance IPT than among those who had recurrences. Elderly patients whose depressions are milder at baseline and who show excellent symptomatic remission during acute and continuation therapy may be good candidates for monthly maintenance IPT after initial successful treatment with antidepressant medication and psychotherapy.
Taylor
M P
MP
Department of Psychiatry, University of Pittsburgh School of Medicine, PA 15213, USA.
Reynolds
C F
CF
Frank
E
E
Cornes
C
C
Miller
M D
MD
Stack
J A
JA
Begley
A E
AE
Mazumdar
S
S
Dew
M A
MA
Kupfer
D J
DJ
D000367:Age Factors; D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D055502:Secondary Prevention; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline