Drug treatment of depression in frail elderly nursing home residents.
The authors conducted a randomized, double-blind, 10-week clinical trial of two doses of nortriptyline in eight nursing homes. Sixty-nine patients, average age 79.5 years, were randomized to receive regular doses (60 mg-80 mg/day) vs. low doses (10 mg-13 mg/day) of nortriptyline. Among the more cognitively intact patients, there was a significant quadratic relationship defining a "therapeutic window" for nortriptyline plasma levels and clinical improvement. There were also significant differences in plasma level-response relationships between depressed patients who were cognitively impaired and those who were more cognitively intact. Depression remains a syndrome that responds to specific treatment, even in frail nursing home patients, and those depressions that occur in patients with significant dementia may represent a treatment-relevant condition with a different plasma level-response relationship than in depression alone.
Streim
J E
JE
Department of Psychiatry, University of Pennsylvania, Philadelphia, USA. jstreim@mail.med.upenn.edu
Oslin
D W
DW
Katz
I R
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Smith
B D
BD
DiFilippo
S
S
Cooper
T B
TB
Ten Have
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T
D000368:Aged; D000369:Aged, 80 and over; D000929:Antidepressive Agents, Tricyclic / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D003704:Dementia / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D003866:Depressive Disorder / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D005260:Female; D016330:Frail Elderly / Q000523:psychology*; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009661:Nortriptyline / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D009735:Nursing Homes; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D009661:Nortriptyline