Continuation treatment of delusional depression in older adults.
Delusional depression responds poorly to acute antidepressant monotherapy but appears to respond to intensive combination pharmacotherapy, however with poor short-term outcomes after initial improvement, particularly in later life. The authors compared the efficacy and safety of continuation combination therapy to monotherapy among older patients after remission from a delusional depression. Twenty-nine older adults with SCID-diagnosed major depression with delusions received continuation treatment with nortriptyline-plus-perphenazine or nortriptyline-plus-placebo under randomized double-blind conditions after achieving remission after ECT. Of the 28 subjects included in efficacy analyses, 25% suffered relapses. The relapse frequency was nonsignificantly greater in combination therapy than in monotherapy subjects. However, combination subjects had significantly more extrapyramidal symptoms, an increased incidence of tardive dyskinesia, and a greater number of falls. Continuation treatment with a conventional antipsychotic does not decrease relapse rates but is associated with significant untoward adverse events in older persons after recovery from a delusional depression.
Meyers
B S
BS
Department of Psychiatry, Westchester Division-New York Presbyterian Hospital, Weill Medical College of Cornell University, 21 Bloomingdale Road, White Plains, NY 10605, USA. bmeyers@med.cornell.edu
Klimstra
S A
SA
Gabriele
M
M
Hamilton
M
M
Kakuma
T
T
Tirumalasetti
F
F
Alexopoulos
G S
GS
D000368:Aged; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D003702:Delusions / Q000188:drug therapy* / Q000523:psychology*; D003863:Depression / Q000188:drug therapy / Q000523:psychology* / Q000628:therapy*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009661:Nortriptyline / Q000627:therapeutic use*; D010546:Perphenazine / Q000627:therapeutic use*; D016896:Treatment Outcome
D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D009661:Nortriptyline; D010546:Perphenazine