Response speed and rate of remission in primary and specialty care of elderly patients with depression.
OBJECTIVE
Depression treatment in primary care elderly patients has been inadequate, resulting in low rates of response and remission. The authors compared treatment remission rates and time-to-remission of elderly subjects enrolled in two ongoing depression treatment studies, one in primary care practices ("PROSPECT") and the other in an academic tertiary mental health care center ("MTLD-2"), in order to assess the value of standardizing and intensifying depression treatment in primary care elderly patients.


METHODS
Authors compared remission rates and time to criterion endpoints via survival analysis. The 126 PROSPECT subjects (mean age 71) included primary care patients with either current episodes of major depression or minor depression. The 129 MTLD-2 subjects (mean age 77) had single or recurrent unipolar major depression. PROSPECT subjects received a variety of open treatments, including the drug citalopram and/or interpersonal psychotherapy (IPT). Both patient and provider preferences influenced treatment selected. MTLD-2 subjects received more structured, open paroxetine treatment and IPT.


RESULTS
The remission rates of PROSPECT and MTLD-2 were 86.5% and 88.4%, respectively. Median time-to-remission in PROSPECT was significantly longer than in MTLD-2 (12 weeks versus 8.7 weeks). Limiting the survival analysis to subjects with major depression produced faster attainment of remission criteria.


CONCLUSIONS
Notwithstanding these differences in speed and rate of symptom resolution, good treatment can work well in geriatric depression in the primary care sector.
Thomas
Leslie
L
Intervention Research Center for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, Pittsburgh, PA 15213, USA.
Mulsant
Benoit H
BH
Solano
Francis X
FX
Black
Ann M
AM
Bensasi
Salem
S
Flynn
Tracy
T
Harman
Jeffrey S
JS
Rollman
Bruce L
BL
Post
Edward P
EP
Pollock
Bruce G
BG
Reynolds
Charles F
CF
D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D012074:Remission Induction; D013405:Suicide / Q000523:psychology; D013997:Time Factors
D000928:Antidepressive Agents