Antidepressant pharmacotherapy in the treatment of depression in the very old: a randomized, placebo-controlled trial.
OBJECTIVE
This study determined the efficacy of antidepressant medication for the treatment of depression in the "old-old."


METHODS
This randomized 8-week medication trial compared citalopram, 10-40 mg/day, to placebo in the treatment of patients 75 and older with unipolar depression.


RESULTS
A total of 174 patients who were 58% women with a mean age of 79.6 years (SD=4.4) and a mean baseline Hamilton Depression Rating Scale score of 24.3 (SD=4.1) were randomly assigned to treatment at 15 sites. There was a main effect for site but not for treatment condition. The remission rate, defined as a final Hamilton depression scale score <10, was 35% for the citalopram and 33% for the placebo groups. However, patients with severe depression (baseline Hamilton depression scale score >24) tended to have a higher remission rate with medication than with placebo (35% versus 19%).


CONCLUSIONS
In the oldest group of community-dwelling patients to be studied to date, medication was not more effective than placebo for the treatment of depression. However, given the considerable psychosocial support received by all patients, the placebo condition represents more than the ingestion of an inactive pill. Across sites, there was considerable range in response to medication, 18% to 82%, and to placebo, 16% to 80%.
Roose
Steven P
SP
New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA. spr2@columbia.edu
Sackeim
Harold A
HA
Krishnan
K Ranga Rama
KR
Pollock
Bruce G
BG
Alexopoulos
George
G
Lavretsky
Helen
H
Katz
Ira R
IR
Hakkarainen
Heikki
H
D000367:Age Factors; D000368:Aged; D015283:Citalopram / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000941:ethics; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D012107:Research Design / Q000592:standards; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
D015283:Citalopram; D010919:Placebos; D017367:Selective Serotonin Reuptake Inhibitors