What is the optimal duration of a short-term antidepressant trial when treating geriatric depression?
BACKGROUND
To determine the optimal duration of an antidepressant trial in elderly patients, the authors examined the probability of eventually responding to treatment based on early improvement.


METHODS
Four hundred seventy-two elderly patients with major depression (nonpsychotic, nonbipolar) were treated under protocolized conditions for up to 12 weeks and assessed weekly with the Hamilton Rating Scale for Depression. The probability of full response after 12 weeks of treatment was calculated in patients who had not fully responded after periods of treatment that lasted for 4 to 10 weeks.


RESULTS
Most of the patients who had shown a partial improvement after 4 weeks of treatment became full responders after 4 or more additional weeks of treatment. By contrast, only a few of those who were nonresponders became full responders even after up to 8 additional weeks of treatment.


CONCLUSIONS
After 4 weeks of treatment, it is possible to reliably identify a subgroup of elderly patients with depression who are more likely to benefit from a change in their treatment than from a few additional weeks of treatment with the same agent.
Mulsant
Benoit H
BH
Advanced Center in Intervention and Services Research for Late-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. benoit_mulsant@camh.net
Houck
Patricia R
PR
Gildengers
Ariel G
AG
Andreescu
Carmen
C
Dew
Mary Amanda
MA
Pollock
Bruce G
BG
Miller
Mark D
MD
Stack
Jacqueline A
JA
Mazumdar
Sati
S
Reynolds
Charles F
CF
D000368:Aged; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002986:Clinical Trials as Topic / Q000379:methods*; D003863:Depression / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy; D005260:Female; D006299:Health Services for the Aged; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012107:Research Design; D016896:Treatment Outcome
D000928:Antidepressive Agents