Impact of prior treatment exposure on response to antidepressant treatment in late life.
OBJECTIVE
The objective of this study was to describe the correlates of prior antidepressant exposure and its association with response to protocolized treatment in older patients with major depression.


METHODS
Based on their prior antidepressant treatment exposure, 193 elderly patients with a major depressive episode were divided into three groups: those with no prior treatment for their current episode (not treated [TN]), those with antidepressant trials of inadequate dose or duration ("treatment-inadequate" [TI]), and those with at least one adequate trial but persisting depression ("treatment-resistant" [TR]). All patients then received protocolized treatment with interpersonal psychotherapy (IPT) and paroxetine plus pharmacologic augmentation if needed. The demographic, clinical, and outcome information were compared among these three groups.


RESULTS
Approximately one-third of the patients referred to the study had been adequately treated (TR), one-third had been inadequately treated (TI), and one-third were not treated for the current episode (TN). Treatment completion rates and reasons for dropping out did not differ statistically among TR, TI, and TN patients. TR patients took longer to respond (13.0 weeks) than either TI or TN patients (7.6 and 8.0 weeks, respectively). TR and TI patients had lower response rates (67% and 71%) than TN patients (86%).


CONCLUSIONS
Prior treatment exposure is an important correlate of course and outcome in late-life depression. Most TR and TI patients eventually respond, but TR patients may require more intensive and longer courses of treatment than TI and TN patients.
Tew
James D
JD
Advanced Center for Interventions and Services Research in Late-Life Mood Disorders, Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA.
Mulsant
Benoit H
BH
Houck
Patricia R
PR
Lenze
Eric J
EJ
Whyte
Ellen M
EM
Miller
Mark D
MD
Stack
Jacqueline A
JA
Bensasi
Salem
S
Reynolds
Charles F
CF
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D016642:Bupropion / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016651:Lithium Carbonate / Q000627:therapeutic use; D008134:Long-Term Care; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use; D017374:Paroxetine / Q000627:therapeutic use*; D011613:Psychotherapy; D019233:Retreatment; D017211:Treatment Failure; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D016642:Bupropion; D016651:Lithium Carbonate; D017374:Paroxetine; D009661:Nortriptyline