title: Residual symptoms and recurrence during maintenance treatment of late-life depression.
abstract: BACKGROUND
  Many older patients who recover from an episode of major depression continue to suffer from depressed mood, anxiety, and sleep problems. Our study assesses the impact of these residual symptoms on the risk of recurrence during maintenance treatment of late-life depression.
  
  
  METHODS
  We analyzed data from a randomized clinical trial of maintenance treatment in patients with unipolar depression aged > or =70, 116 of whom remitted and remained stable during open pharmacotherapy and interpersonal psychotherapy (IPT) and were randomized to clinical management/pharmacotherapy; clinical management/placebo; monthly maintenance IPT/ pharmacotherapy; or monthly maintenance IPT/placebo. We assessed the impact of overall residual symptoms (based on the Hamilton Depression Rating Scale (HAM-D) total score) and of specific residual symptom clusters - mood symptoms (depressed mood, guilt, suicidality, energy/interests), sleep disturbance (early, middle, late insomnia), and anxiety (agitation, psychic and somatic anxiety, hypochondriasis) measured at randomization. Sleep disturbance was also assessed with the Pittsburgh Sleep Quality Index (PSQI). We used Cox proportional hazards regression models controlling for assignment to antidepressant medication versus placebo to identify predictors of recurrence.
  
  
  RESULTS
  Residual anxiety and residual sleep disturbance (as measured by the PSQI but not the HAM-D) independently predicted early recurrence.
  
  
  CONCLUSIONS
  Use of HAM-D clusters to define residual symptoms; analysis limited to completers of acute and continuation treatment.
  
  
  CONCLUSIONS
  In patients with late-life depression who have remitted with pharmacotherapy and psychotherapy, the deleterious effect of residual symptoms is due to persisting anxiety and, possibly, residual sleep disturbance.
authors.affiliation: Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, United States.
authors.forename: Alexandre Y
authors.initials: AY
authors.lastname: Dombrovski
authors.forename: Benoit H
authors.initials: BH
authors.lastname: Mulsant
authors.forename: Patricia R
authors.initials: PR
authors.lastname: Houck
authors.forename: Sati
authors.initials: S
authors.lastname: Mazumdar
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lenze
authors.forename: Carmen
authors.initials: C
authors.lastname: Andreescu
authors.forename: Jill M
authors.initials: JM
authors.lastname: Cyranowski
authors.forename: Charles F
authors.initials: CF
authors.lastname: Reynolds
mesh_terms: D000339:Affect / Q000187:drug effects; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000008:administration & dosage*; D001008:Anxiety Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D003131:Combined Modality Therapy; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008134:Long-Term Care; D008297:Male; D009042:Motivation; D017374:Paroxetine / Q000008:administration & dosage*; D010555:Personality Inventory; D011613:Psychotherapy; D055502:Secondary Prevention; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000523:psychology; D016896:Treatment Outcome
chemical_list: D018687:Antidepressive Agents, Second-Generation; D017374:Paroxetine