Predicting 6-week treatment response to escitalopram pharmacotherapy in late-life major depressive disorder.
OBJECTIVE
Approximately half of older patients treated for major depressive disorder (MDD) do not achieve symptomatic remission and functional recovery with first-line pharmacotherapy. This study aims to characterize sociodemographic, clinical, and neuropsychologic correlates of full, partial, and non-response to escitalopram monotherapy of unipolar MDD in later life.


METHODS
One hundred and seventy-five patients aged 60 and older were assessed at baseline on demographic variables, depression severity, hopelessness, anxiety, cognitive functioning, co-existing medical illness burden, social support, and quality of life (disability). Subjects received 10 mg/d of open-label escitalopram and were divided into full (n = 55; 31%), partial (n = 75; 42.9%), and non-responder (n = 45; 25.7%) groups based on Hamilton depression scores at week 6. Univariate followed by multivariate analyses tested for differences between the three groups.


RESULTS
Non-responders to treatment were found to be more severely depressed and anxious at baseline than both full and partial responders, more disabled, and with lower self-esteem than full responders. In general partial responders resembled full responders more than they resembled non-responders. In multivariate models, more severe anxiety symptoms (both psychological and somatic) and lower self-esteem predicted worse response status at 6 weeks.


CONCLUSIONS
Among treatment-seeking elderly persons with MDD, higher anxiety symptoms and lower self-esteem predict poorer response after six weeks of escitalopram treatment.
Saghafi
Ramin
R
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, USA.
Brown
Charlotte
C
Butters
Meryl A
MA
Cyranowski
Jill
J
Dew
Mary Amanda
MA
Frank
Ellen
E
Gildengers
Ariel
A
Karp
Jordan F
JF
Lenze
Eric J
EJ
Lotrich
Francis
F
Martire
Lynn
L
Mazumdar
Sati
S
Miller
Mark D
MD
Mulsant
Benoit H
BH
Weber
Elizabeth
E
Whyte
Ellen
E
Morse
Jennifer
J
Stack
Jacqueline
J
Houck
Patricia R
PR
Bensasi
Salem
S
Reynolds
Charles F
CF
D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D015283:Citalopram / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012649:Self Concept; D012944:Social Support; D016896:Treatment Outcome
D018687:Antidepressive Agents, Second-Generation; D015283:Citalopram