Recovery from major depression in older adults receiving augmentation of antidepressant pharmacotherapy.
OBJECTIVE
Few data are available concerning the utility of augmentation in late-life depression treatment. The authors examined likelihood, speed, and predictors of recovery in older adults receiving augmentation pharmacotherapy after inadequate response to standardized treatment with paroxetine plus interpersonal psychotherapy.


METHODS
Depression levels were monitored during open treatment in 195 adults age 70 or older. Patients were grouped by whether they required augmentation (bupropion, nortriptyline, or lithium) and compared on likelihood, time, and predictors of recovery.


RESULTS
Augmentation was required for 105 patients (53.8%) because of inadequate treatment response (N=77) or response followed by relapse (N=28). Of these patients, 69 received augmentation and 36 did not (primarily because of consent withdrawal or comorbid medical conditions). Patients receiving augmentation showed lower recovery rates than patients never requiring augmentation: recovery occurred in 50.0% of patients receiving it because of inadequate response, 66.7% of those receiving it after early relapse, and 86.7% of patients never requiring augmentation. Patients receiving augmentation because of inadequate response recovered more slowly, with modestly more side effects than other patients. Greater medical burden and anxiety predicted slower recovery.


CONCLUSIONS
Despite a lower likelihood of recovery in elderly people receiving augmentation, the recovery by over one-half of such patients suggests the value of augmentation for those able to tolerate it. Need for augmentation presages slower recovery in patients showing initial inadequate response; those requiring it after early relapse recovered more quickly. Strategies to further improve the likelihood and speed of recovery after initial treatment failure are needed.
Dew
Mary Amanda
MA
Department of Psychiatry, University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA. dewma@upmc.edu
Whyte
Ellen M
EM
Lenze
Eric J
EJ
Houck
Patricia R
PR
Mulsant
Benoit H
BH
Pollock
Bruce G
BG
Stack
Jacqueline A
JA
Bensasi
Salem
S
Reynolds
Charles F
CF
D000367:Age Factors; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D016642:Bupropion / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004359:Drug Therapy, Combination; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D018020:Lithium Compounds / Q000627:therapeutic use; D008297:Male; D009661:Nortriptyline / Q000627:therapeutic use; D017374:Paroxetine / Q000627:therapeutic use*; D011613:Psychotherapy / Q000379:methods*; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome
D000928:Antidepressive Agents; D018020:Lithium Compounds; D016642:Bupropion; D017374:Paroxetine; D009661:Nortriptyline