Treating depression to remission in older adults: a controlled evaluation of combined escitalopram with interpersonal psychotherapy versus escitalopram with depression care management.
OBJECTIVE
More than half of the older adults respond only partially to first-line antidepressant pharmacotherapy. Our objective was to test the hypothesis that a depression-specific psychotherapy, Interpersonal Psychotherapy (IPT), when used adjunctively with escitalopram, would lead to a higher rate of remission and faster resolution of symptoms in partial responders than escitalopram with depression care management (DCM).


METHODS
We conducted a 16-week randomized clinical trial of IPT and DCM in partial responders to escitalopram, enrolling 124 outpatients aged 60 and older. The primary outcome, remission, was defined as three consecutive weekly scores of 7 or less on the Hamilton rating scale for depression (17-item). We conducted Cox regression analyses of time to remission and logistic modeling for rates of remission. We tested group differences in Hamilton depression ratings over time via mixed-effects modeling.


RESULTS
Remission rates for escitalopram with IPT and with DCM were similar in intention-to-treat (IPT vs. DCM: 58 [95% CI: 46, 71] vs. 45% [33,58]; p = 0.14) and completer analyses (IPT vs. DCM: 58% [95% CI: 44,72] vs. 43% [30,57]; p = 0.20). Rapidity of symptom improvement did not differ in the two treatments.


CONCLUSIONS
No added advantage of IPT over DCM was shown. DCM is a clinically useful strategy to achieve full remission in about 50% of partial responders.
Department of Psychiatry, Advanced Center for Interventions and Services Research for Late-Life Mood Disorders, Clinical Trials Management Unit, University of Pittsburgh School of Medicine, PA, USA. Reynoldsc@upmc.edu
Charles F
CF
Reynolds
Mary Amanda
MA
Dew
Lynn M
LM
Martire
Mark D
MD
Miller
Jill M
JM
Cyranowski
Eric
E
Lenze
Ellen M
EM
Whyte
Benoit H
BH
Mulsant
Bruce G
BG
Pollock
Jordan F
JF
Karp
Ariel
A
Gildengers
Katalin
K
Szanto
Alexandre Y
AY
Dombrovski
Carmen
C
Andreescu
Meryl A
MA
Butters
Jennifer Q
JQ
Morse
Patricia R
PR
Houck
Salem
S
Bensasi
Sati
S
Mazumdar
Jacqueline A
JA
Stack
Ellen
E
Frank
D000368:Aged; D000369:Aged, 80 and over; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D003866:Depressive Disorder / Q000517:prevention & control / Q000628:therapy*; D019468:Disease Management; D005260:Female; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*
D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors