title: Are old-old patients with major depression more likely to relapse than young-old patients during continuation treatment with escitalopram?
abstract: BACKGROUND
  Escitalopram has shown efficacy and tolerability in the prevention of relapse in elderly patients with major depressive disorder (MDD). This post-hoc analysis compared time to relapse for young-old patients (n = 197) to that for old-old patients (n = 108).
  
  
  METHODS
  Relapse prevention: after 12-weeks open-label treatment, remitters (MADRS ≤12) were randomised to double-blind treatment with escitalopram or placebo and followed over 24-weeks. Patients were outpatients with MDD from 46 European centers aged ≥75 years (old-old) or 65-74 years of age (young-old), treated with escitalopram 10-20 mg/day. Efficacy was assessed using the Montgomery Åsberg Depression Rating Scale (MADRS).
  
  
  RESULTS
  After open-label escitalopram treatment, a similar proportion of young-old patients (78%) and old-old patients (72%) achieved remission. In the analysis of time to relapse based on the Cox model (proportional hazards regression), with treatment and age group as covariates, the hazard ratio was 4.4 for placebo versus escitalopram (χ(2)-test, df = 1, χ(2)= 22.5, p < 0.001), whereas the effect of age was not significant, with a hazard ratio of 1.2 for old-old versus young-old (χ(2)-test, df = 1, χ(2) = 0.41, p = 0.520). Escitalopram was well tolerated in both age groups with adverse events reported by 53.1% of young-old patients and 58.3% of old-old patients. There was no significant difference in withdrawal rates due to AEs between age groups (χ(2)-test, χ(2) = 1.669, df = 1, p = 0.196).
  
  
  CONCLUSIONS
  Young-old and old-old patients with MDD had comparable rates of remission after open-label escitalopram, and both age groups had much lower rates of relapse on escitalopram than on placebo.
authors.affiliation: Department of Psychiatry, School of Medicine, Johns Hopkins University, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA. kostas@jhmi.edu
authors.forename: Constantine G
authors.initials: CG
authors.lastname: Lyketsos
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Weiller
authors.forename: Cornelius
authors.initials: C
authors.lastname: Katona
authors.forename: Phillip
authors.initials: P
authors.lastname: Gorwood
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015283:Citalopram / Q000008:administration & dosage / Q000627:therapeutic use*; D003865:Major Depressive Disorder / Q000188:drug therapy* / Q000517:prevention & control; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D016016:Proportional Hazards Models; D055502:Secondary Prevention; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors