Depression Remission Rates Among Older Black and White Adults: Analyses From the IRL-GREY Trial.
OBJECTIVE
This study explored whether older black and white adults with major depressive disorder differed in rates of remission or attrition during open-label treatment with venlafaxine and supportive care.


METHODS
A total of 47 black (10%) and 412 white (90%) adults age ≥60 were treated with open-label venlafaxine extended-release (≤300 mg per day) for 12-14 weeks during the initial phase of an multisite, randomized, placebo-controlled augmentation trial. Participants were help-seeking older adults with nonpsychotic major depressive disorder (single or recurrent episode) referred from specialty clinics, primary care practices, advertisements, and research programs. Remission was defined as a Montgomery-Asberg Depression Rating Scale score of ≤10 for two consecutive assessments at the end of 12 weeks. Kaplan-Meier curves displayed time to dropout and time to initial remission. Cox proportional hazards models assessed differences in attrition and remission rates.


RESULTS
Black participants had greater baseline general medical comorbidity, worse physical health-related quality of life, and poorer cognitive function than white participants. White participants were more likely to have received an adequate trial of antidepressant and psychotherapy before study entry. Baseline depression severity, depression duration, age at onset, and recurrence history did not differ between groups. The groups had similar final doses of venlafaxine and similar rates of attrition and remission. Side-effect profiles were comparable between the groups.


CONCLUSIONS
Despite greater medical comorbidity, lower cognitive function, and less adequate prior exposure to antidepressant treatment and psychotherapy, black participants were no more likely to discontinue antidepressant pharmacotherapy and experienced a rate of remission comparable to white participants.
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Charles A
CA
Hall
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Kevin M
KM
Simon
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Eric J
EJ
Lenze
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Mary Amanda
MA
Dew
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Amy
A
Begley
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Meryl A
MA
Butters
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Daniel M
DM
Blumberger
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Jacqueline A
JA
Stack
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Benoit
B
Mulsant
Dr. Hall, Dr. Dew, Ms. Begley, Dr. Butters, Ms. Stack, and Dr. Reynolds are with the Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. Dr. Simon is also with the Department of Psychiatry, Morehouse University School of Medicine, Atlanta. Ms. Begley and Ms. Stack are also with the NIMH Center for Late Life Depression Prevention and Treatment, University of Pittsburgh. Dr. Lenze is with the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. Dr. Blumberger and Dr. Mulsant are with the Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. Send correspondence to Dr. Reynolds (e-mail: reynoldscf@upmc.edu ).
Charles F
CF
Reynolds
D001741:Black or African American / Q000523:psychology* / Q000706:statistics & numerical data*; D000368:Aged; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010352:Patient Dropouts / Q000523:psychology / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D000069470:Venlafaxine Hydrochloride / Q000627:therapeutic use*; D044465:White People / Q000523:psychology* / Q000706:statistics & numerical data*
D018687:Antidepressive Agents, Second-Generation; D000069470:Venlafaxine Hydrochloride