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Recovery from major depression in older adults receiving augmentation of antidepressant pharmacotherapy.
- Source :
-
The American journal of psychiatry [Am J Psychiatry] 2007 Jun; Vol. 164 (6), pp. 892-9. - Publication Year :
- 2007
-
Abstract
- 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.<br />Method: 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.<br />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.<br />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.
- Subjects :
- Age Factors
Aged
Bupropion therapeutic use
Combined Modality Therapy
Depressive Disorder, Major diagnosis
Depressive Disorder, Major psychology
Drug Therapy, Combination
Female
Geriatric Assessment
Humans
Lithium Compounds therapeutic use
Male
Nortriptyline therapeutic use
Secondary Prevention
Time Factors
Treatment Outcome
Antidepressive Agents therapeutic use
Depressive Disorder, Major drug therapy
Paroxetine therapeutic use
Psychotherapy methods
Subjects
Details
- Language :
- English
- ISSN :
- 0002-953X
- Volume :
- 164
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The American journal of psychiatry
- Publication Type :
- Academic Journal
- Accession number :
- 17541048
- Full Text :
- https://doi.org/10.1176/ajp.2007.164.6.892