Long-Term Antidepressants for Elderly?
Study Shows Depression in Old People Should Be Treated as Chronic Illness
March 15, 2006 - Elderly patients who stay on antidepressant drugs after recovering from depression are much less likely to suffer recurrences than patients taken off the drugs or those treated with psychotherapy alone, an important new study suggests.
Elderly people over the age of 70 who received placebo were more than twice as likely to have their depression return compared with those who received the antidepressant drug Paxil, even after taking into account psychotherapy.
Monthly psychotherapy was not found to be effective for preventing new episodes of depression among the elderly. The groundbreaking findings suggest that in older patients depression should be thought of more as a chronic illness -- like hypertension or diabetes -- than an episodic one, the study's researcher tells WebMD.
The study is published in the March 16 issue of The New England Journal of Medicine.
"We want to change the way physicians think about this illness in the elderly, especially general medicine physicians, because they are the ones who write most of the prescriptions," says Charles F. Reynolds III, MD. "Just like hypertension, depression is often a chronic disease that should be treated indefinitely."
Depression in Elderly
Depression is common among the elderly, even in people who have no history of the disease. The goal of treatment is not only recovery but to prevent recurrences, write the authors.
Depression is widely undertreated in the elderly, and recurrences are common. Rates of recurrent depression during a two-year period range from 50% to 90%, according to the researchers.
Reynolds says depression in older people tends to be tied closely to overall health and health-related disabilities.
"Probably anywhere from 6% to 10% of older primary-care patients are experiencing clinically significant depression at any point in time," he says. "The figure is closer to 15% to 20% for older people in medical hospitals and 20% to 25% for people in nursing homes."
He points out that there is no standard medical treatment strategy for patients who have their first bout of depression very late in life. There is no consensus about whether long-term treatment with antidepressant medication is appropriate in this age group.