Am J Psychiatry 1994; 151:1740-1743
Copyright © 1994 by American Psychiatric Association
Treatment of consecutive episodes of major depression in the elderly
CF Reynolds 3rd, E Frank, JM Perel, MD Miller, C Cornes, AH Rifai, BG Pollock, S Mazumdar, CJ George and PR Houck
Department of Psychiatry, University of Pittsburgh Medical Center, PA.
OBJECTIVE: The purpose of this study was to determine treatment outcome in
elderly patients with consecutively treated episodes of recurrent unipolar
major depression. METHOD: Subjects were 32 "young" elderly patients with
recurrent unipolar depression (mean age = 66.8 years, SD = 5.1) and with
two consecutively treated episodes of major depression. Both index and
subsequent episodes of major depression were treated in open trial with
combined nortriptyline and interpersonal psychotherapy. Rates of remission
in index and subsequent episodes were compared by using nonparametric
statistics and survival analysis with proportional hazards modeling.
RESULTS: Of 30 patients who completed treatment of the subsequent episode,
27 (90%) achieved stable remission of symptoms in both consecutively
treated episodes, whereas three patients (10%) did not. Twenty-two (81%) of
27 patients who responded to treatment had a shorter time to remission in
treatment of the subsequent episode than in the index episode. Survival
analysis with proportional hazards modeling detected a significant
difference in time to remission of the index and subsequent episodes (32
paired observations). CONCLUSIONS: In this research study group, recurrent
episodes of unipolar major depression in the young elderly were
successfully treated to remission in over 80% of patients by using combined
pharmacotherapy and psychotherapy similar to that employed in treatment of
the index episode. Remission rate and time to remission in consecutively
treated episodes were comparable to those in a group of midlife patients
with recurrent depression reported by Kupfer et al. in 1989. Thus,
recurrent depressive disorder appears to be as treatable in the young
elderly as it is in midlife patients.
