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Am J Psychiatry 1996; 153:1418-1422
Copyright © 1996 by American Psychiatric Association
High relapse rate after discontinuation of adjunctive medication for elderly patients with recurrent major depression
CF Reynolds 3rd, E Frank, JM Perel, S Mazumdar, MA Dew, A Begley, PR Houck, M Hall, B Mulsant, MK Shear, MD Miller, C Cornes and DJ Kupfer
Mental Health Clinical Research Center for the Study of Late-Life Mood Disorders, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, PA 15213, USA. reynoldscf@a1.isd.upmc.edu
OBJECTIVE: The authors documented outcomes of elderly depressed patients
requiring adjunctive medication during acute-phase pharmacotherapy because
of slow or partial response to nortriptyline. Twenty-eight patients (17.7%)
received inpatient care at some point during acute-phase treatment. METHOD:
Rates of response, relapse, and sustained remission were examined in 158
elderly patients with recurrent major depression, grouped by whether they
received brief treatment with adjunctive medication (lithium, perphenazine,
or paroxetine) (N = 39) or did not (N = 119). RESULTS: The group receiving
adjunctive medication had a lower rate of response to acute therapy (64.1%
versus 83.2%), a higher relapse rate during continuation therapy (52.0%
versus 6.1%), and a lower rate of sustained remission (recovery) (48.7%
versus 76.5%) than did the group without augmentation. CONCLUSIONS: Elderly
depressed patients requiring augmented pharmacotherapy to achieve remission
may need continuation of adjunctive medication to remain well and to avoid
early relapse. Alternatively, factors that lead to augmentation in the
first place (e.g., heightened anxiety) may also increase the risk of
relapse.
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