Intervention Review

Antidepressants versus placebo for the depressed elderly

  1. Kenneth Wilson1,*,
  2. Patricia G Mottram2,
  3. Anushta Sivananthan3,
  4. A Nightingale4

Editorial Group: Cochrane Depression, Anxiety and Neurosis Group

Published Online: 22 JAN 2001

Assessed as up-to-date: 14 OCT 2000

DOI: 10.1002/14651858.CD000561


How to Cite

Wilson K, Mottram PG, Sivananthan A, Nightingale A. Antidepressants versus placebo for the depressed elderly. Cochrane Database of Systematic Reviews 2001, Issue 1. Art. No.: CD000561. DOI: 10.1002/14651858.CD000561.

Author Information

  1. 1

    Birkenhead, Wirral, UK

  2. 2

    University of Liverpool, Department of Psychiatry, Church Road, Birkenhead, UK

  3. 3

    Cheshire and Wirral Partnership NHS Foundation Trust, Older People's Mental Health, Liverpool, UK

  4. 4

    EMI Academic Unit, Department of Psychiatry, Liverpool, UK

*Kenneth Wilson, Psychiatry, EMI Academic Unit, Univ of Liverpool, St Catherine's Hospital, Church Road, Birkenhead, Wirral, L42 0LQ, UK. kw500505@liverpool.ac.uk. kw500505@liverpool.ac.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 22 JAN 2001

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Depression warranting intervention is found in ten percent of people over the age of 60. Older depressed people are more likely to die than non-depressed. Relatively few receive therapeutic interventions, and those that do, tend to receive low dose antidepressant therapy. Depression in older people is thought to differ in terms of aetiology, presentation, treatment and outcome than in younger people. Concomitant physical illness and increasing social, physical and neurophysiological diversity are associated with the ageing process. Consequently drug treatment of older patients is often carried out in institutions and on patients suffering from multiple physical problems.

Objectives

To determine the efficacy of antidepressant medication compared with placebo in the treatment of depression in older patients.

Search methods

The search strategy incorporated: electronic literature searches of databases held by the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group (CCDAN) (see Collaborative Review Group Search Strategy). Reference lists of related reviews and references of located studies. Contact was made with authors working in the field.

Selection criteria

All randomised, placebo controlled trials using antidepressants in the treatment of the presenting episode of depression in patients described as elderly, geriatric senile or older adult.

Data collection and analysis

Two types of data were extracted (if available) from each study. The first type of data was dichotomous data, this consisted of recovered/not recovered. The second, continuous data,included: Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Rating Scale (MADRS) and other depression rating scale scores. An analysis using Peto Odds ratios for the dichotomous data and weighted mean difference for continuous data was performed using RevMan 3.1. The presence of heterogeneity of treatment effect was assessed.

Main results

Seventeen trials contributed data to the analyses comparing the efficacy of antidepressant treatment and placebo. Analyses of efficacy were based on 245 patients treated with Tricyclic antidepressants (223 with placebo), 365 patients treated with SSRIs (372 with placebo) and 58 patients treated with MAOIs (63 with placebo). The results using a fixed effect model, for the three groups respectively were, TCAs; OR: 0.32 (95% CI: 0.21,0.47), SSRIs; OR; 0.51 (95% CI: 0.36,0.72), MAOIs: OR 0.17 (95% CI: 0.07,0.39).

Authors' conclusions

TCAs, SSRIs and MAOIs are effective in the treatment of older community patients and inpatients likely to have severe physical illness. At least six weeks of antidepressant treatment is recommended to achieve optimal therapeutic effect. There is little evidence concerning the efficacy of low dose TCA treatment. Further trials are required before low dose TCA treatment is routinely recommended.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Antidepressants compared with placebos for depressed older people

Seventeen RCTs were identified by the systematic literature search that met our inclusion criteria and provide suitable data for analysis. We analysed these 17 placebo trials examining the efficacy of antidepressant treatment in older people. Just under 2000 patients were entered into the meta analysis. TCAs, SSRIs and MAOIs proved effective in both institutionalised and community patients. Low dose TCA treatment may be effective but further studies are needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對老人憂鬱症,抗憂鬱藥與安慰劑的比較

憂鬱症的干預被發現在60歲百分之十以上的人。老年憂鬱比不憂鬱的人更容易死。相對而言,這樣的患者很少接受治療干預,而那些接受的,可能得到低劑量抗憂鬱藥治療。憂鬱症在老年人中,被認為病因,表現,治療和結果與年輕的人是不同的。隨之而來的身體疾病和增加社會,身體和神經生理學多樣性與老化的過程有關。因此老年患者的藥物治療往往會在機構和遭受多種生理疾病的病人進行。

目標

要確定在憂鬱症的老年患者,抗憂鬱藥與安慰劑相比的療效。

搜尋策略

該搜索戰略中:由Cochrane憂鬱合作研究,焦慮和神經症審查小組(CCDAN)(見協作審查組搜索策略)舉行電子文獻數據庫檢索。參考文獻列出了相關的審查和研究參考的位置。與這領域的作者取得了聯繫。

選擇標準

所有的隨機,安慰劑對照試驗中使用抗憂鬱藥治療的正處於憂鬱期的患者被描述為elderly, geriatric senile或older adult。

資料收集與分析

由每項研究提取兩種類型的數據(如果有)。第一類數據是二分類數據,這包括恢復/沒有恢復。第二,連續數據,包括:漢密爾頓憂鬱評定量表(HAM  D),蒙哥馬利,艾森貝格評定量表(MADRS)和其他憂鬱量表分數。使用 RevMan 3.1進行分析,分別用Peto比值比為二分類數據和加權平均為連續數據。對治療效果的異質性進行評估。

主要結論

17個試驗數據,作出了貢獻的分析比較抗憂鬱劑和安慰劑治療的療效。療效分析是基於245例治療三環類抗憂鬱藥(223安慰劑),365名病人治療 SSRIs的(372安慰劑)和58單胺氧化脢抑制劑治療的患者(63例安慰劑)。結果使用固定效應模型,在3個小組,分別是,抗憂鬱藥或:0.32(95%CI為:0.21,0.47),SSRIs的; 或; 0.51(95%CI為:0.36,0.72),單胺氧化脢抑制劑:0.17(95%CI為:0.07,0.39)。

作者結論

抗憂鬱藥,SSRIs的和單胺氧化脢抑制劑能有效地治療老年病人住院社會可能產生嚴重的身體疾病。至少六個星期的抗憂鬱治療建議,以達到最佳治療效果。沒有什麼證據有關的療效低劑量三環抗憂鬱藥治療。進一步的試驗之前必須低劑量三環抗憂鬱藥治療常規建議。

翻譯人

本摘要由彰化基督教醫院廖慈凰翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

確定了17個隨機對照試驗的系統的文獻檢索,滿足了我們的納入標準,並提供適當的數據進行分析。我們分析這17安慰劑試驗研究抗憂鬱治療的療效在老年人中。只要患者根據2000年簽訂的Meta分析。抗憂鬱藥,單胺氧化脢抑制劑SSRIs的和行之有效的兩個制度化和社會病人。低劑量的三環抗憂鬱藥治療可能有效,但還需要進一步研究。