Maintenance Treatment for Old-Age Depression Preserves Health-Related Quality of Life: A Randomized, Controlled Trial of Paroxetine and Interpersonal Psychotherapy

Authors

  • Alexandre Y. Dombrovski MD,

    1. From the *Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Advanced Center for Interventions and Services Research in Late-Life Mood DisordersJohn A. Hartford Center for Excellence in Geriatric PsychiatryDepartments of Psychology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§Center for Addictions and Mental Health, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Eric J. Lenze MD,

    1. From the *Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Advanced Center for Interventions and Services Research in Late-Life Mood DisordersJohn A. Hartford Center for Excellence in Geriatric PsychiatryDepartments of Psychology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§Center for Addictions and Mental Health, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Mary Amanda Dew PhD,

    1. From the *Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Advanced Center for Interventions and Services Research in Late-Life Mood DisordersJohn A. Hartford Center for Excellence in Geriatric PsychiatryDepartments of Psychology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§Center for Addictions and Mental Health, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Benoit H. Mulsant MD,

    1. From the *Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Advanced Center for Interventions and Services Research in Late-Life Mood DisordersJohn A. Hartford Center for Excellence in Geriatric PsychiatryDepartments of Psychology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§Center for Addictions and Mental Health, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Bruce G. Pollock MD, PhD,

    1. From the *Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Advanced Center for Interventions and Services Research in Late-Life Mood DisordersJohn A. Hartford Center for Excellence in Geriatric PsychiatryDepartments of Psychology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§Center for Addictions and Mental Health, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Patricia R. Houck MS,

    1. From the *Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Advanced Center for Interventions and Services Research in Late-Life Mood DisordersJohn A. Hartford Center for Excellence in Geriatric PsychiatryDepartments of Psychology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§Center for Addictions and Mental Health, University of Toronto, Toronto, Canada
    Search for more papers by this author
  • Charles F. Reynolds III MD

    1. From the *Western Psychiatric Institute and Clinic, Department of Psychiatry, School of Medicine, University of Pittsburgh, Advanced Center for Interventions and Services Research in Late-Life Mood DisordersJohn A. Hartford Center for Excellence in Geriatric PsychiatryDepartments of Psychology and Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania§Center for Addictions and Mental Health, University of Toronto, Toronto, Canada
    Search for more papers by this author

Address correspondence to Charles F. Reynolds III, MD, WPIC (E1135), 3811 O'Hara Street, Pittsburgh, PA 15213. E-mail: reynoldscf@upmc.edu

Abstract

OBJECTIVES: To determine whether maintenance antidepressant pharmacotherapy and interpersonal psychotherapy sustain gains in health-related quality of life (HR-QOL) achieved during short-term treatment in older patients with depression.

DESIGN: After open combined treatment with paroxetine and interpersonal psychotherapy, responders were randomly assigned to a two (paroxetine vs placebo) by two (monthly interpersonal psychotherapy vs clinical management) double-blind, placebo-controlled maintenance trial. HR-QOL outcomes were assessed over 1 year.

SETTING: University-based clinic.

PATIENTS: Of the referred sample of 363 persons aged 70 and older with major depression, 210 gave consent, and 195 started acute treatment; 116 met criteria for recovery, entered maintenance treatment, and were included in this analysis.

INTERVENTIONS: Paroxetine; monthly manual-based interpersonal psychotherapy.

MEASUREMENTS: Overall HR-QOL as measured using the Quality of Well-Being Scale (QWB) and six specific HR-QOL domains derived from the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) subscales.

RESULTS: All domains of HR-QOL except physical functioning improved with successful acute and continuation treatment. After controlling for any effects of psychotherapy, pharmacotherapy was superior to placebo in preserving overall well-being (P=.04, effect size (r)=0.23), social functioning (P=.02, r=0.27), and role limitations due to emotional problems (P=.007, r=0.30). Interpersonal psychotherapy (controlling for the effects of pharmacotherapy) did not preserve HR-QOL better than supportive clinical management.

CONCLUSION: Maintenance antidepressant pharmacotherapy is superior to placebo in preserving improvements in overall well-being achieved with treatment response in late-life depression. No such benefit was seen with interpersonal psychotherapy.

Ancillary