Outcome of late-life depression after 3 years of sequential treatment
Article first published online: 27 NOV 2008
Copyright © 2008 The Authors. Journal Compilation © 2008 Blackwell Munksgaard
Acta Psychiatrica Scandinavica
Volume 119, Issue 4, pages 274–281, April 2009
How to Cite
Kok, R. M., Nolen, W. A. and Heeren, T. J. (2009), Outcome of late-life depression after 3 years of sequential treatment. Acta Psychiatrica Scandinavica, 119: 274–281. doi: 10.1111/j.1600-0447.2008.01295.x
- Issue published online: 3 MAR 2009
- Article first published online: 27 NOV 2008
- Accepted for publication October 08, 2008
- depressive disorder;
- antidepressive agents
Objective: To study the outcome of a sequential treatment protocol in elderly, severely depressed in-patients.
Method: All 81 patients from a 12-week double-blind randomized controlled trial (RCT) comparing venlafaxine with nortriptyline were asked to participate in a 3 year follow-up study. Thirty-two patients who did not achieve remission during the RCT, entered an open sequential treatment protocol and were treated with augmentation with lithium, switch to a monoamine oxidase inhibitor or ECT.
Results: Seventy-eight of the 81 patients (96.3%) achieved a response [≥50% reduction in Montgomery Åsberg Depression Rating Scale score) and 68 patients (84%) a complete remission (final MADRS score ≤ 10) within 3 years of treatment. Greater severity and longer duration of the depressive episode at baseline predicted poor recovery. Augmentation with lithium may be the best treatment option in treatment resistant depressed elderly. Only few patients dropped-out due to side-effects.
Conclusion: Our study demonstrates the importance of persisting with antidepressant treatment in elderly patients who do not respond to the first or second treatment.