Depressed Elderly Need Ongoing Care

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Patients received either Paxil (paroxetine) or a placebo, plus either psychotherapy or "clinical management" -- in which patients discussed their symptoms but received no psychotherapy.

The result: Within two years after first treatment, depression recurred frequently in all the groups studied. However, rates of relapse were highest among those taking psychotherapy or clinical management alone (68 percent and 58 percent, respectively), and much lower (35 percent) among those taking Paxil plus psychotherapy or clinical management.

Still, a 35 percent relapse rate is troubling, and higher than that seen in younger populations, Reynolds said.

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The findings suggest that "even first episodes of depression in old age represent the appearance of a chronic, recurring illness," he said. "We need to take that perspective with our patients and their families, and offer them appropriate treatment."

That "appropriate treatment" most likely involves SSRI therapy, Reynolds added. Although his group used Paxil, "there's no reason to think that other SSRIs wouldn't perform equally well in the same context." The vast majority of patients who ended up taking Paxil for the full two years of the study showed no side effects, although a few did drop out after experiencing minor discomfort with the drug.

The Pittsburgh trial emphasizes "the importance of maintenance treatment for depression in late life," said Dr. Burton Reifler, a professor of psychiatry at Wake Forest University School of Medicine, and author of an accompanying editorial.

Praising the Pittsburgh study, he noted that "there hasn't been a follow-up that long in any previous controlled trial." While it's too early to make a "hard-and-fast rule" about the length of time elderly patients may need to be placed on antidepressants, Reifler said the findings should prompt doctors to ask the question, "'Do [many] individuals with depression in late life need to be on medication indefinitely?'"

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