Elderly benefit from depression maintenance therapy

By Michelle Rizzo

NEW YORK (Reuters Health) - Among elderly patients who have recovered from an episode of major depression, maintenance treatment with antidepressant drugs is superior to placebo in preserving the improvements in health-related quality of life, according to a recent report.

"Depression is one of the major causes of decline in the health-related quality of life (HR-QOL) of elderly persons," write Dr. Alexandre Y. Dombrovski and colleagues, in the Journal of the American Geriatrics Society.

The researchers, from University of Pittsburgh, Pennsylvania, examined the effectiveness of antidepressant maintenance therapy with paroxetine and interpersonal psychotherapy in retaining the gains in HR-QOL achieved during initial short-term treatment in patients 70 years or older with depression.

A total of 195 patients were initially treated with paroxetine (Paxil) and underwent interpersonal psychotherapy for depression; 116 of them responded and entered the maintenance treatment phase.

The 116 subjects were randomly assigned to maintenance therapy with paroxetine or placebo, given in combination with monthly interpersonal psychotherapy or the usual follow-up care.

Overall HR-QOL, measured using the Quality of Well-Being Scale and the 36-item Medical Outcomes Study Short-Form-Health Survey, was assessed at the beginning of the trial, at the end of short-term treatment, at the end of the first year of long-term treatment, and at recurrence or exit from the study.

Patients who responded to initial and continuation treatment had improvements in all domains of HR-QOL except physical functioning. After weighing the effects of psychotherapy, paroxetine was superior to placebo in maintaining overall HR-QOL.

After weighing the effects of paroxetine, maintenance treatment with interpersonal psychotherapy was no better in preserving HR-QOL than the usual follow-up care.

"Patients receiving paroxetine experienced better quality of life because they were less likely to have another episode of depression compared to those receiving placebo," Dombrovski said in an interview with Reuters Health.

"As with high blood pressure or diabetes, long-term treatment is needed to keep depression under control, Dombrovski added.

"In our study, long-term treatment with an antidepressant was safe for elderly patients and caused few side effects."

SOURCE: Journal of the American Geriatrics Society, September 2007.