Hostname: page-component-7c8c6479df-5xszh Total loading time: 0 Render date: 2024-03-28T13:57:56.377Z Has data issue: false hasContentIssue false

The effect of treatment on the two-year course of late-life depression

Published online by Cambridge University Press:  03 January 2018

Alastair J. Flint*
Affiliation:
Department of Psychiatry, University of Toronto and The Toronto Hospital 200 Elizabeth Street, Toronto, Ontario, Canada
Sandra L. Rifat
Affiliation:
Department of Preventive Medicine and Biostatistics, University of Toronto, Ontario, Canada
*
Dr Alastair J. Flint, The Toronto Hospital (General Division), 200 Elizabeth Street, 8 Eaton North, Room 238, Toronto, Ontario M5G 2C4, Canada. Fax: (416) 340-4198

Abstract

Background

The purpose of this study was to examine the effect of treatment on the long-term course of geriatric depression.

Method

Eighty-four elderly patients who had responded to treatment of the index episode of major depression were maintained on full-dose antidepressant medication and followed on a monthly basis for two years. Relapse and recurrence were treated in a systematic manner.

Results

The cumulative probability of surviving for two years without relapse or recurrence was 74%. Of the 14 patients who suffered recurrence following recovery from the index episode, all responded to a change of treatment, and 71% remained well for the remainder of the study. The risk of recurrence was significantly increased by a delayed response to treatment of the index episode.

Conclusions

Continuation and maintenance treatment with full-dose antidepressant medication, frequent follow-up, and vigorous treatment of relapses and recurrences, were associated with a good outcome in this group of elderly patients.

Type
Papers
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Alexopoulos, G. S., Young, R. C., Abrams, R. C., et al (1989) Chronicity and relapse in geriatric depression. Biological Psychiatry, 26, 551564.Google Scholar
American Psychiatric Aatodation (1987) Diagnostic and Statistical Manual of Medcial Disorders (3rd edn. revised) (DSM-III-R). Washington, DC: APA.Google Scholar
Ames, D. & Allen, N. (1991) The prognosis of depression in old age: good, bad or indifferent? International Journal of Geriatric Psychiatry. 6.477481.CrossRefGoogle Scholar
Baldwin, B. (1991) The outcome of depression in old age. International Journal of Geriatric Psychiatry, 6, 395400.CrossRefGoogle Scholar
Burvill, P. W., Mowry, B. & Hall, W D. (1990) Quantification of physical illness in psychiatric research in the elderly. International Journal of Geriatric Psychiatry. 5, 161170.CrossRefGoogle Scholar
Flint, A. J. (1992) The optimunn duration of antidepressant treatment in the elderly. International Journal of Geriatric Psychiatry 7, 617619.Google Scholar
Flint, A. J. & Rifat, S. L. (1996) The effect of sequential antidepressant treatnnent on geriatric depression. Journal of Affective Disorders. 36, 95105.CrossRefGoogle ScholarPubMed
Folstein, M. F., Foistein, S. E. & McHugh, R. R. (1975) “Mini-Mental State”. A practical method of grading the cognitive state of patients for the clinician. Journal of Psychiatric Research. 12, 189198.Google Scholar
Frank, E., Kupfer, D. J., Perel, J. M., et al (1990) Three-year outcomes for maintenance therapies in recurrent depression. Archives of General Psychiatry. 47, 10931099.Google Scholar
Georgatas, A., McCue, R. E., Cooper, T. B., et al (1988) How effective and safe is continuation therapy in elderly depressed patients? Archives of General Psychiatry. 45, 929932.Google Scholar
Georgatas, A., McCue, R. E., Cooper, T. B., et al (1989) A placebo-controlled comparison of nortriptyline and phenelzine in nnaintenance therapy of elderly depressed patients. Archives of General Psychiatry 46, 783786.Google Scholar
Hamilton, M. (1960) A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.Google Scholar
Jacoby, R. (1993) Long-term antidepressant treatment in the elderly. British Journal of Psychiatry. 143. 551.CrossRefGoogle Scholar
Kupfer, D. J. (1993) Management of recurrent depression. Journal of Clinical Psychiatry. 54 (suppl. 2). 2933.Google Scholar
Lavori, P. W., Kollar, M. B., Muallar, T. L., et al (1994) Recurrence after recovery in unipolar MDD: an observational follow-up study of clinical predictors and somatic treatment as a mediating factor. International Journal of Methods in Psychiatric Research. 4, 211229.Google Scholar
Murphy, E. (1982) Social origins of depression in old age. British Journal of Psychiatry, 141, 135142.Google Scholar
Old Age Dapression Interest Group (1993) How long should the elderly take antidepressants? A double-blind placebo-controlled study of continuation/prophylaxis therapy with dothiepin. British Journal of Psychiatry. 142, 175182.Google Scholar
Raynolds, C. F., Frank, E., Parel, J. M., et al (1994) Treatment of consecutive episodes of major depression in the elderly. American Journal of Psychiatry. 151, 17401743.Google Scholar
Sadavoy, J. & Relman-Sheldon, E. (1983) General hospital geriatric psychiatric treatment: a follow-up study. Journal of the American Geriatrics Society. 31, 200205.CrossRefGoogle ScholarPubMed
Stoudemire, A., Hill, C. D., Dalton, S. T., et al (1994) Rehospitalization rates in older depressed adults after antidepressant and electroconvulsive therapy treatment. Journal of the American Geriatrics Society. 42, 12821285.Google Scholar
Submit a response

eLetters

No eLetters have been published for this article.