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Previous Volume 354:1130-1138 March 16, 2006 Number 11 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Reifler, B. V. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Elderly patients with major depression, including those having a first episode, are at high risk for recurrence of depression, disability, and death.

Methods We tested the efficacy of maintenance paroxetine and monthly interpersonal psychotherapy in patients 70 years of age or older who had depression (55 percent of whom were having a first episode) in a 2-by-2, randomized, double-blind, placebo-controlled trial. Among patients with a response to treatment with paroxetine and psychotherapy, 116 were randomly assigned to one of four maintenance-treatment programs (either paroxetine or placebo combined with either monthly psychotherapy or clinical-management sessions) for two years or until the recurrence of major depression. Clinical-management sessions, conducted by the same nurses, social workers, and psychologists who provided psychotherapy, involved discussion of symptoms.

Results Major depression recurred within two years in 35 percent of the patients receiving paroxetine and psychotherapy, 37 percent of those receiving paroxetine and clinical-management sessions, 68 percent of those receiving placebo and psychotherapy, and 58 percent of those receiving placebo and clinical-management sessions (P=0.02). After adjustment for the effect of psychotherapy, the relative risk of recurrence among those receiving placebo was 2.4 times (95 percent confidence interval, 1.4 to 4.2) that among those receiving paroxetine. The number of patients needed to be treated with paroxetine to prevent one recurrence was 4 (95 percent confidence interval, 2.3 to 10.9). Patients with fewer and less severe coexisting medical conditions (such as hypertension or cardiac disease) received greater benefit from paroxetine (P=0.03 for the interaction between treatment with paroxetine and baseline severity of medical illness).

Conclusions Patients 70 years of age or older with major depression who had a response to initial treatment with paroxetine and psychotherapy were less likely to have recurrent depression if they received two years of maintenance therapy with paroxetine. Monthly maintenance psychotherapy did not prevent recurrent depression. (ClinicalTrials.gov number, NCT00178100 [ClinicalTrials.gov] .)

Source Information

From the Advanced Center for Intervention and Services Research for Late-Life Mood Disorders and the John A. Hartford Center of Excellence in Geriatric Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic (C.F.R., M.A.D., B.G.P., E.F., M.D.M., P.R.H., M.A.B., J.A.S., M.A.S., E.M.W., A.G., J.K., E.L., K.S., S.B., D.J.K.); the Geriatric Research, Education, and Clinical Center, Pittsburgh Veterans Affairs Health Care System (B.H.M.); and the Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh (S.M.) — all in Pittsburgh.

Address reprint requests to Dr. Reynolds at the Western Psychiatric Institute and Clinic, 3811 O'Hara St., Rm. E-1135, Pittsburgh, PA 15213, or at reynoldscf{at}upmc.edu.

Full Text of this Article

Related Letters:

Maintenance Treatment of Depression in Old Age
Edwards J. L., Bajbouj M., Danker-Hopfe H., Dew M. A., Houck P. R., Reynolds C. F. III
Extract | Full Text | PDF  
N Engl J Med 2006; 354:2505-2506, Jun 8, 2006. Correspondence

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