Time Course of Response to Antidepressants in Late-Life Major Depression
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In the treatment of depression, there is considerable interest in the time course of response and, in particular, the speed with which individuals recover from depressive episodes. Examination of the time course and speed of response is critical for assessing the usefulness of specific treatments. However, while this issue has received attention in mid-life adult populations, it has received little consideration in the context of late-life major depression. The synthesis of empirical reports indicates that, while older adults with depression seem to respond with the same speed as mid-life adults, several factors have consistently been associated with reduced speed of response to antidepressant treatment, including greater severity of depressive symptoms and co-occurring anxiety symptoms. Limited evidence suggests that sleep impairment and genetic factors (e.g. presence of the s allele of the serotonin transporter gene promoter region) may also be associated with reduced speed of response. Some factors have consistently been found to be unrelated to speed of response (demographic characteristics, nonpsychiatric physical illnesses) whereas other factors have only mixed evidence supporting any effect (psychosocial and other clinical factors). While there is little work available to date, some evidence suggests that time course and speed of response affect longer-term outcomes of depression pharmacotherapy; thus, older adults with more rapid versus slower patterns of response may differ in the types of maintenance treatment needed to avert additional depressive episodes.
None of potential strategies for accelerating speed of response have been clearly shown to be effective in late-life depression. Future treatment studies for late-life depression should routinely consider not only overall efficacy of a given pharmacotherapy (i.e. total rate of response), but time course and speed of response. To this end, new investigations must be designed to overcome the methodological limitations of prior studies that have examined time course and they should include a range of potential covariates and outcomes of between-patient differences in speed of response. Better understanding of factors related to such differences may suggest new intervention strategies to accelerate response.
KeywordsNimodipine Antidepressant Treatment Depressive Illness Comorbid Anxiety Bright Light Therapy
This manuscript was supported by grants MH60473, MH19986, MH52247, MH37860 and MH43832 from the National Institute of Mental Health, Rockville, MD, USA.
Dr Lenze has received research support from Forest Laboratories, Janssen Pharmaceuticals and Pfizer Inc. Dr Bharucha is a member of the speakers bureau of Pfizer Inc. and Forest Laboratories. Dr Mulsant has received honoraria and/or research support from Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Pfizer Inc. and Solvay. Dr Reynolds has received research support from GlaxoSmithKline, Forest Laboratories and Pfizer Inc.
- 2.Thase ME. Methodology to measure onset of action. J Clin Psychiatry 2001; 62(15 Suppl.): 18–21Google Scholar
- 8.Guy W, editor. ECDEU assessment manual for psychopharmacology. Washington, DC: US Department of Health, Education, and Welfare, 1976; Publication ADM 76–338: 218–22Google Scholar
- 15.Schöne W, Ludwig M. A double-blind study of paroxetine compared with fluoxetine in geriatric patients with major depression. J Clin Psychopharmacol 1993; 13(2 Suppl.): 34–9SGoogle Scholar
- 17.Forlenza OV, Almeida OP, Stoppe A, et al. Antidepressant efficacy and safety of low-dose sertraline and standard-dose imipramine for the treatment of depression in older adults: results from a double-blind, randomized, controlled clinical trial. Int Psychogeriatr 2001; 13: 75–84PubMedCrossRefGoogle Scholar
- 18.Karlsson I, Godderis J, Augusto De Mendonca Lima C, et al. A randomised, double-blind comparison of the efficacy and safety of citalopram compared to mianserin in elderly, depressed patients with and without mild to moderate dementia. Int J Geriatr Psychiatry 2000; 15: 295–305PubMedCrossRefGoogle Scholar
- 27.Kirsch I, Moore TJ, Scoboria A, et al. The emperor’s new drugs: an analysis of antidepressant medication data submitted to the US Food and Drug Administration. Prevent Treat 2002; 5: Article 23, Epub 2002 Jul 15Google Scholar
- 35.Gildengers AG, Houck PR, Mulsant BH, et al. Trajectories of treatment response in late-life depression: psychosocial and clinical correlates. J Clin Psychopharm. In pressGoogle Scholar
- 53.Knowles JB, MacLean AW. Age-related changes in sleep in depressed and healthy subjects: a meta-analysis. Neuropsychopharm 1990; 3: 251–9Google Scholar
- 78.Green TD, Reynolds III CF, Mulsant BH, et al. Accelerating antidepressant response in geriatric depression: a post hoc comparison of combined sleep deprivation and paroxetine versus monotherapy with paroxetine, nortriptyline, or placebo. J Geriatr Psychiatry Neurol 1999; 12: 67–71PubMedCrossRefGoogle Scholar
- 80.Reynolds III CF. Effects of therapeutic sleep deprivation on speed of antidepressant response in elderly depressed patients. Annual Meeting of the American Association of Geriatric Psychiatry; 2003 Mar 3–5, HonoluluGoogle Scholar