Antidepressants versus placebo for the depressed elderly

Abstract

Background Depression warranting intervention is found in ten percent of people over the age of 60. Older depressed people are more likely to die than non-depressed. Relatively few receive therapeutic interventions, and those that do, tend to receive low dose antidepressant therapy. Depression in older people is thought to di er in terms of aetiology, presentation, treatment and outcome than in younger people. Concomitant physical illness and increasing social, physical and neurophysiological diversity are associated with the ageing process. Consequently drug treatment of older patients is o en carried out in institutions and on patients su ering from multiple physical problems. Objectives To determine the e icacy of antidepressant medication compared with placebo in the treatment of depression in older patients. Search methods The search strategy incorporated: electronic literature searches of databases held by the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group (CCDAN) (see Collaborative Review Group Search Strategy). Reference lists of related reviews and references of located studies. Contact was made with authors working in the field. Selection criteria All randomised, placebo controlled trials using antidepressants in the treatment of the presenting episode of depression in patients described as elderly, geriatric senile or older adult. Data collection and analysis Two types of data were extracted (if available) from each study. The first type of data was dichotomous data, this consisted of recovered/not recovered. The second, continuous data,included: Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Rating Scale (MADRS) and other depression rating scale scores. An analysis using Peto Odds ratios for the dichotomous data and weighted mean di erence for continuous data was performed using RevMan 3.1. The presence of heterogeneity of treatment e ect was assessed. Main results Seventeen trials contributed data to the analyses comparing the e icacy of antidepressant treatment and placebo. Analyses of e icacy were based on 245 patients treated with Tricyclic antidepressants (223 with placebo), 365 patients treated with SSRIs (372 with placebo) and 58 patients treated with MAOIs (63 with placebo). The results using a fixed e ect model, for the three groups respectively were,

A Systematic Review of Antidepressant Placebo-Controlled Trials for Geriatric Depression: Limitations of Current Data and Directions for the Future

“…These studies support the clinical observation that antidepressants can effectively treat depression in the elderly, the same conclusion reached by others using meta-analytic techniques (Mittmann et al, 1997;Wilson et al, 2001). Our NNT analysis demonstrated that one must treat eight patients to have one subject achieve even a 50% reduction in depressive symptoms; thus, while antidepressants are more effective than placebo, a significant number of patients will not respond.…”

“…We performed a systematic review of all published randomized, placebo-controlled antidepressant medication trials in populations over age 55 years. Papers were obtained via MEDLINE (1966( -August 2003 and PSYCINFO (1872-August 2003. Unpublished trials, trials examining nonpharmacologic interventions, and papers reporting post hoc analyses were not included in this review unless they provided new insights.…”

The Use of Antidepressants in Belgian Nursing Homes

“…Depression is a treatable illness [19] ; approximately 50-60% patients with major depressive disorder are thought to improve clinically as a consequence of antidepressant treatment [20,21] . In addition, there are other indications to prescribe an antidepressant.…”

Spiritual reminiscence therapy for older people with loneliness, anxiety and depression living in a residential aged care facility, Malaysia: The effectiveness and older people’s experiences

“…Pharmacological intervention is often a first-line approach to treat clinically diagnosed anxiety (Flint, 2005) and depression (Wilson, Mottram, Sivananthan, & Nightingale, 2001) in older people.…”

“…The pharmacological interventions for depression involve antidepressants. Selective serotonin reuptake inhibitors and monoamine oxidase inhibitors were all found effective in comparison to placebos when treating depression among institutionalised older people (Wilson et al, 2001). Anxiolytic medications such as benzodiazepines are the most common pharmacological treatment for anxiety in older people (Lindsey, 2009).…”