APA PRESS RELEASE: Augmenting Drug Treatment Increases  Recovery Prospects for Elderly Patients with Depression

Arlington, Va. - The addition of a second medication to (or "augmentation of") the treatment plan of elderly patients with depression who either failed to respond to initial treatment, or relapsed early, results in a significant increase in the likelihood of recovery after the second
drug is added, a new study has found. However, researchers found that recovery
after augmentation was slower in patients who did not respond to the first
treatment, especially those with more medical conditions, or those who
had anxiety. These new findings are reported in the June issue of The
American Journal of Psychiatry (AJP), the official journal of the American
Psychiatric Association.

The likelihood, speed, and predictors of recovery in elderly patients
with depression following the addition of a second medication are examined
in "Recovery From Major Depression in Older Adults Receiving Augmentation
of Antidepressant Pharmacotherapy" by Mary Amanda Dew, Ph.D., Charles F.
Reynolds III, M.D., and colleagues at the University of Pittsburgh
School of Medicine. The augmentation study included 105 adults age 70 or older
who had major depressive disorder and had experienced inadequate responses or
early relapses after standardized treatment with the SSRI antidepressant
paroxetine and interpersonal psychotherapy.

Three drugs were used as augmenting agents: the antidepressants
sustained-release bupropion and nortriptyline, and the mood stabilizer
lithium. The choice of which agent to give to each patient was based on
each patient's medical status and history. In the absence of medical
contraindications, sustained-release bupropion was the first-line
augmenting agent, followed by nortriptyline, and then lithium. Thirty-six patients
did not receive augmentation, primarily because of unwillingness or due to
the presence of comorbid medical conditions.

The percent of patients who recovered was lower for those who received
augmentation because of inadequate response to the initial treatment
(50 percent) than for those who had early relapses (67 percent) or those
who did not require augmentation at all (87 percent). The patients with
insufficient initial responses also recovered more slowly, over a median of 28
weeks, compared to those with early relapses and those not requiring
augmentation, whose median recovery time was 24 weeks. The patients with inadequate
initial responses also had a modestly higher level of side effects.

An editorial on the study by Susan Schultz, M.D., an AJP deputy editor,
discusses the challenge of coexisting medical conditions in depressed
older adults.

AJP editor-in-chief Robert Freedman, M.D., noted, "These results
suggest that depression in the elderly is as treatable as depression in younger
people, provided that the same vigorous approaches are used. Results in
this trial, restricted to older patients, are quite similar to those we saw
in the STAR-D trials in younger patients."

The study was supported by National Institute of Mental Health grants
MH-071944, MH-43832, MH-37869, MH-65416, MH-067710, MH-069430, and
MH-072907. Other funding received by the authors is disclosed in the
article itself.

Note to Editors: Contact APA's Office of Communications and Public
Affairs at 703-907-8640 or  703-907-7862; or by email at 
<mailto:press@...>
press@... for a copy of the article and accompanying editorial.



About the American Journal of Psychiatry:

The American Journal of Psychiatry, the official journal of the
American Psychiatric Association, publishes a monthly issue with scientific
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<http://www.ajp.psychiatryonline.org/> .



About the American Psychiatric Association:

The American Psychiatric Association is a national medical specialty
society whose more than 38,000 physician members specialize in diagnosis,
treatment, prevention and research of mental illnesses including substance use
disorders.  Visit the APA at www.psych.org <http://www.psych.org/>  and
www.HealthyMinds.org <http://www.healthyminds.org/> .

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