Study: Drugs better for elderly depression
BOSTON (AP) — For elderly people who suffer bouts of depression, drugs work surprisingly better than psychotherapy at keeping these black spells from returning, suggests the longest study ever in patients so old.
The findings from the two-year study may encourage some doctors to prescribe antidepressants for longer periods, perhaps even for life, in patients who have been depressed.
"It's a good idea for you to continue to take the medication indefinitely, just as you take your blood pressure medication or diabetes medication," said psychiatrist Dr. Charles Reynolds at the University of Pittsburgh, who led the study. "It's a very new approach."
Backed by the National Institutes of Health, the study responds to a rising trend to prescribe medicine not just to treat depression, but to keep it from coming back. Results were published Thursday in the New England Journal of Medicine.
Depression is estimated to occur in 3% to 5% of elderly people and it returns more than half the time within three years. Psychotherapy — as well as exercise and socializing — are viewed as effective long-term shields, since they change behavior. Yet psychotherapy did little in this study.
Many psychiatrists continue to believe in psychotherapy, even in some very old patients. Psychiatrists suggest that some patients in this study had undergone biological changes in their brains with aging and lost some mental capabilities, making them benefit more from drugs and less from talking therapy. Also, the psychotherapy in this study was given only once a month for 45 minutes.
The two-year study monitored 116 people ages 70 and above after they recovered from an episode of depression. They were then randomly assigned to take an anti-depression drug, the drug plus psychotherapy, psychotherapy with dummy pills, or dummy pills alone.
Just over a third relapsed into depression with drugs, whether they got psychotherapy or not. More than two-thirds did with psychotherapy and dummy pills, and slightly less with dummy pills alone.
Though the numbers are small, experts view them as significant because it is difficult to recruit elderly volunteers for such research.
Several psychiatrists said the findings probably apply to a range of depression drugs, not just the paroxetine used in this study. They said it's unclear just how long depressed patients may need drugs, but they should be monitored and get some form of therapy for years afterward.
Dr. Burton Reifler, a psychiatrist at Wake Forest University who wrote an accompanying editorial, warned against the tendency to write off the serious illness of depression in the elderly by thinking "if my wife had passed away and I had arthritis and I was 80, I'd be depressed too."
Many other obstacles impede extended treatment, psychiatrists cautioned. The commonly prescribed class of depression drugs, known as SSRIs, can sedate and cause weight gain or sexual problems. Some research links them to an aggravated tendency toward suicide. They may cost as little as $20 a month in generic form, but brand names can cost well over $100.
Also, most old people with depression go to family doctors, who usually lack time and skill to fully monitor and treat the disorder over a long time. "They just don't have the resources to do it, and they don't do it," said psychiatrist Dan Blazer at Duke University.
He said this study should change practice — but may not.
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