Depressed elderly react best to a mix of drugs and psychotherapy

A combination of medication and psychotherapy is significantly more effective in alleviating and preventing major depression in the elderly than either treatment alone, researchers at the University of Pittsburgh Medical Center conclude.

The interdisciplinary research team, which includes three psychologists and was led by a psychiatrist, examined the rate of recurrent depression over three years in a group of 107 participants, age 60 and older, who had recovered from a bout with the disorder after treatment. The patients were split into four groups to receive maintenance treatment: One received nortriptyline, a tricyclic anti-depressant, and monthly interpersonal therapy. A second group received only the medication, while the third group received the psychotherapy and a pla-cebo pill. The fourth group received the placebo medication only.

The team found that the combination of medication and therapy prevented depression from reoccurring in 17, or about 80 percent, of 22 patients. Only slightly more than half (57 percent) of the 24 patients in the medication-only treatment, and about a third (36 percent) of the 21 people who received therapy alone, avoided a recurrence of depression. And only 10 percent of the 29 patients in the placebo group remained well. (Eleven participants dropped out of the study.)

Depression among the elderly is usually treated in six months to a year, but the chance of recurrence during the two to three years after initial treatment is as much as 80 percent, the researchers say.

Psychiatrist Charles Reynolds, MD, led the research. Psychologists on the research team were Ellen Frank, PhD, Mary Amanda Dew, PhD, and Stanley Imber, PhD. The study was published in the Journal of the American Medical Association (Vol. 281, No. 1, p. 39­45).

--S. Sleek

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