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Related Experiment Videos

Antidepressant versus placebo for depressed elderly.

K Wilson1, P Mottram, A Sivanranthan

  • 1Psychiatry, University of Liverpool, EMI Academic Unit, St Catherine's Hospital, Church Road, Birkenhead, Wirral, UK, CH42 OLQ. kw500505@liverpool.ac.uk

The Cochrane Database of Systematic Reviews
|June 19, 2001
PubMed
Summary

Antidepressant medications, including TCAs, SSRIs, and MAOIs, are effective for treating depression in older adults, even those with severe physical illness. A minimum of six weeks of treatment is recommended for optimal therapeutic effects.

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Area of Science:

  • Geriatric Psychiatry
  • Clinical Pharmacology
  • Evidence-Based Medicine

Background:

  • Depression affects 10% of individuals over 60, with higher mortality rates and underutilization of interventions.
  • Depression in older adults presents unique challenges due to age-related physiological and social changes, often co-occurring with physical illnesses.
  • Treatment for geriatric depression is frequently administered in institutional settings and may involve patients with multiple comorbidities.

Purpose of the Study:

  • To evaluate the effectiveness of antidepressant medications compared to placebo in older patients diagnosed with depression.
  • To synthesize evidence from randomized, placebo-controlled trials on antidepressant efficacy in the elderly population.

Main Methods:

  • A systematic literature search was conducted using databases from the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group (CCDAN).

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  • Included were randomized, placebo-controlled trials investigating antidepressants for the presenting episode of depression in elderly, geriatric, or older adult patients.
  • Data extracted included dichotomous (recovered/not recovered) and continuous (depression rating scales like HAM-D, MADRS) outcomes. Analyses employed Peto Odds ratios and weighted mean differences.

    • Main Results:

    • Seventeen trials involving 245 patients on TCAs, 365 on SSRIs, and 58 on MAOIs (compared to placebo groups) contributed to the efficacy analysis.
    • Standardized effect sizes indicated efficacy for TCAs (OR: 0.32), SSRIs (OR: 0.51), and MAOIs (OR: 0.17) in treating depression in older adults.
    • These results suggest a significant benefit of antidepressant treatment over placebo.

    Conclusions:

    • Tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs) demonstrate efficacy in older adult patients, including those with severe physical illness.
    • A treatment duration of at least six weeks is advised to achieve the maximum therapeutic benefit from antidepressant therapy.
    • Limited evidence exists for the efficacy of low-dose TCA treatment, warranting further research before routine recommendation.