Anxious depression in elderly patients. Response to antidepressant treatment

The authors asked whether elderly patients with anxious depression were less responsive to antidepressant treatment than nonanxious depressed patients. A group of 101 depressed patients were treated with 6 weeks of nortriptyline and then, if necessary, 2 weeks of adjunctive lithium. Patients who did not respond to or were intolerant of this first line of treatment were then given 6 weeks of phenelzine (+/- lithium augmentation). Finally, patients failing this second line of treatment were given either a course of electroconvulsive therapy or 6 weeks of fluoxetine (+/- lithium augmentation). Based on their score on the Hospital Anxiety and Depression Scale at index assessment, subjects were divided into anxious and nonanxious groups. Anxious depressed patients were significantly less responsive to nortriptyline on both intent-to-treat and efficacy analyses. They were also more likely to discontinue treatment and, as a result, were significantly less responsive on the intent-to-treat analysis for overall treatment. These results suggest that concurrent symptoms of anxiety have prognostic importance in geriatric depression.