Open-trial maintenance pharmacotherapy in late-life depression: Survival analysis

• Published in: Psychiatry research Vol. 27; no. 3; pp. 225 - 231
• Main Authors: Reynolds, Charles F., Perel, James M., Frank, Ellen, Imber, Stanley, Thornton, Joseph, Morycz, Richard K., Cornes, Cleon, Kupter, David J.
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.03.1989; Elsevier
• Subjects: Affective disorders; Aged; Biological and medical sciences; Clinical Trials as Topic; Depressive Disorder - drug therapy; Depressive Disorder - mortality; Female; Follow-Up Studies; Humans; late-life depression; Long-Term Care; maintenance therapies; Male; Medical sciences; Neuropharmacology; nortriptyline; Nortriptyline - therapeutic use; Pharmacology. Drug treatments; Pilot Projects; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychological Tests; Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Recurrence; survival analysis; nortriptyline; aged; maintenance therapies; late-life depression; Affective disorders; survival analysis; Human; Clinical test; Evaluation; Chemotherapy; Senescence; Treatment; Psychotropic; Antidepressant agent; Depression; Psychometrics; Diagnosis; Elderly
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/0165-1781(89)90138-8

We report preliominary findings from an ongoing, open trial of maintenance nortriptyline pharmacotherapy in 27 elderly depressed patients (median trial length: 18 months). While patients were on maintenance nortriptyline (mean dose: 50 mg/day) with steady-state plasma levels in the range of 50–150 ng/ml, 58% of Q-6 monthly ratings on the Hamilton Rating Scale for Depression have been 10 or lower, Folstein Mini-Mental State ratings have remained above 27, and a minimal level of side effects with no increase over time has been observed. Four of 27 patients (14.8%) have suffered recurrences and have required rehospitalization at 6, 9, 10, and 13 months. Survival analysis showed an 85% survival rate (without recurrence) at 12 months and 81.5% at 18 months. Mean survival time without recurrence is 21.3 months to date. Although our pilot experience with maintenance nortriptyline in late-life depression appears more favorable than outcomes reported in earlier naturalistic studies (where no attempt was made to keep patients in systematic maintenance therapy), the need for controlled studies of maintenance therapies in late-life depression is nonetheless underscored by the current data and other naturalistic data from the United Kingdom.