Early response as predictor of final remission in elderly depressed patients

• Published in: International journal of geriatric psychiatry Vol. 24; no. 11; pp. 1299 - 1303
• Main Authors: Kok, Rob M., van Baarsen, Carlijn, Nolen, Willem A., Heeren, Thea J.
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.11.2009; Psychology Press; Wiley Subscription Services, Inc
• Subjects: Aged; Antidepressive Agents, Second-Generation - therapeutic use; Antidepressive Agents, Tricyclic - therapeutic use; Biological and medical sciences; Comparative analysis; Cyclohexanols - therapeutic use; Depressive Disorder, Major - drug therapy; early improvement; elderly; final response; Geriatric psychiatry; Geriatric psychology; Humans; major depression; Medical sciences; Medical treatment; Mental depression; Middle Aged; Neuropharmacology; Nortriptyline - therapeutic use; Older people; Pharmacology. Drug treatments; prediction; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer; Psychoanaleptics: cns stimulant, antidepressant agent, nootropic agent, mood stabilizer..., (alzheimer disease); Psychology. Psychoanalysis. Psychiatry; Psychopharmacology; Remission Induction; ROC Curve; Treatment Outcome; Venlafaxine Hydrochloride; Psychotropic; Pharmacotherapy; Phénéthylamine derivatives; Reuptake inhibitor; Improvement; Antidepressant agent; Remission; Venlafaxine; major depression; Human; Mood disorder; Nortriptyline; Serotonin; Depression; Tricyclic compound; Recommendation; Response; final response; Treatment; early improvement; Follow up study; Geriatric depression; prediction; Early; Norepinephrine; Predictive factor; Severe; Elderly
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.2261

Background Several studies have attempted to predict the final response or remission based on improvement during the early course of treatment of major depression. There is however a great variation in cut offs used to define early response and in the optimal week to predict final results. Objective To compare different cut offs at different time points early in the treatment of elderly depressed patients. Method A 12 week randomised, controlled trial in 81 elderly inpatients with DSM–IV major depression comparing venlafaxine with nortriptyline. At least 20, 25, 30 or 50% improvement was analysed after 1, 3 and 5 weeks using the Hamilton Depression Rating Scale and the Montgomery Asberg Depression Rating Scale. We plotted sensitivity against 1—specificity and calculated areas under the curve (AUCs). Results The highest percentage of correctly classified patients is found using at least 50% decrease as cut off in week 5, with acceptable sensitivity (81.8%) and specificity (87.4%). In week 5, the AUCs were 0.891 (95% CI 0.798–0.984) and 0.866 (95% CI 0.789–0.983) for the HAM‐D and MADRS, respectively. Conclusions Combining the results from our study and the other studies addressing this issue, we suggest that the treatment should be changed in the elderly if after 3–4 weeks less than 30% improvement in depression score has been achieved. Copyright © 2009 John Wiley & Sons, Ltd.