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Partial Response as a Predictor of Outcome in Geriatric Depression

Received May 24, 2002; revised August 26, September 30, 2002; accepted November 22, 2002. From the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC. Address correspondence to Dr. Steffens, Duke University Medical Center, Box 3903, Duke University Medical Center, Durham, NC 27710. e-mail: steff001{at}mc.duke.edu

Objective: Although geriatric depression generally responds to treatment, patients are often left with residual symptoms after acute treatment. Data are lacking on the eventual outcomes of individuals who are partial responders or poor responders to initial treatment. Methods: The authors examined 200 patients initially treated with a treatment-based guideline approach that allowed for physician choice. Results: After 3 months, 34.0% of patients were remitted, 37.5% had achieved a partial response, and 28.5% were still highly symptomatic. After 6 months of treatment, 51.1% of patients were remitted, 36.5% were partial responders, and 12.5% were still experiencing significant depressive symptoms. Cumulative remission rates over 18 months of treatment were significantly higher among partial responders than among highly symptomatic patients at 6 months, but not at 3 months. In terms of relapse, defined as a Montgomery-Asberg Depression Rating Scale score greater than 15, 42.0% of the remitted and partial-responder groups had relapsed by 18 months. When compared with remitted patients, partial responders at 6 months were more likely to experience a relapse. There were no differences in relapse rate between the two groups at 3 months. Conclusion: These results suggest that during ongoing active treatment of geriatric depression, the level of improvement at 6 months, but not 3 months, is predictive of subsequent course.

Key Words: Depression • Outcome Studies • Antidepressants

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