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Use of SSRIs in "Very Old" Depressed Nursing Home Residents

Received December 26, 1996; revised May 26, 1997; accepted June 26, 1997. From the SUNY Health Science Center at Brooklyn. Address correspondence to Dr. Trappler, SUNY Health Science Center at Brooklyn, Box 1203, 450 Clarkson Avenue, Brooklyn, NY 11203.

The authors examined 50 patients, with a mean age of 89 years (range: 80–98), placed in a prospective, open-label trial of either fluoxetine, sertraline, or paroxetine. At 12-week follow-up, there was a significant overall decline (36%) in Ham-D scores; 42% had at least a 50% decline in their scores. There were no significant differences in responses to the three antidepressants, and all drugs were well tolerated. However, there were significant differences between diagnostic subgroups in the percentage of persons showing at least a 50% decrease in their Ham-D scores: major depressive disorder (MDD; 93%), Alzheimer's disease with MDD (8%), vascular dementia with MDD (6%), and other CNS-related disorders with MDD (83%). The findings confirm earlier accounts that antidepressants may be substantially less effective with MDD secondary to dementia in very old patients.

Key Words: SSRIs • Inpatients • Geriatric Depression

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