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Treatment of 70+-Year-Olds With Recurrent Major Depression

Excellent Short-Term But Brittle Long-Term Response

Received February 10, 1998; revised May 5, 1998; accepted May 18, 1998. From the Mental Health Clinical Research Centers for Late-Life and Mid-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA. Address correspondence to Dr. Reynolds, Department of Psychiatry, University of Pittsburgh Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213.

The authors compared response rates, by age (60–69 vs. 70+) , to acute, continuation, and 1-year maintenance depression treatment. Patients (N=180) received open combined treatment with nortriptyline (NT)/placebo and interpersonal psychotherapy (IPT). Patients who recovered then entered randomized, double-blind maintenance treatment with NT or placebo or received maintenance monthly IPT (combined with NT or placebo). Comparison of time-to-remission and recovery and absolute rates of remission, relapse, recovery, and recurrence yielded similar times to/rates of remission and recovery; however, older patients had far more recurrence during the first year of maintenance therapy. Although responses to acute and continuation treatment with combined NT and psychotherapy were similar, the older group had more recurrence in the first year of maintenance. Continuation of combined medication and psychotherapy may represent the best long-term treatment.

Key Words: Depression • Short-Term Therapy • Longitudinal Outcome

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