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Continuation Treatment of Delusional Depression in Older Adults

Received April 3, 2001; revised April 24, 2001; accepted June 13, 2001. From the Department of Psychiatry, Westchester Division–New York Presbyterian Hospital, Weill Medical College of Cornell University, White Plains, NY 10605. Address correspondence to Dr. Meyers, New York-Presbyterian Hospital–Westchester Division, 21 Bloomingdale Road, White Plains, NY 10605. e-mail: bmeyers{at}med.cornell.edu

Delusional depression responds poorly to acute antidepressant monotherapy but appears to respond to intensive combination pharmacotherapy, however with poor short-term outcomes after initial improvement, particularly in later life. The authors compared the efficacy and safety of continuation combination therapy to monotherapy among older patients after remission from a delusional depression. Twenty-nine older adults with SCID-diagnosed major depression with delusions received continuation treatment with nortriptyline-plus-perphenazine or nortriptyline-plus-placebo under randomized double-blind conditions after achieving remission after ECT. Of the 28 subjects included in efficacy analyses, 25% suffered relapses. The relapse frequency was nonsignificantly greater in combination therapy than in monotherapy subjects. However, combination subjects had significantly more extrapyramidal symptoms, an increased incidence of tardive dyskinesia, and a greater number of falls. Continuation treatment with a conventional antipsychotic does not decrease relapse rates but is associated with significant untoward adverse events in older persons after recovery from a delusional depression.

Key Words: Delusional Depression • Combined Antidepressants • Nortriptyline • Perphenazine

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