View Full Version : NYTs: Antidepressants and the Elderly

03-16-06, 01:45 AM
March 16, 2006
For Elderly, Antidepressants May Trump Psychotherapy (

Antidepressants work better than psychotherapy in preventing relapses in elderly men and women who have recovered from depression (, a new study suggests.

The government-financed study, published today in The New England Journal of Medicine, found that a combination of drugs and therapy was the best way to restore well-being in seriously depressed patients 70 and older. Once the patients had recovered, however, drug treatment was more effective over the next two years than once-a-month psychotherapy.

Experts said the results underscored the challenges of treating depression in people past retirement age who are buffeted by anxieties about dying, losing friends, declining physical health that are different from those of younger adult patients.

The report also suggests that an orchestrated combination of psychotherapy, medication and careful case management followed by continued drug treatment can keep more than 40 percent of elderly people well for at least two years.

Past studies have found that antidepressants alone are no better than placebos in relieving depression in people over 70, who tend to be more vulnerable to the drugs' side effects, including dizziness. But most of the estimated six million elderly Americans who suffer from depression receive little more than a prescription for an antidepressant if they receive treatment at all, psychiatrists say.

"What this study shows is how well we can do when people get the state-of-the-art treatment, from some of the best people in the field, but it's very rarely done this way," said Dr. Gary Kennedy, chief of geriatric psychiatry at the Montefiore Medical Center in the Bronx.

Dr. Charles Reynolds, a psychiatry professor at the University of Pittsburgh, led the study of 195 people 70 and older in a program that included daily doses of the antidepressant Paxil and 12 to 15 weekly, hourlong therapy sessions. The therapy taught people how to manage relations with family members and friends, a common source of distress. The patients continued to see a nurse, social worker or psychologist at least once a month during the study.

After 16 weeks, 116 of the participants had improved significantly. The researchers continued to treat about half of them with medication and case management, and the other half with a placebo. Two years later, 37 percent of those who had continued on medication but did not receive psychotherapy had a recurrence, while 68 percent of those who had only psychotherapy relapsed. When drugs were combined with therapy, 35 percent had a recurrence a result not significantly different from that achieved by medication alone.

Dr. Reynolds and members of his team have received research support from GlaxoSmithKline, the maker of Paxil.

"This is an illness that keeps coming back again and again, and with each succeeding episode it gets tougher to treat," said Dr. Reynolds. "What this study shows, and what I tell patients, is we have a good insurance policy.

"You may make a good recovery and want to stop medication and hope the depression doesn't come back, and that's fine. But you have another option."