Drug treatment of older people with affective disorders in the community: lessons from an attempted clinical trial.

BACKGROUND: Depression and phobic anxiety disorders are the most common psychiatric disorders in people aged 65 and over. SSRI antidepressants are effective in treating both conditions in younger people, and in treating depression in hospital samples of older subjects. No studies have investigated the efficacy of SSRIs in older people with these conditions living in the community.
OBJECTIVES: To evaluate the efficacy and feasibility of treating older people suffering from depression and/or phobic anxiety in the community with fluoxetine alone.
DESIGN: Subjects identified as depressed and/or anxious at screening were offered open-label fluoxetine and were reassessed for affective illness at 3 and 6 months. MEASURES: Outcome was assessed using the depression subscale of the Short Comprehensive Assessment and Referral Evaluation (Short-CARE) Scale and the Anxiety Disorder Scale.
RESULTS: Of 67 subjects with depression and/or phobic anxiety, 55 (81%) were eligible to take fluoxetine. Fifty-four (98%) of these agreed to follow-up but only six (11%) agreed to take medication. No subject was still taking medication by the end of the study. Among those subjects on whom follow-up data were available, 70% of subjects depressed at screening and 97% of those with phobic anxiety retained their diagnoses at 3 months; at 6 months, the figures were 65% and 92% respectively.
CONCLUSIONS: Drug treatment alone is not acceptable to older patients in the community with depression and phobic anxiety disorders. Discussion of symptoms with an appropriate professional is insufficient therapy on its own. Further work is needed to evaluate the effectiveness of a key worker such as a mental health nurse in coordinating treatment of patients with these disorders. Copyright 1999 John Wiley & Sons, Ltd.