BACKGROUND: Up to a third of elderly patients with major depressive disorder are treatment resistant, yet little objective evidence is available to guide the clinician in managing these patients. We report here our experience with elderly subjects with prospectively defined treatment-resistant depression in 2 separate research studies: one entailing an augmentation strategy, the other a change to venlafaxine extended release (XR). METHOD: Fifty-three elderly subjects with major depressive disorder according to DSM-IV criteria who failed treatment with paroxetine plus interpersonal psychotherapy received 1 to 3 trials of augmentation with bupropion sustained release, nortriptyline, or lithium. Successively fewer subjects entered each sequential trial of augmentation. Twelve subjects subsequently received venlafaxine XR monotherapy. Response to treatment was defined as a 17-item Hamilton Rating Scale for Depression score of < 10 for 3 weeks. RESULTS: Sixty percent of subjects (N = 32) responded to some form of augmentation, with 45% (24/53), 31% (5/16), and 43% (3/7) responding to the first, second, and third augmentation trials, respectively. The mean time to response after starting the first augmentation trial was 6.0 (SD = 5.8) weeks. Forty-two percent (N = 5) of the venlafaxine XR-treated subjects responded with the mean time to response of 6.4 (SE = 0.9) weeks. Adverse effects leading to treatment discontinuation and falls were more common in the augmentation subjects than in the venlafaxine XR subjects. CONCLUSION: We observed similar rates and speed of response with an augmentation strategy and a strategy of switching to venlafaxine XR in elderly subjects with prospectively defined treatment-resistant major depressive disorder. Venlafaxine XR was generally better tolerated than the augmentation strategies. Further investigation of venlafaxine XR as a preferred strategy for treatment-resistant geriatric depression is warranted.
BACKGROUND: Up to a third of elderly patients with major depressive disorder are treatment resistant, yet little objective evidence is available to guide the clinician in managing these patients. We report here our experience with elderly subjects with prospectively defined treatment-resistant depression in 2 separate research studies: one entailing an augmentation strategy, the other a change to venlafaxine extended release (XR). METHOD: Fifty-three elderly subjects with major depressive disorder according to DSM-IV criteria who failed treatment with paroxetine plus interpersonal psychotherapy received 1 to 3 trials of augmentation with bupropion sustained release, nortriptyline, or lithium. Successively fewer subjects entered each sequential trial of augmentation. Twelve subjects subsequently received venlafaxine XR monotherapy. Response to treatment was defined as a 17-item Hamilton Rating Scale for Depression score of < 10 for 3 weeks. RESULTS: Sixty percent of subjects (N = 32) responded to some form of augmentation, with 45% (24/53), 31% (5/16), and 43% (3/7) responding to the first, second, and third augmentation trials, respectively. The mean time to response after starting the first augmentation trial was 6.0 (SD = 5.8) weeks. Forty-two percent (N = 5) of the venlafaxine XR-treated subjects responded with the mean time to response of 6.4 (SE = 0.9) weeks. Adverse effects leading to treatment discontinuation and falls were more common in the augmentation subjects than in the venlafaxine XR subjects. CONCLUSION: We observed similar rates and speed of response with an augmentation strategy and a strategy of switching to venlafaxine XR in elderly subjects with prospectively defined treatment-resistant major depressive disorder. Venlafaxine XR was generally better tolerated than the augmentation strategies. Further investigation of venlafaxine XR as a preferred strategy for treatment-resistant geriatric depression is warranted.
Authors: Jordan F Karp; Bruce L Rollman; Charles F Reynolds; Jennifer Q Morse; Frank Lotrich; Sati Mazumdar; Natalia Morone; Debra K Weiner Journal: Pain Med Date: 2012-02-07 Impact factor: 3.750
Authors: Sandipan Bhattacharjee; Jeannie K Lee; Asad E Patanwala; Nina Vadiei; Daniel C Malone; Shannon M Knapp; Wei-Hsuan Lo-Ciganic; William J Burke Journal: Am J Geriatr Psychiatry Date: 2019-02-07 Impact factor: 4.105
Authors: Tyler S Kaster; Zafiris J Daskalakis; Yoshihiro Noda; Yuliya Knyahnytska; Jonathan Downar; Tarek K Rajji; Yechiel Levkovitz; Abraham Zangen; Meryl A Butters; Benoit H Mulsant; Daniel M Blumberger Journal: Neuropsychopharmacology Date: 2018-06-18 Impact factor: 7.853
Authors: Carmen Andreescu; Benoit H Mulsant; Patricia R Houck; Ellen M Whyte; Sati Mazumdar; Alexandre Y Dombrovski; Bruce G Pollock; Charles F Reynolds Journal: Am J Psychiatry Date: 2008-05-01 Impact factor: 18.112
Authors: M L O Shea; L D Garfield; S Teitelbaum; R Civitelli; B H Mulsant; C F Reynolds; D Dixon; P Doré; E J Lenze Journal: Osteoporos Int Date: 2013-01-29 Impact factor: 4.507
Authors: George S Alexopoulos; Carla M Canuso; Georges M Gharabawi; Cynthia A Bossie; Andrew Greenspan; Ibrahim Turkoz; Charles Reynolds Journal: Am J Geriatr Psychiatry Date: 2007-10-10 Impact factor: 4.105
Authors: Benoit H Mulsant; Daniel M Blumberger; Zahinoor Ismail; Kiran Rabheru; Mark J Rapoport Journal: Clin Geriatr Med Date: 2014-06-14 Impact factor: 3.076