This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (266)  • Contact me when this article is cited  Related Content  • Related letter  • Related articles  • Similar articles in JAMA  Topic Collections  • Patient-Physician Relationship/ Care  • Psychiatry  • Depression  • Randomized Controlled Trial  • Alert me on articles by topic  Social Bookmarking   What's this?

A Randomized Controlled Trial in Patients Older Than 59 Years

Charles F. Reynolds III, MD; Ellen Frank, PhD; James M. Perel, PhD; Stanley D. Imber, PhD; Cleon Cornes, MD; Mark D. Miller, MD; Sati Mazumdar, PhD; Patricia R. Houck, MSH; Mary Amanda Dew, PhD; Jacqueline A. Stack, MSN; Bruce G. Pollock, MD, PhD; David J. Kupfer, MD

JAMA. 1999;281:39-45.

Context  Elderly patients with major depression are at high risk for recurrence, increased mortality, and chronic disability.

Objective  To determine the efficacy of maintenance nortriptyline hydrochloride and interpersonal psychotherapy (IPT) in preventing recurrence of major depressive episodes in patients older than 59 years.

Design  A 2x2 randomized, double-blind, placebo-controlled clinical trial, stratified by therapist.

Setting  University-based psychiatric research clinic.

Patients  Of a total of 187 patients with recurrent nonpsychotic unipolar major depression (average age, 67 years; one third aged 70 years) recruited through clinical referral and media announcements, 107 were fully recovered after open acute and treatment continuation with nortriptyline and IPT. These patients were randomly assigned to 1 of 4 maintenance therapy conditions.

Interventions  Monthly medication clinic with nortriptyline hydrochloride (80-120 ng/mL steady-state levels) (n=24); medication clinic with placebo (n=29); monthly maintenance IPT with placebo (n=21); and monthly maintenance IPT with nortriptyline (n=22).

Main Outcome Measure  Recurrence of major depressive episode.

Results  The time to recurrence of a major depressive episode for all 3 active treatments was significantly better than for placebo. Recurrence rates over 3 years were as follows: nortriptyline and IPT, 20% (95% confidence interval [CI], 4%-36%); nortriptyline and medication clinic visits, 43% (95% CI, 25%-61%); IPT and placebo, 64% (95% CI, 45%-83%); and placebo and medication clinic visits, 90% (95% CI, 79%-100%). Combined treatment with nortriptyline and IPT was superior to IPT and placebo and showed a trend to superior efficacy over nortriptyline monotherapy (Wald ²=3.56; P=.06). Subjects aged 70 years and older had a higher and more rapid rate of recurrence than those aged 60 to 69 years.

Conclusion  In geriatric patients with recurrent major depression, maintenance treatment with nortriptyline or IPT is superior to placebo in preventing or delaying recurrence. Combined treatment using both appears to be the optimal clinical strategy in preserving recovery.

Author Affiliations: The Mental Health Clinical Research Centers for Late- and Mid-Life Mood Disorders, Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pa.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED LETTER

Dose of Tricyclic Antidepressants in Elderly Patients
Robert S. Tan and Charles F. Reynolds III
JAMA. 1999;281(20):1891-1892.
EXTRACT | FULL TEXT  

RELATED ARTICLES

January 6, 1999
JAMA. 1999;281(1):101-102.
EXTRACT | FULL TEXT  

Treating Depression as a Recurrent or Chronic Disease
Richard M. Glass
JAMA. 1999;281(1):83-84.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Empirically Derived Decision Trees for the Treatment of Late-Life Depression
Andreescu et al.
Focus 2009;7:79-87.
ABSTRACT | FULL TEXT  

Depression in Late Life: Review and Commentary
Blazer
Focus 2009;7:118-136.
ABSTRACT | FULL TEXT  

Incidence and Recurrence of Late-Life Depression
Luijendijk et al.
Arch Gen Psychiatry 2008;65:1394-1401.
ABSTRACT | FULL TEXT  

Empirically Derived Decision Trees for the Treatment of Late-Life Depression
Andreescu et al.
Am. J. Psychiatry 2008;165:855-862.
ABSTRACT | FULL TEXT  

Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2000 British Association for Psychopharmacology guidelines
Anderson et al.
J Psychopharmacol 2008;22:343-396.
ABSTRACT  

Randomized Trial of Weekly, Twice-Monthly, and Monthly Interpersonal Psychotherapy as Maintenance Treatment for Women With Recurrent Depression
Frank et al.
Focus 2008;6:120-127.
ABSTRACT | FULL TEXT  

Late-Life Depression
Unutzer
NEJM 2007;357:2269-2276.
FULL TEXT  

A Pilot Study of Telephone Care Management and Structured Disease Self-Management Groups for Chronic Depression
Ludman et al.
Psychiatr. Serv. 2007;58:1065-1072.
ABSTRACT | FULL TEXT  

Treatment of Depression in Patients With Coronary Artery Disease
Ziegelstein
JAMA 2007;297:1878-1879.
FULL TEXT  

Randomized Trial of Weekly, Twice-Monthly, and Monthly Interpersonal Psychotherapy as Maintenance Treatment for Women With Recurrent Depression
Frank et al.
Am. J. Psychiatry 2007;164:761-767.
ABSTRACT | FULL TEXT  

Depression in Elderly Diabetes Patients
Trief
Diabetes Spectr. 2007;20:71-75.
FULL TEXT  

Maintenance treatment with paroxetine, but not psychotherapy, prevented recurrent major depression in older people
Williams
Evid. Based Med. 2006;11:111-111.
FULL TEXT  

Two-Year Follow-Up of Bibliotherapy and Individual Cognitive Therapy for Depressed Older Adults
Floyd et al.
Behav Modif 2006;30:281-294.
ABSTRACT  

Sertraline for Prevention of Depression Recurrence in Diabetes Mellitus: A Randomized, Double-blind, Placebo-Controlled Trial.
Lustman et al.
Arch Gen Psychiatry 2006;63:521-529.
ABSTRACT | FULL TEXT  

Enhancing the efficacy of antidepressants with psychotherapy
Petersen
J Psychopharmacol 2006;20:19-28.
ABSTRACT  

The Clinical Conduct of Interpersonal Psychotherapy
Markowitz
Focus 2006;4:179.
ABSTRACT | FULL TEXT  

Maintenance treatment of major depression in old age.
Reynolds et al.
NEJM 2006;354:1130-1138.
ABSTRACT | FULL TEXT  

Play it again, Sam--depression is recurring.
Reifler
NEJM 2006;354:1189-1190.
FULL TEXT  

Social Inequalities in Response to Antidepressant Treatment in Older Adults
Cohen et al.
Arch Gen Psychiatry 2006;63:50-56.
ABSTRACT | FULL TEXT  

Design and Rationale for a Randomized, Controlled Trial of Interpersonal Psychotherapy and Citalopram for Depression in Coronary Artery Disease (CREATE)
Frasure-Smith et al.
Psychosom. Med. 2006;68:87-93.
ABSTRACT | FULL TEXT  

The medical management of depression.
Mann
NEJM 2005;353:1819-1834.
FULL TEXT  

Prognosis of Depression in Old Age Compared to Middle Age: A Systematic Review of Comparative Studies
Mitchell and Subramaniam
Am. J. Psychiatry 2005;162:1588-1601.
ABSTRACT | FULL TEXT  

Use of Psychotherapy for Depression in Older Adults
Wei et al.
Am. J. Psychiatry 2005;162:711-717.
ABSTRACT | FULL TEXT  

Guideline Watch: Practice Guideline for the Treatment of Patients With Major Depressive Disorder, 2nd Edition
Fochtmann and Gelenberg
Focus 2005;3:34-42.
FULL TEXT  

Integrating Psychotherapy and Pharmacotherapy to Improve Outcomes Among Patients With Mood Disorders
Jindal and Thase
Focus 2005;3:114-121.
ABSTRACT | FULL TEXT  

Combined Pharmacotherapy and Psychotherapy as Maintenance Treatment for Late-Life Depression: Effects on Social Adjustment
Lenze et al.
Focus 2005;3:136-139.
ABSTRACT | FULL TEXT  

Antidepressant Pharmacotherapy in the Treatment of Depression in the Very Old: A Randomized, Placebo-Controlled Trial
Roose et al.
Am. J. Psychiatry 2004;161:2050-2059.
ABSTRACT | FULL TEXT  

Psychotherapies with older people: an overview
Hepple
Adv. Psychiatr. Treat. 2004;10:371-377.
ABSTRACT | FULL TEXT  

An Open-Label Trial of Interpersonal Psychotherapy in Depressed Patients With Coronary Disease
Koszycki et al.
Psychosomatics 2004;45:319-324.
ABSTRACT | FULL TEXT  

Combined Pharmacotherapy and Psychological Treatment for Depression: A Systematic Review
Pampallona et al.
Arch Gen Psychiatry 2004;61:714-719.
ABSTRACT | FULL TEXT  

Maintenance Treatment of Insomnia: What Can We Learn From the Depression Literature?
Jindal et al.
Am. J. Psychiatry 2004;161:19-24.
ABSTRACT | FULL TEXT  

Integration of Care: Integrating Psychotherapy and Pharmacotherapy to Improve Outcomes Among Patients With Mood Disorders
Jindal and Thase
Psychiatr. Serv. 2003;54:1484-1490.
ABSTRACT | FULL TEXT  

Evaluation and Management of Geriatric Depression in Primary Care
Lapid and Rummans
Mayo Clin Proc. 2003;78:1423-1429.
ABSTRACT  

Prophylaxis of depression in older people * Author's reply
Kumar and Wilson
Br. J. Psychiatry 2003;183:365-365.
FULL TEXT  

Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Late Life
Charney et al.
Arch Gen Psychiatry 2003;60:664-672.
ABSTRACT | FULL TEXT  

Older community residents with depression: long-term treatment with sertraline: Randomised, double-blind, placebo-controlled study
WILSON et al.
Br. J. Psychiatry 2003;182:492-497.
ABSTRACT | FULL TEXT  

Depression in Late Life: Review and Commentary
Blazer
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2003;58:M249-265.
ABSTRACT | FULL TEXT  

What Drove Private Health Insurance Spending On Mental Health And Substance Abuse Care, 1992-1999?
Mark and Coffey
Health Aff (Millwood) 2003;22:165-172.
ABSTRACT | FULL TEXT  

Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial
Unutzer et al.
JAMA 2002;288:2836-2845.
ABSTRACT | FULL TEXT  

Efficacy of citalopram in the prevention of recurrent depression in elderly patients: placebo-controlled study of maintenance therapy
KLYSNER et al.
Br. J. Psychiatry 2002;181:29-35.
ABSTRACT | FULL TEXT  

A 75-Year-Old Man With Depression
Kroenke
JAMA 2002;287:1568-1576.
FULL TEXT  

Combined Pharmacotherapy and Psychotherapy as Maintenance Treatment for Late-Life Depression: Effects on Social Adjustment
Lenze et al.
Am. J. Psychiatry 2002;159:466-468.
ABSTRACT | FULL TEXT  

Depression associated with Parkinson's disease: Clinical features and treatment
Okun and Watts
Neurology 2002;58:S63-70.
ABSTRACT | FULL TEXT  

Integrative Medicine and Systemic Outcomes Research: Issues in the Emergence of a New Model for Primary Health Care
Bell et al.
Arch Intern Med 2002;162:133-140.
ABSTRACT | FULL TEXT  

The Fate of Integrated Treatment: Whatever Happened to the Biopsychosocial Psychiatrist?
Gabbard and Kay
Am. J. Psychiatry 2001;158:1956-1963.
ABSTRACT | FULL TEXT  

Interpersonal Psychotherapy for Late-Life Depression: Past, Present, and Future
Miller et al.
J. Psychother. Pract. Res. 2001;10:231-238.
ABSTRACT | FULL TEXT  

How well is the clinical importance of study results reported? An assessment of randomized controlled trials
Chan et al.
CMAJ 2001;165:1197-1202.
ABSTRACT | FULL TEXT  

The Efficacy of Exercise as a Long-term Antidepressant in Elderly Subjects: A Randomized, Controlled Trial
Singh et al.
Journals of Gerontology Series A: Biological Sciences and Medical Sciences 2001;56:M497-504.
ABSTRACT | FULL TEXT  

Treatments for late life depression in primary care--a systematic review
Freudenstein et al.
Fam Pract 2001;18:321-327.
ABSTRACT | FULL TEXT  

Prophylactic effect of citalopram in unipolar, recurrent depression: Placebo-controlled study of maintenance therapy
HOCHSTRASSER et al.
Br. J. Psychiatry 2001;178:304-310.
ABSTRACT | FULL TEXT  

Treatment of Chronic Depression With a 12-Week Program of Interpersonal Psychotherapy
Blanco et al.
Am. J. Psychiatry 2001;158:371-375.
FULL TEXT  

Continuation and maintenance therapy in depression
Paykel
Br Med Bull 2001;57:145-159.
ABSTRACT | FULL TEXT  

A Randomized Trial of Relapse Prevention of Depression in Primary Care
Katon et al.
Arch Gen Psychiatry 2001;58:241-247.
ABSTRACT | FULL TEXT  

Psychiatry and the Oldest Old
Blazer
Am. J. Psychiatry 2000;157:1915-1924.
ABSTRACT | FULL TEXT  

The Challenge of Depression in Late Life: Bridging Science and Service in Primary Care
Gallo and Coyne
JAMA 2000;284:1570-1572.
FULL TEXT  

Medicare's Mental Health Coverage
Mickus et al.
Psychiatr. Serv. 2000;51:1050-1051.
FULL TEXT  

Pharmacologic Treatment of Acute Major Depression and Dysthymia: Clinical Guideline, Part 1
Snow et al.
ANN INTERN MED 2000;132:738-742.
FULL TEXT  

Executive Dysfunction and Long-term Outcomes of Geriatric Depression
Alexopoulos et al.
Arch Gen Psychiatry 2000;57:285-290.
ABSTRACT | FULL TEXT  

Peeking Through the Door to the 21st Century
Frank and Kupfer
Arch Gen Psychiatry 2000;57:83-85.
FULL TEXT  

Depression and Aging: A Look to the Future
Reynolds and Kupfer
Psychiatr. Serv. 1999;50:1167-1172.
ABSTRACT | FULL TEXT  

Three-Year Outcomes of Maintenance Nortriptyline Treatment in Late-Life Depression: A Study of Two Fixed Plasma Levels
Reynolds et al.
Am. J. Psychiatry 1999;156:1177-1181.
ABSTRACT | FULL TEXT  

Nortriptyline plus interpersonal psychotherapy was effective in major depression in older adults
Almeida
Evid. Based Ment. Health 1999;2:85-85.
FULL TEXT  

Withdrawing patients from antidepressants
DTB 1999;37:49-52.
ABSTRACT | FULL TEXT  

Dose of Tricyclic Antidepressants in Elderly Patients
Tan and Reynolds III
JAMA 1999;281:1891-1892.
FULL TEXT  

Treating Insomnia in Older Adults: Taking a Long-term View
Reynolds III et al.
JAMA 1999;281:1034-1035.
FULL TEXT  

Maintenance Therapy for Recurrent Depression in Older Patients
JWatch Psychiatry 1999;1999:16-16.
FULL TEXT  

Maintenance Therapy for Recurrent Depression in Older Patients
JWatch General 1999;1999:7-7.
FULL TEXT  

Treating Depression as a Recurrent or Chronic Disease
Glass
JAMA 1999;281:83-84.
FULL TEXT