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Increasing the Efficacy of the Psychopharmacotherapy of Late Depression: Optimization of Treatment Duration

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Objective. This study was performed to analyze the potential for using different methods to increase the efficacy of the psychopharmacotherapy of late depression, particularly by increasing the duration of treatment. Materials and methods. The study included 378 patients aged 50–82 (mean 60.6 ± 8.4) years. Treatment duration effects were studied by dividing patients into groups with short (4–8 weeks), intermediate (12 weeks), and long (20–24 weeks) durations of psychopharmacotherapy. Results and conclusions. Treatment results for durations of less than 8 weeks were significantly worse than those obtained with treatment duration greater than 12 weeks (these groups were not comparable because the initial cohorts were not comparable). By week 24, treatment responses were obtained in 63.9% of patients who had not responded to treatment by week 12, and 43.4% achieved remission. Partial responses and stable positive improvements by 12 weeks (about half the patients achieved remission) were predictors of responses with treatment durations of up to 24 weeks. These data were used to develop algorithms for selection of therapeutic tactics in patients with late depression depending on the results obtained at the first 12 weeks of psychopharmacotherapy.

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References

  1. G. Ya. Avrutskii and A. A. Neduva, Treatment of Mental Diseases, Meditsina, Moscow (1988), 2nd ed.

    Google Scholar 

  2. P. Gareri, U. Falconi, P. De Fazio, and G. De Sarro, “Conventional and new antidepressant drugs in the elderly,” Prog. Neurobiol., 61, No. 4, 353–396 (2000).

    Article  CAS  PubMed  Google Scholar 

  3. M. P. Andrusenko, Developmental Aspects of the Treatment of Late Depression: Auth. Abstr. Doct. Thesis in Med. Sci., Moscow (2004), http://psychiatry.ru/cond/0/diss/2004/24, acc. Aug. 30, 2015.

  4. M. A. Dew, E. M. Whyte, E. J. Lenze, et al., “Recovery from major depression in older adults receiving augmentation of antidepressant pharmacotherapy,” Am. J. Psychiatry, 164, 892–899 (2007), doi: https://doi.org/10.1176/ajp.2007.164.6.892.

    Article  PubMed  Google Scholar 

  5. S. N. Mosolov, Clinical Use of Contemporary Antidepressants, MIA, St. Petersburg (1995).

    Google Scholar 

  6. M. A. Siranchiev, Mild Protracted Depression in the Elderly (late dysthymias): Auth. Abstr. Master’s Thesis in Med. Sci., Moscow (2003), http://psychiatry.ru/cond/0/diss/2003/32/, acc. Aug. 30, 2015.

  7. P. Mottram, K. Wilson, and J. Strobl, “Antidepressants for depressed elderly,” Cochrane Database Syst. Rev., 1:CD003491 (2006), doi: https://doi.org/10.1002/14651858.

    Google Scholar 

  8. Y. Mukai and R. R. Tampi, “Treatment of depression in the elderly: a review of the recent literature on the efficacy of single- versus dual-action antidepressants,” Clin. Ther., 31, No. 5, 945–961 (2009), doi: https://doi.org/10.1016/j.clinthera.2009.05.016.

    Article  CAS  PubMed  Google Scholar 

  9. J. C. Nelson, K. Delucchi, and L. S. Schneider, “Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence,” Am. .J Geriatr. Psychiatry, 16, 558–567 (2008), doi: https://doi.org/10.1097/01.jgp.0000308883.64832.ed.

    Article  PubMed  Google Scholar 

  10. A. A. Nierenberg, “Lessons from STEP-BD for the treatment of bipolar depression,” Depress. Anxiety, 26, No. 2, 106–109 (2009), doi: https://doi.org/10.1002/da.20547.

    Article  PubMed  Google Scholar 

  11. A. S. Avedisova, “A new strategy for increasing treatment efficacy in depressive disorders determined in terms of the primary response,” Psikhiat. Psikhofarmakoter., 13, No. 1, 12–17 (2011).

    Google Scholar 

  12. M. V. Ivanov and N. G. Neznanov, “Psychopharmacological Therapy,” in Psychiatry: National Guidelines, T. B. Dmitrieva et al. (eds.), GEOTAR-Media, Moscow (2009).

    Google Scholar 

  13. V. N. Krasnov, Affective Spectrum Disorders, Practical Medicine, Moscow (2011).

    Google Scholar 

  14. A. B. Smulevich, Depression in General Medicine, MIA, Moscow (2007).

    Google Scholar 

  15. G. W. Arana and J. F. Rosenbaum, Handbook of Psychiatric Drug Therapy, LWW, Philadelphia (2009), 6th ed.

    Google Scholar 

  16. D, Blazer, “Depression in late life: review and commentary,” J. Gerontol. A. Biol. Sci. Med. Sci., 58, No. 3, 249–265 (2003), doi: https://doi.org/10.1093/gerona/58.3.m249.

  17. J. R. Copeland, M. Abou-Saleh, and D. Blazer, Principles and Practice of Geriatric Psychiatry, John Wiley & Sons, Ltd., Chichester (2002), 2nd ed.

    Book  Google Scholar 

  18. S. A. Jacobson, R. W. Pies, and I. R. Katz, Clinical Manual of Geriatric Psychopharmacology, Am. Psychiatr. Publ., Arlington (2007).

    Google Scholar 

  19. C. Tsopelas, R. Stewart, G. M. Savva, et al., “Neuropathological correlates of late-life depression in older people,” Br. J. Psychiatry, 198, 109–114 (2011), doi: https://doi.org/10.1192/bjp.bp.110.078816.

    Article  PubMed  Google Scholar 

  20. G. S. Alexopoulos, “Pharmacotherapy for late-life depression,” J. Clin. Psychiatry, 72, No. 1, e04 (2011), doi: https://doi.org/10.4088/jcp.7085tx2cj.

    Article  PubMed  PubMed Central  Google Scholar 

  21. F. E. Lotrich and B. G. Pollock, “Aging and clinical pharmacology: implications for antidepressants,” J. Clin. Pharmacol., 45, 1106–1122 (2005), doi: https://doi.org/10.1177/0091270005280297.

    Article  CAS  PubMed  Google Scholar 

  22. B. Pollock, C. Forsyth, and R. Bies, “The critical role of clinical pharmacology in geriatric psychopharmacology,” Clin. Pharmacol. Ther., 85, 89–93 (2009), doi: https://doi.org/10.1038/clpt.2008.229.

    Article  PubMed  Google Scholar 

  23. J. Unutzer, “Late-life depression,” N. Engl. J. Med., 22, No. 357, 2269–2276 (2007), doi: https://doi.org/10.1056/nejmcp073754.

    Article  Google Scholar 

  24. V. S. Sheshenin, Clinical-Psychopathological Signs of Late Depression and the Efficacy of Antidepressant Therapy: Auth. Abstr. Master’s Thesis in Med. Sci., Moscow (2000), http://psychiatry.ru/cond/0/diss/2000/53, acc. Aug. 30, 15.

  25. P. Allard, L. Gram, K. Timdahl, et al., “Efficacy and tolerability of venlafaxine in geriatric outpatients with major depression: a double-blind, randomised 6-month comparative trial with citalopram,” Int. J. Geriatr. Psychiatry, 19, No. 12, 1123–1130 (2004), doi: https://doi.org/10.1002/gps.1190.

    Article  PubMed  Google Scholar 

  26. C. Andreescu, B. H. Mulsant, P. R. Houck, et al., “Empirically derived decision trees for the treatment of late-life depression,” Am. J. Psychiatry, 165, 855–862 (2008), doi: https://doi.org/10.1176/appi.ajp.2008.07081340.

    Article  PubMed  PubMed Central  Google Scholar 

  27. C. Dolder, M. Nelson, and A. Stump, “Pharmacological and clinical profile of newer antidepressants: implications for the treatment of elderly patients,” Drugs Aging, 27, No. 8, 625–640 (2010), doi: https://doi.org/10.2165/11537140-000000000-00000.

    Article  CAS  PubMed  Google Scholar 

  28. S. I. Finkel, E. M. Richter, and C. M. Clary, “Comparative efficacy and safety of sertraline versus nortriptyline in major depression in patients 70 and older,” Int. Psychogeriatr., 11, 85–99 (1999), doi: https://doi.org/10.1017/s104161029900561x.

    Article  CAS  PubMed  Google Scholar 

  29. A. G. Gildengers, P. R. Houck, B. H. Mulsant, et al., “Course and rate of antidepressant response in the very old,” J. Affect. Disord., 69, No. 1–3, 177–184 (2002), doi: https://doi.org/10.1016/s0165-0327(01)00334-2.

    Article  PubMed  Google Scholar 

  30. S. Kasper, H. de Swart, and H. Friis Andersen, “Escitalopram in the treatment of depressed elderly patients,” Am. J. Geriatr. Psychiatry, 13, No. 10, 884–891 (2005), doi: https://doi.org/10.1176/appi.ajgp.13.10.884.

    Article  PubMed  Google Scholar 

  31. B. H. Mulsant, R. A. Sweet, J. Rosen, et al., “A double-blind randomized comparison of nortriptyline plus perphenazine versus nortriptyline plus placebo in the treatment of psychotic depression in late life,” J. Clin. Psychiatry, 62, No. 8, 597–604 (2001), doi: https://doi.org/10.4088/jcp.v62n0804.

    Article  CAS  PubMed  Google Scholar 

  32. M. A. Posternak and M. Zimmerman, “Is there a delay in the antidepressant effect? A meta-analysis,” J. Clin. Psychiatry, 66, No. 2, 148–158 (2005), doi: https://doi.org/10.4088/jcp.v66n0201.

    Article  CAS  PubMed  Google Scholar 

  33. C. F. Reynolds, III, M. A. Dew, B. G. Pollock, et al., “Maintenance treatment of major depression in old age,” N. Engl. J. Med., 354, 1130–1138 (2006), doi: https://doi.org/10.1056/nejmoa052619.

    Article  CAS  PubMed  Google Scholar 

  34. P. Rocca, P. Calvarese, F. Faggiano, et al., “Citalopram versus sertraline in latelife nonmajor clinically significant depression: a 1-year follow-up clinical trial,” J. Clin. Psychiatry, 66, 360–369 (2005), doi: https://doi.org/10.4088/jcp.v66n0313.

    Article  CAS  PubMed  Google Scholar 

  35. S. P. Roose, H. A. Sackeim, R. R. Krishnan, et al., “Antidepressant pharmacotherapy in the treatment of depression in the very old: a randomized, placebo-controlled trial,” Am. J. Psychiatry, 161, 2050–2059 (2004), doi: https://doi.org/10.1176/appi.ajp.161.11.2050.

    Article  PubMed  Google Scholar 

  36. A. Schatzberg and S. Roose, “A double-blind, placebo-controlled study of venlafaxine and fluoxetine in geriatric outpatients with major depression,” Am. J. Geriatr. Psychiatry, 14, No. 4, 361–370 (2006), doi: https://doi.org/10.1097/01.jgp.0000194645.70869.3b.

    Article  PubMed  Google Scholar 

  37. M. E. Thase, R. Entsuah, M. Cantillon, and S. G. Kornstein, “Relative antidepressant efficacy of venlafaxine and SSRIs: sex-age interactions,” J. Womens Health (Larchmt.), 14, 609–616 (2005), doi: https://doi.org/10.1089/jwh.2005.14.609.

    Article  Google Scholar 

  38. A. Burns, B. Lawlor, and S. Craig, “Rating scales in old age psychiatry,” Br. J. Psychiatry, 180, 161–167 (2002), doi: https://doi.org/10.1192/bjp.180.2.161.

    Article  PubMed  Google Scholar 

  39. S. A. Montgomery and M. Asberg, “A new depression scale designed to be sensitive to change,” Br. J. Psychiatry, 134, 382–389 (1979), doi: https://doi.org/10.1192/bjp.134.4.382.

    Article  CAS  PubMed  Google Scholar 

  40. K. R. Connolly and M. E. Thase, “If at first you don’t succeed: a review of the evidence for antidepressant augmentation, combination and switching strategies,” Drugs, 71, No. 1, 43–64 (2011), doi: https://doi.org/10.2165/11587620-000000000-00000.

    Article  CAS  PubMed  Google Scholar 

  41. M. Fava, “Diagnosis and definition of treatment-resistant depression,” Biol. Psychiatry, 53, 649–659 (2003), doi: https://doi.org/10.1016/s0006-3223(03)00231-2.

    Article  PubMed  Google Scholar 

  42. E. J. Lenze, M. Sheffrin, H. C. Driscoll, et al., “Incomplete response in late-life depression: getting to remission,” Dialog. Clin. Neurosci., 10, No. 4, 419–430 (2008).

    Google Scholar 

  43. G. S. Malhi, G. B. Parker, J. Crawford, et al., “Treatment-resistant depression: resistant to definition?” Acta Psychiatr. Scand., 112, 302–309 (2005), doi: https://doi.org/10.1111/j.1600-0447.2005.00602.x.

    Article  CAS  PubMed  Google Scholar 

  44. B. Rutherford, J. Sneed, M. Miyazaki, et al., “An open trial of aripiprazole augmentation for SSRI non-remitters with late-life depression,” Int. J. Geriatr. Psychiatry, 22, No. 10, 986–991 (2007), doi: https://doi.org/10.1002/gps.1775.

    Article  PubMed  Google Scholar 

  45. R. C. Shelton, O. Osuntokun, A. N. Heinloth, and S. A. Corya, “Therapeutic options for treatment-resistant depression,” CNS Drugs, 24, No. 2, 131–161 (2010), doi: https://doi.org/10.2165/11530280-000000000-00000.

    Article  CAS  PubMed  Google Scholar 

  46. O. Yu. Rebrova, Statistical Analysis of Medical Data. Use of STATISTICA, Mediasfera, Moscow (2002).

    Google Scholar 

  47. V. V. Ryakhovskii, Early Outcomes of Depression in People at Involutional and Old Age: Auth. Abstr. Master’s Thesis in Med. Sci., http://psychiatry.ru/cond/0/diss/2011/189, acc. Aug. 30, 2015.

  48. C. Gasto, V. Navarro, T. Marcos, et al., “Single-blind comparison of venlafaxine and nortriptyline in elderly major depression,” J. Clin. Psychopharmacol., 23, No. 1, 21–26 (2003), doi: https://doi.org/10.1097/00004714-200302000-00004.

    Article  CAS  PubMed  Google Scholar 

  49. R. M. Kok, W. A. Nolen, and T. J. Heeren, “Venlafaxine versus nortriptyline in the treatment of elderly depressed inpatients: a randomised, double-blind, controlled trial,” Int. J. Geriatr. Psychiatry, 22, No. 12, 1247–1254 (2007), doi: https://doi.org/10.1002/gps.1823.

    Article  PubMed  Google Scholar 

  50. D. Mazeh, B. Shahal, A. Aviv, et al., “A randomized, single-blind comparison of venlafaxine with paroxetine in elderly patients suffering from resistant depression,” Int. Clin. Psychopharmacol., 22, No. 6, 371–375 (2007), doi: https://doi.org/10.1097/yic.0b013e32817396ae.

    Article  PubMed  Google Scholar 

  51. M. Petrovic, P. De Paepe, and L. Van Bortel, “Pharmacotherapy of depression in old age,” Acta Clin. Belg., 60, No. 3, 150–156 (2005), doi: https://doi.org/10.1179/acb.2005.028.

    Article  CAS  PubMed  Google Scholar 

  52. I. A. Meshandin, Dynamics of the Clinical Features and Social Functioning during the Treatment of Elderly Patients with Combined Depressive Disorders and Psychoorganic Lesions of Vascular Origin: Auth. Abstr. Master’s Thesis in Med. Sci., http://bekhterev.ru/upload/documents/arf_meshan.pdf, acc. Aug. 30, 2015.

  53. R. M. Berman, M. Fava, M. E. Thase, et al., “Aripiprazole augmentation in major depressive disorder: a double-blind, placebo-controlled study in patients with inadequate response to antidepressants,” CNS Spectr., 14, No. 4, 197–206 (2009);

    Article  PubMed  Google Scholar 

  54. P. Blier, H. E. Ward, P. Tremblay, et al., “Combination of antidepressant medications from treatment initiation for major depressive disorder: a double-blind randomized study,” Am. J. Psychiatry, 167, No. 3, 281–288 (2010), doi: https://doi.org/10.1176/appi.ajp.2009.09020186.

    Article  PubMed  Google Scholar 

  55. C. Cooper, C. Katona, K. Lyketsos, et al., “A systematic review of treatments for refractory depression in older people,” Am. J. Psychiatry, 168, No. 7, 681–688 (2011), doi: https://doi.org/10.1176/appi.ajp.2011.10081165.

    Article  PubMed  Google Scholar 

  56. E. Tedeschini, Y. Levkovitz, N. Iovieno, et al., “Efficacy of antidepressants for late-life depression: a meta-analysis and meta-regression of placebo-controlled randomized trials,” J. Clin. Psychiatry, 72, No. 12, 1660–1668 (2011), doi: https://doi.org/10.4088/jcp.10r06531.

    Article  CAS  PubMed  Google Scholar 

  57. M. J. Rapoport, “Translating geriatric psychiatry research into practice: coping with uncertainty,” Can. Geriatr. J., 15, No. 2, 28–30 (2012), doi: https://doi.org/10.5770/cgj.15.43.

    Article  PubMed  PubMed Central  Google Scholar 

  58. M. Altieri, I. Maestrini, A. Mercurio, et al., “Depression after minor stroke: prevalence and predictors,” Eur. J. Neurol., 19, No. 3, 517–521 (2012), doi: https://doi.org/10.1111/j.1468-1331.2011.03583.x.

    Article  CAS  PubMed  Google Scholar 

  59. J. E. Rojo, K. Gibert, J. Cobo, et al., “Onset of antidepressant action: a pharmacological question?” Hum. Psychopharmacol., 20, No. 6, 425–433 (2005), doi: https://doi.org/10.1002/hup.708.

    Article  CAS  PubMed  Google Scholar 

  60. V. Henkel, F. Seemuller, M. Obermeier, M. Adli, et al., “Does early improvement triggered by antidepressants predict response/remission? Analysis of data from a naturalistic study on a large sample of inpatients with major depression,” J. Affect. Disord., 115, No. 3, 439–449 (2009), doi: https://doi.org/10.1016/j.jad.2008.10.011.

    Article  CAS  PubMed  Google Scholar 

  61. H. A. Sackeim, S. P. Roose, and P. W. Lavori, “Determining the duration of antidepressant treatment: application of signal detection methodology and the need for duration adaptive designs (DAD),” Biol. Psychiatry, 59, No. 6, 483–492 (2006), doi: https://doi.org/10.1016/j.biopsych.2005.08.033.

    Article  PubMed  Google Scholar 

  62. J. D. Tew, B. H. Mulsant, P. R. Houck, et al., “Impact of prior treatment exposure on response to antidepressant treatment in late life,” Am. J. Geriatr. Psychiatry, 14, No. 11, 957–965 (2006), doi: https://doi.org/10.1097/01.jgp.0000222311.70424.85.

    Article  PubMed  Google Scholar 

  63. L. C. Barry, J. J. Abou, A. A. Simen, and T. M. Gill, “Under-treatment of depression in older persons,” J. Affect. Disord., 136, No. 3, 789–796 (2012), doi: https://doi.org/10.1016/j.jad.2011.09.038.

    Article  PubMed  Google Scholar 

  64. C. Coupland, P. Dhiman, R. Morriss, et al., “Antidepressant use and risk of adverse outcomes in older people: population based cohort study,” BMJ, 343, 4551 (2011), doi: https://doi.org/10.1136/bmj.d4551.

    Article  Google Scholar 

  65. H. M. Kim, K. Zivin, D. Ganoczy, et al., “Predictors of alternative antidepressant agent initiation among, veterans diagnosed with depression,” Pharmacoepidemiol. Drug Saf., 19, No. 10, 1049–1056 (2010), doi: https://doi.org/10.1002/pds.1985.

    Article  PubMed  PubMed Central  Google Scholar 

  66. R. T. Mulder, W. G. Watkins, P. R. Joyce, and S. E. Luty S, “Age may affect response to antidepressants with serotonergic and noradrenergic actions,” J. Affect. Disord., 76, No. 1–3, 143–149 (2003), doi: https://doi.org/10.1016/s0165-0327(02)00083-6.

  67. T. K. Rajji, B. H. Mulsant, F. E. Lotrich, et al., “Use of antidepressants in late-life depression,” Drugs Aging, 25, No. 10, 841–853 (2008), doi: https://doi.org/10.2165/00002512-200825100-00003.

    Article  CAS  PubMed  Google Scholar 

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  1. Sechenov First Moscow State Medical University, Russian Ministry of Health, Moscow, Russia

    N. N. Ivanets, M. A. Kinkul’kina, T. I. Avdeeva, Yu. G. Tikhonova & A. V. Luk’yanova

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  1. N. N. Ivanets
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  2. M. A. Kinkul’kina
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  3. T. I. Avdeeva
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Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 116, No. 4, pp. 16–27, April, 2016.

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Ivanets, N.N., Kinkul’kina, M.A., Avdeeva, T.I. et al. Increasing the Efficacy of the Psychopharmacotherapy of Late Depression: Optimization of Treatment Duration. Neurosci Behav Physi 47, 877–889 (2017). https://doi.org/10.1007/s11055-017-0485-0

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