PITTSBURGH, Jan. 6, 1999 -- In the first-ever study to compare different therapies for the treatment and prevention of recurrent major depression in the elderly, researchers at the University of Pittsburgh Medical Center (UPMC) have found that a combination of medication and psychotherapy is significantly more effective than medication or psychotherapy alone and that continued treatment can significantly reduce the risk of recurrence.
The study, in today’s Journal of the American Medical Association, examined the rate of recurrence in a group of 124 depressed elderly participants aged 60 and older who had been split into four groups to compare the effectiveness of different treatments. One group received both the antidepressant drug nortriptyline, a tricyclic antidepressant, and monthly interpersonal therapy (IPT). A second group received only the medication, while a third group received only IPT. The fourth group received a placebo. They all were followed for three years.
The results showed that the combination of nortriptyline and IPT prevented recurrence of depression in 80 percent of the patients, while medication alone prevented recurrence in 57 percent of the patients and IPT in 36 percent. Only 10 percent of patients in the placebo group remained well.
"These results clearly show that a combination of medication and interpersonal therapy is the best treatment for preventing recurrence of depression in the elderly," commented principal investigator Charles F. Reynolds III, M.D., professor of psychiatry and neuroscience at UPMC’s Western Psychiatric Institute and Clinic (WPIC). "These results are at odds with the way treatment standards are moving under managed care. Most plans allow only medication or medication with limited therapy. If our results hold true, combination therapy would not only be better for the patients, but save health care dollars in the long run."
Depression in old age affects at least one in six people and an even higher percentage among those in hospitals and nursing homes. It has serious health consequences, including suicide, illness and increased health care costs to society. Depression in the elderly is usually treated over a six-to-twelve-month period, but the chance of a recurrence during the two to three years after initial treatment is approximately 60 to 80 percent.
"Because of the devastating effects this disorder has on the elderly, we have made it a priority to find effective maintenance treatments to prevent recurrences," said Dr. Reynolds. "It was important for us to assess the major treatment strategies because some elderly patients may refuse to take medication and some have added stresses such as bereavement and role transitions to cope with."
"Dr. Reynolds and his team of researchers should be commended for their contribution to the field. To conduct a study of this magnitude requires a cohesive team of investigators committed to their community," commented Arthur S. Levine, M.D., senior vice chancellor for the Health Sciences and dean of the School of Medicine at the University of Pittsburgh. "A long-term commitment by patients and their families is essential, and the unique bond Dr. Reynolds’ researchers have formed with their patients encourages them to see the study through."
The study is a continuation of research centered at WPIC. In 1990, Ellen Frank, Ph.D., professor of psychiatry and psychology, and David J. Kupfer, M.D., Thomas Detre Professor and Chair, department of psychiatry and professor of neuroscience, published a landmark paper regarding the treatment of recurrent depression among adults. That study found that medication alone worked as well as a combination of medication and psychotherapy in preventing the recurrence of depression in middle-aged adults.
Other authors include: Ellen Frank, Ph.D.; James M. Perel, Ph.D.; Stanley D. Imber, Ph.D.; Cleon Cornes, M.D.; Mark D. Miller, M.D.; Sati Mazumdar, Ph.D.; Patricia R. Houck, M.S.H.; Mary Amanda Dew, Ph.D.; Jacqueline A. Stack, M.S.N.; Bruce G. Pollock, Ph.D.; and David J. Kupfer, M.D., all of the University of Pittsburgh School of Medicine.
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