Regular Research ArticleDynamic Prediction of Treatment Response in Late-Life Depression
Section snippets
Participants
Between July 20, 2009, and April 13, 2012, we screened 759 depressed patients aged 60 years and older, with 351 excluded because of failure to satisfy inclusion/exclusion criteria of the study. We excluded patients with a lifetime diagnosis of bipolar disorder, schizophrenia, schizoaffective, or other psychotic disorders; current psychotic symptoms; dementia; scores of 20 or less on the Folstein Mini-Mental Status Examination; a history of alcohol or substance abuse within the past 3 months;
Results
As presented in Table 1 (univariate analyses of the completer sample), 105 participants (48.0%) were classified as remitters and 114 (52.0%) as non-remitters, with no significant differences in referral sources or use of benzodiazepines between them. Non-remitters received higher end-phase doses (mg/day) of venlafaxine than did remitters (279 versus 201). Twelve variables were associated with remission at p less than 0.05 and were included in the multivariate models: age, sex, education,
Discussion
In depressed older adults, easily measured patient characteristics (sex, baseline level of depressive symptoms, and evidence of symptomatic improvement at Week 2) predicted the likelihood of remission after 12 weeks of treatment with venlafaxine XR. If a profile suggests treatment resistance, the clinician and patient can consider other treatment strategies, such as switching medication or augmentation of the initial antidepressant early in the course of treatment. Conversely, for older
References (41)
- et al.
Response speed and rate of remission in primary and specialty care of elderly patients with depression
Am J Geriatr Psychiatry
(2002) - et al.
Maintenance treatment for recurrent depression in late-life
Am J Geriatr Psychiatry
(2000) - et al.
Impact of prior inadequate treatment exposure on response to antidepressant treatment in late life
Am J Geriatr Psychiatry
(2006) - et al.
Determining the duration of antidepressant treatment: application of signal detection methodology and the need for duration adaptive designs (DAD)
Biol Psychiatry
(2006) - et al.
Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence
Am J Geriatr Psychiatry
(2008) - et al.
Development and validation of the Penn State Worry Questionnaire
Behav Res Ther
(1990) - et al.
Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale
Psychiatry Res
(1992) - et al.
The 16-Item Quick Inventory of Depressive Symptomatology (QIDS), clinician rating (QIDS-C), and self-report (QIDS-SR): a psychometric evaluation in patients with chronic major depression
Biol Psychiatry
(2003) - et al.
Epidemiology and diagnosis of depression in late-life
J Clin Psychiatry
(1999) - et al.
Epidemiology of psychiatric disorders in late life
Prim Psychiatry
(1998)