Maintenance treatment with paroxetine, but not psychotherapy, prevented recurrent major depression in older people

摘要

Major depression is often chronic and associated with serious negative health outcomes.Although several maintenance trials have shown that selective serotonin-reuptake inhibitors (SSRIs) and other non-tricyclic agents are effective for prevention of recurrence of depression in adults, few randomised trials have evaluated these maintenance therapies in elderly adults.Recently, trials testing SSRIs against placebo found that citaiopram, but not sertraline, was effective for preventing depression recurrence in elderly adults.The discrepancy in the findings of these 2 studies could have been caused by various factors, including the specific medication tested, characteristics of the patient samples, medication adherence and pharmacokinetic factors, and study methods.Similar to the citaiopram trial,the study by Reynolds ef a/ supports the use of SSRI long term maintenance therapy in elderly adults with a first episode of depression. The study is important because it had a long follow up time (2 y) for monitoring for depression recurrence. As well, the authors examined whether a non-medication treatment (monthly maintenance psychotherapy) could prevent recurrence of depression; the trial had sufficient power to show, and indeed revealed, no effect.Replication of these findings will be needed to confirm the effectiveness of SSRI maintenance therapy among depressed, community dwelling, elderly adults seen in routine outpatient practice settings. Other research is needed to provide information about the care of specific subpopula-tions of elderly adults not included in previous trials.