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Titolo:
Initial recovery patterns may predict which maintenance therapies for depression will keep older adults well
Autore:
Dew, MA; Reynolds, CF; Mulsant, B; Frank, E; Houck, PR; Mazumdar, S; Begley, A; Kupfer, DJ;
Indirizzi:
Univ Pittsburgh, Sch Med, Dept Psychiat, Western Psychiat Inst & Clin, Pittsburgh, PA 15213 USA Univ Pittsburgh Pittsburgh PA USA 15213 & Clin, Pittsburgh, PA 15213 USA Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA 15213 USA Univ Pittsburgh Pittsburgh PA USA 15213 idemiol, Pittsburgh, PA 15213 USA Univ Pittsburgh, Dept Psychol, Pittsburgh, PA 15213 USA Univ Pittsburgh Pittsburgh PA USA 15213 Psychol, Pittsburgh, PA 15213 USA
Titolo Testata:
JOURNAL OF AFFECTIVE DISORDERS
fascicolo: 2, volume: 65, anno: 2001,
pagine: 155 - 166
SICI:
0165-0327(200107)65:2<155:IRPMPW>2.0.ZU;2-C
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESEARCH DIAGNOSTIC-CRITERIA; LATE-LIFE DEPRESSION; GERIATRIC DEPRESSION; MENTAL-DISORDERS; MAJOR DEPRESSION; PROGNOSIS; NORTRIPTYLINE; PSYCHOTHERAPY; RECURRENCE; PLACEBO;
Keywords:
major depression; older adults; treatment response profiles; maintenance therapies; nortriptyline; interpersonal psychotherapy;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Social & Behavioral Sciences
Life Sciences
Citazioni:
40
Recensione:
Indirizzi per estratti:
Indirizzo: Dew, MA Univ Pittsburgh, Sch Med, Dept Psychiat, Western Psychiat Inst & Clin, 3811 O Hara St, Pittsburgh, PA 15213 USA Univ Pittsburgh 3811 O Hara St Pittsburgh PA USA 15213 A 15213 USA
Citazione:
M.A. Dew et al., "Initial recovery patterns may predict which maintenance therapies for depression will keep older adults well", J AFFECT D, 65(2), 2001, pp. 155-166

Abstract

Background: Although active maintenance treatments appear superior to placebo in preventing depression recurrence in older adults, few data are available to guide maintenance modality selection to maximize the probability ofcontinued wellness for a given patient. Patients' temporal patterns of acute treatment response may predict who requires which maintenance therapy toremain well. Methods: Depression levels were observed over 16 weeks of combined nortriptyline (NT) and interpersonal psychotherapy (IPT) in 140 persons aged greater than or equal to 60 years with recurrent major depression. Subjects were empirically classified into four groups: rapid, sustained responders; delayed, sustained responders; mixed responders without sustained improvement; prolonged nonresponders. Groups were compared on subsequent recovery rates and on time to depression recurrence after randomization to 3 years of combined maintenance therapy (monthly IPT with NT), monotherapy (either IPT or NT alone), or medication clinic with placebo. Pretreatment psychosocial and clinical variables were controlled. Results: Initial responseprofile predicted ultimate recovery rates, as well as who remained well, given the maintenance treatment received. Rapid initial responders showed lower recurrence risk with either combined or monotherapy, relative to placebo. Specific types of monotherapy appeared equally effective in rapid responders. In initially mixed responders, only combined therapy was superior to placebo. It was marginally superior to monotherapy. For delayed responders,combined therapy was superior to placebo; monotherapy did not differ from the other maintenance conditions. Prolonged nonresponders did not benefit from maintenance treatment. Limitations: Subjects had only recurrent, unipolar depression. Initial response profile groups were established empiricallyand require replication. Sample sizes in initial response profile by maintenance treatment cells were small. Conclusion: The ability to match patients to maintenance treatments more likely to prevent recurrence may be enhanced by considering the temporal profile of initial response to acute treatment. (C) 2001 Elsevier Science B.V. All rights reserved.

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Documento generato il 04/04/20 alle ore 09:04:49