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. 2001;2001(2):CD000561.
doi: 10.1002/14651858.CD000561.

Antidepressant versus placebo for depressed elderly

K Wilson  1 , P Mottram, A Sivanranthan, A Nightingale
Affiliations

Antidepressant versus placebo for depressed elderly

K Wilson et al. Cochrane Database Syst Rev. 2001.

Abstract

Background: Depression warranting intervention is found in ten percent of people over the age of 60. Older depressed people are more likely to die than non-depressed. Relatively few receive therapeutic interventions, and those that do, tend to receive low dose antidepressant therapy. Depression in older people is thought to differ in terms of aetiology, presentation, treatment and outcome than in younger people. Concomitant physical illness and increasing social, physical and neurophysiological diversity are associated with the ageing process. Consequently drug treatment of older patients is often carried out in institutions and on patients suffering from multiple physical problems.

Objectives: To determine the efficacy of antidepressant medication compared with placebo in the treatment of depression in older patients.

Search strategy: The search strategy incorporated: electronic literature searches of databases held by the Cochrane Collaboration Depression, Anxiety and Neurosis Review Group (CCDAN) (see Collaborative Review Group Search Strategy). Reference lists of related reviews and references of located studies. Contact was made with authors working in the field.

Selection criteria: All randomised, placebo controlled trials using antidepressants in the treatment of the presenting episode of depression in patients described as elderly, geriatric senile or older adult.

Data collection and analysis: Two types of data were extracted (if available) from each study. The first type of data was dichotomous data, this consisted of recovered/not recovered. The second, continuous data,included: Hamilton Depression Rating Scale (HAM-D), Montgomery-Asberg Rating Scale (MADRS) and other depression rating scale scores. An analysis using Peto Odds ratios for the dichotomous data and weighted mean difference for continuous data was performed using RevMan 3.1. The presence of heterogeneity of treatment effect was assessed.

Main results: Seventeen trials contributed data to the analyses comparing the efficacy of antidepressant treatment and placebo. Analyses of efficacy was based on 245 patients treated with TCAs (223 with placebo), 365 patients treated with SSRIs (372 with placebo) and 58 patients treated with MAOIs (63 with placebo). The standardised effect size for the three groups respectively were: TCAs; OR: 0.32 (0.21,0.47), SSRIs; OR; 0.51 (0.36,0.72), MAOIs: 0.17 (0.07,0.39).

Reviewer's conclusions: TCAs, SSRIs and MAOIs are effective in the treatment of older community patients and inpatients likely to have severe physical illness. At least six weeks of antidepressant treatment is recommended to achieve optimal therapeutic effect. There is little evidence concerning the efficacy of low dose TCA treatment. Further trials are required before low dose TCA treatment is routinely recommended.

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Conflict of interest statement

None

Figures

1.1
1.1. Analysis
Comparison 1 TCA and related versus Placebo, Outcome 1 Recovered.
1.2
1.2. Analysis
Comparison 1 TCA and related versus Placebo, Outcome 2 Hamilton Depression Rating Scale.
1.3
1.3. Analysis
Comparison 1 TCA and related versus Placebo, Outcome 3 Other observer rating scales.
1.4
1.4. Analysis
Comparison 1 TCA and related versus Placebo, Outcome 4 Discontinuation rates.
2.1
2.1. Analysis
Comparison 2 SSRI and related versus Placebo, Outcome 1 Recovered.
2.2
2.2. Analysis
Comparison 2 SSRI and related versus Placebo, Outcome 2 Hamilton Depression Rating Scale.
2.3
2.3. Analysis
Comparison 2 SSRI and related versus Placebo, Outcome 3 Other observer rating scales.
2.4
2.4. Analysis
Comparison 2 SSRI and related versus Placebo, Outcome 4 Discontinuation rates.
3.1
3.1. Analysis
Comparison 3 MAOI and related versus Placebo, Outcome 1 Recovered.
3.4
3.4. Analysis
Comparison 3 MAOI and related versus Placebo, Outcome 4 Discontinuation rates.
4.1
4.1. Analysis
Comparison 4 Atypical Antidepressants, Outcome 1 Recovered.
4.3
4.3. Analysis
Comparison 4 Atypical Antidepressants, Outcome 3 Other observer rating scales.
4.4
4.4. Analysis
Comparison 4 Atypical Antidepressants, Outcome 4 Discontinuation rates.
6.2
6.2. Analysis
Comparison 6 Length of Study and recovery, Outcome 2 28 days.
6.4
6.4. Analysis
Comparison 6 Length of Study and recovery, Outcome 4 42 days.
6.5
6.5. Analysis
Comparison 6 Length of Study and recovery, Outcome 5 49 days.
7.1
7.1. Analysis
Comparison 7 Recruitment source and recovery, Outcome 1 Institutionalised patients.
7.2
7.2. Analysis
Comparison 7 Recruitment source and recovery, Outcome 2 Community dwelling patients.
8.1
8.1. Analysis
Comparison 8 Types of depression and recovery, Outcome 1 Major depressive disorder.
8.2
8.2. Analysis
Comparison 8 Types of depression and recovery, Outcome 2 Other categories of depression.
9.2
9.2. Analysis
Comparison 9 Low Dose antidepressants, Outcome 2 Observer rating scales.
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