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

doi:10.1136/ebm.11.4.111

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Evidence-Based Medicine 2006;11:111; doi:10.1136/ebm.11.4.111
Copyright © 2006 by the BMJ Publishing Group Ltd.

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Therapeutics

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

Reynolds CF 3rd, Dew MA, Pollock BG, et al. Maintenance treatment of major depression in old age. N Engl J Med 2006;354:1130–8.[Abstract/Free Full Text]

Q In older patients with major depression who respond to treatment, does maintenance therapy with paroxetine, psychotherapy, or a combination prevent recurrence of depression?

Clinical impact ratings IM/Ambulatory care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Psychiatry $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ Geriatrics $*$ $*$ $*$ $*$ $*$ $*$ ${star}$ GP/FP/Primary care $*$ $*$ $*$ $*$ $*$ $*$ ${star}$

Key Words: depressive disorder (major) • paroxetine • psychotherapy • serotonin uptake inhibitors

The first 150 words of the full text of this article appear below.

METHODS
Design randomised, 2 x 2 factorial design, placebo controlled trial.

Allocation {concealed^*}^.

Blinding blinded (clinicians, patients, and outcome assessors).^* Cliniciansand patients were not blinded to the psychotherapy intervention.

Follow up period 2 years.

Setting specialised university-based clinic in Pittsburgh, Pennsylvania,USA.

Patients 116 patients $>=$ 70 years of age (mean age 77 y, 65% women) whohad major depression according to the DSM-IV criteria, score $>=$ 15 on the Hamilton Rating Scale for Depression (HRSD) (range0–52 [worst]), score $>=$ 17 on the Folstein Mini-Mental StateExamination (range 0–30 [best]), and a sustained clinicalresponse after several months of treatment with paroxetine,10–40 mg/day, and psychotherapy (weekly, then biweekly).

Intervention paroxetine plus psychotherapy (n = 28), paroxetine plus clinicalcare (n = 35), placebo plus psychotherapy (n = 35), or placeboplus clinical care (n = 18) for 2 years. Paroxetine was continuedat the individually titrated dose. Psychotherapy or clinical. . . [Full text of this article]

John W Williams, Jr, MD, MHS

Duke University Medical Center, Durham, North Carolina, USA

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Evid. Based Med. 2006 11: 127. (in Glossary) [Extract] [Full Text] [PDF]