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

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 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 ★★★★★★☆ Psychiatry ★★★★★★☆ Geriatrics ★★★★★★☆ GP/FP/Primary care ★★★★★★☆


Embedded ImageDesign

randomised, 2 × 2 factorial design, placebo controlled trial.

Embedded ImageAllocation


Embedded ImageBlinding

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

Embedded ImageFollow up period

2 years.

Embedded ImageSetting

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

Embedded ImagePatients

116 patients ⩾70 years of age (mean age 77 y, 65% women) who had major depression according to the DSM-IV criteria, score ⩾15 on the Hamilton Rating Scale for Depression (HRSD) (range 0–52 [worst]), score ⩾17 on the Folstein Mini-Mental State Examination (range 0–30 [best]), and a sustained clinical response after several months of treatment with paroxetine, 10–40 mg/day, and …

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  • * See glossary

  • Information provided by author.

  • For correspondence: Dr C F Reynolds, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA. reynoldscf{at}

  • Sources of funding: National Institute of Mental Health and National Center for Minority Health and Health Disparities.

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