RESEARCH - Effectiveness of antidepressant unclear in elderly

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Effectiveness of antidepressant unclear in elderly

Last Updated: 2004-11-25 7:30:22 -0400 (Reuters Health)

By Alison McCook

NEW YORK (Reuters Health) - Depressed people 75 or older are just as

likely to improve after an 8-week course with an inactive, placebo drug

as with an antidepressant, new research indicates.

The study shows that after a short course of the antidepressant

medication citalopram (Celexa), around one-third of elderly people with

depression went into remission -- the same improvement rate seen in

people taking a placebo drug.

However, study author Dr. P. Roose of the New York State

Psychiatric Institute in New York City cautioned that these findings do

not suggest that the antidepressant is no better than doing nothing at

all.

All of the participants in the study were treated to some kind of

" active intervention, " he said. For instance, even placebo-takers

received a free medical workup, an MRI, weekly visits with health

professionals, and free rides to and from their appointments, among

other amenities.

Moreover, seeing a marked improvement in one-third of the people taking

the drug shows that something was likely helping them, Roose noted --

but whether it was the drug or the supportive environment is not clear,

he said.

" The response rate that you're going to get from medicine is going to

depend on the circumstances in which you give it, " Roose said in an

interview. " Giving a placebo is not doing nothing. "

Roose added that Forest Laboratories, which sells Celexa, funded the

study. However, he and his colleagues designed the research, and

gathered and analyzed the results, he noted.

Celexa is a member of a family of antidepressants known as selective

serotonin reuptake inhibitors (SSRIs). Although SSRIs appear to help

many people, they do not seem to have the same " robust effectiveness " in

older adults, Roose explained.

In contrast, another type of antidepressants known as tricyclics appear

to help the elderly with depression, but carry a significant risk of

side effects such as cardiovascular problems, the New York researcher

said.

To investigate how Celexa measures up to a placebo drug under optimal

conditions, Roose and his colleagues asked 174 people at least 75 years

of age with depression to take either Celexa or a placebo for 8 weeks,

and noted how they improved.

As Roose and his team report the results in the American Journal of

Psychiatry. " The active intervention and drugs was no different from the

active intervention plus placebo, " Roose told Reuters Health.

He added that among people with severe depression, Celexa-takers showed

much bigger improvements than people on placebo. However, a close look

at the data showed that the difference likely stems from the fact that

people with severe depression responded less well to the placebo

condition.

The difference is " not because the drug worked so much better, but

because the placebo worked so much worse, " Roose noted.

Clearly, more research is needed to understand how best to treat older

adults with depression, the researcher said.

SOURCE: American Journal of Psychiatry, November 2004

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org