PMID- 19539096
OWN - NLM
STAT- MEDLINE
DCOM- 20090828
LR  - 20181201
IS  - 0149-2918 (Print)
IS  - 0149-2918 (Linking)
VI  - 31
IP  - 5
DP  - 2009 May
TI  - Treatment of depression in the elderly: a review of the recent literature on the 
      efficacy of single- versus dual-action antidepressants.
PG  - 945-61
LID - 10.1016/j.clinthera.2009.05.016 [doi]
AB  - BACKGROUND: Despite the prevalence of depression in the elderly, there is a 
      shortage of randomized controlled studies comparing the efficacy of various 
      antidepressant classes in this population. OBJECTIVES: This review of recent data 
      on the treatment of depression in the elderly examined the relative efficacy of 
      the selective serotonin reuptake inhibitors (SSRIs) and 2 antidepressant classes 
      having broader neuroreceptor activity-the tricyclic antidepressants (TCAs) and 
      the serotonin-norepinephrine reuptake inhibitors (SNRIs). Tolerability was 
      examined as a secondary objective. METHODS: A systematic review of MEDLINE, 
      PsycINFO, and PubMed (January 2003-January 2009) was performed using the terms 
      antidepressant, SSRI, SNRI, TCA, depression, randomized controlled trials, human 
      trials, and individual antidepressant names. The criteria for inclusion in the 
      review were a doubleblind design, a placebo control or active comparator group, a 
      population exclusively aged > or = 59 years, and enrollment of patients with a 
      diagnosis of major depressive disorder. RESULTS: The literature search identified 
      18 trials of the treatment of depression in the elderly: 10 compared SSRIs either 
      head to head or versus placebo, 2 compared TCAs with SSRIs, and 6 examined SNRIs 
      (2 vs placebo, 1 vs a TCA, and 3 vs SSRIs). In 2 head-to-head trials, one of 
      which measured efficacy in terms of change in Hamilton Depression Rating Scale 
      (HAM-D) scores and response rates, and the other in terms of a preset 90% CI, 
      TCAs and SSRIs had comparable efficacy. The data from 5 studies using various 
      measures (including changes in Montgomery-Asberg Depression Rating Scale, HAM-D, 
      or Geriatric Depression Scale [GDS] scores; response rates; and remission rates) 
      suggested no additional efficacy benefit for the SNRI venlafaxine compared with 
      SSRIs or TCAs. In a single trial, duloxetine was significantly more effective 
      than placebo in terms of reductions in HAM-D and GDS scores (both, P < 0.001). 
      CONCLUSION: The available data, although limited, suggest that the dual-action 
      agents (TCAs and SNRIs) do not appear to confer any additional benefits in 
      efficacy over single-action agents (SSRIs) in the treatment of depression in the 
      elderly.
FAU - Mukai, Yuki
AU  - Mukai Y
AD  - Department of Psychiatry, Yale University School of Medicine, New Haven, 
      Connecticut 06519, USA.
FAU - Tampi, Rajesh R
AU  - Tampi RR
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Clin Ther
JT  - Clinical therapeutics
JID - 7706726
RN  - 0 (Antidepressive Agents)
SB  - IM
MH  - Aged
MH  - Aging/*psychology
MH  - Antidepressive Agents/adverse effects/*therapeutic use
MH  - Depressive Disorder/*drug therapy
MH  - Humans
MH  - Middle Aged
MH  - Randomized Controlled Trials as Topic
MH  - Treatment Outcome
RF  - 41
EDAT- 2009/06/23 09:00
MHDA- 2009/08/29 09:00
CRDT- 2009/06/23 09:00
PHST- 2009/03/20 00:00 [accepted]
PHST- 2009/06/23 09:00 [entrez]
PHST- 2009/06/23 09:00 [pubmed]
PHST- 2009/08/29 09:00 [medline]
AID - S0149-2918(09)00162-3 [pii]
AID - 10.1016/j.clinthera.2009.05.016 [doi]
PST - ppublish
SO  - Clin Ther. 2009 May;31(5):945-61. doi: 10.1016/j.clinthera.2009.05.016.