Are there predictors of outcome in depressed elderly nursing home residents during treatment with mirtazapine orally disintegrating tablets?

Abstract

In this sample of depressed nursing home residents treated with mirtazapine orally disintegrating tablets, advanced age, medical illness, and cognitive impairment did not predict response. The findings suggest that these variables need not be viewed as obstacles to treatment.

Predictors of Response and Remission to Antidepressants in Geriatric Depression: A Systematic Review

“…Three double-blind RCTs and 1 open study assessed several demographic and clinical variables as predictors of response but failed to reach a level of significance. 30 –33 Georgotas et al 30 tested 21 variables as potential predictors of remission to antidepressants: 12 clinical variables (anhedonia, mood autonomy, anxiety, agitation, retardation, low energy, hypochondriasis, diurnal variation in the morning and in the afternoon, initial, middle and late insomnia, weight gain during episode), 4 demographic variables (age, sex, mental status, family history of depression), and 4 variables characterizing the depressive illness (presence of a precipitant, number of prior episodes of depression, duration of current episode, age of onset of first episode). In all, 25 older adult patients with MDD were taking nortriptyline, 22 patients were taking phenelzine (monoamine oxidase inhibitor), and 28 patients were taking a placebo.…”

“…In a 12-week, open-label study, 124 nursing home residents with MDD were taking mirtazapine. 33 The association of response with different predictors (age, medical burden, cognitive impairment, sex, history of prior depression, and depression severity) was examined. These hypothesized predictors were not associated with response or with discontinuation of antidepressant treatment.…”

“…Three double-blind RCTs and 1 open study assessed several demographic and clinical variables as predictors of response but failed to reach a level of significance. [30][31][32][33] Georgotas et al 30 tested 21 variables as potential predictors of remission to antidepressants: 12 clinical variables (anhedonia, mood autonomy, anxiety, agitation, retardation, low energy, hypochondriasis, diurnal variation in the morning and in the afternoon, initial, weeks with olanzapine plus sertraline or olanzapine plus placebo). 32 They included 142 patients with MDD aged 60 to 83 years.…”

Moderators of Outcome in Late-Life Depression: A Patient-Level Meta-Analysis

“…Some studies found no predictors (11)(12)(13). A few predictors have been suggested in individual studies.…”

Depression in nursing homes

“…Trappler and Cohen (1998) reported a good response to selective serotonin response inhibitors (SSRIs) in two out of 29 cases of dementia with depression, 15 out of 16 cases of major depression with no dementia, and five of six cases of depression due to a medical condition. Nelson et al (2007), in an open label study of mirtazapine given to 119 residents, none with severe dementia, reported that after 12 weeks there had been more than a 50% reduction in scores on a depression rating scale in 47% of the residents. Evidence from random controlled trials of antidepressants given to elderly people, most being physically well and living independently, suggests efficacy in 50-60%, with about 30% response to placebo.…”