Continuation Treatment of Delusional Depression in Older Adults

Meyers, Barnett S.; Klimstra, Sibel; Gabriele, Michelle; Hamilton, Mimi; Kakuma, Tatsu; Tirumalasetti, Fughik; Alexopoulos, George S.

doi:10.1097/00019442-200111000-00010

Cited by 58 publications

(7 citation statements)

References 36 publications

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“…Twenty-one RCTs were excluded because they did not use antidepressants but acetyl-L-carnitine (Bella et al, 1990;Gecele et al, 1991), ACTH 4-9 analog (Frederiksen et al, 1985), adinazolam (Feighner et al, 1990), brofaromine (Moller and Volz, 1993), diclofensine (Gentili et al, 1984;Jansen et al, 1982), flupenthixol (Hostmaelingen et al, 1989), lithium (Wilkinson et al, 2002), methylphenidate (Wallace et al, 1995), nimodipine (Taragano et al, 2001(Taragano et al, , 2005, perphenazine (Meyers et al, 2001), procaine (Aslan et al, 1986;Bălăceanu-Stolnici et al, 1996), rolipram (Behnke et al, 1992), St. John's Wort (Harrer et al, 1999), sulpiride (Kivelä and Lehtomäki, 1987), tryptophan (Cooper and Datta, 1980;Rousseau, 1987), or combined fluphenazine/nortriptyline (Brodie et al, 1975).…”

Section: Resultsmentioning

confidence: 99%

“…RCTs aimed at specific subgroups were not included to produce more homogeneous results: 7 studies including a majority of patients with dementia (Cunha et al, 2007;Lyketsos et al, 2003;Magai et al, 2000;Passeri et al, 1993;Petracca et al, 1996Petracca et al, , 2001Rosenberg et al, 2010), two in patients with dysthymia or minor depression (Devanand et al, 2005;Williams et al, 2000b) and one in patients with treatment-resistant depression (Sunderland et al, 1994). The only RCT in patients with a psychotic depression was a continuation trial already excluded because patients using nortriptyline were randomized to perphenazine or placebo (Meyers et al, 2001).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy of treatment in older depressed patients: A systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants

Kok

Nolen

Heeren³

2012

Journal of Affective Disorders

150

123

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Efficacy of treatment in older depressed patients: A systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants

Kok

Nolen

Heeren³

2012

Journal of Affective Disorders

150

123

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“…Meyers et al [76], under randomized double-blind conditions, compared the efficacy and safety of continuation combination therapy to monotherapy. Fifteen PDs received nortriptyline (plasma level 50-150 ng/ml) or sertraline (50-100mg) plus perphenazine (12-16mg) and 13 PDs received nortriptyline (plasma level 50-150 ng/ml) or sertraline (50-100mg) alone.…”

Section: Treatmentmentioning

confidence: 99%

Psychotic (Delusional) Major Depression in the Elderly: A Review

Gournellis¹,

Lykouras

2006

CPSR

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The prevalence in the community of psychotic (delusional) major depression (PMD) in the elderly was found to be 1%. In inpatient settings the frequency of the disorder varies between 24% and 53%. There is also evidence that its frequency increases in old age. In the elderly, PMD compared to non-PMD was found to be a more severe and melancholic form of depression with more psychomotor disturbances (agitation or retardation) and feelings of guilt, more anxiety and hypochondriacal complains and less insight. Delusional beliefs of paranoid and hypochondriacal content have been found to be prominent. Additionally, elderly psychotic depressives (PDs) are possibly at greater risk of suicide attempt. Also, elderly PDs have been observed to have more cognitive processing difficulties. As regards neurobiological findings, they have been found to have lower dopamine-beta-hydroxylase activity, smaller volume of prefrontal cortex, more brain stem and left-side frontotemporal atrophy, enlargement of the third ventricle and pontine reticular formation hypertensities. The prognosis for the disorder seems worse, with higher relapse rates and mortality although not all studies are in agreement. In the acute phase, the response to ECT is favourable (88%), however the response rates to combination of an antipsychotic and an antidepressant (25-50%) seem to be inferior to those observed in younger adults (70-80%). Close follow-up and continuation therapy with an antidepressant is needed to avoid relapses.

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“…A 20% difference would mean that 5 patients would need to be treated with olanzapine to prevent 1 case of relapse. Based on the review of literature [14-16,65] and STOP-PD stabilization data, we estimate that 15% of participants who are maintained on sertraline plus olanzapine will have a relapse in the RCT. A relapse rate of 35% in the sertraline plus placebo group would therefore be consistent with the hypothesized 20% difference between treatment groups.…”

Section: Methodsmentioning

confidence: 99%

“…A relapse rate of 35% in the sertraline plus placebo group would therefore be consistent with the hypothesized 20% difference between treatment groups. Based on our previous experience of conducting studies of the continuation and maintenance treatment of PD [12,65,66], we predict that attrition during the RCT will not exceed 10%. This attrition rate might appear to be low, but this is because those subjects most vulnerable to attrition will likely drop out in the phases prior to randomization.…”

Section: Methodsmentioning

confidence: 99%

Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD ΙΙ

et al. 2013

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BackgroundPsychotic depression (PD) is a severe disabling disorder with considerable morbidity and mortality. Electroconvulsive therapy and pharmacotherapy are each efficacious in the treatment of PD. Expert guidelines recommend the combination of antidepressant and antipsychotic medications in the acute pharmacologic treatment of PD. However, little is known about the continuation treatment of PD. Of particular concern, it is not known whether antipsychotic medication needs to be continued once an episode of PD responds to pharmacotherapy. This issue has profound clinical importance. On the one hand, the unnecessary continuation of antipsychotic medication exposes a patient to adverse effects, such as weight gain and metabolic disturbance. On the other hand, premature discontinuation of antipsychotic medication has the potential risk of early relapse of a severe disorder.Methods/designThe primary goal of this multicenter randomized placebo-controlled trial is to assess the risks and benefits of continuing antipsychotic medication in persons with PD once the episode of depression has responded to treatment with an antidepressant and an antipsychotic. Secondary goals are to examine age and genetic polymorphisms as predictors or moderators of treatment variability, potentially leading to more personalized treatment of PD. Individuals aged 18-85 years with unipolar psychotic depression receive up to 12 weeks of open-label treatment with sertraline and olanzapine. Participants who achieve remission of psychosis and remission/near-remission of depressive symptoms continue with 8 weeks of open-label treatment to ensure stability of remission. Participants with stability of remission are then randomized to 36 weeks of double-blind treatment with either sertraline and olanzapine or sertraline and placebo. Relapse is the primary outcome. Metabolic changes are a secondary outcome.DiscussionThis trial will provide clinicians with much-needed evidence to guide the continuation and maintenance treatment of one of the most disabling and lethal of psychiatric disorders.Trial registration and URLNCT: NCT01427608

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Continuation Treatment of Delusional Depression in Older Adults

Cited by 58 publications

References 36 publications

Efficacy of treatment in older depressed patients: A systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants

Efficacy of treatment in older depressed patients: A systematic review and meta-analysis of double-blind randomized controlled trials with antidepressants

Psychotic (Delusional) Major Depression in the Elderly: A Review

Sustaining remission of psychotic depression: rationale, design and methodology of STOP-PD ΙΙ

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