Antidepressant wards off blues in elderly

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NEW YORK Mar 17 (Reuters) Maintenance treatment with paroxetine -- known by the brand names Paxil or Seroxat -- helps prevent major depression from recurring in older adults, new research shows. On the other hand, monthly psychotherapy sessions seem not to have the same benefit.

Recurrent depression is a common problem among the elderly, with rates as high as 90 per cent over a period of 2 to 3 years being reported.

Effective treatments for this age group are aimed at not only remedying the initial depressive episode, but also at preventing recurrences. Antidepressants classified as ''selective serotonin-reuptake inhibitors'' or SSRIs, which include paroxetine, have become first-line agents for late-life depression, but their ability to stave off recurrences is unclear.

Dr Charles F Reynolds, III, from the University of Pittsburgh School of Medicine, and colleagues conducted a study with 116 patients (all at least 70 years of age) who had previously responded to treatment with paroxetine plus psychotherapy.

In the new study, the participants were randomly assigned to one of four maintenance programs for dealing with their depression: daily paroxetine or an inactive ''placebo'' pill, alone or combined with either monthly psychotherapy sessions or review visits during which no specific psychotherapy was applied, but the subjects were asked about depressive symptoms.

As reported in this week's New England Journal of Medicine, the groups that received placebo plus either psychotherapy or review sessions had recurrence rates of 68 per cent and 58 percent, respectively.

By contrast, the recurrence rates in the groups given paroxetine were roughly 36 per cent.

''Our data provide support for the use of maintenance SSRI pharmacotherapy, but not interpersonal psychotherapy, to prevent recurrent depression in people 70 years of age or older, including those with a first episode of depression,'' the investigators concludes.

''Time has taught us to have a healthy respect for the damage that depression causes and for the potential of depression to recur,'' Dr. Burton V. Reifler, from Wake Forest University School of Medicine in Winston-Salem, North Carolina, comments in a related editorial. ''Over time, too, comes the knowledge of how to prevent such recurrence.''