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Published Online: 1 July 2011

A Systematic Review of Treatments for Refractory Depression in Older People

Claudia Cooper, Ph.D., M.R.C.Psych., Cornelius Katona, M.D., F.R.C.Psych., Kostas Lyketsos, M.D., M.H.S., Dan Blazer, M.D., Ph.D., Henry Brodaty, M.D., F.R.A.N.Z.C.P., Peter Rabins, M.D., M.P.H., Carlos Augusto de Mendonça Lima, M.D., D.Sci., and Gill Livingston, M.D., F.R.C.Psych.Authors Info & Affiliations

Publication: American Journal of Psychiatry

Volume 168, Number 7

https://doi.org/10.1176/appi.ajp.2011.10081165

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Abstract

Objective:

The authors systematically reviewed the management of treatment-refractory depression in older people (defined as age 55 or older).

Method:

The authors conducted an electronic database search and reviewed the 14 articles that fit predetermined criteria. Refractory depression was defined as failure to respond to at least one course of treatment for depression during the current illness episode. The authors rated the validity of studies using a standard checklist and calculated the pooled proportion of response to any treatment reported by at least three studies.

Results:

All the studies that met inclusion criteria investigated pharmacological treatment. Most were open-label studies, and the authors found no double-blind randomized placebo-controlled trials. The overall response rate for all active treatments investigated was 52% (95% CI=42–62; N=381). Only lithium augmentation was assessed in more than two trials, and the response rate was 42% (95% CI=21–65; N=57). Only two studies included comparison groups receiving no additional treatment, and none of the participants in these groups responded. In single randomized studies, extended-release venlafaxine was more efficacious than paroxetine, lithium augmentation more than phenelzine, and selegiline more than placebo.

Conclusions:

Half of the participants responded to pharmacological treatments, indicating the importance of managing treatment-refractory depression actively in older people. The only treatment for which there was replicated evidence was lithium augmentation. Double-blind randomized controlled trials for management of treatment-refractory depression in older people, encompassing pharmacological and nonpharmacological therapies and populations that reflect the levels of physical and cognitive impairment present in the general older population with depression, are needed.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry

Go to American Journal of Psychiatry

American Journal of Psychiatry

Volume 168 • Number 7 • July 2011

Pages: 681 - 688

PubMed: 21454919

History

Received: 17 August 2010

Revision received: 21 November 2010

Accepted: 7 January 2011

Published online: 1 July 2011

Published in print: July 2011

Authors

Affiliations

Claudia Cooper, Ph.D., M.R.C.Psych.

From the Department of Mental Health Sciences, University College London.

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Cornelius Katona, M.D., F.R.C.Psych.

From the Department of Mental Health Sciences, University College London.

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Kostas Lyketsos, M.D., M.H.S.

From the Department of Mental Health Sciences, University College London.

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Dan Blazer, M.D., Ph.D.

From the Department of Mental Health Sciences, University College London.

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Henry Brodaty, M.D., F.R.A.N.Z.C.P.

From the Department of Mental Health Sciences, University College London.

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Peter Rabins, M.D., M.P.H.

From the Department of Mental Health Sciences, University College London.

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Carlos Augusto de Mendonça Lima, M.D., D.Sci.

From the Department of Mental Health Sciences, University College London.

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Gill Livingston, M.D., F.R.C.Psych.

From the Department of Mental Health Sciences, University College London.

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Notes

Address correspondence to Dr. Cooper, Department of Mental Health Sciences, University College London, Holborn Union Building, Archway Campus, Highgate Hill, London, N19 5LW; [email protected] (e-mail).

Funding Information

Dr. Katona has provided consultancy advice and given talks for Eli Lilly, Lundbeck, and Pfizer. Dr. Lyketsos has received grant support (research or CME) from the Associated Jewish Federation of Baltimore, AstraZeneca, Bristol-Myers Squibb, Eisai, Elan, Eli Lilly, Forest, GlaxoSmithKline, the National Football League, National Institute on Aging, NIMH, Novartis, Ortho-McNeil, Pfizer, and the Weinberg Foundation; has acted as consultant or adviser to Adlyfe, AstraZeneca, Eisai, Eli Lilly, Forest, Genentech, GlaxoSmithKline, Lundbeck, Merz, NFL Benefits Office, NFL Players Association, Novartis, Supernus, Takeda, and Wyeth; and has received honoraria or travel support from Forest, GlaxoSmithKline, Health Monitor, and Pfizer. Dr. Rabins has provided legal testimony for Janssen Pharmaceuticals. Dr. Livingston has received grant support from GlaxoSmithKline, Lundbeck, and Novartis. All other authors report no financial relationships with commercial interests.

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