Objective: To study the outcome of a sequential treatment protocol in elderly, severely depressed in-patients.
Method: All 81 patients from a 12-week double-blind randomized controlled trial (RCT) comparing venlafaxine with nortriptyline were asked to participate in a 3 year follow-up study. Thirty-two patients who did not achieve remission during the RCT, entered an open sequential treatment protocol and were treated with augmentation with lithium, switch to a monoamine oxidase inhibitor or ECT.
Results: Seventy-eight of the 81 patients (96.3%) achieved a response [> or = 50% reduction in Montgomery Asberg Depression Rating Scale score) and 68 patients (84%) a complete remission (final MADRS score < or = 10) within 3 years of treatment. Greater severity and longer duration of the depressive episode at baseline predicted poor recovery. Augmentation with lithium may be the best treatment option in treatment resistant depressed elderly. Only few patients dropped-out due to side-effects.
Conclusion: Our study demonstrates the importance of persisting with antidepressant treatment in elderly patients who do not respond to the first or second treatment.