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People age 70 and older who continued taking the anti depression medicate that helped them to initially recover from their first episode of depression were 60 percent less likely to experience a new episode of depression over a two-year meditate period than those who stopped taking the medication, according to a meditate funded by the National Institute of Mental Health (NIMH), part of the National Institutes of Health. The meditate addresses a major question in the medical care of depression — when to discontinue medication.

Published in the March, generic viagra store New England Journal of Medicine, the meditate showed that long-term medical care (for at least 2 years) after a patient is symptom-free is effective in preventing future depressive episodes.

“This meditate demonstrates the benefits of keeping older patients on an anti depression medicate long after they become symptom-free,” said NIMH’s director Thomas R. Insel, M.D.

The clinical trial agsdhfgdfed whether maintenance medical care — long-term medical care given to patients to enable them to maintain a symptom-free or sickness-free state — is effective in preventing future episodes of depression in patients 70 years and older. It also agsdhfgdfed whether anti depression medicate medication and psychomedical care were effective, and whether the extent of patients’ medical burden had an impact on rates of recurrence.

According to Charles F. Reynolds III, M.D., and colleagues at the University of Pittsburgh, the meditate speaks directly to the controversy over the benefits and risks of administering long-term anti depression medicate medical care to elderly patients who have only one lifetime occurrence of major depression. To date, the consensus has been that older patients experiencing their first episode of depression should be treated to full remission and then have a limited period of continuation medical care for 6 to 12 months to ensure the stability of the remission and further improve recovery.

“Most geriatric psychiatrists would not have thought that elderly 70 and older who experienced one episode of depression were candidates for longer term maintenance medical care of up to two years,” said Reynolds. “They would agree that elderly with two or more episodes are appropriately prescribed maintenance medical care, but these data allow us to go one step further and suggest that, in fact, even those with single episodes fare considerably better out to two years if they continue use of the medication that got them well.”

Patients ages 70 and older with depression who achieved full remission of symptoms after medical care using a combination of Paxil(Paroxetine) (a selective serotonin reuptake inhibitor) and interpersonal psychomedical care (IPT) (psychomedical care that focuses on interpersonal relationships) were administered maintenance medical care where researchers agsdhfgdfed the effectiveness of difference medical care regimens in keeping patients symptom-free for up to 2 years. These patients were randomly assigned to one of four maintenance medical care groups: (1) Paxil(Paroxetine); (2) placebo; (3) Paxil(Paroxetine) and monthly interpersonal psychomedical care (IPT); and (4) placebo and IPT.

The meditate found maintenance medical care was effective in older group with depression. Across all four medical care groups, rates of remission significantly differed. Among patients who received Paxil(Paroxetine) in the maintenance phase, 63 percent remained in remission; 42 percent of those who received placebo remained in remission; 65 percent of patients who received Paxil(Paroxetine) and IPT remained in remission; and 32 percent of patients who received placebo and IPT remained in remission.

Contrary to the researchers’ hypothesis, which predicted that IPT would significantly reduce rates of recurrence, according to the meditate , IPT did not show preventive efficacy in group 70 years and older.

“But that does not mean that otherness types of psychomedical care are not effective,” said Reynolds. “It could be that this population needs a more structured and focused type of psychomedical care — one that works better with cognitive impairment and greater disability than does IPT — such as problem-solving psychomedical care. Involving caregivers to a greater extent may also help.”

The meditate also showed that older group with multiple chronic physical disorders did not do as well on Paxil(Paroxetine) as those with fewer medical problems, although they did show some benefit. The burden associated with more chronic and disabling sicknesss often drives the depression, making it more difficult to treat, the authors conclude. Despite this, the researchers indicate that maintenance anti depression medicate medication may be effective in primary care settings where patients have multiple chronic sicknesss

“What makes this meditate so practical is that it shows you can combine chronic sickness management of depression with the chronic sickness management of otherness illnesses to benefit both the patient’s mental illness as well as their physical illness,” he said.

The meditate is part of an overall NIMH effort to conduct practical clinical trials in “real world” settings that address public health issues important to persons affected by major mental illnesses.

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For more information on depression and how to treat it in older adults, visit http://www.nimh.nih.gov/healthinformation/depressionmenu.cfm and http://www.nimh.nih.gov/healthinformation/depoldermenu.cfm

NIMH is part of the National Institutes of Health (NIH), the Federal Government’s primary agency for biomedical and behavioral research. NIH is a component of the U.S. Department of Health and Human Services.

Contact: NIMH Press Office
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