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Predictors of Non-remission for Antidepressant Treatment among the Elders with Major Depressive Disorder: A Preliminary Open-label Study

Yi-Cheng Wu, Yi-Chun Yeh, Ju-Yu Yen, Chih-Hung Ko, Cheng-Fang Yen, Cheng-Sheng Chen

Background: Treatment for depressive elders is a challenge due to the complexity
in clinical manifestation, medical comorbidity and etiologies. There has
been scant of the literature regarding treatment outcomes and their correlates
among the elderly patients with major depressive disorder at acute stage in Taiwan.
We conducted a preliminary 12-week open-labeled trial of antidepressants for the
late-life major depressive disorder, and examined the predictors of patients with
poor outcome. Methods: Sixty elderly patients with late-life major depressive disorder
were recruited for a 12-week open-labeled study of acute antidepressants
treatment. Depressive severities were assessed using 17-item Hamilton Depression
Rating Scale for Depression (HAMD17) at weeks, 0, 2, 4, 8, and 12-week. Treatment
remission were defi ned by HAMD17 ≦7 and Clinical Global Inventory (CGI)
≦2. Antidepressants were prescribed according to clinical judgment. The intentto-
treat population using the last observation carried forward (LOCF) method was
used for analysis. Results: Among the patients achieving remission during the
trial, the proportions of remitted patients of each visit were: 15.4% at the 2-week,
23.1% at the 4-week, 50% at the 8-week, and 11.5% at the 12-week. We found that
the elderly patients with late-onset of fi rst major depressive episode, higher scores
of mood factor, and sleep factor were likely to be non-remitted from antidepressant
treatments. Conclusions: In this study, only 40% of elder patients could complete
12-week acute antidepressant treatments. Near half of all study participants reached
remission. In summary, late-onset of the disease, severe depressed mood, and sleep
disturbances could be the predictors for non-remission. But the study results need
to be validated in future studies with larger sample sizes in the numbers of the
study subjects as well as group comparation and randomization in design.
Key Word elderly, late-life depression, antidepressant
Editorial Committe, Taiwanese Journal of Psychiatry
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