ANXIOUS DEPRESSION IN ELDERLY PATIENTS - RESPONSE TO ANTIDEPRESSANT TREATMENT

The authors asked whether elderly patients with anxious depression wer e less responsive to antidepressant treatment than nonanxious depresse d patients, A group of 101 depressed patients were treated with 6 week s of nortriptyline and then, if necessary, 2 weeks of adjunctive lithi um. Patients who did not respond to or were intolerant of this first l ine of treatment were then given 6 weeks of phenelzine (+/- lithium au gmentation). Finally, patients failing this second line of treatment w ere given either a course of electroconvulsive therapy or 6 weeks of f luoxetine (+/- lithium augmentation). Based on their score on the Hosp ital Anxiety and Depression Scale at index assessment, subjects were d ivided into anxious and nonanxious groups. Anxious depressed patients were significantly less responsive to nortriptyline on both intent-to- treat and efficacy analyses. They were also more likely to discontinue treatment and, as a result, were significantly less responsive on the intent-to-treat analysis for overall treatment. These results suggest that concurrent symptoms of anxiety have prognostic importance in ger iatric depression.