THE EFFECT OF SEQUENTIAL ANTIDEPRESSANT TREATMENT ON GERIATRIC DEPRESSION

This study evaluated the outcome of elderly depressed patients who wer e refractory to, or intolerant of, an initial trial of nortriptyline a nd who then underwent systematic treatment with other antidepressant t herapies. 101 patients entered the study and 61% responded to nortript yline. 64% of patients who did not improve with nortriptyline eventual ly responded to other antidepressant treatments, Response to second-li ne treatment (phenelzine) was significantly slower than response to th e tricyclic antidepressant. Treatment nonresponders were more likely t o have a longer episode length at index assessment and higher baseline anxiety scores compared with responders, This study demonstrates the importance of persisting with systematic antidepressant therapy in eld erly patients who do not respond to the first trial of treatment.