IMPACT OF PHYSICAL ILLNESS ON QUALITY-OF-LIFE AND ANTIDEPRESSANT RESPONSE IN GERIATRIC MAJOR DEPRESSION

OBJECTIVE: Because physical illness may influence quality of life, we assessed its impact on functional status and treatment outcome in olde r depressed patients who participated in a clinical trial, which showe d a significantly higher remission rate for fluoxetine over placebo (3 1.6% vs 18.6%, P < .001). DESIGN: Six-week, randomized, double-blind, placebo-controlled trial of fluoxetine, 20 mg daily. SETTING: Multiple clinical sites, both university and private. PARTICIPANTS: Outpatient s (N = 671) were greater than or equal to 60 years (mean +/- SD = 67.7 +/- 5.7), met DSM-III-R criteria for unipolar major depression and ha d baseline scores greater than or equal to 16 on the Hamilton Depressi on Rating Scale. MEASUREMENTS: The 36-item short-form health survey (S F-36) was used to measure baseline and posttreatment functional health and well-being. Physical illness was rated by number of current chron ic or historical illnesses. Change from baseline to endpoint in the Ha milton Depression Rating Scale total score was used to measure depress ion outcome. MAIN RESULTS: Most patients reported physical illness: 83 % had one or more chronic illness, and 89% had one or more historical illness. Greater numbers of baseline chronic illness indicated worse p hysical functioning, general health perceptions, and vitality and grea ter bodily pain and role limitation from physical problems. Historical physical illness was associated with worse physical functioning, vita lity, general health perceptions, social functioning, and mental healt h. Although the number of chronic illnesses did not influence treatmen t response, historical physical illness was associated with greater fl uoxetine response and lower placebo response. CONCLUSIONS: These findi ngs suggest that both current and previous physical illness are associ ated with lower quality oi life in geriatric depression and that depre ssed older patients with chronic physical illness respond to antidepre ssants as well as those without such illness. Recovery from previous p hysical illness should be explored as a potential predictor of antidep ressant treatment outcome.