TREATMENT OF CONSECUTIVE EPISODES OF MAJOR DEPRESSION IN THE ELDERLY

Objective: The purpose of this study was to determine treatment outcom e in elderly patients with consecutively treated episodes of recurrent unipolar major depression. Method: Subjects were 32 ''young'' elderly patients with recurrent unipolar depression (mean age=66.8 years, SD= 5.1) and with two consecutively treated episodes of major depression. Both index: and subsequent episodes of major depression were treated i n open trial with combined nortriptyline and interpersonal psychothera py. Rates of remission in index and subsequent episodes were compared by using nonparametric statistics and survival analysis with proportio nal hazards modeling. Results: Of 30 patients who completed treatment of the subsequent episode, 27 (90%) achieved stable remission of sympt oms in both consecutively treated episodes, whereas three patients (10 %) did not. Twenty-two (81%) of 27 patients who responded to treatment had a shorter time to remission in treatment of the subsequent episod e than in the index episode. Survival analysis with proportional hazar ds modeling detected a significant difference in time to remission of the index and subsequent episodes (32 paired observations). Conclusion s: In this research study group, recurrent episodes of unipolar major depression in the young elderly were successfully treated to remission in over 80% of patients by using combined pharmacotherapy and psychot herapy similar to that employed in treatment of the index episode. Rem ission rate and time to remission in consecutively treated episodes we re comparable to those in a group of midlife patients with recurrent d epression reported by Kupfer et al. in 1989. Thus, recurrent depressiv e disorder appears to be as treatable in the young elderly as it is in midlife patients.