PRETREATMENT SYSTOLIC ORTHOSTATIC BLOOD-PRESSURE AND TREATMENT RESPONSE IN GERIATRIC DEPRESSION - A REVISIT

Three previous studies have found significant positive correlations be tween pretreatment systolic orthostatic blood pressure (PSOP) and tric yclic antidepressant (TCA) response in geriatric depression (i.e., the greater the pretreatment orthostatic drop, the greater the treatment response). The purposes of this study were to revisit the question of whether PSOP predicts TCA response and also to examine whether large s ystolic orthostatic pressure (SOP) is a state or trait variable in lat e-life depression. We retrospectively examined PSOP data collected fro m 48 elderly patients with recurrent unipolar depression treated with nortriptyline (mean level in plasma, 85.3) in the open, acute-treatmen t phase of an ongoing double-blind, placebo-controlled study of mainte nance therapies in late-life depression. PSOP was not significantly co rrelated with treatment response as measured by the Hamilton Rating Sc ale for Depression at weeks 7 to 9 (r = -0.12, not significant). Likew ise, a 10-mm PSOP cutoff did not significantly differentiate patients by responder status. We did find that all five of our placebo-randomiz ed, maintenance therapy patients with PSOPs greater than 10 mm had mar ked decreases in their SOPs in the nortriptyline-free, well state. Thu s, our findings fail to replicate earlier reports of PSOP predicting T CA response in geriatric depression. However, our results do prelimina rily suggest that large SOP may be state dependent' We discuss plans t o study prospectively whether large SOP is state dependent and whether SOP is a clinically useful predictor of recurrence in late-life depre ssion.