2-YEAR OUTCOME OF PSYCHOTIC DEPRESSION IN LATE-LIFE

Objective: The purpose of this study was to determine whether elderly patients with psychotic depression differed in long-term outcome from patients with nonpsychotic depression. Method: The study group consist ed of 19 patients with psychotic major depression who had responded to ECT (N = 15), nortriptyline and perphenazine (N = 2), or nortriptylin e, perphenazine, and adjunctive lithium (N = 2) and 68 nonpsychotic de pressed patients who had responded to either nortriptyline alone (N = 61) or nortriptyline and lithium (N = 7). All patients were maintained on regimens of full-dose nortriptyline. When prescribed for the index episode, adjunctive lithium was also maintained but perphenazine was withdrawn 16 weeks after response. Patients were followed on a monthly basis for 2 years or until relapse or recurrence, whichever occurred first. Results: Patients with psychotic depression had a substantially higher frequency of relapse or recurrence of depression and a shorter time to these events than nonpsychotic depressed patients. At index a ssessment, patients with psychosis were more severely depressed and ha d had more prior episodes of depression, but these factors did not acc ount for the difference in outcome between the two groups. Furthermore , before entering the study, none of the psychotic patients had receiv ed adequate treatment for the index episode of depression, and so thei r pool outcome could not be attributed to prior treatment resistance. Conclusions: Even when they achieved remission and were maintained on a regimen of full-dose antidepressant medication, older patients with psychotic depression were at greater risk of relapse or recurrence tha n were their nonpsychotic counterparts. In particular, continuation/ma intenance treatment with tricyclic monotherapy following response to E CT had limited efficacy in this group of patients. These findings rais e important questions about the optimal treatment of psychotic depress ion in late life.