Which elderly depressed patients remain well on maintenance Interpersonal Psychotherapy alone?: Report from the Pittsburgh study of maintenance therapies in late-life depression

The aim of this study was to identify elderly depressed patients who can re main well on maintenance Interpersonal Psychotherapy (IPT) alone, after dis continuation of antidepressant medication. Using Cox proportional hazards m odels, increased severity of depression at pretreatment was associated with increased recurrence rates, to art extent greater in patients maintained o n monthly IPT than in those maintained on nortriptyline. The long-term resp onse to maintenance IPT was correctly identified in 20/25 cases by a pretre atment Hamilton score of greater than or equal to 20. Fourteen of sixteen p atients with pretreatment scores of greater than or equal to 20 experienced recurrence of major depression on maintenance IPT while 6/9 patients with pretreatment scores of less than 20 did not. (Fisher exact P = .01). The sa me pattern of recurrence in relation to severity was not evident in mainten ance placebo, nortriptyline, or combination treatment. lit addition, Hamilt on scores during continuation treatment were lower (less than or equal to 7 ) among those who remained well on maintenance IPT than among those who had recurrences. Elderly patients whose depressions are milder at baseline and who show excellent symptomatic remission during acute and continuation the rapy may be good candidates for monthly maintenance IPT after initial succe ssful treatment with antidepressant medication and psychotherapy. (C) 1999 Wiley-Liss, Inc.