Drug treatment of depression in frail elderly nursing home residents

The authors conducted a randomized, double-blind, 10-week clinical trial of two doses of nortriptyline in eight nursing homes. Sixty-nine patients, av erage 79.5 years, were randomized to receive regular doses (60 mg-80 mg/day ) vs. low noses (10 mg-13 mg/day) of nortriptyline. Among the more cognitiv ely intact patients, there was a significant quadratic relationship definin g a "therapeutic window" for nortriptyline plasma levels and clinical impro vement. There were also significant differences in plasma level-response re lationships between depressed patients who were cognitively impaired and th ose who were more cognitively intact. Depression remains a syndrome that, r esponds to specific treatment, even in frail nursing home patients, and tho se depressions that occur in patients with significant dementia may represe nt a treatment-relevant condition with a different plasma level-response re lationship than in depression alone.