Initial recovery patterns may predict which maintenance therapies for depression will keep older adults well

Background: Although active maintenance treatments appear superior to place bo in preventing depression recurrence in older adults, few data are availa ble to guide maintenance modality selection to maximize the probability of continued wellness for a given patient. Patients' temporal patterns of acut e treatment response may predict who requires which maintenance therapy to remain well. Methods: Depression levels were observed over 16 weeks of comb ined nortriptyline (NT) and interpersonal psychotherapy (IPT) in 140 person s aged greater than or equal to 60 years with recurrent major depression. S ubjects were empirically classified into four groups: rapid, sustained resp onders; delayed, sustained responders; mixed responders without sustained i mprovement; prolonged nonresponders. Groups were compared on subsequent rec overy rates and on time to depression recurrence after randomization to 3 y ears of combined maintenance therapy (monthly IPT with NT), monotherapy (ei ther IPT or NT alone), or medication clinic with placebo. Pretreatment psyc hosocial and clinical variables were controlled. Results: Initial response profile predicted ultimate recovery rates, as well as who remained well, gi ven the maintenance treatment received. Rapid initial responders showed low er recurrence risk with either combined or monotherapy, relative to placebo . Specific types of monotherapy appeared equally effective in rapid respond ers. In initially mixed responders, only combined therapy was superior to p lacebo. It was marginally superior to monotherapy. For delayed responders, combined therapy was superior to placebo; monotherapy did not differ from t he other maintenance conditions. Prolonged nonresponders did not benefit fr om maintenance treatment. Limitations: Subjects had only recurrent, unipola r depression. Initial response profile groups were established empirically and require replication. Sample sizes in initial response profile by mainte nance treatment cells were small. Conclusion: The ability to match patients to maintenance treatments more likely to prevent recurrence may be enhance d by considering the temporal profile of initial response to acute treatmen t. (C) 2001 Elsevier Science B.V. All rights reserved.