Antidepressants in elderly: Metaregression of double-blind, randomized clinical trials

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• 作者：Raffaella Calati^a ; Maria Salvina Signorelli^b ; Martina Balestri^c ; Agnese Marsano^c ; Diana De Ronchi^c ; Eugenio Aguglia^b ; Alessandro Serretti^c ; ^{alessandro.serretti@unibo.it}
• 关键词：Older ; Elderly ; Depression ; Antidepressant ; Effectiveness ; Clinic profile
• 刊名：Journal of Affective Disorders
• 出版年：2013
• 出版时间：May, 2013
• 年：2013
• 卷：147
• 期：1-3
• 页码：1-8
• 全文大小：253 K

文摘

Background

Depression is common in the elderly and in the last few years this led to a significant increase in antidepressant prescription rates. However, little is known about antidepressant efficacy profile in relation with socio-demographic and clinical features in this population.

The aim of the present study was to define the most suitable socio-demographic and clinical profile for the use of antidepressant treatments in late-life depression.

Methods

MEDLINE, EMBASE and PsycINFO were searched for randomized controlled trials (RCTs) focused on efficacy of antidepressants of all classes in major depressed elderly subjects (>60 years old). Reviews and meta-analyses focusing on this topic have been considered as well. Thirty-four RCTs were included and socio-demographic and clinical features were investigated via meta-regression analysis as moderators of efficacy measures (standardized mean difference based on Hamilton Depressive Rating Scale and Montgomery-Asberg Depression Rating Scale).

Results

A lower rate of response to antidepressants of all classes was found in patients of male gender, of older age, and with a longer mean duration of the current episode. On the contrary, a higher rate of response was found in patients with a higher baseline severity and at their first episode of illness. Subsamples treated with selective serotonin reuptake inhibitors alone yielded similar results.

Limitations

RCTs only have been included.

Conclusions

A number of socio-demographic and clinical features have been found to moderate antidepressant efficacy in elderly population. Those variables could help clinicians for a more individualized treatment.