Maintenance Antidepressant Treatment Improves Well-Being in Late-Life Depression

October 1, 2007 — Maintenance antidepressant pharmacotherapy is superior to placebo in preserving improvements in overall health-related quality of life (HR-QOL) achieved with treatment response in late-life depression, according to the results of a study reported in the September issue of the Journal of the American Geriatrics Society.
"Depression is one of the major causes of decline in the health-related quality of life (HR-QOL) of elderly persons," write Alexandre Y. Dombrovski, MD, from the University of Pittsburgh in Pennsylvania, and colleagues. "Because HR-QOL matters to patients and families and is a crucial outcome of depression treatment beyond improvement in symptomatic status, clinicians need to know whether treatment improves and maintains it. To the authors' knowledge, only two randomized, controlled trials have examined the long-term effect of treatment on various domains of HR-QOL."
The hypothesis of this study was that paroxetine would be superior to placebo and that interpersonal psychotherapy would be superior to clinical management, after controlling for the effects of the other treatment.
Open combined treatment with paroxetine and interpersonal psychotherapy identified patients aged 70 years and older with major depression who responded to dual therapy. Responders were randomized to a 2 (paroxetine vs placebo) by 2 (monthly, manual-based interpersonal psychotherapy vs clinical management) double-blind, maintenance trial in which HR-QOL outcomes were evaluated during 1 year of maintenance treatment at a university-based clinic.
Of 363 persons with late-life depression referred for study, 210 gave consent. Of 195 patients who began acute, open-label treatment, 116 met criteria for recovery, were randomized to maintenance treatment, and were included in this analysis.
Outcome measures were overall HR-QOL measured with the Quality of Well-Being Scale (QWB), as well as 6 specific HR-QOL domains derived from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) subscales.
Except for physical functioning, all domains of HR-QOL improved with successful acute and continuation treatment. After controlling for effects of psychotherapy, treatment with paroxetine was superior to placebo in preserving overall well-being (P = .04; effect size [r] = 0.23), social functioning (P =.02; r = 0.27), and role limitations as a result of emotional problems (P =.007; r = 0.30). Compared with supportive clinical management, interpersonal psychotherapy was no better at preserving HR-QOL, after controlling for the effects of treatment with paroxetine.
"Maintenance antidepressant pharmacotherapy is superior to placebo in preserving improvements in overall well-being achieved with treatment response in late-life depression," the study authors write. "No such benefit was seen with interpersonal psychotherapy."
Limitations of the study include a predominantly white sample with more severe depressive symptoms responsive to acute treatment, limiting generalizability.
"Overall, the effects of pharmacotherapy on HR-QOL observed in this study range from modest (0.23) for overall quality of life and social functioning (0.27) to moderate for emotional role functioning (0.30), the domain most directly affected by depression," the study authors conclude. "These effects compare favorably with small or nonsignificant effects of secondary prevention programs in coronary heart disease, angiotensin-converting enzyme inhibitors, and calcium channel blockers in congestive heart failure and with the effects of various antihypertensive agents."
The National Institute of Mental Health and the John A. Hartford Foundation supported this study. GlaxoSmithKline provided paroxetine tablets for use in this study. Some of the authors have disclosed various financial relationships with Astra-Zeneca, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GSK, Janssen, Lundbeck, Pfizer, Johnson & Johnson, Organon, and Sepracor.
J Am Geriatr Soc. 2007;55:1325-1332.