Continuation and Maintenance Treatments for Depression in Older People

Summary

A Cochrane review [Abstract] 1 included 7 studies with a total of 803 subjects with depression. All participants were aged 60 and over. Six trials compared antidepressant medication with placebo; two involved psychological therapies. Primary outcome measures were rates of recurrence of depression. Comparing antidepressants with placebo, at 6 months follow-up there was no significant difference. At 12 months follow-up there was a significant difference favouring antidepressants in reducing recurrence compared with placebo (RR = 0.67, 95% CI 0.55 to 0.82; NNTB = 5; 3 RCTs, n = 247). At 24 months there was no significant difference for antidepressants overall, however, for the subgroup of tricyclic antidepressants there was significant benefit (RR = 0.70, 95% CI 0.50 to 0.99, NNTB = 5; 3 RCTs, n = 169). At 36 months there was no significant difference for antidepressants overall. There was no difference in treatment acceptability or death rates between antidepressant and placebo. There was no significant difference between psychological treatment and antidepressant in recurrence rates at 12, 24, and 36 months (one RCT, n = 53) or between combination and antidepressant alone.

Comment: The quality of the evidence is downgraded by imprecise results (few patients for each comparison) and indirectness of evidence (differences in interventions, only few antidepressants studied, short follow-up time).