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Antidepressant use in elderly medical inpatients

Lessons from an attempted clinical trial

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Abstract

The authors conducted a clinical trial to examine the efficacy and safety of nortriptyline in the treatment of major depression in elderly medical inpatients. The diagnosis of major depression was made by a psychiatrist in 41 of 680 patients 65 years of age or older. The study was halted at the midpoint because of inadequate patient recruitment, primarily a consequence of medical illnesses that prevented more than 80% of eligible patients from participating in or completing the clinical trial. Major or minor medical contraindications to the use of antidepressants were present in over 90% of depressed patients. Short-term follow-up was cnducted on untreated depressed patients, those receiving antidepressants at the time of assessment, and those in whom antidepressant treatment was initiated after assessment. Non-randomized exposure to antide-pressants did not predict remission of depression at follow-up due to spontaneous remission in the untreated group. Given the prevalence of medical contraindications to antidepressant use among depressed elderly patients and the problems with side effects in treated patients, there were few depressed, elderly hospitalized patients who were candidates for antidepressant therapy.

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Author information

Authors and Affiliations

  1. the Geriatric Research Education and Clinical Center, VA and Duke University Medical Center, Durham, North Carolina

    Harold G. Koenig MD & Harvey J. Cohen MD

  2. the Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina

    Harvey J. Cohen MD

  3. the Affective Disorders Program, Duke University Medical Center, Durham, North Carolina

    Dan G. Blazer MD, PhD

  4. the Department of Psychiatry, Duke University Medical Center, Durham, North Carolina

    Veeraindar Goli MD, Frank Shelp MD, Harold S. Kudler MD & Keith G. Meador MD

Authors
  1. Harold G. Koenig MD
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  2. Veeraindar Goli MD
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  3. Frank Shelp MD
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  4. Harold S. Kudler MD
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  5. Harvey J. Cohen MD
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  6. Keith G. Meador MD
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  7. Dan G. Blazer MD, PhD
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Additional information

Supported by the Sandoz Pharmaceutical Corporation, Center for the Study of Aging and Human Development, Duke University Medical Center (grant #AG00371), the Mellon Foundation, and the Clinical Research Center for the Study of Depression in the Elderly, NIMH (grant #MH40159).

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Koenig, H.G., Goli, V., Shelp, F. et al. Antidepressant use in elderly medical inpatients. J Gen Intern Med 4, 498–505 (1989). https://doi.org/10.1007/BF02599548

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