Lack
of efficacy of citalopram in treating very old
depressed patients
The
number of the very old people is growing rapidly
and the prevalence of illnesses in this
population is high. Major depression is common
in these fragile subjects and if it is not
diagnosed and treated, the risk of suicide or
comorbidity with other diseases is important.
Most geriatric trials only include patients aged
under 75 and the applicability of data on
efficacy, safety and tolerability to older
subjects has not been demonstrated. Hence the
importance of a recent study which investigated
the efficacy of antidepressant treatment in
"old-old" population.
A multi-centre (15 sites), double blind,
randomised, 8-week trial compared the selective
serotonin reuptake inhibitor (SSRI), citalopram
(10-40 mg/day), to placebo in depressed patients
aged 75 and older. Among the 174 patients, 58%
were women. The mean age was 79.6 years,
and the mean baseline Hamilton Depression Rating
Scale (HDRS) score was 24.3.
There was a marked site variability in response
rates for both drug and placebo, across sites
the citalopram response ranged from 18% to 82%
and placebo response from 16% to 80%. In most
sites there was no drug/placebo difference;
whether a patient responded or not depended at
what site they were treated at rather than the
treatment they received. The rate of remission
(a score <10 on the HDRS) was 35% with
citalopram and 33% with placebo. The frequency
of any treatment-emergent adverse effects or in
dropout rate was similar in both groups.
The lack of effectiveness of citalopram in the
treatment of depression in the very old patients
cannot be generalized to all SSRIs and rather
underlines the necessity for more systematic
studies of antidepressant treatments in this un
predictable patient population. Roose
SP, Sackeim HA, Krishnan KR, Pollock BG,
Alexopoulos G, Lavretsky H, Katz IR, Hakkarainen
H; Old-Old Depression Study Group.
Antidepressant pharmacotherapy in the treatment
of depression in the very old: a randomized,
placebo-controlled trial. Am J Psychiatry 161:
2050-2059, 2004.