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Published Online: 1 June 2013

Moderators of Outcome in Late-Life Depression: A Patient-Level Meta-Analysis

J. Craig Nelson, M.D., Kevin L. Delucchi, Ph.D., and Lon S. Schneider, M.D.Authors Info & Affiliations

Publication: American Journal of Psychiatry

Volume 170, Number 6

https://doi.org/10.1176/appi.ajp.2012.12070927

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Abstract

Age at onset, severity of symptoms, and illness duration are all important moderators in tailoring depression treatment. This meta-analysis found that antidepressants were not effective in elderly patients with late-onset depression of short duration, but they were effective in patients with a longer duration of illness that was at least moderately severe.

Abstract

Objective

The authors sought to identify factors that moderate outcome in late-life major depression and that identify patients for whom antidepressants have clinically meaningful effects.

Method

A previous systematic review identified 10 placebo-controlled trials of second-generation antidepressants in outpatients with major depressive disorder who were age 60 or older. For the present study, the authors obtained from the sponsors of the 10 trials individual patient data, including age, sex, duration of illness (current age minus age at onset), course (single episode or recurrent depression), baseline depression severity, treatment assignment, and outcomes. Logistic regression models were estimated and tested to examine the association of potential moderator variables with treatment response and the treatment group-response interaction.

Results

All moderator variables were collected and documented for seven of the 10 trials (N=2,283). Univariate and multivariate analyses were restricted to these seven trials. Illness duration was the only variable significantly associated with drug-placebo differences in the multivariate model. In patients with an illness duration >10 years, baseline depression severity was also significantly associated with drug-placebo differences. In those with an illness duration >10 years and a Hamilton Depression Rating Scale score ≥21, the drug-placebo difference in response rates was relatively robust (number needed to treat=4). In the remaining patients, the drug-placebo difference in response rates was small (46.3% compared with 41.5%).

Conclusions

Older patients with a long illness duration and moderate to severe depression appear to benefit from antidepressants as compared with placebo. Antidepressants do not appear to be effective for older patients with short illness duration.

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Information & Authors

Information

Published In

American Journal of Psychiatry

Volume 170 • Number 6 • June 2013

Pages: 651 - 659

PubMed: 23598969

History

Received: 16 July 2012

Revision received: 8 November 2012

Revision received: 12 December 2012

Accepted: 19 December 2012

Published online: 1 June 2013

Published in print: June 2013

Authors

Affiliations

J. Craig Nelson, M.D.

From the Department of Psychiatry, University of California San Francisco; and the Departments of Psychiatry and Behavioral Sciences and of Neurology, Keck School of Medicine, and the Leonard Davis School of Gerontology, University of Southern California, Los Angeles.

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Kevin L. Delucchi, Ph.D.

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Lon S. Schneider, M.D.

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Notes

Address correspondence to Dr. Nelson ([email protected]).

Funding Information

Dr. Nelson has served as a consultant, adviser, or speaker for, received research support or travel support from, or participated in CME for AstraZeneca, Avanir, Bristol-Myers Squibb, Cenestra Health, Corcept, Eli Lilly, Eli Lilly Global, Forest, Health Resources and Services Administration, Labopharm, Lundbeck, Medtronic, Merck, Merck Asia, Mylan/Dey Pharma, NIMH, Orexigen, Otsuka, Otsuka Asia, Pfizer, Sunovion, and Theracos; he has provided expert testimony for Finnegan, Henderson et al. on behalf of Eli Lilly, and he owns stock in Atossa. Dr. Schneider has received consulting fees from AC Immune, Allon, AstraZeneca, Baxter, Biogen-Idec, Chiesi, Elan, Eli Lilly, En Vivo, GlaxoSmithKline, Ibsen, Johnson & Johnson, Lundbeck, Merck, Pfizer, Roche, Takeda, Toyama, and Zinfandel; he and University of Southern California have received research grants from Baxter, Eli Lilly, Genentech, Novartis, and Pfizer. Dr. Delucchi reports no financial relationships with commercial interests.

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Moderators of Outcome in Late-Life Depression: A Patient-Level Meta-Analysis

Abstract