Factors Associated with Response in Depressed Elderly Outpatients Treated with Escitalopram in a Naturalistic Setting in Germany

Abstract

Background: An open, multi-centre study was designed to address the effectiveness and tolerability profile of treatment with escitalopram under naturalistic conditions, in elderly outpatients (above 65 years of age) with depression.

Patients and Methods: A total of 2 050 patients completed 8 weeks of treatment with escitalopram. Rating scales included a short version of the Montgomery-Åsberg Depression Rating Scale (svMADRS), the Clinical Global Impression – Severity scale (CGI-S), and the Clinical Global Impression –Improvement scale (CGI-I) for the assessment of various clinical parameters.

Results: Most patients improved in their general state of health and showed a decrease in the severity of their depression. The majority (82.7%) of patients received initially 10 mg/day escitalopram. The mean svMADRS total score decreased from 31.9±7.9 at baseline to 14.2±8.5 at week 8. On completion, 63.9% of the patients were responders (≥50% decrease of svMADRS total score from baseline) and 48.6% were remitters (svMADRS total score ≤12 at week 8). Statistically significantly more patients aged between 66 and 75 years responded to treatment and achieved remission than those aged >75 years. Logistic regression, using stepwise backward elimination, was used to model response to treatment. Statistically significant positive factors were having a current episode ≤1 month and duration of illness ≤1 year. Significant negative factors were being male, being older than 75 years, and having need of further psychotropic medication. Compared to patients diagnosed with unspecified dementia with other symptoms being predominantly depressive (F03, according to ICD-10), the response to escitalopram was significantly better for patients with depressive episodes (F32) or recurrent depressive episodes (F33), but significantly worse for patients with affective disorder (F31 or F34). The differences versus affective disorders were significant, while those for depressive episodes and recurrent depressive episodes vs. affective disorders were not significant.

Conclusion: This observational study corroborates the effectiveness and tolerability of escitalopram treatment for elderly patients in a naturalistic treatment setting.

References

• 1 Bech P, Andersen HF, Wade A. Effective dose of escitalopram in moderate versus severe DSM-IV major depression.  Pharmacopsychiatry. 2006;  39 128-134
• 2 Bech P, Tanghoj P, Cialdella P. et al . Escitalopram dose-response revisited: an alternative psychometric approach to evaluate clinical effects of escitalopram compared to citalopram and placebo in patients with major depression.  Int J Neuropsychopharmacol. 2004;  7 238-290
• 3 Gorwood P, Weiller E, Lemming O. et al . Escitalopram prevents relapse in older patients with major depressive disorder.  Am J Geriatr Psychiatry. 2007;  15 581-593
• 4 Guy W. ECDEU Assessment Manual for Psychopharmacology, revised.  US Dept Health, Education, and Welfare publication (ADM). 1976;  76-338 Rockville, MD, National Institute of Mental Health
• 5 Kennedy SH, Lam RW, Morris B. CANMAT Depression Work Group . Clinical guidelines for depressive disorders. Summary of recommendations relevant to family physicians.  Can Fam Physician. 2003;  49 489-491
• 6 Klysner R, Bent-Hansen J, Hansen HL. et al . Efficacy of citalopram in the prevention of recurrent depression in elderly patients: placebo-controlled study of maintenance therapy.  Br J Psychiatry. 2002;  181 29-35
• 7 Möller HJ, Langer S, Schmauß M. Escitalopram in clinical practice: Results of an open-label trial in outpatients with depression in a naturalistic setting in Germany.  Pharmacopsychiatry. 2007;  40 53-57
• 8 Möller HJ, Schnitker J. [Prospective study using a modified Montgomery-Asberg depression scale].  Nervenarzt. 2007;  DOI 10.1007/s00115-007-2278-0
• 9 Möller HJ. Isn’t the efficacy of antidepressants clinically relevant? A critical comment on the results of the metaanalysis by Kirsch et al. 2008.  Eur Arch Psychiatry Clin Neurosci. 2008;  258 451-455
• 10 Möller HJ, Baldwin D, Goodwin G. et al . Do SSRIs or antidepressants in general increase suicidality? WPA Section on Pharmacopsychiatry: consensus statement.  Eur Arch Psychiatry Clin Neurosci. 2008;  258 3-23
• 11 Montgomery S, Möller HJ. Is the significant superiority of escitalopram compared to other antidepressants clinically relevant?.  Int Clin Psychopharmacol. 2009;  24 111-118
• 12 Nelson JC, Delucchi K, Schneider LS. Efficacy of second generation antidepressants in late-life depression: a meta-analysis of the evidence.  Am J Geriatr Psychiatry. 2008;  16 558-567
• 13 Trivedi MH, Rush AJ, Wisniewski SR. et al STAR*D Study Team Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.  Am J Psychiatry. 2006;  163 28-40

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