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Maintenance Treatment for Old‐Age Depression Preserves Health‐Related Quality of Life: A Randomized, Controlled Trial of Paroxetine and Interpersonal Psychotherapy
Author(s) -
Dombrovski Alexandre Y.,
Lenze Eric J.,
Dew Mary Amanda,
Mulsant Benoit H.,
Pollock Bruce G.,
Houck Patricia R.,
Reynolds Charles F.
Publication year - 2007
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2007.01292.x
Subject(s) - paroxetine , interpersonal psychotherapy , medicine , pharmacotherapy , quality of life (healthcare) , placebo , randomized controlled trial , psychiatry , supportive psychotherapy , depression (economics) , interpersonal communication , antidepressant , clinical psychology , psychology , alternative medicine , anxiety , nursing , social psychology , macroeconomics , pathology , economics
OBJECTIVES: To determine whether maintenance antidepressant pharmacotherapy and interpersonal psychotherapy sustain gains in health‐related quality of life (HR‐QOL) achieved during short‐term treatment in older patients with depression. DESIGN: After open combined treatment with paroxetine and interpersonal psychotherapy, responders were randomly assigned to a two (paroxetine vs placebo) by two (monthly interpersonal psychotherapy vs clinical management) double‐blind, placebo‐controlled maintenance trial. HR‐QOL outcomes were assessed over 1 year. SETTING: University‐based clinic. PATIENTS: Of the referred sample of 363 persons aged 70 and older with major depression, 210 gave consent, and 195 started acute treatment; 116 met criteria for recovery, entered maintenance treatment, and were included in this analysis. INTERVENTIONS: Paroxetine; monthly manual‐based interpersonal psychotherapy . MEASUREMENTS: Overall HR‐QOL as measured using the Quality of Well‐Being Scale (QWB) and six specific HR‐QOL domains derived from the Medical Outcomes Study 36‐item Short‐Form Health Survey (SF‐36) subscales. RESULTS: All domains of HR‐QOL except physical functioning improved with successful acute and continuation treatment. After controlling for any effects of psychotherapy, pharmacotherapy was superior to placebo in preserving overall well‐being ( P= .04, effect size ( r ) = 0.23), social functioning ( P= .02, r= 0.27), and role limitations due to emotional problems ( P= .007, r= 0.30). Interpersonal psychotherapy (controlling for the effects of pharmacotherapy) did not preserve HR‐QOL better than supportive clinical management. CONCLUSION: Maintenance antidepressant pharmacotherapy is superior to placebo in preserving improvements in overall well‐being achieved with treatment response in late‐life depression. No such benefit was seen with interpersonal psychotherapy.