Abstract
Introduction
Bupropion immediate release (IR) and bupropion sustained release (SR) are frequently used to treat geriatric depression, as they have few cardiovascular, gastrointestinal and sexual adverse effects. We sought to examine the efficacy and dosing patterns of bupropion in a naturalistic cohort of elderly subjects with major depression (MD).
Methods
31 elderly (β>β60 years) patients with unipolar MD (DSMβIV) who were enrolled in Duke's Mental Health Clinical Research Center for the Study of Depression in Later Life were prescribed bupropion SR or IR, alone or in combination with other antidepressant agents, for 12 weeks. MontgomeryβAsberg depression rating scale (MADRS) scores and clinical global impression (CGI) severity scores were used to define response.
Results
74% (23/31) of the sample were responders (MADRSβ<β15) and 53% (16/30) achieved a partial (CGIβ=β2) or complete (CGIβ=β1) remission of MD at week 12. Among patients treated with bupropion SR monotherapy, the mean (range) maximal daily dose achieved was 240βmg (150β400βmg). Among those treated with bupropion IR, the mean (range) maximum daily dose achieved was 258βmg (150β450βmg). In subjects on monotherapy, 67% (10/15) of MD subjects were responders (MADRSβ<β15) and 50% (7/14) achieved full or partial remission. Response rates did not differ statistically among those with high and low medical comorbidity.
Conclusions
In this naturalistic 12βweek study, geriatric MD patients with high and low medical comorbidity responded well to bupropion and bupropion SR. In elderly patients, four to eight week acute treatment periods may be insufficient. Our findings suggest that nearly 50% of elderly depressed subjects at a tertiary center may need combination therapy over the course of their illness. Controlled randomized studies to establish the longβterm efficacy and optimal dose of the newer antidepressants in geriatric depression are urgently needed. Copyright Β© 2001 John Wiley & Sons, Ltd.