Predicting 6-week treatment response to escitalopram pharmacotherapy in late-life major depressive disorder

✍ Scribed by Ramin Saghafi; Charlotte Brown; Meryl A. Butters; Jill Cyranowski; Mary Amanda Dew; Ellen Frank; Ariel Gildengers; Jordan F. Karp; Eric J. Lenze; Francis Lotrich; Lynn Martire; Sati Mazumdar; Mark D. Miller; Benoit H. Mulsant; Elizabeth Weber; Ellen Whyte; Jennifer Morse; Jacqueline Stack; Patricia R. Houck; Salem Bensasi; Charles F. Reynolds III

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 99 KB
• Volume: 22
• Category: Article
• ISSN: 0885-6230
• DOI: 10.1002/gps.1804

✦ Synopsis

Abstract

Objective

Approximately half of older patients treated for major depressive disorder (MDD) do not achieve symptomatic remission and functional recovery with first‐line pharmacotherapy. This study aims to characterize sociodemographic, clinical, and neuropsychologic correlates of full, partial, and non‐response to escitalopram monotherapy of unipolar MDD in later life.

Methods

One hundred and seventy‐five patients aged 60 and older were assessed at baseline on demographic variables, depression severity, hopelessness, anxiety, cognitive functioning, co‐existing medical illness burden, social support, and quality of life (disability). Subjects received 10 mg/d of open‐label escitalopram and were divided into full (n = 55; 31%), partial (n = 75; 42.9%), and non‐responder (n = 45; 25.7%) groups based on Hamilton depression scores at week 6. Univariate followed by multivariate analyses tested for differences between the three groups.

Results

Non‐responders to treatment were found to be more severely depressed and anxious at baseline than both full and partial responders, more disabled, and with lower self‐esteem than full responders. In general partial responders resembled full responders more than they resembled non‐responders. In multivariate models, more severe anxiety symptoms (both psychological and somatic) and lower self‐esteem predicted worse response status at 6 weeks.

Conclusion

Among treatment‐seeking elderly persons with MDD, higher anxiety symptoms and lower self‐esteem predict poorer response after six weeks of escitalopram treatment. Copyright © 2007 John Wiley & Sons, Ltd.