Continuing Treatment of Depression in the Elderly:A Systematic Review and Meta-Analysis of Double-Blinded Randomized Controlled Trials With Antidepressants

Objective: To establish the efficacy and tolerability of continuing treatment with antidepressants in preventing relapses and recurrences in elderly depressed patients and to analyze differences between tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs). Design: The authors conducted a systematic literature search to identify all randomized, placebo-controlled, double-blinded clinical trials (RCTs) in elderly patients. Data were pooled from eight double-blinded RCTs of continuation and maintenance treatment in the elderly with 925 participating patients. Results: The number of patients needed to treat (NNT) for antidepressants to prevent one additional relapse or recurrence was 3 6 (95% confidence interval [CI]: 2.8-4.8). The NNT for TCAs was 2.9 (95% CI: 2.2-4.6), compared with a NNT for SSRIs of 4.2 (95% CI: 3.2-5.9). In the five studies that provide drop out data, 14 of 330 patients (4.2%) using an antidepressant dropped out due to side effects compared with 17 of 330 patients (5.2%) using a placebo (x(2) = 0.305, df = 1, p = 0.581). Tolerability did not differ between TCAs and SSRIs. Conclusion: Continuing treatment with antidepressants in elderly patients is efficacious compared with placebo in preventing relapses and recurrences. Efficacy and tolerability during long-term treatment does not differ between TCAs and SSRIs. (Am J Geriatr Psychiatry 2011; 19:249-255)