Seniors with hard to treat depression require two-drug combination

Seniors with hard to treat depression require two-drug combinationWhen treated with only an antidepressant, many seniors with depression do not receive enough benefits. A study from the University of Washington unveiled that adding an antipsychotic medication to the antidepressant medication can better help seniors with hard to treat depression.

In previous research conducted on younger adults, the addition of an antipsychotic medication relieved symptoms when antidepressants alone failed to. Not only did the new test reveal symptoms of depression in seniors subsided, but there was a reduction in suicidal thoughts as well.


First author, Eric J. Lenze, M.D., said, “It’s important to remember that older adults may not respond to medications in the same way as younger adults. There are age-related changes in the brain and body that suggest certain treatments may work differently, in terms of benefits and side effects, in older adults. Even when a strategy works for patients in their 30s, it needs to be tested in patients in their 70s before it can be considered effective in older patients.”

Previous studies estimated that seven million seniors suffer from depression. Worse yet, nearly 90 percent of them are not receiving necessary treatment and 78 percent didn’t receive treatment at all.

Seniors with depression have more need for health care services, and the suicide rates are higher than all other age groups. Furthermore, depression is a risk factor for dementia.

Co-author Benoit H. Mulsant, M.D. said, “This is a rare study because it looks at depression specifically in older adults. It’s important to treat older adults for depression, especially given that adults with late-life depression are at an increased risk of developing dementia. But this research demonstrates that older adults do respond to depression therapy.”

468 seniors over the age of 60 were used for the study. Each of them received an antidepressant for 12 weeks – the majority of them were still clinically depressed after the 12 weeks was over.

Lenze said, “We know that in older adults with depression, about half will not respond to medication. They may have a minimal response, but they’ll still be depressed. The question we wanted to answer was whether there was anything else we could do for them.”

In the second phase of the study, for those who did not respond to the antidepressant alone, patients were given either a placebo or an antipsychotic drug.  The two-drug combo led to higher rates of remission (44 percent) in comparison to the placebo group (22 percent).

Dr. Charles F. Reynolds from the University of Pittsburg said, “This study is a major advance in support of evidence-based care for older adults with depression. By publishing our findings in The Lancet, we hope particularly to reach primary care physicians, who provide most of the treatment for depressed older adults. The excellent safety and tolerability profile of aripiprazole, as well as its efficacy, should support its use in primary care, with appropriate medical monitoring.”

Although there were some minor side effects to the two-drug combo, researchers feel the benefits greatly outweigh the side effects. Lenze said, “Antipsychotic medications can cause increasing amounts of fat and thereby increase blood sugar, potentially contributing to diabetes. But compared with placebo, aripiprazole was no more likely to produce increased fat in these patients and had no effect on blood sugar, insulin or lipids.”


Lenze proposes further research be conducted to determine the specific factors that result in a medication not working.

The findings were published in The Lancet.


Author Bio

Emily Lunardo studied medical sociology at York University with a strong focus on the social determinants of health and mental illness. She is a registered Zumba instructor, as well as a Canfit Pro trainer, who teaches fitness classes on a weekly basis. Emily practices healthy habits in her own life as well as helps others with their own personal health goals. Emily joined Bel Marra Health as a health writer in 2013.


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