Objective: Depression in the elderly is a common problem and most of the sufferers remain untreated. Antidepressant pharmacotheraphy in late life depresion is different than in young adults. There is known a little data about reversible MAO-inhibitor moclobemide in late life depression. To research safety and effectiveness of moclobemide in treatment depressed geriatric patients, and also its effectiviness on comorbid anxiety symptoms, this study was carried.
Design: Prospective open-label study.
Materials and Methods: It was conducted in the Geropsychiatry Unit of Istanbul University, Istanbul Medical School. 16 patients older than 60 years diagnosed with Major depressive disorder (DSM IV criteria , APA, 1994) were enrolled. During the study patients were treated with moclobemide 150 mg-450mg, twice daily, depending on the patients response and tolerance. If necessary, the moclobemide dose was incresed to 600 mg. Efficacy was assessed with the with Geriatric Depression Scale(GDS), Hamilton Rating Scale for Depression (HRSD), Clinical Global Impressions-severity (CGI-S) saceles. Beck Anxiety Inventory (BAI) was also used in assesment of anxiety. Patients were monitored every two weeks in 8 weeks, after that every 4 weeks for 24 weeks. At the end of the eighth week of active treatment, subjects who had total HDRS, GDS score reduction > 50 %, were considered responders. The frequency and type of the side effects were recorded. Statistical analyses were performed in the intent-to-treat population.
Results: The mean age was 68.06(SD+6.25) years (range, 60-80). 14 of 16 patients were female ( 87.5%). 13 patients had more than one comorbid physical illness. All of them had first depressed episode after 60 years old. 6 patients met dystimic disorder also. Within the second week, 2 patients were dropped out because of these side effects: hypertension and headache. At the eighth week, 2 patients were assessed as non-responder and they were excluded from the study. During the study, 50% of patients had experienced side effects. The most frequent side-effects were hedache(n=4), insomnia (n=3), somnolence (n=3), dizziness (n=2). GDS and HRSD, CGI-Scores were beginning to decrease at 4 weeks of treatment and significant at 8 weeks moclobemide treatment. Mean GDS scores decreased significantly from 18.62 (+4.2) to 7.41 (+ 2.0) at the end of 8 week , and HRSD scores decreased from 22.06 (+6.2) to 9.69 (+ 2.8). Mean CGI-I scores decreased from 4.22+1.0 to 1.84+0.4 at week 8 (p<0.05) Mean BAI scores decreased 15.37+9.3 to 6.76+2.6. Responders were finished 24 week follow-up period. Same dosage administered and no relapse was observed. Moclobemide was titrated slowly and well-tolarated. 2 patients were dropped out and 2 patients were non-respondent. Non-respondents had dysthymic disorders also.
Conclusion: Older patients can be treated with moclobemide as safely and effective as other antidepressants with slow titration and monitorisation for side effects carefully.
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