Objective: To critically review modern antidepressant treatment trials in the elderly.
Design: In samples of late-life depressives, literature and abstract review identified five prospective double-blind, placebo-controlled studies of an antidepressant and five head-to-head comparisons of antidepressants that employed routinely prescribed agents. Applicable studies were carefully evaluated according to study design, outcome measures, data analysis/significance testing, and conclusions drawn. Each study will be discretely described.
Materials and Methods: Literature review was conducted via Medline. Relevant studies presented in meetings were included. Where a published abstract of the study was not available, the senior author/presenter was contacted.
Results: Against the context of the above study evaluation parameters, questions consistently emerged that challenged both statistical significance and results interpretations. These included methodological issues such as analyses conducted on completers, not intent-to-treat subjects; lack of categorical responder data; lack of statistical significance; and wide confidence intervals suggesting inconclusive results.
Conclusion: Taken together, this critical review suggests methodological inconsistencies from study-to-study; and less-than-compelling evidence documenting the proven efficacy of these agents in the treatment of depression in the elderly. As such, this effort supports the need for aditional antidepressant treatment trials in the burgeoning population of older adults.
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