Depression: Two-Drug Combination Helps Seniors

A two-drug combination may be helpful in treating seniors with difficult depression. The findings are published in The Lancet.

Researchers at the University of Washington examined 468 people over 60 diagnosed with depression. Findings revealed that adding a low dose of the antipsychotic drug aripiprazole (brand name Abilify) helped to relieve symptoms of depression when an antidepressant wasn't effective by itself.

"This is a rare study because it looks at depression specifically in older adults," says Dr. Benoit Mulsant, a co-author of the study and Senior Scientist at CAMH, in a news release. "It's important to treat older adults effectively, especially given that adults with late-life depression are at an increased risk of developing dementia. Our research demonstrates that older adults respond to treatment for depression."

During the study, each participant received an extended-release formulation of the antidepressant drug venlafaxine (brand name Effexor XR) for 12 weeks. About half of these patients still were clinically depressed after 12 weeks of treatment.

During the second phase of the study, patients who did not initially respond to venlafaxine continued receiving the drug along with either aripiprazole (an antipsychotic that's oftentimes prescribed to treat schizophrenia or manic episodes linked to bipolar disorder) or a placebo.

The two-drug combination led to a remission of depression in 44 per cent of the treatment-resistant patients, compared to only 29 per cent of those who had received the placebo.

"This study is a major advance in support of evidence-based care for older adults with depression," said Dr. Charles F. Reynolds, a co-author of the study and the UMPC Endowed Professor in Geriatric Psychiatry at the University of Pittsburgh. "By publishing our findings inThe 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."

Though some side-effects were linked to taking the medications, including weight gain and metabolic issues (typically linked to antipsychotic medications) aripirazole showed no more effects than the placebo in producing increased fat in these patients, including no extra effects on blood sugar, insulin or lipids.

However, with future studies, researchers hope to predict exactly which types of older patients with depression are more likely to benefit from the two-drug combination.

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