Programme no. 466-P
Efficacy of SSRIs for acute major depression in the elderly
Sven Frederick Østerhus*1, Annette Sofie Davidsen2
1Department of General Medicine,University of Copenhagen,Copenhagen,Denmark, 2Department of General Medicine,University of Copenhagen,Copenhagen,Denmark
* = Presenting author
Objectives: The aim of the article was to assess the evidence of the effect of SSRIs for major depression in the elderly.
Background: Antidepressants are commonly prescribed to the elderly, who unfortunately often have a greater risk of side-effects, including sudden cardiac death.
Three systematic reviews and meta-analyses were found eligible for inclusion. The results varied. Two studies found a statistically significant difference in favour of SSRIs for remission (OR 0.52 and 1.24, NNT 8.9 and 21.2, respectively), and one study a statistically significant difference for response (OR 1.36 and 1.61, NNT 12.4 and 8.3, respectively). One study found no difference for either remission nor response.
Regarding continuous measures, two of the included studies provided a mean change in HAMD-score of 1.2 and 1.37 points respectively, favouring SSRIs compared to placebo, although the analysis in one of the studies was not restricted to major depression. One study found no effect in a quality-of–life analysis using SF-36.
PubMED, EMBASE, PsychINFO and the Cochrane Library were searched for systematic reviews and meta-analyses investigating the effect of antidepressants in elderly with major depression. To avoid publication bias, the reviews had to include unpublished studies.
The results of the included studies were stratified and discussed.
Conclusion: The effect of antidepressants in elderly with major depression, although statistically significant, remains clinically questionable. Considering the greater prevalence of side effects, the risk-benefit ratio for antidepressants in the elderly is dubiously advantageous.
Points for discussion:
1. Are antidepressants being prescribed to frequently to the elderly?
2. What are the causes of depressive symptoms in the elderly?
3. What alternatives to antidepressants can we as general practitioners offer to the elderly?