LONG-TERM ANTIDEPRESSANT USE: AFFECTIVE/COGNITIVE EFFECT

这项研究将试图解决几个关键领域的治疗 老年抑郁症，即：（a）是慢性抗抑郁药预防 （超过20周）在已从以下疾病中恢复的老年患者中是必要的 急性抑郁发作 (b)长期三环维持 治疗降低老年抑郁症复发率？ (c)Li+是否 维持治疗降低老年抑郁症复发率？ (d)慢性Li+的医学和神经心理后遗症是什么 老年人预防？ (e)有哪些并发的疾病和 药物干扰抗抑郁药的有效性 研究中的战略？ 所有60岁以上的病人都将接受广泛的医疗， 神经学、实验室、神经心理学和心理诊断学 评价。 符合重度抑郁症诊断标准的患者 将以标准方式用三环去甲替林治疗 （NT）. 经过20周的稳定期后， 达到，患者对治疗有反应，并被认为是在 然后将缓解的患者随机接受1）安慰剂， 停止NT，2）单独维持NT或3）维持Li+。 每组患者将接受为期两年的随访， 监测他们抑郁症的复发。 此外，本发明还提供了一种方法， 与长期使用锂有关的可能副作用 去甲替林将通过定期评估 血清水平、临床状态、自我报告的投诉（通过 副作用检查表）和神经心理功能。 试图 将确定哪些副作用最普遍， 很麻烦，而且很可能导致不遵守。 本研究的第二部分将评估以下药物的预防作用： NT或Li+对接受ECT治疗的患者复发性抑郁症的影响 抗药性抑郁症 如果患者有以下情况， 在治疗血清水平下，4周后对NT无反应。 二十 在ECT完成且患者病情稳定后，患者将 然后随机分配到上述维持治疗组。 然后，患者将接受与最终研究中患者相似的随访。 研究的组成部分。 总的来说， 这项研究是为了检测特定抗抑郁药的疗效， 降低抑郁症复发率的策略，并探讨 这些治疗在老年人中可能的相关副作用 人口

This study will attempt to address several critical areas in treatment of geriatric depression, namely: (a) Is chronic antidepressant prophylaxis (beyond 20 weeks) necessary in geriatric patients who have recovered from an acute depressive episode? (b) Does chronic tricyclic maintenance therapy decrease recurrence rates in geriatric depression? (c) Does Li+ maintenance therapy decrease recurrence rates of depression in the elderly? (d) What are the medical and neuropsychological sequelae of chronic Li+ prophylaxis in the elderly? (e) What concurrent medical conditions and medications interfere with the effectiveness of the antidepressant strategies under study? All patients over the age of 60 will be given extensive medical, neurological, laboratory, neuropsychological and psychodiagnostic evaluations. Patients meeting diagnostic criteria for major depression will be treated in a standard fashion with the tricyclic nortriptyline (NT). After a stabilization period of 20 weeks on NT alone has been achieved, patients who have responded to treatment and are considered in remission will then be randomized to receive 1) placebo with gradual discontinuation of NT, 2) maintenance NT alone or 3) maintenance Li+. Patients in each group will then be followed for a period of two years and monitored for recurrence of their depressive disorder. In addition, possible side-effects associated with long-term use of lithium on nortriptyline will be closely monitored through periodic assessments of serum levels, clinical status, self-reported complaints (as measured by a side-effects checklist), and neuropsychological functioning. An attempt will be made to determine which side effects are most prevalent, most bothersome, and most likely to lead to non-compliance. A second component of the study will evaluate the prophylactic effects of NT or Li+ on recurrent depression in patients who have received ECT for medication resistant depression. Patients will be offered ECT if they have not responded to NT after 4 weeks with a therapeutic serum level. Twenty weeks after ECT has been completed and patients are stable, patients will then be randomly assigned to maintenance therapy groups as outlined above. Patients will then be followed similarly to the patients in the final component of the study. To summarize, the overall long-term objectives of this study are to examine the efficacy of particular antidepressant strategies in minimizing recurrence rates of depression and to explore possible associated side-effects of these treatments in a geriatric population.