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 老年性抑郁症，即：(A)是慢性抗抑郁药预防 (超过20周)对于康复的老年患者是必要的 急性抑郁发作？(B)进行慢性三环维持 治疗能降低老年抑郁症的复发率吗？(C)Li+ 维持治疗能降低老年抑郁症的复发率吗？ (D)慢性Li+的医学和神经心理后遗症是什么？ 老年人的预防措施？(E)同时出现的医疗状况及 药物会干扰抗抑郁剂的疗效 正在研究的战略？ 所有60岁以上的患者都将得到广泛的医疗服务， 神经学、实验室、神经心理学和心理诊断学 评估。符合重度抑郁症诊断标准的患者 将以三环去甲替林的标准方式治疗 (新界)。在经过20周的稳定期后，仅NT一人就已经 已实现，对治疗有反应并被视为 然后，缓解率将随机接受1)渐进式安慰剂 停止NT，2)单独维护NT或3)维护Li+。 然后，每组患者将接受为期两年的随访，并 监测他们抑郁障碍的复发情况。此外, 长期服用锂可能产生的副作用 去甲替林将通过定期评估 血清水平、临床状态、自我报告的主诉(以 副作用清单)，以及神经心理功能。一次尝试 将被用来确定哪些副作用最普遍，最 很麻烦，而且最有可能导致不遵守规定。 这项研究的第二部分将评估预防效果 NT或Li+对接受ECT治疗的复发性抑郁症患者的影响 药物抵抗型抑郁症。如果患者有，他们将被提供ECT 用治疗性血清水平治疗4周后对NT无反应。二十 在ECT完成且患者情况稳定的几周后，患者将 然后随机分配到如上所述的维持治疗组。 然后，患者将被跟踪，类似于决赛中的患者 研究的组成部分。综上所述， 这项研究是为了检验特定抗抑郁剂的疗效。 降低抑郁症复发率的策略和探索 这些治疗在老年患者中可能相关的副作用 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.