Citation

Paille F, Maheut-Bosser A, Hanesse B. NPG Neurologie - Psychiatrie - Geriatrie 2004; 4(21): 9-34.

Copyright

(Copyright © 2004)

DOI

10.1016/S1627-4830(04)97940-8

PMID

unavailable

Abstract

Depression in the elderly is a frequent pathology which poses various diagnostic problems. Its treatment is based on antidepressant drugs and psychotherapies. Many arguments are in favour of the efficacy of antidepressants based on clinical trials, epidemiologic data or clinical experience, but their real efficacy is still a matter of debate. Specific problems are posed by the prescription of these drugs to failed elderly who often have many other diseases. This article synthesizes published scientific data: clinical trials, meta-analyses, systematic reviews or consensus. It tries to answer to different questions:-Are antidepressants more effective than placebo in older people to treat major depressive disorders, minor depressive disorders or dysthymia?-Is there any difference between the various classes of antidepressants or between the different molecules within the same class?-Are these drugs effective on symptoms other than depressive symptoms: suicide, quality of life, cognitive functions...?-Are there differences in the tolerance of the different drugs?-What are the optimal posology and duration of acute treatment? What are the optimal posology and duration of maintenance treatment?-What attitude should be adopted in the case of resistance to treatment?-Are there prognostic factors of the response to treatment? Data synthesis of these different topics shows that a lot of studies have been published, but very few concern very old failed patients. Thus few data are useful to guide practitioners in practice. Other studies are needed taking into account specificities of older people to allow an optimal use of the available treatments. © 2004 Elsevier Masson SAS. All rights reserved.

Language: fr

Keywords

Depression; elderly; meta-analysis; antidepressants; placebo; clinical trials; consensus