New Study Seeks to Determine if Most Depressed Seniors Could Benefit from Prozac
November 03, 1998
The first-ever study to determine whether the antidepressant Prozac relieves a mild form of depression often experienced by older people, is being conducted by researchers at the University of Rochester Medical Center.
More than one in five people over the age of 60 - more than 18,000 in Monroe County alone - suffer from some form of depression. About a quarter of these people suffer from a well-understood condition known as major depression, for which physicians commonly prescribe antidepressants such as Prozac. However, many more older people suffer from milder forms of depression known as "subsyndromal" or "minor" depression. Almost half of older patients suffering minor or subsyndromal forms of depression are prescribed antidepressants even though there has never been a study to determine if such prescriptions work for this group.
"It's entirely possible that there are different mechanisms causing the two types of depression," said Jeffrey M. Lyness, M.D., Director of the Laboratory of Depression and Medical Comorbidity in the Program in Geriatrics and Neuropsychiatry at the University of Rochester. "The situation is like getting a flu shot to prevent catching a cold. It won't work. A cold is not a weaker form of the flu; it's an entirely different affliction requiring a different treatment."
To diagnose a patient's depression, doctors consider the patient's symptoms: A patient must have a minimum of five symptoms such as depressed mood, decreased interests or ability to enjoy activities, feelings of guilt, hopelessness, thoughts that life is not worth living, trouble concentrating, or a change in sleep, appetite, or weight. These symptoms must be present for most of the day, nearly every day, for two consecutive weeks or longer to be symptomatic of major depression. Those (delete "people") people who show some – but not all – of these symptoms, are considered as having either minor depression or subsyndromal depression.
"Doctors don't have a rule book to go by for this," said Lyness. "Maybe an older woman has a low sense of self-worth -- but mostly in the mornings. That may not qualify as major depression, but the woman is suffering. We need to better understand what treatments work best to help her."
The elderly are especially susceptible to the effects of depression. Lyness' earlier studies with patients in the Rochester area have shown that older patients with minor or subsyndromal depression are more often physically ill, and have more difficulty performing day-to-day tasks such as shopping, doing laundry, dressing, or preparing their meals.
The study will be held at the University of Rochester Medical Center and will evaluate the progress of 50 elderly patients, half of whom will receive pills containing Prozac, and half of whom will receive a placebo. Patients will be evaluated by interviews with study staff. They also will receive a free physical examination upon entering the trial. Then, once a week for the next 12 weeks they will meet with study staff either in their own home, or in the study offices at the Medical Center, so Lyness and his colleagues can learn if their depressive symptoms are improving. Medications are free to study participants, and patients are paid for their participation. Lyness believes that when the study is completed in late 1999, its results will shed light on more effective treatments for those suffering from these conditions.
Patients who believe they may be eligible for this study and are interested in participating should talk with their own physician. Physicians who have patients they would like to refer to the study can call Dr. Lyness' research office at the University of Rochester Medical Center at 275-2217.