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Use of Adjunctive Therapy in Older Depressed Adults Who are Resistant to Antidepressant Treatment 

Use of Adjunctive Therapy in Older Depressed Adults Who are Resistant to Antidepressant Treatment
Chapter:
Use of Adjunctive Therapy in Older Depressed Adults Who are Resistant to Antidepressant Treatment
Author(s):

J. Craig Nelson

DOI:
10.1093/med/9780199796816.003.0021
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date: 22 February 2020

While antidepressants are effective in late life depression, similar to younger patients, a minority of older adults achieve remission with initial treatment. In the 10 placebo controlled trials of second generation antidepressants in older adults, the remission rate was 32.6%. As a consequence adjunctive treatments (addition of a drug not approved for use in depression) or combination treatments (use of two approved antidepressants) are frequently employed, especially in partial responders or to target specific residual symptoms. This chapter reviews the evidence for the efficacy of adjunctive and combination treatments in late life depression. Limited evidence suggests that with 3 to 4 sequential trials, a substantial percentage of older depressed adults will achieve remission.

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