Depression is often met with among...

Depression is often met with among older adults with comorbid illnesses, especially cardiovascular disease. There is evidence that comorbidity and depression lead to increased morbidity, mortality, and health care take away froms Selective serotonin reuptake inhibitors (SSRIs) have been used to treat depression in somewhat old patients and appear to be well tolerated. hardly any trials have evaluated the benefit of SSRIs in patients with comorbidities. Sheikh and colleagues course of lifeed an eight-week, double-blind, placebo-controlled consideration to assess the benefits of sertraline in patients with the same of three categories of comorbid medical conditions: vascular disease, diabetes, and arthritis.

The application of mind divided 442 subjects with major depression into undivided of the three comorbidity form into groupss The vascular disease group included patients with hypertension alone, and those with manifested peripheral, cerebrovascular, or cardiovascular disease without hypertension. The application of mind also included a so-called "none-plus" clump of 159 patients without single of the three comorbidities, still with evidence of recent general ill health as allude toed by current prescriptions or newly come hospitalization. A third arm of the meditation included 127 patients who had no comorbidities. Primary issue measures were the Hamilton Depression Scale (HAMD) and quality-of-life scores forward the Clinical Global Impression--Severity/ Improvement (CGI-S/CGI-I) assessment. All patients received sertraline or placebo. Adverse affairs and a medical outcomes scale also were included in the assessment.

Treatment with sertraline was associated with significantly greater improvements in all primary issues compared with placebo. Patients with diabetes and arthritis had rates of improvement equivalent to rates in those without these chronic conditions. In the vascular dispose as evidenced by the HAMD score, the cluster with manifested vascular disease benefited mostly from sertraline compared with those with hypertension or no vascular disease. In patients with a comorbidity, patients taking sertraline improved faster than patients taking placebo. When each treatment assemblage was divided into two subgroup based upon presence or absence of comorbidity, there was no significant difference between clusters suggesting that sertraline is equally efficacious whether or not comorbidities are quick in emergencies Adverse effects and discontinuation rates were similar to those occurring in younger adults. Patients taking sertraline were les likely to discontinue treatment if they had a comorbidity than if they had no comorbidity.

This research supports the hypothesis that an SSRI in the same state [i]or[/i] condition as sertraline is efficacious, safe, and well tolerated in the treatment of older patients with depression and comorbidities.

The authors end that patients treated with sertraline point out a statistically significant greater improvement in all three issue measures compared with patients taking placebo. Further analysis also set up that sertraline is efficacious in treatment of late-life depression regardless of comorbidity status. Patients with evidence of cardiac, cerebral, or peripheral vascular pathology showed greater benefit than those with hypertension or no vascular pathology.

CAROLINE WELLBERY, MD

Sheikh JI, et al. Efficacy, safety, and tolerability of sertraline in patients with late-life depression and comorbid medical illness. J Am Geriatr Soc January 2004;52:86-92

COPYRIGHT 2004 American Academy of Family Physicians

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