Discrimination of recovery in the treatment of elderly patients with recurrent major depression: Limits of prediction


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The aim of this work was to determine: (1) the temporal course of recovery in elderly patients with recurrent major nonpsychotic depression treated with combined pharmacotherapy and psychotherapy; (2) the point at which recovering patients can be reliably distinguished from those who will not recover; and (3) the limits of accuracy in predicting recovery. The study group consisted of 101 elderly patients: 82 recovered, 19 no recovered. The method used was random regression and discriminant junction analyses. Reliable and persistent differences between recovering and no recovering elderly patients in Hamilton depression ratings were detected by week 4 of treatment in a random regression model. Discrimination of final outcome, using Hamilton ratings, current age, episode duration, and personality pathology score (derived from the Personality Assessment Form) increased greatly between weeks 4 and 5 of treatment, reaching a ceiling of 75-80%. The ability to predict eventual treatment outcome for major depressive episodes in late life rests upon changes in clinical condition during the first 4 to 5 weeks of treatment. Under highly standardized treatment conditions, 75-80% of patients can be reliably discriminated during early treatment with respect to eventual treatment outcome. Depression 2:218–222 (1994/1995). © 1995 Wiley-Liss, Inc.
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