Pharmacological treatment of depression in older primary care patients: the PROSPECT algorithm

Pharmacological treatment of depression in older primary care patients: the PROSPECT algorithm PROSPECT (Prevention of Suicide in Primary care Elderly–Collaborative Trial) is testing whether a trained clinician (the ‘health specialist’) can work in close collaboration with a primary care physician to implement a comprehensive depression management program and improve outcomes in older depressed patients. An algorithm guiding the selection and use of antidepressant medications has been developed to assist PROSPECT health specialists. This algorithm is presented and the rationale underlying the proposed treatment sequence is discussed. The PROSPECT algorithm builds upon existing guidelines after updating them and adapting them to the special circumstances of older primary care patients. Special attention has been paid to the tolerability and the target doses of the recommended antidepressant agents and to the duration of antidepressant trials. Patients who are unable to tolerate or do not respond to an antidepressant can be switched to another agent or be treated with interpersonal psychotherapy. Agents that produce only a partial response can be combined with other antidepressants or with interpersonal psychotherapy. Treatments for which empirical evidence exists are favored. However, treatments that are often poorly tolerated by elderly patients are given lower priority than treatments more likely to be tolerated. Similarly, trials that are simpler to implement in primary care are favored. Copyright © 2001 John Wiley & Sons, Ltd. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Geriatric Psychiatry Wiley

Pharmacological treatment of depression in older primary care patients: the PROSPECT algorithm

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Publisher
Wiley
Copyright
Copyright © 2001 John Wiley & Sons, Ltd.
ISSN
0885-6230
eISSN
1099-1166
D.O.I.
10.1002/gps.465
Publisher site
See Article on Publisher Site

Abstract

PROSPECT (Prevention of Suicide in Primary care Elderly–Collaborative Trial) is testing whether a trained clinician (the ‘health specialist’) can work in close collaboration with a primary care physician to implement a comprehensive depression management program and improve outcomes in older depressed patients. An algorithm guiding the selection and use of antidepressant medications has been developed to assist PROSPECT health specialists. This algorithm is presented and the rationale underlying the proposed treatment sequence is discussed. The PROSPECT algorithm builds upon existing guidelines after updating them and adapting them to the special circumstances of older primary care patients. Special attention has been paid to the tolerability and the target doses of the recommended antidepressant agents and to the duration of antidepressant trials. Patients who are unable to tolerate or do not respond to an antidepressant can be switched to another agent or be treated with interpersonal psychotherapy. Agents that produce only a partial response can be combined with other antidepressants or with interpersonal psychotherapy. Treatments for which empirical evidence exists are favored. However, treatments that are often poorly tolerated by elderly patients are given lower priority than treatments more likely to be tolerated. Similarly, trials that are simpler to implement in primary care are favored. Copyright © 2001 John Wiley & Sons, Ltd.

Journal

International Journal of Geriatric PsychiatryWiley

Published: Jun 1, 2001

References

  • Treatment‐resistant depression in the elderly
    Bonner, Bonner; Howard, Howard
  • The additional benefit of extending an antidepressant trial past seven weeks in the depressed elderly
    Georgotas, Georgotas; McCue, McCue
  • Comparison of the tolerability and efficacy of citalopram and amitriptyline in elderly depressed patients treated in general practice
    Kyle, Kyle; Petersen, Petersen; Overo, Overo
  • Comorbid anxiety disorders in late‐life depression
    Mulsant, Mulsant; Reynolds, Reynolds; Shear, Shear; Sweet, Sweet; Miller, Miller
  • Managing late‐life depression in primary care practice: a case study of the health specialist's role
    Schulberg, Schulberg; Bryce, Bryce; Reynolds, Reynolds
  • Treatment of major depression with psychotherapy or psychotherapy–pharmacotherapy combinations
    Thase, Thase; Greenhouse, Greenhouse; Frank, Frank

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