Tuesday, August 18, 2015

Black, White Seniors With Depression Respond Similarly to Venlafaxine

Despite greater comorbidity and less prior exposure to antidepressant treatment and psychotherapy, older African Americans appear to be no more likely to discontinue venlafaxine treatment and experience a rate of remission from depression that is comparable to white seniors, according to a study appearing online in Psychiatric Services in Advance.

The results suggest that with appropriate pharmacotherapy embedded in good supportive care it is possible to mitigate the well-established disparity in antidepressant outcomes between older black and white adults, according to the study authors.

Researchers from several institutions analyzed data from the initial phase of a NIMH-sponsored multicenter trial (Pittsburgh, St. Louis, and Toronto) called “Incomplete Response in Late-Life Depression: Getting to Remission” (IRL-GREY). In the initial phase of IRL-GREY, a total of 47 black and 412 white adults aged 60 or older were treated with open-label venlafaxine extended-release for 12 to 14 weeks.

Venlafaxine extended-release was initiated at 37.5 mg per day and titrated to a target dose of 150 mg per day. At the end of week six, non-remitters had their dose increased further to a target dose of up to 300 mg per day. Throughout the study, pharmacotherapy was embedded in a model of depression care management including supportive clinical care focusing on psychoeducation about depression and its treatment, depressive symptoms, suicidal ideation, countermeasures for medication adverse effects, and treatment adherence.

Baseline depression severity, depression duration, age at onset, and recurrence history did not differ between groups; however, black participants had greater baseline general medical comorbidity, worse physical health–related quality of life, and poorer cognitive function compared with white participants. White participants were also more likely to have received an adequate trial of antidepressant and psychotherapy before study entry.

Despite the differences between the two groups, the study authors found that black and white participants had similar final doses of venlafaxine and similar rates of attrition and remission.

“Our findings suggest that with adequate treatment it is possible to mitigate the disparity in antidepressant outcomes between older black and white adults,” the researchers stated. “With appropriate pharmacotherapy embedded in good supportive care, black and white older adults with major depressive disorder can do equally well.”

For related information, see the Psychiatric News article “No Racial Differences Found in Effectiveness of Psychotherapy for Depression.”

(Image: Sophie Louise Davis/Shutterstock.com)


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