Treatment Optimization of Depression in Elderly Patients in a Psychiatric Hospital

Abstract

Objective: Development of methods for increasing the effectiveness of antidepressant therapy in a gerontopsychiatric hospital by including drugs with neuro-metabolic and neuroprotective
properties in the treatment regimen of elderly patients with depressive disorders.
Material and methods: 152 elderly in-patients (60 years and older) with different forms of depressive episodes in according to ICD-10 were treated with two types of antidepressant therapy
for 56 days. The first group of patients (44 patients) received monotherapy by one of the new generation antidepressants (fluvoxamine, venlafaxine or agomelatine) The second group of 108
patients received complex therapy with one of the same antidepressants in combination with one of the neuroprotective drugs (cerebrolysin, carnitine, citicoline, ethylmethylhydroxypyridine
succinate or actovegin). The efficacy of therapy was assessed using standardized scales of HAMD-17, HARS, CGI-S and CGI-I; the level of cognitive activity is on the MMSE scale, a 10-
word memorization test and a mute clock drawing test.
Results: The rate of therapeutic response and the overall effectiveness were significantly higher in elderly depressive patients with complex therapy. In this group, the proportion of responders
by the 28th day of therapy was 2 times higher (81.5 % versus 40.5 % with p < 0.0001) than in the group with monotherapy. By the end of treatment in the group with complex therapy,
the change in the average total score HAMD-17 was 76.3 % in comparison with 63.1% (p < 0.0001) in the group with monotherapy, and the share of complete remissions was 76.6% and
34.2 % respectively (p < 0.0001). In patients with complex therapy, there was also a faster improvement in cognitive functioning.
Conclusions: A new method of complex antidepressant therapy in combination with neuroprotective drugs allows achieving a faster and fuller therapeutic response and shortening
hospitalization of patients with late-life depressive.