Fluoxetine treatment of dysthymia in the elderly

Background: Despite their prevalence, little is known about the treatment of mild depressive syndromes in older patients. The purpose of this study was to evaluate the efficacy of fluoxetine in dysthymic disorder in the elderly. Method: Twenty-three elderly outpatients with dysthymic disorder (DSM-III-R criteria) entered a 13-week study of fluoxetine (2-week placebo run-in period and 11 weeks of fluoxetine treatment with a dose range of 20- 60 mg/day). Ratings to assess clinical response included the Hamilton Rating Scale for Depression (HAM-D), the Clinic Global Impression (CGI), and the Cornell Dysthymia Rating Scale (CDRS). Results: Nine patients (39%) had never received psychiatric treatment during the index episode, despite a long duration of illness (mean ± SD = 18.5 ± 17.1 years). Twenty of the 23 patients completed the entire study. The mean ± SD HAM-D (24-item) score decreased from 14.6 ± 3.7 to 7.9 ± 5.0 during the trial, and the CDRS score decreased from 28.1 ± 9.1 to 15.7 ± 10.0. When response criteria of a 50% reduction from baseline in the HAM-D score, final HAM-D score ≤ 8, and a CGI score of 1 or 2 (very much or much improved) were used, 12 (60%) of the completers were responders. Side effects were uncommon, and the fluoxetine was generally well tolerated. Conclusion: These preliminary findings suggest that fluoxetine is an effective treatment in elderly patients with dysthymic disorder. Double-blind, placebo-controlled studies are warranted.