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Association of Antidepressants and Other Medications with Mortality in the Residential-Care Elderly

Department of Psychiatry, University of Pennsylvania, Philadelphia Geriatric Center (Drs. Katz and Parmelee), and from the Medical College of Pennsylvania (Drs. Beaston-Wimmer and Smith), Philadelphia, Pennsylvania.

Patricia A. Parmelee, PhD

Department of Psychiatry, University of Pennsylvania, Philadelphia Geriatric Center (Drs. Katz and Parmelee), and from the Medical College of Pennsylvania (Drs. Beaston-Wimmer and Smith), Philadelphia, Pennsylvania.

Patricia Beaston-Wimmer, PhD

Department of Psychiatry, University of Pennsylvania, Philadelphia Geriatric Center (Drs. Katz and Parmelee), and from the Medical College of Pennsylvania (Drs. Beaston-Wimmer and Smith), Philadelphia, Pennsylvania.

Buster D. Smith, MD

Department of Psychiatry, University of Pennsylvania, Philadelphia Geriatric Center (Drs. Katz and Parmelee), and from the Medical College of Pennsylvania (Drs. Beaston-Wimmer and Smith), Philadelphia, Pennsylvania.

To explore the extent to which treatment of depression affects survival, we evaluated the association between use of antidepressant medications and death rates among the residents of a large residential-care facility for the elderly using a retrospective record-review study (N=624). One year survival, among those taking antidepressants (10.9%), was 11.8% compared to 11.1% among the remainder of the population. A second study followed a group of 32 patients in the same institution who had participated in a therapeutic trial of nortriptyline treatment for major depression. Patients who experienced adverse medical events during treatment exhibited significantly increased mortality; among treatment completers, there was no significant relationship between mortality and therapeutic response. These findings suggest that the inability to tolerate treatment with an antidepressant can be considered a manifestation of physiologic frailty and increased vulnerability to mortality from disease. The previously reported decrease in survival among residential-care patients with major depression is not paralleled by a similar effect in those taking antidepressants. This may reflect selection factors with respect to the ability to tolerate antidepressants, rather an effect of treatment.

Journal of Geriatric Psychiatry and Neurology, Vol. 7, No. 4, 221-226 (1994)
DOI: 10.1177/089198879400700405


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