***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A multi-centre general practice study was carried out to compare flupenthixol and a sustained-release preparation of amitriptyline in the primary care treatment of depression in the elderly . Fifty-one clinical ly depressed patients , aged 65 years or over , were allocated at r and om to one of the two treatment groups in this 4-week double-blind , double-dummy study . On entry , patients received either a 0.5 mg flupenthixol tablet in the morning and a placebo capsule at night ( 25 patients ) or a 25 mg sustained-release amitriptyline capsule at night and a placebo tablet in the morning ( 26 patients ) , but at the end of the first or second weeks the dosage could be doubled according to the assessed clinical need . Fourteen patients in each treatment group had their dosages doubled . Patient assessment was undertaken on study entry and after 1 , 2 and 4 weeks of treatment using a 0 to 3 scale global assessment and the Montgomery Asberg Depression Rating Scale ; side-effects were recorded on the UKU Scale . After 4-weeks ' treatment , over 80 % of patients in each group had improved and in the flupenthixol group there was additionally a noticeable and highly significant reduction in symptom severity after only 1 week of treatment . Patients treated with flupenthixol had fewer and milder side-effects BACKGROUND The highly recurrent nature of major depression in the young and the elderly warrants long-term antidepressant treatment . AIMS To compare the prophylactic efficacy of citalopram and placebo in elderly patients ; to evaluate long-term tolerability of citalopram . METHOD Out- patients , > or = 65 years , with unipolar major depression ( DSM-IV : 296.2 x or 296.3 x ) and Montgomery-Asberg Depression Rating Scale score > or = 22 were treated with citalopram 20 - 40 mg for 8 weeks . Responders continued on their final fixed dose of citalopram for 16 weeks before r and omisation to double-blind treatment with citalopram or placebo for at least 48 weeks . RESULTS Nineteen of the 60 patients using citalopram  v. 41 of the 61 patients using placebo  had recurrence . Time to recurrence was significantly different between citalopram- and placebo- patients , in favour of citalopram ( log-rank test , P<0.0001 ) . Long-term treatment was well tolerated . CONCLUSIONS Long-term treatment with citalopram is effective in preventing recurrence of depression in the elderly and is well tolerated The authors conducted a r and omized , double-blind , 10-week clinical trial of two doses of nortriptyline in eight nursing homes . Sixty-nine patients , average age 79.5 years , were r and omized to receive regular doses ( 60 mg-80 mg/day ) vs. low doses ( 10 mg-13 mg/day ) of nortriptyline . Among the more cognitively intact patients , there was a significant quadratic relationship defining a " therapeutic window " for  nortriptyline plasma levels and clinical improvement . There were also significant differences in plasma level-response relationships between depressed patients who were cognitively impaired and those who were more cognitively intact . Depression remains a syndrome that responds to specific treatment , even in frail nursing home patients , and those depressions that occur in patients with significant dementia may represent a treatment-relevant condition with a different plasma level-response relationship than in depression alone Abstract 5′-Methyltetrahydrofolic acid ( 5′- MTHF ) in addition to st and ard psychotropic medication significantly improved clinical recovery in depressed patients with borderline or definite folate deficiency , and significantly reduced depressive symptoms in elderly normofolatemic patients after 3 weeks of treatment . In this equivalence study the effect of 5′- MTHF on depressive symptoms and cognitive status was compared to Trazodone ( TRZ ) in normofolatemic elderly patients with mild to moderate dementia and depression . Ninety-six patients with dementia , scoring 12–23 at the Mini Mental State Examination ( MMSE ) and ≥18 at the Hamilton Depression Rating Scale ( HDRS ) after a 2-week placebo run-in , were r and omized to receive either 5′-MTHF ( 50 mg/day p.o . ) ( 47 patients ) or TRZ ( 100 mg/day p.o . ) ( 49 patients ) in a double-blind design for 8 weeks . HDRS was assessed before , after 4 weeks and at the end of treatment ; Rey ’s Verbal Memory ( RVM ) test for immediate and delayed recall was evaluated before and after treatment . After 4 weeks of treatment HDRS score was reduced from 23±5 to 20±6 in the 5′-MTHF ( p<0.05 vs baseline ) , and from 23±3 to 21±4 in the TRZ group ( p<0.05 vs baseline ) . p]A further significant decrease to 18±6 and 19±5 respectively was obtained at the end of the treatment period ( p<0.05 vs week 4 ) with 5′-MTHF and TRZ . HDRS was administered again after a 4-week , drug-free , follow-up period : no change vs the post treatment scores was observed either in the 5′-MTHF or in the TRZ group ( 18±7 and 19±5 respectively ) . RVM test for immediate recall was significantly improved ( p<0.05 ) at week 8 vs baseline in the 5′-MTHF group whereas no significant change occurred in the TRZ group . No change in delayed recall was observed after treatment in either group . Tolerability was good for both treatments . This study shows that 5′-MTHF and TRZ are equally effective in improving depressive symptoms in patients with mild to moderate dementia and suggests that pharmacological doses of 5′-MTHF may exert psychotropic effects irrespective of folate status . ( Aging Clin . Exp . Res . 1 : 63–71 , 1993 Using data from a larger 12-week clinical trial , the authors evaluated the comparative efficacy and safety of sertraline  ( n=42 ) and fluoxetine  ( n=33 ) in patients over age 70 with a diagnosis of major depressive disorder . Similar improvement on measures of depression , including remission of depressive symptoms , was evident , although significantly more sertraline-treated patients achieved a criterion clinical response . Significantly greater improvement for the sertraline group was apparent on the Digit Symbol Substitution Test , but not on two other measures of cognitive functioning . Although there was no difference in the rate of adverse events experienced , fluoxetine-treated patients lost significantly more body weight over the 12-week trial than did sertraline-treated patients , whereas the latter group exhibited significantly more " shaking . BACKGROUND We examined the effect of high-dose selegiline in 16 treatment-resistant older depressive patients . We hypothesized that selegiline , at a dosage of 60 mg/d , would be at least partially effective but that the higher doses would not maintain the monoamine oxidase B selectivity observed with the lower doses of selegiline . METHODS Sixteen treatment-resistant subjects ( mean [ + /- SD ] age , 65.6 + /- 9.3 years ) entered a double-blind , r and omized , crossover study of placebo vs 3 weeks of selegiline at a dosage of 60 mg/d . Objective measures of mood and behavior were obtained in all subjects , and 10 of the subjects underwent repeated lumbar punctures for analysis of monoamine metabolites in the cerebrospinal fluid . RESULTS Objective measures of mood and behavior revealed significant improvement in the Hamilton Depression Rating Scale score ( 37.4 % decrease ) , the Global Depression score ( 22.7 % decrease ) , and the Brief Psychiatric Rating Scale score ( 19.3 % decrease ) ; subjective behavioral measures , however , did not show significant improvement during the 3-week medication trial . Cerebrospinal fluid values revealed a statistically significant drop in 3-methoxy-4-hydroxyphenylglycol ( 51 % ) and 5-hydroxyindoleacetic acid ( 17 % ) levels , and there was a significant lowering of systolic blood pressure on st and ing ( 15 % ) , but these changes were not accompanied by clinical side effects . CONCLUSIONS Our results suggest that high-dose selegiline can be an effective antidepressant in treatment-resistant older depressive patients . While the selegiline dose required has nonselective monoamine oxidase effects and thus would not be free of possible tyramine interactions , other advantages suggest that further investigations with selegiline are warranted in this population OBJECTIVE Authors studied the efficacy and tolerability of mirtazapine and paroxetine in elderly patients with major depression during an acute phase ( 8 weeks ) and an extension phase ( 16 weeks ) . METHODS Patients with major depression and without dementia , at least 65 years old , were eligible ; they were r and omized to mirtazapine or paroxetine once daily , with doses increasing over 42 days . Efficacy was assessed with the Ham-D and Clinical Global Impressions Scale , and tolerability was assessed from adverse events . RESULTS Of 255 patients r and omized , 126 on mirtazapine and 120 on paroxetine were included in the efficacy analysis . Differences favoring mirtazapine were observed for the mean change from baseline in Ham-D-17 score . Other significant differences were in the proportion of patients classified as responders ( 50 % decrease from baseline Ham-D-17 scores ) at Day 14 and in remission ( Ham-D-17 score of 7 or less ) at Day 42 . The median time to response was 26 days in the mirtazapine group and 40 days in the paroxetine group . The mirtazapine group also showed more reduction in Ham-D Factor I ( Anxiety/Somatization ) and Factor VI ( Sleep Disturbance ) scores . Efficacy of both drugs was maintained during the extension phase . Patients on paroxetine were more likely to discontinue therapy in the acute phase because of adverse events . CONCLUSION During the first weeks of treatment , antidepressant effects were more pronounced in the mirtazapine group , suggesting that mirtazapine has an earlier onset of action . Mirtazapine also demonstrated a better tolerability profile and represents a valuable option for the treatment of depression in elderly patients BACKGROUND Depression in older people is often unrecognised and untreated or under-treated . Antidepressant treatment may itself exacerbate a pre-existing illness , interact with concomitant medications or produce undesirable cognitive and sedative side effects . Newer antidepressants may offer advantages in terms of a lesser burden of adverse effects . METHODS The comparative tolerability of the unique selective noradrenaline reuptake inhibitor ( selective NRI ) reboxetine ( 4 - 6 mg/day ; n = 176 ) and that of imipramine ( 50 - 100 mg/day ; n = 171 ) was assessed in an elderly ( > 65 years ) cohort of depressed or dysthymic patients in an 8-week , double-blind , multicentre trial . Comparative efficacy was also assessed . RESULTS Overall , 68 % of patients in the reboxetine group experienced adverse events compared with 71 % in the imipramine group . Reboxetine-treated patients were less likely to develop hypotension and related symptoms ( 7 % vs. imipramine 16 % ) or cardiovascular disorders ( 12.5 % vs. imipramine 21.1 % ) , while those treated with imipramine were less likely to experience insomnia ( 6.3 % vs. 2.9 % ) . Adverse events were more often assessed as related to treatment ( 43 % ) and moderate to severe in intensity ( 73 % ) with imipramine than with reboxetine ( 33 % and 65 % , respectively ) . Furthermore , there were fewer serious adverse events in the reboxetine-treated group ( P = 0.019 ) . The reduction in the Hamilton Rating Scale for Depression ( HAM-D ) was comparable between the treatment groups in the total population . At the last assessment , the majority of patients in both treatment groups were assessed as normal to borderline or mildly ill using the Clinical Global Impression ( CGI ) scale . In a sub analysis of the dysthymic patients a modest but significant difference in favour of imipramine was observed for both HAM-D and CGI assessment s. This may have been a reflection of a trend towards more severe depressive symptoms at baseline in the reboxetine group . CONCLUSIONS Reboxetine is as effective as imipramine in the treatment of depression in elderly patients but is at least as well tolerated with a lower risk of hypotension and related symptoms , fewer serious adverse events , adverse event-related withdrawals and treatment-related adverse events OBJECTIVE To examine the efficacy of fluoxetine in the treatment of depression in patients with probable Alzheimer 's disease ( AD ) . METHODS This double-blind , parallel- design study included a consecutive series of 41 AD subjects meeting DSM-IV criteria for major or minor depression who were r and omized to receive fluoxetine ( up to 40 mg/day ) or identical-appearing placebo .  All patients received biweekly evaluations consisting of the Hamilton Depression Scale ( HAM 
    Output:
    
RESULTS All classes of antidepressant ( TCA 's , SSRIs and other antidepressants ) were more effective than placebo in achieving response .
In achieving remission however , only pooling all 3 classes of antidepressants together showed a statistically significant difference from placebo .
No differences were found in remission or response rates between classes of antidepressants .
TCAs were also equally effective compared with SSRIs in achieving response in more severely depressed patients .
CONCLUSIONS Antidepressant treatment in older depressed patients is efficacious .
We could not demonstrate differences in effectiveness between different classes of antidepressants ; this was also the case in more severely depressed patients