***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 
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    Input: Background The success of a human intervention trial depends upon the ability to recruit eligible volunteers . Many trials fail because of unrealistic recruitment targets and flawed recruitment strategies . In order to predict recruitment rates accurately , research ers need information on the relative success of various recruitment strategies . Few published trials include such information and the number of participants screened or approached is not always cited . Methods This paper will describe in detail the recruitment strategies employed to identify older adults for recruitment to a 6-month r and omised controlled dietary intervention trial which aim ed to explore the relationship between diet and immune function ( The FIT study ) . The number of people approached and recruited , and the reasons for exclusion , will be discussed . Results Two hundred and seventeen participants were recruited to the trial . A total of 7,482 letters were sent to potential recruits using names and addresses that had been supplied by local Family ( General ) Practice s. Eight hundred and forty three potential recruits replied to all methods of recruitment ( 528 from GP letters and 315 from other methods ) . The eligibility of those who replied was determined using a screening telephone interview , 217 of whom were found to be suitable and agreed to take part in the study . Conclusion The study demonstrates the application of multiple recruitment methods to successfully recruit older people to a r and omised controlled trial . The most successful recruitment method was by contacting potential recruits by letter on NHS headed note paper using contacts provided from General Practice s. Ninety percent of recruitment was achieved using this method . Adequate recruitment is fundamental to the success of a research project , and appropriate strategies must therefore be adopted in order to identify eligible individuals and achieve recruitment targets . Trial registration numberIS RCT N45031464 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 BACKGROUND Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence .  Maintenance antidepressants for at least 2 years is the current recommended treatment , but many individuals are interested in alternatives to medication . Mindfulness-based cognitive therapy ( MBCT ) has been shown to reduce risk of relapse or recurrence compared with usual care , but has not yet been compared with maintenance antidepressant treatment in a definitive trial . We aim ed to see whether MBCT with support to taper or discontinue antidepressant treatment ( MBCT-TS ) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months . METHODS In this single-blind , parallel , group r and omised controlled trial ( PREVENT ) , we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants , from primary care general practice s in urban and rural setting s in the UK . Participants were r and omly assigned to either MBCT-TS or maintenance antidepressants ( in a 1:1 ratio ) with a computer-generated r and om number sequence with stratification by centre and symptomatic status . Participants were aware of treatment allocation and research assessors were masked to treatment allocation . The primary outcome was time to relapse or recurrence of depression , with patients followed up at five separate intervals during the 24-month study period . The primary analysis was based on the principle of intention to treat . The trial is registered with Current Controlled Trials , IS RCT N26666654 . FINDINGS Between March 23 , 2010 , and Oct 21 , 2011 , we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practice s. 212 patients were r and omly assigned to MBCT-TS and 212 to maintenance antidepressants . The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months ( hazard ratio 0·89 , 95 % CI 0·67 - 1·18 ; p=0·43 ) , nor did the number of serious adverse events . Five adverse events were reported , including two deaths , in each of the MBCT-TS and maintenance antidepressants groups . No adverse events were attributable to the interventions or the trial . INTERPRETATION We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence . Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence , residual depressive symptoms , and quality of life . FUNDING National Institute for Health Research ( NIHR ) Health Technology Assessment ( HTA ) programme , and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula CONTEXT In older people , depressive symptoms are common , psychological adjustment to aging is complex , and associated chronic physical illness limits the use of antidepressants . Despite this , older people are rarely offered psychological interventions , and only 3 r and omized controlled trials of individual cognitive behavioral therapy ( CBT ) in a primary care setting have been published . OBJECTIVE To determine the clinical effectiveness of CBT delivered in primary care for older people with depression . DESIGN A single-blind , r and omized , controlled trial with 4- and 10-month follow-up visits . PATIENTS A total of 204 people aged 65 years or older ( mean [ SD ] age , 74.1 [ 7.0 ] years ; 79.4 % female ; 20.6 % male ) with a Geriatric Mental State diagnosis of depression were recruited from primary care . INTERVENTIONS Treatment as usual ( TAU ) , TAU plus a talking control ( TC ) , or TAU plus CBT . The TC and CBT were offered over 4 months . OUTCOME MEASURES Beck Depression Inventory-II ( BDI-II ) scores collected at baseline , end of therapy ( 4 months ) , and 10 months after the baseline visit . Subsidiary measures were the Beck Anxiety Inventory , Social Functioning Question naire , and Euroqol . Intent to treat using Generalized Estimating Equation and Compliance Average Causal Effect analyses were used . RESULTS Eighty percent of participants were followed up . The mean number of sessions of TC or  CBT was just greater than 7 . Intent-to-treat analysis found improvements of -3.07 ( 95 % confidence interval [ CI ] , -5.73 to -0.42 ) and -3.65 ( 95 % CI , -6.18 to -1.12 ) in BDI-II scores in favor of CBT vs TAU and TC , respectively . Compliance Average Causal Effect analysis compared CBT with TC . A significant benefit of CBT of 0.4 points ( 95 % CI , 0.01 to 0.72 ) on the BDI-II per therapy session was observed . The cognitive therapy scale showed no difference for nonspecific , but significant differences for specific factors in therapy . Ratings for CBT were high ( mean [ SD ] , 54.2 [ 4.1 ] ) . CONCLUSION Cognitive behavioral therapy is an effective treatment for older people with depressive disorder and appears to be associated with its specific effects . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N18271323 OBJECTIVE This study compared the long-term efficacy of two fixed plasma levels of nortriptyline in preventing or delaying recurrence of major depression in elderly patients and in minimizing residual depressive symptoms and somatic complaints . METHOD The authors r and omly assigned 41 elderly patients with histories of recurrent major depression to 3-year , double-blind maintenance pharmacotherapy using nortriptyline , with controlled plasma concentrations of 80 - 120 ng/ml versus 40 - 60 ng/ml . The authors compared times to , and rates of , recurrence of major depression . They also compared frequencies of side effects , noncompliance episodes , and subsyndromal symptomatic flare-ups . RESULTS Major depressive episodes recurred for six ( 29 % ) of 21 subjects in the 80 - 120-ng/ml condition and eight ( 40 % ) of 20 subjects in the 40 - 60-ng/ml condition , a nonsignificant difference . Most recurrences took place in the first year of maintenance treatment . Hamilton depression scores in the subsyndromal range ( higher than either 10 or 7 ) occurred significantly more often at 40 - 60 ng/ml , while constipation occurred significantly more often at 80 - 120 ng/ml . The proportions of patients reporting missed doses did not differ . CONCLUSIONS Maintenance pharmacotherapy with nortriptyline at 80 - 120 ng/ml is associated with fewer residual depressive symptoms , that is , a less variable long-term response , than pharmacotherapy at 40 - 60 ng/ml , but constipation is more frequent and there is no difference in recurrence of syndromal major depressive episodes . Treatment at 80 - 120 ng/ml may be preferable , because of fewer residual symptoms and less variability of response , as long as side effect burden can be managed successfully Background Escitalopram has shown efficacy and tolerability in the prevention of relapse in elderly patients with major depressive disorder ( MDD ) . This post-hoc analysis compared time to relapse for young-old patients ( n = 197 ) to that for old-old patients ( n = 108 ) . Method Relapse prevention : after 12-weeks open-label treatment , remitters ( MADRS ≤12 ) were r and omised to double-blind treatment with escitalopram or placebo and followed over 24-weeks . Patients were out patients with MDD from 46 European centers aged ≥75 years ( old-old ) or 65 - 74 years of age ( young-old ) , treated with escitalopram 10 - 20mg/day . Efficacy was assessed using the Montgomery Åsberg Depression Rating Scale ( MADRS ) . Results After open-label escitalopram treatment , a similar proportion of young-old patients ( 78 % ) and old-old patients ( 72 % ) achieved remission . In the analysis of time to relapse based on the Cox model ( proportional hazards regression ) , with treatment and age group as covariates , the hazard ratio was 4.4 for placebo versus escitalopram ( χ2-test , df = 1 , χ2= 22.5 , p < 0.001 ) , whereas the effect of age was not significant , with a hazard ratio of 1.2 for old-old versus young-old ( χ2-test , df = 1 , χ2 = 0.41 , p = 0.520 ) . Escitalopram was well tolerated in both age groups with adverse events reported by 53.1 % of young-old patients and 58.3 % of old-old patients . There was no significant difference in withdrawal rates due to AEs between age groups ( χ2-test , χ2 = 1.669 , df = 1 , p = 0.196 ) . Conclusions Young-old and old-old patients with MDD had comparable rates of remission after open-label escitalopram , and both age groups had much lower rates of relapse  on escitalopram than on placebo CONTEXT Elderly patients with major depression are at high risk for recurrence , increased mortality , and chronic disability . OBJECTIVE To determine the efficacy of maintenance nortriptyline hydrochloride and interpersonal psychotherapy ( IPT ) in preventing recurrence of major depressive episodes in patients older than 59 years . DESIGN A 2 x 2 r and omized , double-blind , placebo-controlled clinical trial , stratified by therapist . SETTING University-based psychiatric research clinic . PATIENTS Of a total of 187 patients with recurrent nonpsychotic unipolar major depression ( average age , 67 years ; one third aged > or = 70 years ) recruited through clinical referral and media announcements , 107 were fully recovered after open acute and treatment continuation with nortriptyline and IPT . These patients were r and omly assigned to 1 of 4 maintenance therapy conditions . INTERVENTIONS Monthly medication clinic with nortriptyline hydrochloride ( 80 - 120 ng/mL steady-state levels ) ( n = 24 ) ; medication clinic with placebo ( n = 29 ) ; monthly maintenance IPT with placebo ( n = 21 ) ; and monthly maintenance IPT with nortriptyline ( n = 22 ) . MAIN OUTCOME MEASURE Rec 
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Continuing antidepressant medication for 12 months appears to be helpful with no increased harms ; however , this was based on only three small studies , relatively few participants , use of a range of antidepressant classes , and clinical ly heterogeneous population s. Comparisons at other time points did not reach statistical significance .