***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: OBJECTIVE The authors examined which , if any , research design features and patient characteristics would significantly differ between successful and unsuccessful antidepressant trials . METHOD Clinical trial data were review ed for nine antidepressants approved by the Food and Drug Administration between 1985 and 2000 . From the antidepressant research programs on these medications , 52 clinical trials were included in the study . The authors evaluated trial design features , patient characteristics , and difference in response between placebo and antidepressant . RESULTS Nine trial design features and patient characteristics were present in the research programs for all nine of the antidepressants . The severity of depressive symptoms before patient r and omization , the dosing schedule ( flexible versus fixed ) , the number of treatment arms , and the percentage of female patients  were significantly associated with the difference in response to antidepressant and placebo . The duration of the antidepressant trial , number of patients per treatment arm , number of sites , and mean age of the patients were similar in successful trials ( with a greater antidepressant-placebo difference ) and less successful trials ( with a smaller antidepressant-placebo difference ) . CONCLUSIONS These findings may help in the design of future antidepressant trials 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 Dysthymia is one of the most prevalent problems in primary care , especially in the elderly . In this study , we evaluated the demographic and clinical predictors of nonresponse to treatment in primary care patients with dysthymia . The study sample consisted of 338 primary care patients meeting DSMIII-R criteria for dysthymia from 4 diverse geographic sites in a r and omized controlled 11-week trial of paroxetine , problem-solving therapy or placebo .  Patients who attended at least 4 treatment sessions were used in the analysis . A score of less than 7 on the Hamilton was defined as a positive response to treatment . By Week 11 , 52.2 % of patients had a positive response to treatment . Patients with lower levels of education ( odds ratio 0.44 , 95 % CI 0.23 , 0.86 ) , higher scores on the personality dimension of neuroticism ( odds ratio 0.58 , 95 % CI 0.36 , 0.92 ) and those with more severe medical illness ( odds ratio 0.97 , 95 % CI 0.95 , 0.99 ) were less likely to recover with either active or placebo treatments . Elderly women ( > 60 years of age ; odds ratio 0.19 , 95 % CI 0.05 , 0.66 ) were also less likely to respond to all treatments ; however , females had a significantly higher response to placebo treatment compared to males . The factors associated with lack of response to treatment included lower-levels of education , high neuroticism , more severe medical illness and being an older female . This analysis is based on patients agreeing to participate in a r and omized controlled trial , limiting representativeness of the sample , however , the demographic and clinical characteristics are common in elderly depressed primary care patients , and may signal the need for increased mental health specialty consultation OBJECTIVE The present study examined the efficacy and tolerability of acute escitalopram treatment in depressed patients aged 60 years or older . METHODS Patients aged > or = 60 years with Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition major depressive disorder were r and omized to 12 weeks of double-blind , flexible-dose treatment with escitalopram ( 10 - 20 mg/day ; N = 130 ) or placebo ( N = 134 ) . The prospect ively defined primary efficacy end point was change from baseline to week 12 in Montgomery-Asberg Depression Rating Scale ( MADRS ) total score using the last observation carried forward approach . RESULTS A total of 109 ( 81 % ) patients in the placebo group and 96 ( 74 % ) patients in the escitalopram group completed treatment . Mean age in both groups was approximately 68 years . Mean baseline MADRS scores were 28.4 and 29.4 for the placebo and escitalopram treatment groups , respectively . Escitalopram did not achieve statistical significance compared with placebo in change from baseline on the MADRS ( least square mean difference : -1.34 ; last observation carried forward ) . Discontinuation rates result ing from adverse events were 6 % for placebo and 11 % for escitalopram . Treatment-emergent adverse events reported by > 10 % of patients in the escitalopram group were headache , nausea , diarrhea , and dry mouth . CONCLUSIONS Escitalopram treatment was not significantly different from placebo treatment on the primary efficacy measure , change from baseline to week 12 in MADRS . In patients aged 60 years or older with major depression , acute escitalopram treatment appeared to be well tolerated BACKGROUND There is suggestive evidence that depression increases risk of myocardial infa rct ion ( MI ) , but there are no prospect i ve studies in which the measure of depression corresponds to clinical criteria . This study examines prospect ively whether a major depressive episode increases the risk of incident MI and evaluates the role of psychotropic medication use in this relationship . METHODS AND RESULTS The study is based on a follow-up of the Baltimore cohort of the Epidemiologic Catchment Area Study , a survey of psychiatric disorders in the general population . A history of major depressive episode , dysphoria ( 2 weeks of sadness ) , and psychotropic medication use were assessed in 1981 , and self-reported MI was assessed in 1994 . Sixty-four MIs were reported among 1551 respondents free of heart trouble in 1981 . Compared with respondents with no history of dysphoria , the odds ratio for MI associated with a history of dysphoria was 2.07 ( 95 % CI , 1.16 to 3.71 ) , and the odds ratio associated with a history of major depressive episode was 4.54 ( 95 % CI , 1.65 to 12.44 ) , independent of coronary risk factors . In multivariate models , use of barbiturates , meprobamates , phenothiazines , and lithium was associated with an increased risk of MI , whereas use of tricyclic antidepressants and benzodiazepines was not . Among individuals with no history of dysphoria , only lithium use was significantly associated with MI . CONCLUSIONS These data suggest that a history of dysphoria and a major depressive episode increase the risk of MI . The association between psychotropic medication use and MI is probably a reflection of the primary relationship between depression and MI BACKGROUND Treatment studies of depression in residential care are limited . Reports of predictors of response are rare . In the largest nursing home prospect i ve antidepressant trial reported , we examined predictors of response . METHODS This was a 12-week open-label study of mirtazapine orally disintegrating tablets performed in 30 US nursing homes . Subjects were men and women aged > or=70 , with a Mini Mental State Exam ( MMSE ) score > or=10 , who had a depressive disorder that required antidepressant treatment .  Mirtazapine was started at 15 mg at bedtime , and adjusted to 15 - 45 mg/day . A 16-item Hamilton Depression Rating Scale was used to assess depression at baseline , weeks 2 , 4 , 8 , and 12 or early termination . RESULTS One hundred and twenty-four patients received at least one dose of study drug and of these , 119 had at least one post-drug assessment . Mean age was 82.9 years and 72 % were female .  Response rates at 12 weeks were 47 % on the HAMD and 54 % on the CGI . Age , sex , MMSE score , medical burden , history of prior depression , and baseline HAMD severity were not significantly associated with HAMD response ( > or=50 % improvement ) and in most cases correlations were trivial , < 0.1 . Advanced age , medical burden , and cognitive impairment did not predict adverse events . CONCLUSIONS In this sample of depressed nursing home residents treated with mirtazapine orally disintegrating tablets , advanced age , medical illness , and cognitive impairment did not predict response . The findings suggest that these variables need not be viewed as obstacles to treatment CONTEXT Few r and omized controlled trials have evaluated the efficacy of treatments for major depression in patients with coronary artery disease ( CAD ) . None have simultaneously evaluated an antidepressant and short-term psychotherapy . OBJECTIVE To document the short-term efficacy of a selective serotonin reuptake inhibitor ( citalopram ) and interpersonal psychotherapy ( IPT ) in reducing depressive symptoms in patients with CAD and major depression . DESIGN , SETTING , AND PARTICIPANTS The Canadian Cardiac R and omized Evaluation of Antidepressant and Psychotherapy Efficacy , a r and omized , controlled , 12-week , parallel-group , 2 x 2 factorial trial conducted May 1 , 2002 , to March 20 , 2006 , among 284 patients with CAD from 9 Canadian academic centers . All patients met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition criteria for diagnosis of major depression of 4 weeks ' duration or longer and had baseline 24-item Hamilton Depression Rating Scale ( HAM-D ) scores of 20 or higher . INTERVENTIONS Participants underwent 2 separate r and omizations : ( 1 ) to receive 12 weekly sessions of IPT plus clinical management ( n = 142 ) or clinical management only ( n = 142 ) and ( 2 ) to receive 12 weeks of citalopram , 20 to 40 mg/d ( n = 142 ) , or matching placebo ( n = 142 ) . MAIN OUTCOME MEASURES The primary outcome measure was change between baseline and 12 weeks on the 24-item HAM-D , administered blindly during central ized telephone interviews ( tested at alpha = .033 ) ; the secondary outcome measure was self-reported Beck Depression Inventory II ( BDI-II ) score ( tested at alpha = .017 ) . RESULTS Citalopram was superior to placebo in reducing 12-week HAM-D scores ( mean difference , 3.3 points ; 96.7 % confidence interval [ CI ] , 0.80 - 5.85 ; P = .005 ) , with a small to medium effect size of 0.33 . Mean HAM-D response ( 52.8 % vs 40.1 % ; P = .03 ) and remission rates ( 35.9 % vs 22.5 % ; P = .01 ) and the reduction in BDI-II scores ( difference , 3.6 points ; 98.3 % CI , 0.58 - 6.64 ; P = .005 ; effect size = 0.33 ) also favored citalopram . There was no evidence of a benefit of IPT over clinical management , with the mean HAM-D difference favoring clinical management ( -2.26 points ; 96.7 % CI , -4.78 to 0.27 ; P = .06 ; effect size , 0.23 ) . The difference on the BDI-II did not favor clinical management ( 1.13 points ; 98.3 % CI , -1.90 to 4.16 ; P = .37 ; effect size = 0.11 ) . CONCLUSIONS This trial documents the efficacy of citalopram administered in conjunction with weekly clinical management for major depression among patients with CAD and found no evidence of added value of IPT over clinical management . Based on these results and those of previous trials , citalopram or sertraline plus clinical management should be considered as a first-step treatment for patients with CAD and major depression . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N15858091 OBJECTIVE Selective serotonin reuptake inhibitors ( SSRIs ) are widely used to treat depression , but the rates , timing , and baseline predictors of remission in " real world " patients are not established . The authors ' primary objectives in this study were to evaluate the effectiveness of citalopram , an SSRI , using measurement-based care in actual practice , and to identify predictors of symptom remission in out patients with major depressive disorder . METHOD This clinical study included out patients with major depressive disorder who were treated in 23 psychiatric and 18 primary care 
    Output:
    
In patients with an illness duration > 10 years , baseline depression severity was also significantly associated with drug-placebo differences .
Older patients with a long illness duration and moderate to severe depression appear to benefit from antidepressants as compared with placebo .
Antidepressants do not appear to be effective for older patients with short illness duration