***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: 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 Major depression is an illness with a high prevalence and is most commonly seen and treated by general practitioners ( GPs ) . AIM To determine the level of disability in depressed patients seen in a primary care setting , and to investigate whether the level of disability was associated with the severity of the depression . METHOD Prospect i ve data collection , using the 36-item Shortened Form ( SF-36 ) , from the Medical Outcomes Study , as a measure of disability , and from the Beck Depression Inventory ( BDI ) in a sample of depressed patients recruited from a Counselling versus Antidepressant in Primary Care ( CAPC ) study in the Trent Region . All patients met the research diagnostic criteria for major depression . RESULTS Two hundred and fifty patients were assessed . These patients reported high levels of disability compared both with published norms and with other chronic physical illnesses . Increases in disability were especially noticeable in the domains of the SF-36 that were specific to mental illness . There was a significant correlation between scores on the SF-36 and the BDI . CONCLUSION This study confirms that depressed patients in primary care report high levels of disability on the SF-36 , and that the instrument is both specific to the domains expected to be affected by mental disorder and is sensitive to the severity of mood disturbance BACKGROUND The current study was design ed to assess the safety and efficacy of imipramine and buspirone in the treatment of major depression in elderly depressed attendees of primary care practice s. METHOD 177 patients aged 65 and over ( mean age = 72 years ; range , 65 - 89 ) who met DSM-III-R criteria of unipolar major depression with a minimum Hamilton Rating Scale for Depression score of 18 were r and omly assigned to 8 weeks of double-blind , placebo-controlled treatment with flexible doses of either imipramine or buspirone . RESULTS Moderate to marked global improvement after 8 weeks of treatment ( LOCF analysis ) occurred in 70 % of patients treated with imipramine , 61 % of patients treated with buspirone , and 42 % of patients treated with placebo ( chi2 = 9.1 , df = 2 , p < .02 ) . Drug treatment was well tolerated , with 77 % of imipramine- and 61 % of buspirone-treated patients completing 8 weeks of therapy . Imipramine/placebo differences were present from week 2 on , but buspirone/placebo differences occurred only at week 8 . The presence of comorbid medical illness or concomitant use of nonpsychiatric prescription medications was not associated with poorer antidepressant response , increased adverse effects , or study attrition . CONCLUSION Imipramine and to a lesser extent buspirone were found to be effective and well tolerated in the treatment of elderly depressed out patients A total of 101 patients entered a double-blind , parallel-group study in general practice , comparing the efficacy and tolerability of paroxetine and amitriptyline in elderly depressed patients . All patients received placebo for 1 week followed by active therapy for a total of 6 weeks . Medication was r and omly allocated , two-thirds of the patients took paroxetine ( 20 mg daily ) and one-third received amitriptyline ( 50 mg daily ) ; this dose was increased to 30 mg and 100 mg , respectively , after 1 week . Of the patients who entered the placebo run-in , 90 took active treatment and were evaluable on an intention-to-treat basis ( 56 paroxetine , 32 amitriptyline ) . The mean age of the patients was 72 years . Significant reductions in Hamilton Depression Rating Scale ( HAMD ) from baseline to the end of treatment were seen for both groups ( p < 0.01 ) , with no difference between treatments . The HAMD score was reduced by half , or more , for 76 % of patients taking paroxetine and 86 % taking amitriptyline . Significant improvement was observed in the investigators ' Clinical Global Impression ( CGI ) score for 57 % of patients taking paroxetine and 52 % on amitriptyline . Improvements after treatment were also observed in the Leeds Sleep Evaluation Question naire ( LSEQ ) scores . Significantly fewer patients taking paroxetine reported adverse events ( 34 % vs 63 % taking amitriptyline , p = 0.02 ) . Those taking paroxetine experienced significantly fewer anticholinergic side effects ( 7 % vs 25 % taking amitriptyline , p = 0.04 ) . Overall , this study confirmed the effectiveness of paroxetine as an antidepressant drug . The relatively low incidence of adverse events , compared with amitriptyline , particularly the anticholinergic side effects which may be associated with disturbances in cognitive function , makes paroxetine suitable for the treatment of elderly depressed patients in general practice A double-blind study involving sixty-two patients , aged 65 years or over , treated for twenty-eight days , showed that fluphenazine 0 - 5 mg/nortriptyline 10 mg three times daily was superior to promazine 50 mg three times daily in relieving symptoms of anxiety and was associated with a lower incidence of side-effects . The results are discussed in the light of the nature of anxiety/depression syndromes in the elderly and it is suggested that since symptoms of anxiety in these disorders are often manifestations of an underlying depressive illness , the antidepressant effect of the nortriptyline may have enhanced the ' anxiolytic ' advantage of fluphenazine/nortriptyline OBJECTIVE To determine the validity of a two- question case-finding instrument for depression as compared with six previously vali date d instruments . DESIGN The test characteristics of a two- question case-finding instrument that asks about depressed mood and anhedonia were compared with six common case-finding instruments , using the Quick Diagnostic Interview Schedule as a criterion st and ard for the diagnosis of major depression . SETTING Urgent care clinic at the San Francisco Department of Veterans Affairs Medical Center . PARTICIPANTS Five hundred thirty-six consecutive adult patients without mania or schizophrenia . MEASUREMENTS AND MAIN RESULTS Measurements were two questions from the Primary Care Evaluation of Mental Disorders patient question naire , both the long and short forms of the Center for Epidemiologic Studies Depression Scale , both the long and short forms of the  Book Depression Inventory , the Symptom-Driven Diagnostic System for Primary Care , the Medical Outcomes Study depression measure , and the Quick Diagnostic Interview Schedule . The prevalence of depression , as determined by the st and ardized interview , was 18 % ( 97 of 536 ) . Overall , the case-finding instruments had sensitivities of 89 % to 96 % and specificities of 51 % to 72 % for diagnosing major depression . A positive response to the two-item instrument had a sensitivity of 96 % ( 95 % confidence interval [ CI ] , 90 - 99 % ) and a specificity of 57 % ( 95 % CI 53 - 62 % ) . Areas under the receiver operating characteristic curves were similar for all of the instruments , with a range of 0.82 to 0.89 . CONCLUSIONS The two- question case-finding instrument is a useful measure for detecting depression in primary care . It has similar test characteristics to other case-finding instruments and is less time-consuming Ninety-five elderly depressed patients were entered into an open trial of 0.5 to 1.0 mg flupenthixol dihydrochloride , as a single daily dose in the morning . Eighty-seven patients were treated and assessed for 14 days , 6 patients failed to attend follow-up appointments and 2 patients were withdrawn from the trial because of acute physical illness . After 14-days ' treatment , a decrease in the severity of the illness was recorded on the Clinical Global Impression Scale in 77 % of the patients , and statistically significant improvements were noted in the 5 individually rated symptoms of lowered mood , fatigue , tendency to weep , feelings of inadequacy and irritability . The number and severity of adverse effects recorded on a check-list decreased during the treatment period . The results suggest that flupenthixol is an effective antidepressant and is well tolerated by the elderly as a single daily dose 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 Recurrence of major depressive episode . RESULTS The time to recurrence of a major depressive episode for all 3 active treatments was significantly better than for placebo .  Recurrence rates over 3 years were as follows : nortriptyline and IPT , 20 % ( 95 % confidence interval [ CI ] , 4%-36 % ) ; nortriptyline and medication clinic visits , 43 % ( 95 % CI , 25%-61 % ) ; IPT and placebo , 64 % ( 95 % CI , 45%-83 % ) ; and placebo and medication clinic visits , 90 % ( 95 % CI , 79%-100 % ) . Combined treatment with nortriptyline and IPT was superior to IPT and placebo and showed a trend to superior efficacy over nortriptyline monotherapy ( Wald chi2 = 3.56 ; P = .06 ) . Subjects aged 70 years and older had a higher and more rapid rate of recurrence than those aged 60 to 69 years . CONCLUSION In geriatric patients with recurrent major depression , maintenance treatment with nortriptyline or IPT is superior to placebo in preventing or delaying recurrence . Combined treatment using both appears to be the optimal clinical strategy in preserving recovery Abstract Objective : To investigate the efficacy of intervention by a psychogeriatric team in the treatment of depression in elderly disabled people receiving home care from their local authority . Design : R and omised controlled trial with blind follow up six months after recruitment . Setting : Community of south east London . Subjects : 69 people aged 65 or over who received home care and were depressed according to criteria of the st and ardised automatic geriatric examination for computer assisted taxonomy ( AGECAT ) . 33 were r and omly allocated to an intervention group and 36 to a control group . Intervention : Members of the intervention group received an individual package of care that was formulated by the community psychogeriatric team in their catchment area and implemented by a research er working as a member of that team . The control group received normal general practitioner care . Main outcome measures : Recovery from depression ( AGECAT case at recruitment but non-case at follow up ) . Results : Data were analysed on an intention to treat basis . 19 ( 58 % ) of the intervention group recovered compared with only nine ( 25 % ) of the control group , a difference of 33 % ( 95 % confidence interval 10 % to 55 % ) . This powerful treatment effect persisted after controlling for possible confounders in logistic regression analysis , with members of the intervention group more likely than members of the control group to have recovered at follow up ( odds ratio 9.0 ( 2.0 to 41.5 ) ) . This did not seem to be a simple effect of antidepressant prescription : use of ant 
    Output:
    
CONCLUSION There is little evidence of effectiveness for a variety of treatment approaches for depression in older people in primary care , particularly in those with less severe depression .