TORONTO — Older patients who suffer from both depression and lower back pain may benefit greatly in both areas by taking a high dose of the antidepressant venlafaxine.
About 50% of older adults live with chronic pain, and depression symptoms were more common in this group than those without such pain, according to a 2006 study. In addition, the pain can lead to memory and cognition problems, depression, and greater use of health care.
The Addressing Depression and Pain Together (ADAPT) trial, led by Jordan Karp, MD, a geriatric psychiatrist and medical director for psychiatry at UPMC Pain Medicine in Pittsburgh, sought to find out whether a high-dose of venlafaxine, a serotonin norepinephrine reuptake inhibitor, at doses up to 300 mg per day would alleviate both conditions.
In addition, the researchers sought to find out if adding problem-solving therapy for depression and pain (PST-DP), which involved talk therapy and cognitive-behavioral therapy, would improve the results even more.
“We need to treat these as linked conditions,” Karp said during a presentation on the study at the American Psychiatric Association Annual Meeting. “Late-life treatment-resistant depression is the rule, not the exception, when treating older adults.”
He added that in the U.S. And Canada, between 25% and 50% of older adults (those older than 60) who live in community settings reported chronic pain, while between 49% and 83% of nursing home residents do.
In the study, 227 older patients with both depression and chronic pain started the trial. Karp said venlafaxine was chosen as “reuptake inhibition of norepinephrine may lead to further anti-depressant effects as well as enhanced analgesia.”
In the first part of the trial, all patients were given 150mg/day of venlafaxine for six weeks. Those who responded well were excluded from the second part. In that phase, all patients received up to 300mg/day (median dose 244mg). But one cohort of the group also received PST-DP. Those sessions lasted 30-45 minutes and people received an average of eight or nine total.
Data showed that while depression and pain decreased significantly (a 40% bivariate response) in both groups, “we didn’t obtain any additional benefit of [PST-DP] in terms of improved response.”
Karp said that he plans on following up with the patients for 12 months to see if they relapse or not.
Karp J. Addressing Depression and Pain Together: The “ADAPT” Clinical Trial for Older Adults With Depression and Chronic Low Back Pain. Presented at: APA 2015. May 16-20, 2015; Toronto, Canada.