Pretreatment Systolic Orthostatic Blood Pressure and Treatment Response in Geriatric Depression

Three previous studies have found significant positive correlations between pretreatment systolic orthostatic blood pressure (PSOP) and tricyclic antidepressant (TCA) response in geriatric depression (i.e., the greater the pretreatment orthostatic drop, the greater the treatment response). The purposes of this study were to revisit the question of whether PSOP predicts TCA response and also to examine whether large systolic orthostatic pressure (SOP) is a state or trait variable in late-life depression. We retrospectively examined PSOP data collected from 48 elderly patients with recurrent unipolar depression treated with nortriptyline (mean level in plasma, 85.3) in the open, acute-treatment phase of an ongoing double-blind, placebo-controlled study of maintenance therapies in late-life depression. PSOP was not significantly correlated with treatment response as measured by the Hamilton Rating Scale for Depression at weeks 7 to 9 (r = -0.12, not significant). Likewise, a 10-mm PSOP cutoff did not significantly differentiate patients by responder status. We did find that all five of our placebo-randomized, maintenance therapy patients with PSOPs greater than 10 mm had marked decreases in their SOPs in the nortriptyline-free, well state. Thus, our findings fail to replicate earlier reports of PSOP predicting TCA response in geriatric depression. However, our results do preliminary suggest that large SOP may be state dependent. We discuss plans to study prospectively whether large SOP is state dependent and whether SOP is a clinically useful predictor of recurrence in late-life depression.