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December 20, 2000

Treatment of Mild Depression in Elderly Patients

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(23):2993-2994. doi:10.1001/jama.284.23.2993

To the Editor: Dr Williams and colleagues1 concluded that paroxetine showed moderate benefit for depressive symptoms and mental health functioning in elderly patients with dysthymia and more severely impaired elderly patients with minor depression. We feel that this conclusion is more optimistic than would be suggested by more precise expressions for the treatment effect, namely the absolute risk reduction (ARR) and the number needed to treat (NNT).2 It is possible to calculate the NNT from the authors' Table 3, which shows remission rates for patients attending 4 or more treatment sessions. For both dysthymia and minor depression, 52 of 106 (49.1%) patients receiving paroxetine reached remission, compared to 53 of 119 (44.5%) patients receiving placebo. The ARR is therefore 4.6%. In other words, the individual patient has a 4.6% chance of benefiting from paroxetine. However, the 95% confidence interval (CI) of the ARR is –8.5% to 17.6%.3 The interval contains 0 and so it can be concluded that the ARR is not statistically significant. Even the 90% CI does not reach significance (−6.6% to 15.5%). The NNT is 100/4.6 = 21.7. This indicates that about 22 older patients with minor depression or dysthymia need to be treated with paroxetine rather than standard or placebo treatment for 1 additional patient to benefit after 11 weeks of treatment. The 95% CI of the NNT goes to infinity because 0 is part of the 95% CI for the ARR. Thus, the 95% CI of the NNT (benefit) is 5.68 to infinity and the NNT (harm) is 11.7 to infinity.4 Given the ARR and NNT with their 95% CIs, we believe that paroxetine did not show benefit.

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