Elderly patients are less likely to have a recurrence of depression if they continue to take medication for two years after the first episode, a new study has found.

But monthly psychotherapy on its own could not forestall a repeat bout of the blues, according to University of Pittsburgh researchers led by Dr. Charles Reynolds, of Western Psychiatric Institute and Clinic.

"It's not enough to get well," he said. "What counts is staying well, and the treatments we have available help people to stay well."

The findings are in today's New England Journal of Medicine.

In the study, 116 people 70 or older who had depression were randomly assigned to one of four groups: treatment with paroxetine, or Paxil, either alone or with monthly interpersonal psychotherapy; or a placebo pill either alone or with monthly psychotherapy.

Groups that got a placebo were 2.4 times more likely to have a recurrence of depression than the those that got paroxetine. Around two-thirds of the people who got a placebo and psychotherapy became ill again, while about one-third of the medication users relapsed.

"The use of an antidepressant medication lowered recurrence rate by approximately 60 percent as compared with the use of a pill-placebo and supportive care," Dr. Reynolds said.

Many older people live with chronic conditions such as arthritis, high blood pressure and diabetes, and depression can make things worse.

"That's the nature of depression in old age," Dr. Reynolds said. "It coexists with and amplifies the suffering and the disability that are caused by other chronic medical illnesses."

Slightly more than half of the study participants experienced their first episode of depression in old age.

"Traditionally, the practice has been to offer such patients follow-up treatment for only six or 12 months, and then to stop the medication," the doctor explained. "But our data showed that people are safer, better off, more likely to stay well, if they continue the medication for at least two years."

Although he doesn't have evidence to support it, Dr. Reynolds would advise his elderly depression patients to take medication even longer than two years.

"It's very likely in any case that the protective effect of the medication would continue," he said. "Without it, people would be at pretty high risk for getting sick again."

It's likely that other antidepressants in the same class, the selective serotonin reuptake inhibitors, or SSRIs, would work as well as paroxetine at keeping depression at bay, Dr. Reynolds added.

The researchers found that although the psychotherapy used in the study, which works on coping skills, helped patients recover from depression, it did not prevent recurrence. Previous studies showed that it did benefit patients in their 60s and younger.

A different kind of therapy, however, perhaps one that emphasizes practical matters such as problem-solving, might be more helpful for elderly patients who have cognitive impairments, Dr. Reynolds noted.

"Every step toward improving the outcome of depression late in life has considerable public health significance," said Dr. Burton Reifler, of Wake Forest University, in another article in the journal.

He said that many people, including doctors, consider late life depression "an inevitable consequence" of chronic illness or, "even worse, as a normal part of the aging process."

"Dismissing depression as inevitable denies the patient a fair chance of recovery," Dr. Reifler said.

Volunteers are needed for future studies, he said. To be eligible, you must be 60 or older with symptoms of depression or anxiety. For more information, call 412-246-6006.