Frailty and Depression in Late Life: A High-Risk Comorbidity with Distinctive Clinical Presentation and Poor Antidepressant Response

2021 ◽  
Author(s):  
Patrick J Brown ◽  
Adam Ciarleglio ◽  
Steven P Roose ◽  
Carolina Montes Garcia ◽  
Sarah Chung ◽  
...  
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Depressive Disorders ◽  
Latent Class ◽  
Rating Scale ◽  
Controlled Trial ◽  
Antidepressant Medication ◽  
Biological Aging ◽  
Antidepressant Response ◽  
Previous Response

Abstract Background Investigate the longitudinal relationship between physical frailty, the clinical representation of accelerated biological aging, and antidepressant medication response in older adults with depressive illness. Methods An 8-week randomized placebo-controlled trial (escitalopram or duloxetine) followed by 10-months of open antidepressant medication treatment (augmentation, switch strategies) was conducted in an outpatient research clinic. 121 adults age > 60 years with Major Depressive (MDD) or Persistent Depressive Disorders and a 24-item Hamilton Rating Scale for Depression (HRSD) > 16 were enrolled. Primary measures assessed serially over 12-months include response (50% reduction from baseline HRSD score), remission (HRSD score < 10), and frailty (non/intermediate frail [0-2 deficits] vs frail [> 3 deficits]); latent class analysis was used to classify longitudinal frailty trajectories. Results A 2-class model best fit the data, identifying a consistently-low frailty-risk (63% of the sample) and consistently-high frailty-risk (37% of the sample) trajectory. Response and remission rates (P’s<.002) for adults in the high-risk frailty class were at least 21 percentage-points worse than those in the low-risk class over 12-months. Furthermore, subsequent frailty was associated with previous frailty (P’s < .01) but not previous response or remission (P’s > .10). Conclusions Antidepressant medication is poorly effective for MDD occurring in the context of frailty in older adults. Furthermore, even when an antidepressant response is achieved, this response does little to improve their frailty. These data suggest that standard psychiatric assessment of depressed older adults should include frailty measures and that novel therapeutic strategies to address comorbid frailty and depression are needed.

Abstract TP168: Efficacy of a Pictogram to Promote Stroke Knowledge Among Illiterate Korean Elderly

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Cha-Nam Shin ◽  
Jeongha Sim ◽  
Dongchoon Ahn
Keyword(s):  
Older Adults ◽  
High Risk ◽  
Longitudinal Research ◽  
Controlled Trial ◽  
Intervention Group ◽  
Warning Signs ◽  
Repeated Measure ◽  
Control Group ◽  
Control Group Design ◽  
Stroke Knowledge

Background and Purpose: Extensive research supports the importance of knowledge in stroke prevention and reducing prehospital delay time. However, the level of stroke knowledge among Korean older adults remains low. In particular, older adults who are illiterate lack of stroke information despite being at high risk. The purpose of this study was to develop and examine the efficacy of a pictogram to enhance stroke knowledge in the high-risk and illiterate older adults. Methods: We conducted a pretest-posttest nonequivalent control group design study and compared differences in stroke knowledge before and after the intervention. A total of 117 older adults (82 in the intervention group and 35 in the control group) who were 60 years and older residing in community participated in the study. Participants in the intervention group received a pictogram-based education, while participants in the control group received a powerpoint-based education. Stroke knowledge was measured by structured survey questionnaires. Descriptive statistics for sample characteristics, repeated measure ANOVA for the efficacy, and independent t-test for satisfaction comparison between groups were used. Results: The intervention group showed a higher increase in stroke knowledge (F=16.45), awareness of risk factors (F=15.71), stroke warning signs and symptoms (F=17.29), and action at stroke (F=19.36) compared to the control group at p <.001. Also, the intervention group reported that they would recommend the education program to others (t=2.64, p<.05) and the program was applicable to real situation (t=4.47, p <.001), which were scored higher than the control group. Conclusions: The data revealed that a pictogram-based education is more effective than a powerpoint-based education among illiterate older adults. Replicated studies with this pictogram in a larger randomized controlled trial is warranted, which may give greater validity to our findings. Future longitudinal research is recommended to examine retention of stroke knowledge over the long term.

scholarly journals Equivalent beneficial effects of unilateral and bilateral prefrontal cortex transcranial magnetic stimulation in a large randomized trial in treatment-resistant major depression

2013 ◽  
Vol 16 (9) ◽  
pp. 1975-1984 ◽  
Author(s):  
Paul B. Fitzgerald ◽  
Kate E. Hoy ◽  
Ajeet Singh ◽  
Ranil Gunewardene ◽  
Christopher Slack ◽  
...  
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Clinical Response ◽  
Magnetic Stimulation ◽  
Rating Scale ◽  
Remission Rate ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Controlled Trial ◽  
Treatment Resistant ◽  
Previous Response ◽  
Beneficial Effects

Abstract Repetitive transcranial magnetic stimulation treatment (rTMS) is an effective treatment for depression but the optimal methods of administration have yet to be determined. Recent studies have produced conflicting results as to whether unilateral rTMS is more or less effective than sequentially applied bilateral rTMS. To address this we conducted a trial comparing sequential bilateral rTMS to right-sided unilateral rTMS using a priming protocol. Patients with treatment-resistant depression (n = 179) were enrolled in a two-arm randomized controlled trial across a 4-wk time period. The primary outcome assessment was the Hamilton Depression Rating Scale. Overall, there was a substantial response rate of >50% (and a 40% remission rate); however, there were no significant differences in clinical response between the two treatment groups. rTMS was well tolerated with a very low discontinuation rate. There was no relationship between response in the current trial and previous response, or non-response, to electroconvulsive therapy. We found no significant differences in clinical response between sequential bilateral rTMS and right-sided unilateral rTMS applied with a priming protocol. The results of this study do not support superior efficacy of bilateral rTMS and instead suggest that other approaches should be explored to increase treatment efficacy.

Anxiety Symptoms in Older Adults with Depression Are Associated with Suicidality

2018 ◽  
Vol 45 (3-4) ◽  
pp. 180-189 ◽  
Author(s):  
Anette Bakkane Bendixen ◽  
Knut Engedal ◽  
Geir Selbæk ◽  
Cecilie Bhandari Hartberg
Keyword(s):  
Older Adults ◽  
Cognitive Functioning ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Medical Condition ◽  
Anxiety Symptoms ◽  
Clock Drawing Test ◽  
General Medical Condition ◽  
Icd 10 ◽  
Severity Of Depression

Objective: Anxiety symptoms are common in older adults with depression, but whether severe anxiety is associated with poorer outcomes of depression is unknown. The objective of the present study was to examine the association between severity of anxiety and severity of depression and physical illness, suicidality, and physical and cognitive functioning in older adults with depression. Methods: We included 218 older adults with diagnoses of a depressive disorder according to the ICD-10 criteria; their mean age (SD) was 75.6 (7.2), and 67.0% were women. The Geriatric Anxiety Inventory (GAI) was used to measure the severity of anxiety symptoms. The Montgomery-Aasberg Depression Rating Scale (MADRS) was used to assess the severity of depression. We obtained information on the level of functioning with the Physical Self-Maintenance Scale (PSMS) by Lawton and Brody and on cognition with the Mini-Mental State Examination (MMSE) and the Clock-Drawing Test (CDT). Physical health was determined based on information regarding falls and weight loss and an assessment of each patient’s general medical condition. The treating physician evaluated current suicidality in a comprehensive and standardized way. Results: Higher GAI scores were significantly associated with scores on the MADRS (β = 0.233, p = 0.002) and suicidality (β = 0.206, p = 0.006). Levels of physical or cognitive functioning were not associated with the GAI score. Conclusion: The severity of anxiety symptoms was associated with the severity of depression and suicidality in older adults with depressive disorders. The results could indicate a need to focus greater attention on the treatment of anxiety and suicidality in older patients with depression.

scholarly journals T34. THE IMPACT OF ANTIDEPRESSANT USE ON THE TRANSITION TO PSYCHOSIS RATE IN THE NEURAPRO TRIAL

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S244-S245
Author(s):  
Monika Schlögelhofer ◽  
Patrick D McGorry ◽  
Barnaby Nelson ◽  
Maximus Berger ◽  
Connie Markulev ◽  
...  
Keyword(s):  
High Risk ◽  
Young People ◽  
Rating Scale ◽  
Antidepressant Medication ◽  
Rank Test ◽  
Omega 3 ◽  
Ultra High Risk ◽  
Antidepressant Use ◽  
Randomised Controlled ◽  
The Impact

Abstract Background Over the last two decades, several randomised controlled trials (RCTs) have indicated that preventive psychosocial, pharmacologic (Van der Gaag et al. 2013), and nutritional interventions (Amminger et al. 2010) are likely to be beneficial in people at ultra-high risk (UHR) of psychosis, in terms of delaying or preventing a transition to psychosis. Antidepressant medication is commonly prescribed in young people at UHR for psychosis; however, the evidence regarding its efficacy for psychosis prevention is limited (Fusar-Poli et al. 2007; Cornblatt et al. 2007; Fusar-Poli et al. 2015). The main aim of the present study is to investigate the impact of concomitant AD medication on the transition to psychosis rate in young people at ultra-high risk of psychosis who participated in the NEURAPRO trial (McGorry et al. 2017). Methods In this secondary analysis, data from 304 participants of a multicenter, double-blind, placebo-controlled, randomized clinical trial (NEURAPRO) of omega-3 polyunsaturated fatty acids (omega-3 PUFAs) were included. During the trial, concomitant antidepressant medication was permitted for treatment of moderate to severe major depressive disorder (a score of ≥ 21 on the Montgomery-Asberg Depression Rating Scale, MADRS) in all participants. Results Of 304 participants, 189 (62.2%) were treated with ADs. 98 (64.1%) of those were in the omega-3 group and 91 (60.3%) in the placebo group. The transition rate to psychosis was higher in individuals who received AD treatment (13.2%; 25 of 189) as in individuals without ADs (6.1%; 7 of 115). The Kaplan-Meier survival curve estimated a group difference of X2 = 3.237, P = .072 (log rank test). Discussion Antidepressants are widely used in early psychosis. This analysis does not support the view that antidepressants may have reduced the transition to psychosis rate in this cohort. The findings are limited by the fact that antidepressants were prescribed based on clinical discretion. A randomised controlled trial is needed to determine whether antidepressants have a role in prevention of transition to psychosis.

Evidence for the treatment of moderate depression: a systematic review

2017 ◽  
Vol 34 (3) ◽  
pp. 197-204 ◽  
Author(s):  
D. Aherne ◽  
A. Fitzgerald ◽  
C. Aherne ◽  
N. Fitzgerald ◽  
M. Slattery ◽  
...  
Keyword(s):  
Systematic Review ◽  
Depressive Disorders ◽  
Controlled Trial ◽  
Combined Treatment ◽  
Antidepressant Medication ◽  
Inclusion Criteria ◽  
Randomized Controlled ◽  
Search Terms ◽  
Moderate Depression ◽  
Different Levels

ObjectivesThis study aims to investigate existing evidence for the effectiveness of psychological treatments and/or antidepressant medication as a treatment for those diagnosed with moderate levels of depression.MethodsA PRISMA systematic review of articles using electronic research databases (2000–2014) was conducted to identify studies investigating the effectiveness of psychotherapy and/or medication as a treatment for people with moderate levels of depression. Search terms included moderate depression, psychotherapy and/or medication, depressive disorders, antidepressants, psychotherapy, mental health services, and randomized-controlled trial (RCT). The included studies were then assessed, extracted, and synthesised.ResultsA total of 14 studies met the inclusion criteria (11 RCTs and three additional studies) for this review. The findings of the systematic review indicate that there is limited evidence available specific to the treatment of moderate depression and that this research seems to suggest that psychotherapy or combined treatment has a beneficial effect.ConclusionsGiven that depression is one of the biggest challenges the world faces at present, further research is required to examine the effectiveness of treatment for different levels of depression severity.

Correlations Between Neuroendocrine Disorders and Biochemical Brain Metabolites Alterations in Antidepressant Treatment

2018 ◽  
Vol 69 (3) ◽  
pp. 621-626
Author(s):  
Luminita Ageu ◽  
Cristina Talpos ◽  
Ghizela Kanalas ◽  
Simina Crisan ◽  
Carmen Lacramioara Zamfir ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Mr Spectroscopy ◽  
Depressive Disorders ◽  
Rating Scale ◽  
Antidepressant Treatment ◽  
Treatment Strategies ◽  
Antidepressant Medication ◽  
Brain Metabolites ◽  
Gamma Aminobutyric Acid ◽  
Pharmacogenetic Testing

We approach the theme of modern investigation and treatment strategies, based on biochemical, clinical-biological, metabolic, pharmacogenetic, neuro-imagistic, and neuroendocrine integrative correlations in the management of depressive disorders. Our main objective was to investigate: the biochemical brain metabolites [N-acetyl-aspartate (NAA), gamma-aminobutyric acid (GABA), aspartate (Asp), creatine (CR), glutamine (Gln), glicerophosphocholine (GPC), phosphocholine (PC), phosphocreatine (PCr), taurine (Tau), N-methyl-D-aspartate (N-MDA), serine, glycine, choline (Cho)]; the neuroimagistic and neurobiological markers and the metabolic abnormalities in correlation with the molecular pharmacogenetic testing in children and adolescents treated with antidepressant medication. Our research was conducted between 2009-2016 on 90 children and adolescents with depressive disorders -45 children-G1, who benefited of pharmacogenetic testing tailored pharmacotherapy, and 45 without pharmacogenetic testing-G2. The patients were also evaluated by MR spectroscopy at baseline and after pharmacotherapy. The efficacy of the chosen therapy in correlation with the pharmacogenetic testing was evaluated by the mean change in the CDRS (Child Depression Rating Scale) total scores, in the CGI-S/I (Clinical Global Impression Severity/Improvement), CGAS (Clinical Global Assessment of Functioning) and by the change of the relevant neurobiological markers and MR spectroscopy biochemical brain metabolites. Our results showed statistically significant differences in the clinical scores between the studied groups. Our research could represent a proof that the biochemical brain metabolites registered in depressive disorders modified values in the MR spectroscopy and the administration of antidepressants could determine metabolic and neuroendocrine abnormalities (changed lipid profiles, high insulin and plasma glucose levels, weight gain, obesity), especially when chosen without prior pharmacogenetic testing.

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