scholarly journals Review of treatment for late-life depression

2013 ◽  
Vol 19 (4) ◽  
pp. 302-309 ◽  
Author(s):  
Charlotte L. Allan ◽  
Klaus P. Ebmeier
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Late Life ◽  
Line Treatment ◽  
Late Life Depression ◽  
Nonpharmacological Treatment ◽  
Augmentation Strategies ◽  
Treatment Of Depression ◽  
Favourable Side Effect Profile

SummaryDepressive disorder in those over the age of 60 has many clinical similarities to depression in younger adults, but biological changes related to ageing may necessitate a different approach to treatment. We present an evidence-based review of treatment for late-life depression, focusing on pharmacological approaches, including monotherapy, combination and augmentation strategies. Selective serotonin reuptake inhibitors such as sertraline and citalopram are well tolerated, have the advantage of a favourable side-effect profile, and are good options for first-line treatment. Second-line treatment options include combination therapy with a second antidepressant, or treatment augmentation with an antipsychotic or lithium. We also consider evidence for nonpharmacological treatment strategies, including psychological therapy and neurostimulation. Finally, we summarise evidence for treatment of depression in patients in dementia.

scholarly journals 116 Retrospective Analysis of Clozapine Augmentation in Treatment-Resistant Schizophrenia in an Outpatient Setting

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 73-74
Author(s):  
Charles Odom ◽  
Frozan Walyzada ◽  
Pankaj Manocha ◽  
Monika Gashi ◽  
Ashaki Martin ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Treatment Options ◽  
D2 Receptor ◽  
Treatment Strategies ◽  
Outpatient Setting ◽  
Mood Stabilizers ◽  
Adjunctive Treatment ◽  
Supporting Evidence ◽  
Treatment Resistant ◽  
Augmentation Strategies

AbstractStudy ObjectivesThis retrospective analysis hopes to add to the literature about Treatment Resistant Schizophrenia (TRS), augmentation strategies with antipsychotics used in our patient population with the hopes of clarifying what possibilities should be further studied. In addition, we aim to emphasize the need for focusing on individualized treatment and multidisciplinary efforts to ensure compliance and appropriate disposition options.MethodWe reviewed retrospectively 3025 charts of patients between January 2017 to March 2017 in our outpatient department establishing which antipsychotic clozapineaugmentation strategies were being used. We also did a literature review to establish what augmentation strategies are recommended. These patients will then be compared to a random sample of patients in the clinic who were not prescribed clozapine and compared for readmission rate, side effect profile, length of stay while admitted, frequency of clinic attendance and compliance with outpatient appointments.ResultsOut of 3025 patients 35 were prescribed Clozapine as monotherapy and 5 patients had clozapine plus psychopharmacological augmentation. Ages ranged from 21-86. Out of the 39 patients, there were 13 male and 26 female. The predominant diagnosis was mood disorder or MDD with psychotic features followed by schizophrenia. The augmentation antipsychotics used were aripiprazole and risperidone. In the literature, the most frequent augmentation strategy for TRS is adding another antipsychotic with more D2 receptor blockade. Other strategies involve identifying and treating the symptoms not controlled by clozapine.ConclusionsCurrently augmentation of Clozapine in TRS is highly individualized due to lack of supporting evidence to state the contrary. When working with treatmentresistant patients who are not responding to clozapine alone, it is imperative to thoroughly review and consider all treatment options and augmentation strategies. More studies should be done in controlled settings to better evaluate possibilities as well as more evaluations to be done on other ways of augmentation of clozapine. Literature has stated between 20-60% of patients are defined as TRS. Clozapine is considered as one of the most effective treatment available at present time for TRS. Recent literature suggests despite its superior efficacy, as many as 70% of those suffering from TRS on clozapine continue to suffer from positive, negative or cognitive symptoms. The literature has abundant adjunctive treatment strategies such as the addition of antipsychotics, mood stabilizers, antidepressants, or even with the use of electroconvulsive therapy. We emphasize the importance of correctly identifying TRS patients who may benefit from the initiation of clozapine, what would be beneficial for them if they do not respond, how to tailor their treatment to target symptoms not being ameliorated, and recommend treatment in these complex cases be multidisciplinary.Funding AcknowledgementsNo funding.

Neuroanatomical Abnormalities in Older Depressed Adults With Apathy: A Systematic Review

2019 ◽  
Vol 33 (5) ◽  
pp. 289-303 ◽  
Author(s):  
Monique A. Pimontel ◽  
Dora Kanellopoulos ◽  
Faith M. Gunning
Keyword(s):  
Systematic Review ◽  
Treatment Options ◽  
Late Life ◽  
Anterior Cingulate ◽  
Late Life Depression ◽  
Efficacious Treatment ◽  
Focal Brain Injury ◽  
Aging Populations ◽  
Future Treatments ◽  
Poor Outcomes

Objective: Apathy is a common phenomenon in late-life depression and is associated with poor outcomes. Apathy is often unrecognized in older depressed adults, and efficacious treatment options are lacking. This review provides a systematic review of the neuroanatomical abnormalities associated with apathy in late-life depression. In addition, the review summarizes the neuroimaging findings from studies of neurodegenerative and focal brain injury conditions that frequently present with apathy. The goal is to elucidate cerebral network abnormalities that give rise to apathy in older adults with mood disturbances and to inform future treatment targets. Method: Systematic literature review. Results: The few studies that have directly examined the neuroanatomical abnormalities of apathy in late-life depression suggest disturbances in the anterior cingulate cortex, insula, orbital and dorsal prefrontal cortex, striatum, and limbic structures (ie, amygdala, thalamus, and hippocampus). Studies examining the neuroanatomical correlates of apathy in other aging populations are consistent with the pattern observed in late-life depression. Conclusions: Apathy in late-life depression appears to be accompanied by neuroanatomical abnormalities in the salience and reward networks. These network findings are consistent with that observed in individuals presenting with apathy in other aging-related conditions. These findings may inform future treatments that target apathy.

Consumer Advertising of Psychiatric Medications Biases the Public Against Nonpharmacological Treatment

2005 ◽  
Vol 7 (3) ◽  
pp. 175-179 ◽  
Author(s):  
Jeffrey R. Lacasse
Keyword(s):  
United States ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Scientific Evidence ◽  
The United States ◽  
Pharmaceutical Companies ◽  
Nonpharmacological Treatment ◽  
The Public ◽  
Direct To Consumer ◽  
Treatment Of Depression ◽  
Direct To Consumer Advertising

In the United States, aWntidepressant medications are heavily promoted through direct-to-consumer advertising, which is regulated by the Food and Drug Administration (FDA). Advertisements for selective serotonin reuptake inhibitors frequently contain information inconsistent with the scientific evidence on the treatment of depression with antidepressants. The information presented serves to promote the use of antidepressants by biasing the public against nonpharmacological treatment of depression. While the FDA enforces regulations requiring fair and balanced presentation when comparing one medication to another, there appears to be no action taken against pharmaceutical companies that distort scientific evidence in order to disparage nonmedical approaches to depression.

Venlafaxine and duloxetine: A comparison of efficacy and tolerability for the treatment of depression in elderly patients

2013 ◽  
Vol 3 (5) ◽  
pp. 258-265
Author(s):  
Hugh Franck ◽  
Jonathan Potter ◽  
Joshua Caballero
Keyword(s):  
Selective Serotonin Reuptake Inhibitors ◽  
Extended Release ◽  
The Elderly ◽  
Late Life Depression ◽  
First Line ◽  
Geriatric Population ◽  
Online Databases ◽  
Treatment Of Depression ◽  
Extended Release Formulations ◽  
Norepinephrine Reuptake

The geriatric population has a disproportionally higher rate of depression and related suicide compared to the general population. While selective serotonin reuptake inhibitors are considered first line, serotonin norepinephrine reuptake inhibitors (SNRIs) are commonly used. Online databases including MEDLINE, EMBASE, International Pharmaceutical Abstracts, and CINAHL were searched (up to June 2013) to identify trials using SNRIs in the elderly. Results revealed 15 studies involving venlafaxine (n=10) and duloxetine (n=5) use in the elderly. Overall, venlafaxine and duloxetine appear to be similar in efficacy and tolerability in treating late life depression. However, venlafaxine has been more extensively studied in this particular population, appears to carry fewer drug interactions, and is available in generic forms for regular and extended-release formulations. Doses greater than 225 mg/day for venlafaxine or 60 mg/day for duloxetine appear to lead to greater discontinuation rates.

Late Life Depression, Postural Instability and Dyspnea: The He.s.i.o.d. Study (Hexameter Study in Older Depressed)

2017 ◽  
Vol 41 (S1) ◽  
pp. S646-S646
Author(s):  
M. Belvederi Murr ◽  
E. Nerozzi ◽  
N. Padula ◽  
C. Tacconi ◽  
A. Coni ◽  
...  
Keyword(s):  
Primary Care ◽  
Postural Stability ◽  
Fear Of Falling ◽  
Antidepressant Drug ◽  
Treatment Strategies ◽  
Antidepressant Drugs ◽  
Late Life ◽  
Late Life Depression ◽  
Residual Symptoms ◽  
Risk Of Falls

IntroductionLate life major depression (LLMD) is usually treated within primary care, but still with unsatisfactory outcomes and significant residual symptoms. Moreover, LLMD increases symptoms of anxiety, dyspnea, fear of falling (FOF), and risk of falls. Evidence from non-depressed patients suggests the efficacy of breathing and postural exercises; in particular, rhythmic breathing during poetry recitation was shown to improve cardio-respiratory synchronization. Thus, the aim of the HESIOD study was to test the efficacy of antidepressants plus breathing and postural exercises to improve patients’ anxiety mood, dyspnea, FOF, and postural stability.MethodsTwo non-randomised groups were compared: (1) antidepressant drugs plus weekly sessions of breathing/postural exercises based on the rhythmic recitation of hexameter poetry (intervention); (2) antidepressant drugs plus weekly sessions of group reading (comparator). Patients aged 65 +, with non-psychotic recurrent LLMD were recruited from a psychiatric consultation-liaison program for primary care. The main outcome measure was remission from depression (MADRS score ≤ 10) at 24 weeks. Secondary outcomes will include accelerometer-based measures of postural stability; patient-rated dyspnea, and FOF.ResultsPreliminary data on 34 patients show that patients receiving breathing and postural exercises displayed greater remission rates than those in the reading group (47.1% vs. 11.8%, P = 0.02). Further analyses will examine the effects on postural stability, dyspnea and FOF.ConclusionsBreathing and postural exercises may exert significant clinical advantage when added to the standard antidepressant drug therapy for LLMD. This study might prompt further research on innovative treatment strategies to improve the outcomes of late life depression in primary care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Improvement of late life depression after therapeutic enoxaparin: two case reports

2018 ◽  
Vol 26 (5) ◽  
pp. 534-536 ◽  
Author(s):  
David Graham ◽  
Qi Xuan Wu ◽  
Ian Gilligan ◽  
Raiz Ismail ◽  
Mark Walker
Keyword(s):  
Pulmonary Embolism ◽  
Elderly Patients ◽  
Inpatient Treatment ◽  
Case Reports ◽  
Late Life ◽  
Organic Basis ◽  
Late Life Depression ◽  
Treatment Of Depression ◽  
Significant Clinical Improvement ◽  
Vascular Component

Objective: Late life depression (LLD) may have a significant vascular component. While this organic basis remains controversial it would explain the refractory nature of LLD. Moreover, depression is a risk factor for venous thrombus embolism (VTE). This paper aims to describe two elderly patients with LLD who developed and were treated for pulmonary embolism (PE). Methods: Two cases of elderly patients who developed PE while they were undergoing inpatient treatment for depression are presented. This is discussed using the vascular and the cytokine hypotheses of depression as an explanatory framework. Results: Both patients showed significant clinical improvement in their mental state following therapeutic enoxaparin despite no other changes to their management of depression. This observed benefit of enoxaparin can be explained by the vascular hypothesis of LLD, and possibly the cytokine hypothesis of major depression. Conclusion: Enoxaparin may be a novel adjunct to the treatment of depression in elderly patients. The possible benefit of enoxaparin would require further study to exclude a coincidence in these clinical cases.

Treatment preferences for depression in the elderly

2016 ◽  
Vol 29 (3) ◽  
pp. 389-398 ◽  
Author(s):  
Claudia Luck-Sikorski ◽  
Janine Stein ◽  
Katharina Heilmann ◽  
Wolfgang Maier ◽  
Hanna Kaduszkiewicz ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Treatment Options ◽  
Treatment Success ◽  
Depression Scale ◽  
Late Life ◽  
Care Utilization ◽  
Treatment Preferences ◽  
Late Life Depression ◽  
Care Needs

ABSTRACTBackground:If patients are treated according to their personal preferences, depression treatment success is higher. It is not known which treatment options for late-life depression are preferred by patients aged 75 years and over and whether there are determinants of these preferences.Methods:The data were derived from the German “Late-life depression in primary care: needs, health care utilization, and costs (AgeMooDe)” study. Patients aged 75+ years (N = 1,230) were recruited from primary care practices. Depressive symptoms were determined using the Geriatric Depression Scale (GDS-15). Support for eight treatment options was determined.Results:Medication, psychotherapy, talking to friends and family, and exercise were the preferred treatment options. Having a GDS score ≥ 6 significantly lowered the endorsement of some treatment options. For each treatment option, the probability of choosing the indecisive category “I do not know” was significantly increased in participants with moderate depressive symptoms.Conclusions:Depressive symptoms influence the preference for certain treatment options and also increase indecision in patients. The high preference for psychotherapy suggests a much higher demand for late-life psychotherapy in the future. Healthcare systems should begin to prepare to meet this anticipated need. Future studies should include previous experience with treatment methods as a confounding variable.

scholarly journals Cognitive control, reward-related decision making and outcomes of late-life depression treated with an antidepressant

2015 ◽  
Vol 45 (14) ◽  
pp. 3111-3120 ◽  
Author(s):  
G. S. Alexopoulos ◽  
K. Manning ◽  
D. Kanellopoulos ◽  
A. McGovern ◽  
J. K. Seirup ◽  
...  
Keyword(s):  
Decision Making ◽  
Cognitive Control ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Rating Scale ◽  
Late Life ◽  
Hierarchical Cluster ◽  
Late Life Depression ◽  
Patients At Risk ◽  
Poor Outcomes ◽  
Abnormal Performance

Background.Executive processes consist of at least two sets of functions: one concerned with cognitive control and the other with reward-related decision making. Abnormal performance in both sets occurs in late-life depression. This study tested the hypothesis that only abnormal performance in cognitive control tasks predicts poor outcomes of late-life depression treated with escitalopram.Method.We studied older subjects with major depression (N = 53) and non-depressed subjects (N = 30). Executive functions were tested with the Iowa Gambling Test (IGT), Stroop Color-Word Test, Tower of London (ToL), and Dementia Rating Scale – Initiation/Perseveration domain (DRS-IP). After a 2-week placebo washout, depressed subjects received escitalopram (target daily dose: 20 mg) for 12 weeks.Results.There were no significant differences between depressed and non-depressed subjects on executive function tests. Hierarchical cluster analysis of depressed subjects identified a Cognitive Control cluster (abnormal Stroop, ToL, DRS-IP), a Reward-Related cluster (IGT), and an Executively Unimpaired cluster. Decline in depression was greater in the Executively Unimpaired (t = −2.09, df = 331, p = 0.0375) and the Reward-Related (t = −2.33, df = 331, p = 0.0202) clusters than the Cognitive Control cluster. The Executively Unimpaired cluster (t = 2.17, df = 331, p = 0.03) and the Reward-Related cluster (t = 2.03, df = 331, p = 0.0433) had a higher probability of remission than the Cognitive Control cluster.Conclusions.Dysfunction of cognitive control functions, but not reward-related decision making, may influence the decline of symptoms and the probability of remission of late-life depression treated with escitalopram. If replicated, simple to administer cognitive control tests may be used to select depressed older patients at risk for poor outcomes to selective serotonin reuptake inhibitors who may require structured psychotherapy.

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