Anterior cingulate integrity may be required for antidepressant response. To assess anterior cingulate processes related to treatment response, we studied error-related negativity and error positivity produced during an emotional go/no-go challenge, a task activating the rostral anterior cingulate. Twelve elderly patients with major depression, treated with escitalopram 10 mg daily, were studied. Patients who remained symptomatic after 8 weeks of treatment had larger error-related negativity and smaller error positivity amplitude compared with patients who achieved remission. The error-related negativity is elicited during conflict detection and the error positivity reflects the emotional reaction to error. Thus, these findings suggest that two distinct conflict-processing functions of the anterior cingulate are important for antidepressant response of geriatric depression.
The diagnosis and treatment of late-life depression is often complicated by its clinical context. As a rule, late-life depression afflicts medically ill, disabled persons living under chronic stress and/or isolation. Symptoms and signs of medical illnesses and behavioral limitations from disability are often difficult to distinguish from depressive symptomatology. Under-reporting of depressed mood and other psychological symptoms is common by older adults and contributes to under-diagnosis of depression. Many antidepressant drugs and some psychotherapies have been found more efficacious than their respective comparison conditions. However, each of these treatments helps less than half of depressed older adults, necessitating a treatment strategy in which failure or intolerance of each treatment step informs the next. Clinical subpopulations of late-life depression — psychotic depression, dysthymic disorder, depression associated with an adverse life event, treatment-resistant depression, and residual symptoms of depression — require special attention.
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