Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report

Cf, Reynolds; Frank, Ellen; Jm, Perel; Sd, Imber; Cornes, Cleon; Rk, Morycz; Mazumdar, Sati; Miller, '; Bg, Pollock; Ah, Rifai

doi:10.1176/ajp.149.12.1687

Cited by 124 publications

(4 citation statements)

References 11 publications

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“…Data for the current study include 711 depressed patients drawn from 6 clinical trials conducted at the University of Pittsburgh between 1982 and 2001: Maintenance Therapies in Recurrent Depression, 19 Maintenance Therapies in Late-Life Depression, 20 Psychobiology of Recovery from Depression, 21 Nocturnal Penile Tumescence in Depression Study, 22 Social Zeitgebers in Depression, 23 and Maintenance Psychotherapy in Recurrent Depression. 24 Detailed methods and main hypotheses for each of these studies have been published previously.…”

Section: Methodsmentioning

confidence: 99%

Insomnia and Objectively Measured Sleep Disturbances Predict Treatment Outcome in Depressed Patients Treated With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

Troxel

Kupfer²,

Reynolds³

et al. 2011

J. Clin. Psychiatry

127

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Objective Insomnia and objectively measured sleep disturbances predict poor treatment outcomes in patients with major depressive disorder (MDD). However, prior research has utilized individual clinical trials with relatively small sample sizes and has focused on insomnia symptoms or objective measures, but not both. The present study is a secondary analysis that examines the degree to which insomnia, objective sleep disturbances, or their combination, predicts depression remission following pharmacotherapy and/or psychotherapy treatment. Methods Participants were 711 depressed patients drawn from six clinical trials. Remission status, defined as a score of ≤ 7 on the Hamilton Rating Scale for Depression (HDRS) over two consecutive months, served as the primary outcome. Insomnia was assessed via the 3 sleep items on the HDRS. Objectively measured short sleep duration (total sleep time < = 6 hours), and prolonged sleep latency (SL >30 minutes) or wakefulness after sleep onset (WASO>30) were derived from in-laboratory polysomnographic (PSG) sleep studies. Logistic regression predicted the odds of non-remission according to insomnia, each of the objective sleep disturbances, or their combination, after adjusting for age, sex, treatment modality, and baseline depressive symptoms. Results Prolonged sleep latency alone (OR = 1.82; CI: 1.23, 2.70) or in combination with insomnia (OR = 2.03; CI: 1.13, 3.95) predicted increased risk of non-remission. In addition, insomnia and sleep duration individually and in combination were each associated with a significantly increased risk of non-remission (p’s < .05). Conclusion Findings suggest that objectively measured prolonged sleep latency and short sleep duration independently, or in conjunction with insomnia are risk factors for poor depression treatment outcome.

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Section: Methodsmentioning

confidence: 99%

Insomnia and Objectively Measured Sleep Disturbances Predict Treatment Outcome in Depressed Patients Treated With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

Troxel

Kupfer²,

Reynolds³

et al. 2011

J. Clin. Psychiatry

127

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show abstract

“…One Nevada HMO found that patients on SSRIs, 80% of whom had never seen a psychiatrist, had been taking the antidepressants for an average of 3 years (over half for more than 9 months) without being withdrawn [133]. In studies advocating long-term maintenance on antidepressants for relapsers [134, 135, 136, 137, 138, 139], recovery from depression has typically been defined in terms of symptomatic remission for a specified period of time [140]. For a patient to be considered recovered in these studies, there is no requirement that treatment be discontinued, even though the concept of recovery implies the possibility that treatment can be discontinued [114].…”

Section: Belief No 4: Antidepressants Are More Effective Than Psychomentioning

confidence: 99%

Raising Questions about Antidepressants

Antonuccio

Danton

DeNelsky

et al. 1999

Psychother Psychosom

104

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Antidepressant medication has apparently become the most popular treatment for depression in the USA. Several beliefs about the efficacy of antidepressant medications prevail among mental health professionals and the public. This paper explores relevant research data and raises questions about these beliefs. Many of the common beliefs about these medications are not adequately supported by scientific data. The following issues are raised: (1) industry-funded research studies which result in negative findings sometimes do not get published; (2) placebo washout procedures may bias results in some studies; (3) there are serious questions about the integrity of the double-blind procedure; (4) the ‘true’ antidepressant drug effect in adults appears to be relatively small; (5) there is minimal evidence of antidepressant efficacy in children; (6) side effects are fairly common even with the newer antidepressants; (7) combining medications raises the risk for more serious complications; (8) all antidepressants can cause withdrawal symptoms; (9) genetic influences on unipolar depression appear to be weaker than environmental influences; (10) biochemical theories of depression are as yet unproven; (11) biological markers specific for depression have been elusive; (12) dosage and plasma levels of antidepressants have been minimally related to treatment outcome; (13) preliminary evidence suggests that patients who improve with cognitive-behavioral psychotherapy show similar biological changes as those who respond to medication, and (14) the evidence suggests that psychological interventions are at least as effective as pharmacotherapy in treating depression, even if severe, especially when patient-rated measures are used and long-term follow-up is considered.

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“…With regard to treatment, older depressed patients may be undertreated compared with younger adults [13]. Yet, over 80% of elderly depressed outpatients without significant comorbid medical illness or dementia who are optimally treated may recover and remain well during follow-up [9, 14]. …”

Section: Introductionmentioning

confidence: 99%

Incremental decreases in quality-adjusted life years (QALY) associated with higher levels of depressive symptoms for U.S. Adults aged 65 years and older

Jia

Lubetkin

2017

Health Qual Life Outcomes

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BackgroundQuality-adjusted life years (QALY) is a single value index that quantifies the overall burden of disease. It reflects all aspects of heath, including nonfatal illness and mortality outcomes by weighting life-years lived with health-related quality of life (HRQOL) scores. This study examine the burden of disease due to increasing levels of depressive symptoms by examining the association between the 9-item Patient Health Questionnaire (PHQ-9) scores and QALY for U.S. adults aged 65 years and older.MethodsWe ascertained respondents’ HRQOL scores and mortality status from the 2005–2006, 2007–2008, and 2009–2010 cohorts of the National Health and Nutrition Examination Survey (NHANES) with mortality follow-up data through December 31, 2011. This analysis included respondents aged 65 years and older (n = 3,680). We estimated the mean QALY throughout the remaining lifetime according to participants’ depression severity categories: none or minimal (PHQ-9 score 0–4), mild (5–9), moderate (10–14), and moderately severs and severe (15 or higher). We estimated QALY loss due to major depressive disorder (PHQ-9 score 10 or higher) and to mild depression (5–9).ResultsThe QALY for persons with none/minimal, mild, moderate, and moderately severe/severe depression were 14.0, 7.8, 4.7, and 3.3 years, respectively. Compared to persons without major depressive disorder, persons with major depressive disorder had 8.3 fewer QALY (12.7 vs. 4.4), or a 65% loss. Compared to persons who reported “none” or minimal depressive symptoms, persons who reported mild depressive symptoms had 6.2 fewer QALY (14.0 vs. 7.8), or a 44% loss. The same patterns were noted in demographic and socioeconomic subgroups and according to number of comorbidities.ConclusionsThis study not only confirmed the significant burden of disease for major depressive disorder among the U.S. elderly, but also showed an incremental decrease in QALY with an increasing severity of depressive symptoms as well as significant QALY loss due to mild depression. Specifically, individuals with higher (or more impaired) PHQ-9 scores had significantly fewer QALYs and our findings of fewer years of QALY for persons with major depressive disorder and mild depression were not only statistically significant but also clinically important.

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Combined pharmacotherapy and psychotherapy in the acute and continuation treatment of elderly patients with recurrent major depression: a preliminary report

Cited by 124 publications

References 11 publications

Insomnia and Objectively Measured Sleep Disturbances Predict Treatment Outcome in Depressed Patients Treated With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

Insomnia and Objectively Measured Sleep Disturbances Predict Treatment Outcome in Depressed Patients Treated With Psychotherapy or Psychotherapy-Pharmacotherapy Combinations

Raising Questions about Antidepressants

Incremental decreases in quality-adjusted life years (QALY) associated with higher levels of depressive symptoms for U.S. Adults aged 65 years and older

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