Older Adults With Severe, Treatment-Resistant Depression

Unützer, Jürgen; Park, Mijung

doi:10.1001/2012.jama.10690

Cited by 49 publications

(38 citation statements)

References 79 publications

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“…These findings help clarify the risk-benefit ratio of aripiprazole augmentation for clinicians facing the common situation of treatment-resistant depression in their older patients. 35 …”

Section: Discussionmentioning

confidence: 99%

Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo-controlled trial

et al. 2015

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Summary Background Treatment-resistant major depressive disorder is common and potentially life-threatening in older persons, in whom little is known about the benefits and risks of augmentation pharmacotherapy. Methods We conducted a multi-site, placebo-controlled, randomized clinical trial to test the efficacy and safety of aripiprazole augmentation for older adults with treatment-resistant depression. We treated 468 participants aged 60 and older with current major depressive episode with venlafaxine extended-release (ER); 96 (20.5%) did not complete this open phase, 191 (40.8%) remitted, and 181 (38.7%) did not remit and were randomized to 12 weeks of double-blind augmentation with aripiprazole or placebo. The computer-generated randomization was done in blocks and stratified by site. The primary endpoint was remission, defined as Montgomery-Asberg Depression Rating Scale scores ≤10 (and at least two points below the score at the start of the randomized phase) at both of the final two consecutive visits. We also assessed resolution of suicidal ideation, and safety and tolerability with cardiometabolic and neurological measures. Analyses were conducted according to the intention-to-treat principle. This trial is registered with ClinicalTrials.gov, number NCT00892047. Findings Older adults on aripiprazole had a higher remission rate than those on placebo (44% versus 29%; odds ratio [OR]=2.0, 95% CI 1.1–3.7, p=0.03; number needed to treat [NNT]=6.6 [95% CI 3.5–81.8]). Overall, remission was stable during 12 additional weeks of continuation treatment. The resolution of suicidal ideation was more marked with aripiprazole than with placebo. Akathisia was the most common adverse effect (27% of participants on aripiprazole). Compared to placebo, aripiprazole was also associated with more Parkinsonism but not with treatment-emergent suicidal ideation, QTc prolongation, or increases in adiposity, glucose, insulin, or lipids. Interpretation In older adults who fail to achieve remission from depression with a first-line antidepressant, the addition of aripiprazole is effective in achieving and sustaining remission. Tolerability concerns include potential for akathisia and Parkinsonism. Funding National Institute of Mental Health, UPMC Endowment in Geriatric Psychiatry, Taylor Family Institute for Innovative Psychiatric Research, National Center for Advancing Translational Sciences, and the Campbell Family Mental Health Research Institute.

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“…These findings help clarify the risk-benefit ratio of aripiprazole augmentation for clinicians facing the common situation of treatment-resistant depression in their older patients. 35 …”

Section: Discussionmentioning

confidence: 99%

Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo-controlled trial

et al. 2015

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“…Exercise has the potential to be an effective treatment or treatment adjunct for late-life depression (e.g., Blake, Mo, Malik, & Thomas, 2009; Sjosten & Kivela, 2006). Even for older adults with fragility or health issues, low-intensity exercises can be pursued and may help build strength and improve self-efficacy (Unützer & Park, 2012). Other specific forms of exercise, such as yoga, may also improve depressive symptomology for young-old adults (Patel, Newstead, & Ferrer, 2012).…”

Section: Discussionmentioning

confidence: 99%

Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use

Kitchen

McKibbin

Wykes

et al. 2013

Clinical Gerontologist

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The purpose of this study was to investigate depression treatment preferences and anticipated service use in a sample of adults aged 55 years or older who reside in rural Wyoming. Sixteen participants (mean age = 59) completed 30- to 60-minute, semi-structured interviews. Qualitative methods were used to characterize common themes. Social/provider support and community gatekeepers were perceived by participants as important potential facilitators for seeking depression treatment. In contrast, perceived stigma and the value placed on self-sufficiency emerged as key barriers to seeking treatment for depression in this rural, young-old sample. Participants anticipated presenting for treatment in the primary care sector and preferred a combination of medication and psychotherapy for treatment. Participants were, however, more willing to see mental health professionals if they were first referred by a clergy member or primary care physician.

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“…9 Depression in older age is an important risk factor for all-cause dementia, 10 and is associated with higher utilization of health care services, caregiver burden, and suicide rates. 11,12 …”

Section: Discussionmentioning

confidence: 99%

Clinicians' Views on Treatment-Resistant Depression: 2016 Survey Reports

Arandjelovic

Eyre

Lavretsky

2016

The American Journal of Geriatric Psychiatry

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Background There is a relative paucity of information on both empirical and subjective treatment strategies for treatment-resistant depression (TRD), especially in late life. This paper reviews the findings from two 2016 surveys conducted through the American Psychiatric Association publication the Psychiatric Times and via a member survey by the American Association for Geriatric Psychiatry (AAGP). Methods We present the results of the two surveys in terms of descriptive frequencies and percentages and discuss the strengths and weaknesses of various approaches to late-life TRD. Results The Psychiatric Times survey received 468 responses, and the AAGP survey received 117 responses, giving an overall sample of 585 responses. The majority (76.3%) of respondents from both groups believed that a large randomized study comparing the risks and benefits of augmentation and switching strategies for TRD in patients aged 60 years and older would be helpful, and 80% of clinicians believed their practice would benefit from the findings of such a study. Of the treatment strategies that need evidence of efficacy, the most popular options were augmentation/combination strategies, particularly augmentation with aripiprazole (58.7%), bupropion (55.0%), and lithium (50.9%). Conclusions Late-life TRD constitutes a large proportion of clinical practices, particularly of geriatric psychiatry, with lacking evidence of efficacy of most treatment strategies. These surveys indicate a clear need for a large randomized study that compares risks and benefits of augmentation and switching strategies.

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Older Adults With Severe, Treatment-Resistant Depression

Cited by 49 publications

References 79 publications

Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo-controlled trial

Efficacy, safety, and tolerability of augmentation pharmacotherapy with aripiprazole for treatment-resistant depression in late life: a randomised, double-blind, placebo-controlled trial

Depression Treatment Among Rural Older Adults: Preferences and Factors Influencing Future Service Use

Clinicians' Views on Treatment-Resistant Depression: 2016 Survey Reports

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